August 28, 2014


A study by the University of Oxford and University of Edinburgh published in The Lancet Psychiatry, The Lancet and The Lancet Oncology reveals that three-quarters of depressed cancer patients do not receive treatment for their depression. The researchers propose that a new treatment programme, including anti-depressants and therapy, can address this.

 Jacqui Graves, Head of Health and Social Care for Macmillan Cancer Support, says:

“Cancer can have a devastating impact on patients, causing many to feel alone and isolated, and we know that a huge number of patients will experience depression.

“Depression may be a temporary reaction to a patient’s diagnosis and something that can be addressed through information and support, but in other cases it can be more complex and a patient may need therapy or medication.

“It’s heart-breaking to think that cancer patients who are already dealing with the toughest fight of their lives are also struggling with depression, without adequate support.

“Macmillan Cancer Support welcomes any treatment where cancer patients have their individual needs assessed and their treatment is tailored, whether that’s giving them emotional or practical support, or treating them for depression.

“Anyone experiencing depression should get in touch with their GP. Macmillan provides information and support for people affected by cancer through its telephone helpline.”

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August 27, 2014


Today [Tuesday] Public Health England’s National Cancer Intelligence Network (NCIN) published new one-year cancer survival data for England1. Mike Hobday, Director of Policy and Research at Macmillan Cancer Support, says:

“Whilst it’s encouraging to see that overall survival rates for some of the most common cancers in England are improving, we know that we still have a long way to go here in the UK if we are to catch up with the best in Europe.

“These new figures by Public Health England’s NCIN show that there is a massive difference for patients when their cancer is diagnosed early. Lung cancer patients are more than four times more likely to survive at least a year after diagnosis if the disease is caught early2. Colorectal cancer patients are more than twice as likely to survive3. And there are big improvements in the life chances of women with breast cancer4.

“The ability of the NHS to undertake such detailed analysis of cancer survival is growing very rapidly, providing increasingly strong evidence on how we can continue to improve cancer care across the country.

“Sadly, we know that for far too many people, this improvement isn’t yet happening. Macmillan Cancer Support is urging all political parties to make cancer a top priority at the upcoming general election and commit to reducing the number of people diagnosed in A&E.”


1 NCIN’s ‘Cancer Survival in England by Stage’ report is available upon request from the PHE Press Office.

2 Lung cancer patients in 2012 in England were more than four times more likely to survive a year after diagnosis if diagnosed at stage one (87%) compared with stage four (19%).  These rates have been age standardised and are relative to the general population.

Colorectal cancer patients were more than twice as likely to survive a year after diagnosis if diagnosed at stage one (98%) compared with stage four (46%).

Breast cancer patients were more likely survive a year after diagnosis if diagnosed at stage one (100%) compared with stage four (67%).  These rates have all been age standardised, rounded to the nearest 1% and are relative to the general population

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August 26, 2014

Horizon, Should I eat meat? BBC2 20th August, 2014

In his second programme on the perils of meat eating Michael Moseley examined the environmental impact of the livestock industry.

In short the livestock industry impacts on the environment in two main ways – land use and carbon footprint.

First, some startling statistics.

A quarter of the ice free global land mass is devoted to grazing

A third of the crops grown world wide go to feed animals

Turning to the carbon footprint issue an adult cow produces on average 500 litres of the potent greenhouse methane per day, predominantly through eructation. It is estimated that cattle contribute as much to global warming as family cars.

A particular feature of the last half century or so has been the massive increase in beef production and beef consumption stemming in part from the action of the US Congress in 1946 in prescribing beef as the only legal content of hamburgers.

Would it be possible to reduce the methane production by cattle without reducing their numbers? The answer is yes, by changing their diet from grass to corn for example. This is already happening in the US on a growing scale with the development of feedlots where cattle are kept in pens and fed on cornflakes, growth hormones and antibiotics. The result is more efficiently produced beef plus a significant reduction in methane production per unit of meat produced.

One of the crops that is increasingly used to feed lifestock is soya which is currently produced mainly in South America on land “reclaimed” from tropical forest. The reduction is such forest is having a significant positive effect on global warming over and above that of the livestock that the soya is used to feed.

The estimated total impact of livestock production, taking all factors into consideration, is 14.5% of all greenhouse gas emissions.

Not all livestock have the same effect on carbon footprint. Cattle have the greatest impact per kilo of meat produced and chickens the least.

So the answer is clear – if you have to eat meat opt for chicken which scores highly on its health impact and on its carbon footprint.

And, perhaps surprisingly, intensively reared chicken is the greenest form of chicken available.

The prospects for reducing meat consumption globally are poor if only because of the growing population and the trend for 3rd world countries to increase their meat consumption as they become richer.

So, short of removing meat from the global dietary is there a solution? It seems that there might be if the scale of meat production were substantially reduced and if it were done on a more traditional model. For instance raising cattle on poor quality land that could not support arable crops would seem a more environmentally friendly approach than feedlots for example.

Other possible solutions include artificial meat where some progress is being made; and the farming of insects as a source of protein.

So, on grounds of its environment impact, meat consumption has to be constrained perhaps, it is suggested, to 100 grammes per day within a mainly plant based diet.

All in all a well presented series on an important topic. Michael Moseley is rapidly becoming a major public health guru of increasing influence.

Paul Walker, August 2014

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August 20, 2014

Horizon: Should I eat meat – the big health dilemma. 18th August, 2014, BBC2

I have to confess to being a Michael Moseley fan. Not as accomplished a communicator as Alice Roberts or some of the other current female science/arts/history documentary presenters but eminently watchable nevertheless.

His most recent offering – in two parts – aims to assess the impact of meat eating firstly on human health and then on the global environment.

The health promotion messages about meat eating and health are almost as confusing and changing as those about saturated fats and health.

One thing that seems to be a fixed point in the meat and health debate is that white meat, eg poultry, is not associated with any documented health problems. So Moseley’s focus was entirely on so called red meat – beef, lamb and pork – and on processed foods such as bacon, ham, sausages and salami type products.

On the positive side red meat is a good source of protein providing all the essential amino acids, and of micronutrients like iron and zinc, and of vitamin B12 and other B vitamins.

On the alleged cardiovascular impact of red meat consumption the evidence is unclear and often contradictory. A large study in Southern California looking at the impact of lifestyle on longevity, involving a population of Seventh Day Adventists, among whom vegetarianism is common, shows a lower risk of heart attacks among vegetarians and a 5 year positive difference in life expectancy compared to red meat eaters. But evidence from the EPIC (European Prospective Investigation into Cancer) study suggests that a low but not zero amount of meat may be positively protective.

So what is it in red meat that is the cause of the problem? At one time it was thought that it was the saturated fat content. Now the evidence is that the harmful effects of saturated fats have been overstated. A low saturated fat diet can seemingly make the lipid profile worse and a high saturated fat diet can lower the risk of stroke.

The harmful agent in red meat seems to be l-carnitine which is changed by gut flora into trimethylamine-N-oxide (TMAO) which reduces cholesterol excretion resulting in a clogging of the arteries.

Turning to processed meats the evidence is much clearer – they increase the incidence of cardiovascular disease and of certain forms of cancer, notably intestinal cancer. The main culprit for cancer seems to be the sodium nitrite they contain. This reacts with aminoacids in the gut to produce nitrosamines which are carcinogenic.

So, what is the level of risk associated with eating processed meats? 20% seems to be the currently accepted figure. Undoubtedly a very significant risk.

A piece of good news, not unexpected, is that a high fibre diet is partially protective against the harmful effects of red and processed meats.

Michael Moseley majors in personal participation in his programmes and though he baulked at having an endoscopy performed to see whether he has developed any of the intestinal polyps that are the precursors of bowel cancer, he did submit himself to a high red and processed meat diet for a month to see what effect it had on his health indices. The result was significant increases in blood cholesterol, low density lipoprotein, body fat (mainly abdominal) and blood pressure.

Moseley’s interpretation of this evidence is that a healthy diet is predominantly plant based supplemented with meat, preferably white meat, or better still fish. Clearly meat must no longer be the centrepiece of a meal but at most an accompanying garnish. And, probably, one should remove all processed meats from one’s dietary until further notice.

Paul Walker, August 2014.

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August 18, 2014

Key steps to tackling the obesity epidemic, 1 outlawing sugar

Some years ago, as a member of the now defunct UK Public Health Association, I was a little surprised to note that one of its corporate objectives was to act against “anti-health forces.” I wondered what these forces might be in a developed country like ours but it was soon pointed out to me that the tobacco industry could quite reasonably be characterised as an “ anti-health force.” Since then I have come to realise that there are in fact many anti-health forces and that the promotion of public health necessarily involves a war against them.

One of these, currently very much in the limelight, is the agri-food industry responsible in large measure for the escalating obesity epidemic. The latter is well documented but providing some measure of the size of the problem is the remarkable statistic that we are on average three stones heavier than we were 50 years ago. Which reminds me of my first visit to the US in 1980 when it struck me very forcibly that it was a land of two nations – not black and white, but fat and athletically thin. Little did I know then that what appeared to be yet another example of American exceptionalism would soon apply worldwide.

It is generally accepted that there are many factors which have contributed to the obesity epidemic but some of these can be laid squarely at the door of the US. Among these were the decision of the US government in the 1970s to subsidise cheap food, particularly corn; the subsequent increased use of corn syrup (fructose) as a sweetener; the suppression, under pressure from the sugar lobby, of US government guidelines advocating a decrease in consumption of sugars; and the demonisation of fats so allowing the food industry to create a lucrative market for low fat foods containing very high levels of sugars.

Interestingly, there is evidence that fructose in corn syrup may influence weight more than other sugars by neutralising leptin, the hormone that mediates the feeling of satiety.

It is fructose of course which is the sweetening agent in all those soft drinks – Coca Cola and the rest – that are now consumed to excess.

Trying to persuade people to avoid sweet drinks and confectionery is hardly realistic. Having a sweet tooth seems to be part of being human. But there is an obvious technological solution staring us in the face namely the replacement of fructose and other calorie dense sweeteners by non calorific sweetening agents of which there are several to choose from.

Sucralose is my personal favourite, indistinguishable in taste – at least to me – to ordinary sugar. I have no experience of using this or any other similar agent in cookery but I am informed that it is possible to substitute sugar with no detriment to taste or texture.

So, the phased introduction of a ban on calorific sweeteners would seem to be an obvious first step in tackling the obesity problem. Obvious but not easy, however, as the scale of the vested interests supporting the sugar industry is certainly as great as it was in the 1970s when such interests succeeded in persuading the US government to suppress guidelines advocating a decrease – not a ban – in the consumption of sugar.

So, if we are serious about tackling the obesity epidemic the public health community must gear itself up for a long and no doubt bloody battle with the sugar lobby. The war against the tobacco industry, which still goes on, has taught us just how powerful anti-health forces can be and how difficult they are to defeat. 

Paul Walker, August 2014

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