Category Archives: Cholesterol

New Zealand bans vaginal mesh implants

New Zealand has become the first major country to effectively ban vaginal mesh implants in response to safety concerns over the surgery.

The country’s Ministry of Health announced on Monday that it had written to leading mesh suppliers asking them to stop marketing the products from January – or prove that their products are safe.

Ministry of Health spokesman, Stewart Jessamine, told a New Zealand radio station: “We’re always cautious about the use of the word ‘ban’, but effectively the companies are agreeing no longer to sell these products … in New Zealand from the 4th of January.”

The move goes considerably further than recent announcements in other countries, such as Australia and the UK, which only restrict the use of pelvic mesh operations for organ prolapse. In New Zealand, the use of mesh implants to treat urinary incontinence, which accounts for the vast majority of mesh operations, will also be effectively banned, according to an announcement posted on the government website.

The decision has been applauded by campaigners, many of whom argue that the potential complications of mesh surgery, which include chronic pain and implants cutting through the vagina, are unacceptable. However, doctors expressed concern at the far-reaching nature of the ban.

It is now widely accepted that vaginal mesh should not be routinely offered for prolapse, where the pelvic organs bulge into the vagina. But many doctors maintain that mesh surgery to treat stress urinary incontinence can have advantages over traditional surgery and believe that these procedures should continue to be offered.

“This makes New Zealand the only country in the world to have banned all of these procedures and will leave women without effective surgical options for these debilitating conditions,” said Giovanni Losco, a urologist in Christchurch and spokesman for the Urological Society of Australia and New Zealand.

Carl Heneghan, professor of evidence-based medicine at the University of Oxford, says the medical profession needs to acknowledge that there have been major failings in regulation and act to address the issue. If they don’t then other regulators may also react with outright bans.

“[New Zealand] is basically saying ‘we can’t guarantee patient safety’,” he added.

Jessamine said that the decision had been taken after reviewing data on mesh safety provided in November by the Australian government, which had been carrying out its own inquiry into the use of pelvic implants. “We’ve reviewed that data and come to the opinion that the data is sound and we now believe the risks of the use of these products in the pelvis for prolapse and stress incontinence far outweighs the benefits,” he said.

“We’ve got an ability within our legislation to limit the use of those products, to discourage and ultimately remove those products from the market,” he added.

Owen Smith, a shadow cabinet minister, who chairs the all-party parliamentary group on surgical mesh implants, described the announcement as “hugely significant”. “It’s the first major country to effectively ban mesh for all pelvic operations. It’s precisely what we’ve been calling for in the UK.”

Stop accusing men of overreacting – ‘man flu’ really does exist, doctor claims

The fight against the ridicule of “man flu” has been taken up by a doctor who says, somewhat tongue-in cheek, that he delved into the issue after growing tired of being accused of overreacting.

In a treatise based on previous studies – some scientific, some notably less so – the Dr Kyle Sue not only puts the case that men might indeed experience worse cold and flu symptoms than women, but also explores why such a difference might have evolved.

“I do think that the research does point towards men having a weaker immune response when it comes to common viral respiratory infections and the flu,” said Sue, a clinical assistant professor in family medicine from the Memorial University of Newfoundland. “This is shown in the fact that they [have] worse symptoms, they last longer, they are more likely to be hospitalised and more likely to die from it.”

But others were not persuaded by Sue’s arguments, pointing out that many different factors can affect how bad a bout of cold or flu is.

The article, published in the British Medical Journal, involved a wry look at previous studies and put forward a number of strands of evidence that suggest men might really experience worse symptoms than women when it comes to viral respiratory illnesses.

Among them, the author points out that mouse studies have suggested that testosterone could dampen immune response to influenza, while certain female sex hormones could boost it. What’s more, some studies on a small group of humans revealed that cells from pre-menopausal women showed different immune responses to the type of virus behind the common cold to those of men of the same age – the difference was not seen when cells from men were compared to those of post-menopausal female peers.

The study also notes that research from the US showed men had higher rates of deaths linked to flu compared to women of the same age, while data from Hong Kong shows men had a higher risk of winding up in hospital with seasonal flu than women. It also pushes back against the idea that men crumble at the first sneeze – pointing to a study which found women were more likely than men to cut down activities when it came to minor respiratory illnesses.

The article also reveals that a survey in a popular magazine found that men took twice as long to recover from such viral illnesses as women.

“Since about half of the world’s population is male, deeming male viral respiratory symptoms as ‘exaggerated’ without rigorous scientific evidence could have important implications for men, including insufficient provision of care,” Sue writes.

Sue admitted the studies didn’t take into account other differences between men and women, such as how much individuals smoked, or that men have been found to be worse at looking after themselves and seeking medical care than women.

“There need to be more studies, higher quality studies that control for other factors between men and women before we can definitely say that this difference in immunity exists,” he told the Guardian. “Is it that women are more resilient, that they are able to juggle more when they are ill, or is it that they don’t have as severe symptoms? That we are not too sure about. But I think everyone should be given the benefit of the doubt when they are ill.”

Sue also explored whether there was an evolutionary explanation for why men might experience worse symptoms than women when it comes to viral respiratory infections.

Among the theories put forward, Sue notes higher testosterone levels might offer upsides when it comes competing against other males that outweigh the possible negative impact on the immune system, or that being more under the weather keeps males bedbound and hence potentially out of the way of predators.

“Perhaps now is the time for male-friendly spaces, equipped with enormous televisions and reclining chairs, to be set up where men can recover from the debilitating effects of man flu in safety and comfort,” Sue suggests.

“I am hopeful that next time men are being criticised as exaggerating their symptoms they can say ‘hey, look at this study, there is some proof that I am not!’” he added.

But not everyone is bowled over by Sue’s arguments, including Peter Barlow, associate professor of immunology and infection at Edinburgh Napier University.

“There are a significant number of factors which can contribute to the severity of an influenza infection,” he said. “As the author of the article alludes, it is currently impossible to say whether there are sex-specific differences in susceptibility to influenza virus, or in the progression of the infection.”

Portugal shows the way ahead on drugs policy | Letters

The driving force behind Portugal’s capacity to rescue itself from the throes of an opioid crisis is an emphasis on personalised care that galvanises the community and functions conterminously with the decriminalisation of all substances (The big fix: Portugal’s truce on drugs, 5 December). Crucially, Portugal’s radical policy has gone some way to eradicate the taboo on drug misuse. This cultural shift highlights the very tangible affects of ostracising users from the local community, be it through labelling them with derogatory language – “junkie” or “smackhead” etc – or by deeming them antisocial criminals.

As the UK sinks further into its opioid epidemic, the necessity of radically reforming its legal, political and sociocultural policies on drugs is pushed further to the fore. This means shifting the emphasis from criminalisation to healthcare, increasing public spending on health services, and encouraging communal support for drug users.
Yasmin Batliwala
Chair, WDP drug and alcohol charity

Congratulations on your long read on Portugal’s drugs policy. This should be required reading for policymakers who have refused to base drug and addiction policy on evidence. A young man I know has been to prison 11 times in the last three years. On each occasion the offences have been directly linked to drug and alcohol addiction. The young man is homeless and leaves prison, without meaningful support, to life on the street and a seemingly inevitable return to prison.

At the very least the government should be consulting evidence, and recognising that the justice system is failing addicts and the taxpayer.
Ian McCauley
Reading, Berkshire

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Brain drain: our default responses to flu | Daniel Glaser

I’ve been laid up with flu and as I return to full cognitive function, I’ve been pondering the neuroscience. A fever’s tweak to your temperature regulation circuits triggers not only shivering, but also indirect loops. ‘Feeling’ cold can make you turn up the thermostat, grab blankets and take to your bed.

It’s not clear whether it’s the bug or your defences that are in control, but using your body as a laboratory, it’s fascinating to wait for the paracetamol to work. When it hits you suddenly start sweating and kick off the covers as your hypothalamus catches on to the actual temperature of your body.

Researchers have been looking at external signs, too. Evidence suggests the walking patterns, sweat and facial expression of sufferers can reflect their infection before even they are aware of it. This may help others to steer clear.

Internet activity is a promising avenue, too. The ‘Google flu trends’ project is currently suspended, in public at least, pending improvements. But within the rich mine of subconscious information we reveal through our searches, we perhaps find the earliest traces of infection. Keep well, everyone.

Dr Daniel Glaser is director of Science Gallery at King’s College London

US prisoner gouged out eyes after jail denied mental health care, lawsuit says

A mentally ill Colorado prisoner gouged his eyes out and became permanently blind after jail officials repeatedly denied him treatment for psychosis despite multiple suicide attempts, according to a lawsuit.

Ryan Partridge, 31, sued Boulder law enforcement officials on Thursday, alleging that while he was jailed for months for minor offenses that were later dismissed, officers ignored numerous acts of self mutilation and responded to delusional episodes by beating and tasing him. Officials also ignored a judge’s emergency order to get Partridge psychiatric treatment, leaving him alone in his cell where he “plucked out his own eyeballs”, the suit said.

His case appears to be a particularly gruesome example of the way Americans with mental illness struggle to get help, and can end up in jails and prisons that punish them with cruel treatment and refuse to provide medical services.

“I hope that things will change, not just for people with mental disorders, but for the people in disciplinary,” Partridge said by phone, explaining how solitary confinement and other punishments exacerbated his mental illness. “Getting tased and beaten, all that is stressful. What can be worse than that is the delusion that arises in isolation.”

Boulder County sheriff’s officials called the allegations “untrue and incomplete” in a statement, but did not comment on any specific claims.


Getting tased and beaten, all that is stressful. What can be worse than that is the delusion that arises in isolation

Ryan Partridge

Partridge began suffering from schizophrenia in his late 20s, and his parents were repeatedly forced to call the police due to violent outbursts, the suit said. The Boulder native was in and out of jail for minor offenses related to mental illness – all misdemeanors, such as loitering, trespassing and mischief – and at one point, he was homeless, Lane said.

Jail records show that Partridge was experiencing psychosis in early 2016 when he reported that he was going to gouge out his eyes and banged his head into a toilet, leaving him bloodied and with broken teeth, according to the lawsuit.

Although Partridge told a mental-health worker that he had suicidal thoughts and officials were aware of his psychosis, deputies repeatedly responded to him with violence, the suit said. One deputy allegedly punched and tased him and sent him to a “secure disciplinary cell” in March of 2016.

Although a judge ordered that he should be sent to a state mental hospital, Partridge remained at the jail and was again punched and tased when he ignored orders, according to the complaint. When two deputies later saw Partridge attempting to gouge out his eyes, they put him in a “restraint chair”, placed a “spit sock” over his head and tased him, the suit said.

Ryan Partridge with his mother Shelley five years ago.


Ryan Partridge with his mother Shelley five years ago. Photograph: Courtesy of family

After a brief stay at a community hospital, he was sent back to jail, where he was suffering from increasingly intense paranoia.

On 1 November 2016, during a psychotic episode, Partridge attempted suicide by climbing to the top of a second-floor railing in the jail and jumping head first to the ground, smashing his head on a table and cement floor and suffering broken vertebra, the suit said. He tried to jump again from the same railing a month later before guards stopped him.

One deputy began mockingly referring to him as “Parachute Partridge”, the suit said.

Despite the suicide attempts and injuries, a mental health worker and a sergeant concluded he was “not a risk to himself and that the jump was merely an attention-seeking behavior”, his lawyers wrote.

Partridge said in an interview that spending so much time alone, unable to talk to his parents or attorneys, was deeply harmful to his mental state: “It’s just very difficult psychologically … That led to more delusional thinking.”

As his mental health deteriorated toward “severe insanity”, the jail ignored a court’s emergency order and his parents’ pleas to hospitalize him, the lawsuit said.

“I’ll never forget the feeling of literally knowing my son is being abused and tortured and I can’t do anything to stop it,” his father Richard Partridge said by phone.

He ultimately gouged his eyes out with his fingers in December, and when deputies discovered him in his cell with his eyes swollen shut and blood on his hands, they proceeded to try and handcuff him before slamming him to the ground and tasing him, the suit alleged. Eventually, he was taken to a hospital and released from jail.

Commander Mike Wagner of the Boulder sheriff’s office said the department can’t comment on pending litigation or an inmate’s health, but said some of the claims were false, adding in a statement, “We are aware of the very difficult circumstances surrounding Mr Partridge’s time in-custody at the Boulder County jail. Our mental health professionals, deputies, and staff faced very difficult situations involving Mr Partridge, and went above and beyond in trying to assist him during his time in-custody.”

Partridge’s attorney David Lane said he hoped the lawsuit sparked national reforms: “We want to send a message to jails and prisons across this country that deliberate indifference to the mental health needs of inmates will be so costly. … Tasing and beating does not count as rendering aid or assistance to someone suffering from a psychotic break.”

Richard Partridge said the public needed to understand that schizophrenia is a disability and argued that the government should not incarcerate people for mental illness: “You can take a sane person, and if you treat them inhumanely, they can take out their eyes as well.”

The former inmate is now living with his family, and he said his mental health has dramatically improved. The damage to his eyes, however, was so severe that no surgery could bring his vision back, according to doctors.

He said he is slowly adjusting to blindness: “It’s a different form of solitude. I feel alone even when I’m around people.”

Contact the author: sam.levin@theguardian.com

  • In the UK, Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In Australia, the crisis support service Lifeline is 13 11 14. Other international suicide helplines can be found at www.befrienders.org.

Inquiry announced into case of rogue surgeon Ian Paterson

The government will launch an independent national inquiry into the actions of the rogue surgeon Ian Paterson, who was sentenced to 20 years in jail in August after carrying out needless surgery on patients who were left traumatised and scarred.

The inquiry will begin in January and report in the summer of 2019, and will be chaired by the Right Rev Graham James, the bishop of Norwich.

Paterson, a consultant breast surgeon at the Heart of England NHS foundation trust (HEFT) who practised privately at Spire Parkway and Spire Little Aston, was found guilty in April of 17 counts of wounding patients with intent.

The NHS has paid out almost £10m in compensation to more than 250 patients, and Spire healthcare agreed in September to settle a further 750 cases.

The government said the scope of the investigation would include the independent sector, and it would examine whether the Care Quality Commission’s inspection regime needed to be strengthened.

The health minister Philip Dunne said he was determined that lessons would be learned so that similar problems could be avoided in both the NHS and the private sector.

Concerns were raised about Paterson as far back as 2003 but, despite several internal and external investigations and complaints from patients, GPs and other surgeons, the General Medical Council did not suspend him until 2011.

Dunne said: “Ian Paterson’s malpractice sent shockwaves across the health system due to the seriousness and extent of his crimes. I believe an independent, non-statutory inquiry, overseen by Bishop Graham James, is the right way forward to ensure that all aspects of this case are brought to light and lessons learned so we can better protect patients in the future.”

Lawyers for Paterson’s victims said they were disappointed that the inquiry would not be statutory and would not have the power to force people to give evidence under oath or give binding recommendations.

“We have previously expressed doubt in the current government’s political commitment to take on and tackle failings of the private health sector that were so vividly exposed in this terrible case,” said Tom Jones, the head of policy at Thompsons Solicitors, which represented about 500 victims. “Our concerns are reinforced by the potential for this inquiry to kick the can down the road and whose recommendations will not be binding.”

Kashmir Uppal, of Access Legal, said the inquiry was a “positive step” but victims were disappointed and concerned. “The government has said patients’ interests will be put at the heart of this inquiry and so it must take place in public and fully expose the failings that allowed Ian Paterson to continue practising in the private sector long after concerns were raised about him.”

James, the inquiry chair, said serious questions remained unanswered. “It is vital that the inquiry be informed by the concerns of former patients of Ian Paterson and their representatives,” he said. “The interests of all patients, whether they seek treatment in the NHS or the private sector, should be at the heart of this inquiry.”

The government said the inquiry would consider oversight of care in the private sector, the sharing of complaints between private hospitals and the NHS, the role of private health insurers, and arrangements for medical indemnity cover for clinicians in the private sector.

One of Paterson’s former patients, Sarah Jane Downey, said she was pleased the inquiry would report quickly, but she shared the concerns of other victims. “It worries me that the inquiry won’t have the ability to compel witnesses. We know there were people who aided and abetted Paterson and they need to answer questions,” she said. “It is a worry that it could be toothless.”

Spire Healthcare, which runs Parkway and Little Aston hospitals, where Paterson practised, initially argued that as Paterson was not technically its employee, it was not responsible for his actions.

In September, it agreed to settle all claims against it relating to Paterson, paying £27.2m into a £37m fund, with the balance funded by Paterson’s insurers and the Heart of England trust.

Those who need it most don’t get psychiatric care. It’s a mental health crisis | Vyom Sharma

What, precisely, is a crisis? Generally, things have to get pretty bad to be defined as one. “Housing”, “North Korean”, and ”global financial” have all seemed to earn that suffix. The problem with defining “crisis” is partly one of banality through overuse – if you believe even half of what you read, we are perpetually beset by it, in one form or another. So hearing the c-word in a context anything less than epic tends to be accompanied with a faint echo of hyperbole, and twinges of cynicism.

This cynicism can be a trap – it certainly was for me. Within the last decade of practicing medicine, I felt like if I had a dollar for every time I heard the words “mental health crisis”, I could single-handedly fund its fix. The phrase became a cliché. Over time, experience within the system bred familiarity, which spawned complacency.

Crisis is a word without a standard metric, common barometer, and sharp threshold. Its precise definition is akin to asking how long a piece of rope is. The only true answer is that it depends. But you know when you have enough to tie a noose. This week we’ve learned precisely how long that piece of rope is: a Victorian man who killed his mother amid a psychotic episode had to wait 14 months for a bed in a psychiatric hospital.

This is a new low. It’s bad enough that people die without getting adequate psychiatric help. But it turns out even killing someone else isn’t enough to qualify for psychiatric care. This is about as clear a demonstration of a “mental health crisis” as we will get.

To attribute this failure to an unfortunate lapse is to deny the very real, systemic problems that arise from mental healthcare being underfunded. This event did not occur in a vacuum. A deeper look exposes how the system, in its current state, is geared to end in such horrors.

Often the people most seriously afflicted by mental illness are the poorest, who cannot afford private psychiatric care. The problem is that publicly funded outpatient clinics are in very short supply. So often the only way to access psychiatric care out in the community is through “Catt” – Crisis Assessment and Treatment Team. That’s right, the only guaranteed way to be quickly linked in with publicly funded psychiatric care is to be in crisis. That’s how the system works.

Many patients have only this option available because they are in a strange chasm – not unwell enough to warrant a 000 call, but too unwell to wait weeks to see a private psychiatrist even if they can afford to see one. So the Catt service is often overburdened. GPs around Australia have a morose, longstanding joke about this; we say that the letters in Catt stand for “Can’t Attend Today Team”. When the “crisis” team is too busy to attend, you know there’s a problem.

This is not an indictment on the service – far from it. To say it is “overloaded” is like calling an acrobatic plate spinner “busy”. It is a job requiring a rare constitution – infinite patience, high stakes decisions, the ability to treat people who are of threat to themselves and others, and being firsthand witness to tragedy after tragedy. I’ve often seen Catt workers as patients for their own mental health. It might be a crisis in and of itself.

Depressingly, it seems the people viewing the situation with most clarity might be our youngest. Findings from Mission Australia Survey published this week show that Australians aged 15 to 19 ranked mental health as the issue of greatest national concern. Most worryingly, they identified mental health as an impediment to their future pursuits. The nurturing of at-risk adolescents through mental healthcare ought to bolster their optimism, but the failings of our system might be eroding it.

Statistics and position statements fail to capture these moments of clarity about our health system. And sometimes, reading cold statistics on per-capita funding, or wait times, without having to personally experience their impact, lulls you into the trap of confusing complaints for hyperbole.

There is another trap we can fall into. It’s one I was in for years. That trap is the belief that Australian healthcare, ranked consistently within the top-ten in the world is, overall, brilliant. That statement is undeniably true, and yet the key word here is “overall”.

If you forget those with mental illness, Indigenous Australians, LGBTIQ community, refugees and other at-risk groups, we’re doing spectacularly. The problem is that we are a country largely composed of at-risk groups. If you aren’t marginalised in this country, chances are you once were, or are descended from someone who was, or are shoulder-to-shoulder with someone who stands at the margins. And it’s at the margins where crisis thrives. That’s where we have to look to see the crisis for what it truly is.

Dr Vyom Sharma is a GP in Melbourne and a health commentator

Fighting infection: from Joseph Lister to superbugs – Science Weekly podcast

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In March 1867, the Lancet published an article by surgeon Joseph Lister that would change the healthcare landscape completely. The article was the first of several, detailing the culmination of Lister’s life work exploring the connection between germs and infection. Fast forward a century-and-a-half and today Joseph Lister is widely known as the father of antiseptic surgery, saving countless lives both in hospitals and further afield. But how was it that Lister came to his groundbreaking conclusions? How did his colleagues react? And, looking at the present situation, what challenges might we face that Lister would be all too familiar with?

This week, helping Nicola Davis delve into the life and work of Joseph Lister is Dr Lindsey Fitzharris, historian of science and author of The Butchering Art. And to help join the dots between Lister’s groundbreaking work and the challenges healthcare professionals face today – including antibiotic resistance – is chief medical officer for England and chief medical advisor to the UK government Professor Dame Sally Davies.

Radical diet can reverse type 2 diabetes, new study shows

A radical low-calorie diet can reverse type 2 diabetes, even six years into the disease, a new study has found.

The number of cases of type 2 diabetes is soaring, related to the obesity epidemic. Fat accumulated in the abdomen prevents the proper function of the pancreas. It can lead to serious and life-threatening complications, including blindness and foot amputations, heart and kidney disease.

A new study from Newcastle and Glasgow Universities shows that the disease can be reversed by losing weight, so that sufferers no longer have to take medication and are free of the symptoms and risks. Nine out of 10 people in the trial who lost 15kg (two-and-a-half stone) or more put their type 2 diabetes into remission.

Prof Roy Taylor from Newcastle University, lead researcher in the trial funded by Diabetes UK, said: “These findings are very exciting. They could revolutionise the way type 2 diabetes is treated. This builds on the work into the underlying cause of the condition, so that we can target management effectively.

“Substantial weight loss results in reduced fat inside the liver and pancreas, allowing these organs to return to normal function. What we’re seeing … is that losing weight isn’t just linked to better management of type 2 diabetes: significant weight loss could actually result in lasting remission.”

Worldwide, the number of people with type 2 diabetes has quadrupled over 35 years, rising from 108 million in 1980 to 422 million in 2014. This is expected to climb to 642 million by 2040. Type 2 diabetes affects almost 1 in 10 adults in the UK and costs the NHS about £14bn a year.

Type 2 diabetes is usually treated with medication and in some cases, bariatric surgery to restrict stomach capacity, which has also been shown to reverse the disease.

“Rather than addressing the root cause, management guidelines for type 2 diabetes focus on reducing blood sugar levels through drug treatments. Diet and lifestyle are touched upon, but diabetes remission by cutting calories is rarely discussed,” said Taylor.

“A major difference from other studies is that we advised a period of dietary weight loss with no increase in physical activity, but during the long-term follow up increased daily activity is important. Bariatric surgery can achieve remission of diabetes in about three-quarters of people, but it is more expensive and risky, and is only available to a small number of patients.”

The trial results, published in the Lancet and presented at the International Diabetes Federation Congress in Abu Dhabi, show that after one year, participants had lost an average of 10kg, and nearly half had reverted to a non-diabetic state.

There were 298 adults on the trial aged 20–65, who had been diagnosed with type 2 diabetes within the last six years, from 49 primary care practices in Scotland and Tyneside. Half of the practices put their patients on the very low calorie diet, while the rest were a control group, in which patients received usual care. Only 4% of the control group managed to achieve remission.

The diet was a formula of 825–853 calories per day for 3 to 5 months, followed by the stepped reintroduction of food over two to eight weeks. The participants were all given support throughout, including cognitive behaviour therapy and were encouraged to exercise.

“Our findings suggest that even if you have had type 2 diabetes for six years, putting the disease into remission is feasible”, says Prof Michael Lean from the University of Glasgow who co-led the study. “In contrast to other approaches, we focus on the need for long-term maintenance of weight loss through diet and exercise and encourage flexibility to optimise individual results.”

Isobel Murray, 65 from North Ayrshire, was one of those who took part. Over two years she lost three and a half stone (22kg) and no longer needs medication. “It has transformed my life,” she said. “I had type 2 diabetes for two to three years before the study. I was on various medications which were constantly increasing and I was becoming more and more ill every day.

“When the doctors told me that my pancreas was working again, it felt fantastic, absolutely amazing. I don’t think of myself as a diabetic anymore.”

Taylor said that the trail shows that the very large weight losses that bariatric surgery can bring about are not necessary to reverse the disease. “The weight loss goals provided by this programme are achievable for many people. The big challenge is long-term avoidance of weight re-gain,” he said.

Kidney disease patients should keep taking their medicines | Letters

We are concerned that the headline on your article (Kidney drug ‘may do more harm than good’, say experts, 25 November) is misleading and could result in kidney patients stopping taking their medicines. When your kidneys do not work properly, dangerous levels of chemicals like potassium or phosphate can build up in your body. People who have kidney disease are usually given dietary advice as to how to help restrict their intake alongside medicines that bind these chemicals so that they can be excreted; and there is clear evidence that phosphate binders reduce levels of phosphate. Diet alone is not usually enough to reduce these levels, so medicines to help do this are important as without them levels could become too high and result in an increased chance of death.

Nobody should stop taking their medicines after reading this article. If any of your readers are concerned then they need to speak to their doctor about the best ways to reduce phosphate in their diet in combination with taking the right phosphate binder for them and if they should swap to a calcium-free version. Undoubtedly more research is required because evidence in this area is changing all the time and what patients need is clear, simple guidance that they know they can trust – not misleading and potentially dangerous headlines.
Fiona Loud
Director of policy, Kidney Care UK

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