History > 2007 > UK > Health (II)

Revolution in cancer treatment

Scientists discover technique for pain-free,
highly effective chemotherapy
- the latest milestone in a miraculous medical journey

Published: 12 April 2007
The Independent
By Steve Connor, Science Editor
 

Cancer treatment could be on the brink of a revolution following a study showing that it may be possible significantly to improve the effectiveness of chemotherapy drugs without causing side effects.

Scientists have conducted a series of pioneering experiments demonstrating a new way of making tumour cells far more susceptible to attack with extremely low doses of anti-cancer drugs. The development offers hope that the gruesome side effects of chemotherapy, suffered by tens of thousands of cancer patients, may at some point become a thing of the past.

In addition to making chemotherapy more effective at eliminating tumour cells from the body, the study suggests that it is also possible to lower dosage levels to a point where toxic side effects from the drugs are unlikely to occur.

The breakthrough was made possible with a revolutionary medical technique called RNA interference, which allows scientists to "silence" certain genes in a pioneering development first highlighted by The Independent in 2002.

In one of the experiments, for instance, the scientists found that lung cancer tumour cells can be made to be 10,000 times more sensitive to the anti-cancer drug Taxol - an unprecedented improvement in the power of the treatment.

Taxol - also known as paclitaxel - is also used to treat ovarian cancer and advanced breast cancer. Side effects include fatigue, nausea, numbness and bone marrow depletion leading to lowered immunity and vulnerability to infections.

However, the scientists who conducted the study emphasised that further research in the laboratory and on animals will be needed before the first clinical trials on cancer patients can begin in no less than three to five years time. "There's nothing here that is immediately useful to those individuals with cancer," said Michael White, professor of cell biology at the University of Texas Southwestern Medical Centre in Dallas.

"We're still at the beginning, but this sort of approach is very fast and very effective. It shortens the discovery process, which makes the development process so much quicker."

The scientists grew cells from human lung cancers in the test tube and tested the ability of anti-cancer drugs such as Taxol to attack them after treatment with RNA-interference (RNA-i).

The RNA-i technique in this experiment was designed to "silence" or switch off certain genes in the tumour that appear to be turned on as part of the cancerous process. This made the cells dramatically more susceptible to the anti-cancer drugs.

Since its initial development over the past 10 years, RNA-i has proved to be one of the most exciting areas of biomedical research with prospects of its being used to treat conditions as varied as inherited disorders, blindness, viral infections and now improving the efficacy and safety of cancer therapy.

In the latest experiment with RNA-i, scientists screened a total of more than 21,000 genes and found that 87 can influence a tumour cell's sensitivity to chemotherapy, and that six in particular were strongly linked with Taxol sensitivity, according to the study published in the journal Nature.

When some of the genes were silenced by RNA-i they became a thousand times more sensitive to Taxol. When other genes were silenced, sensitivity to the drug rose ten-thousandfold.

Professor White said: "Chemotherapy is a very blunt instrument. It makes people sick, and its effects are very inconsistent. Identifying genes that make chemotherapy drugs more potent at lower doses is a first step toward alleviating these effects in patients."

The study attempted to investigate why some cancer patients fail to respond to chemotherapy, and why some develop severe side effects from the treatment. "The cells in tissue culture mimic the effects you see in people," Professor White explained.

Nearly 85,000 different molecules of RNA - a substance similar to the DNA genetic blueprint - were used in the study to screen a cell's genes by targeting those that could be silenced. The process gradually switches them off, much like an electric dimmer switch.

Professor White said: "The idea of the screen was to be able to take advantage of the new generation of technology to silence any gene we want.

"That's the power of a genome-wide screen - you go in without any expectation and let the data tell you what's important."

The scientists have already started trials on laboratory animals with cancer to see if the RNA-i approach can be used to make them more sensitive to lower doses of chemotherapy drugs.

Professor White said: "We're conducting animal studies based on lung cancer and ovarian cancer models. These experiments are not difficult and basically they have been shown to work but we still need to have the data published in a peer-reviewed way." Although it could still take between three and five years for clinical trials with existing anti-cancer drugs, it will take 10 years or longer to develop new drugs that are able to work alongside RNA-i, he said.

The scientists also tested the RNA-i approach using other anti-cancer drugs, such as gemcitabine and vinorelbine, but they did not see the dramatic effects that they recorded with paclitaxel.

"Our studies using additional drugs indicate that the genes we uncovered are highly specific for paclitaxel," said Angelique Whitehurst, a researcher at the University of Texas and lead author of the study. The findings indicated that it was not just the effect of silencing certain genes that had the observed effect on the cancer cells, but the interaction of the gene-silencing approach with paclitaxel that was responsible, Professor White said. "Being able to do this in human cells, and being able to do it fast, this is very powerful," he added.

'Chemotherapy was an awful experience'

Christine Davies, breast cancer survivor, 60

Christine Davies, from Cheltenham, was diagnosed with breast cancer in May 1992. After seven months of chemotherapy she was finally given the all-clear.

"Chemotherapy was just the most awful experience; I know some people manage OK but I think I was a particularly bad case. From the first dose onwards, I wondered how I was going to cope. My daughter was only 10 years old and my husband, a teacher, was working away from home every week in London.

"My diary entry from the day I had my first dose reads: 'First lot of chemo. What a bolt from the blue.' I was sick at midnight, then at 4am, then again at 6am.

"The worst thing was the muscle spasm - my throat completely froze up and I could hardly talk. It's hard to imagine it now but I remember I just couldn't get my tongue in my mouth. I was standing at the sink with my daughter behind me and all I could think of was how I could stop her from seeing what was wrong. I got in such a state - it was so frightening that I had to call the doctor, who told me to take Valium to relax the muscles in my mouth.

"I had five lots of chemo in all, from September through to March the next year. They put me on a cocktail of different drugs. The third time was dreadful; I was sick for the first time at 11pm, then eight or nine times more until getting up at 5.15 in the morning. The drugs also gave me pains in my joints, particularly my hips. And I couldn't eat at all - my daughter says the only thing she remembers me being able to swallow were these awful boiled sweets that afterwards made me feel sick just because of the association with the chemo. There were times when I was terribly ill, followed by periods in between doses when just not to be feeling ill made me really happy. My daughter had her 11th birthday; we had a lovely party with all the family. Then came the next dose and I would be back in bed, on my own, feeling so low I couldn't face seeing anyone. The day before the last dose I wrote in my diary that I couldn't explain 'how much I'm dreading it'. That one turned out to be the most debilitating of all and made me sick for two whole days.

"If there were a way to lessen the side effects, to diminish the sickness and nausea, I would think it would transform the experience. For me that was what made it so awful and what, in comparison, made radiotherapy perfectly bearable. When you feel so sick like that your body just can't do anything."

The first line of defence

What is it?

Chemotherapy is the use of a combination of anti-cancer drugs to destroy cancer cells

When was it discovered?

In 1909, by Paul Ehrlich, who used an arsenic compound, arsphenamine to treat syphilis.

How does it work?

The drugs stop the cancerous cells from dividing, and therefore reproducing themselves

When is it used?

Before an operation to shrink a cancer, or after to clear any remaining cancerous cells

Common side-effects

Tiredness, nausea and a greater risk of developing a second form of cancer.

Revolution in cancer treatment, I, 12.4.2007,
http://news.independent.co.uk/world/science_technology/article2442002.ece

Call to screen

all prospective hospital patients

for superbug

· Rising death rates from C difficile prompt alarm
· Specialist proposes setting up quarantine zones

Friday April 6, 2007
Guardian
Polly Curtis, health correspondent

The government should consider a mass screening programme to test all patients for the most virulent form of superbug before they are admitted to hospital, a doctor suggests today. Hospitals could set up quarantine zones to isolate all infected patients to prevent its spread, John Starr, a specialist in geriatric medicine at Edinburgh University, argues in the British Medical Journal.

The measure was prompted by the soaring death rates from Clostridium difficile. Latest figures suggest the bug was responsible for at least 3,800 deaths in 2005 - 2,000 more than MRSA - and an outbreak in Norfolk has contributed to the deaths of at least 30 people this year.

Unlike MRSA, C. difficile is rampant in the community, with 13,000 cases acquired outside of hospitals last year. One in 20 people also carry the bug without experiencing symptoms. To prevent the spread through hospitals, where people are vulnerable, all patients could be screened on admission, Dr Starr says. With 20% of the 150,000 hospital beds in England now in private rooms, these could be used to isolate infected patients, he suggests.

An outbreak of a hypervirulent strain of C. difficile at James Paget hospital in Norfolk has contributed to 17 deaths since the end of last year. C. difficile is resistant to alcohol-based cleaning products now routinely used in hospitals to tackle MRSA.

A second Norfolk hospital, Queen Elizabeth in Kings Lynn, reported 13 deaths of patients with C. difficile this year.

A spokesman for Queen Elizabeth hospital said it was being penalised because its efficient reporting had identified the deaths. Six of the eight deaths as a result of C. difficile were of people who acquired the bug before they came to hospital.

Michael Summer, vice-chair of the Patients Association, said routine screening might be "a bit over the top". But he added: "There is not enough screening at present and we would argue for more."

A Department of Health spokesman said there were no plans for a compulsory screening programme. The government has provided £50m funding to trusts to boost infection control measures.

What is Clostridium difficile?

A superbug like MRSA but more prevalent. In 2005, there were 1,600 deaths linked to MRSA, 3,800 to C. difficile.

What are the symptoms?

Mainly severe diarrhoea, which is treatable with antibiotics.

What can be done?

Hospitals control MRSA through alcohol-based cleaners. C. difficile needs steam cleaning.

Call to screen all prospective hospital patients for superbug, G, 6.4.2007, https://www.theguardian.com/society/2007/apr/06/
nhs.health

Ban on human-animal embryos

is unacceptable, MPs say

· Government plan is threat to UK science, says report
· Ministers accused of using flawed consultation

Thursday April 5, 2007
Guardian
Ian Sample, science correspondent

Government plans to outlaw the creation of embryos which are part-human, part-animal are "unacceptable" and threaten to undermine Britain's leading position in stem cell science, MPs will say today.

A report by the Commons science committee calls on ministers to scrap the proposed ban and accuses the government of basing its opposition to the research on a "deeply flawed" consultation.

The committee's demands - which follow a letter to the prime minister signed by 223 medical charities and patients' groups supporting the research - leave the government increasingly isolated in its intention to prohibit the experiments.

Many scientists believe the research will pave the way for new treatments of diseases such as Alzheimer's, Parkinson's and cystic fibrosis. They want to create animal-human embryos to understand the molecular minutiae behind such conditions. The researchers would pluck a cell from a patient and insert it into a hollowed cow or rabbit egg and stimulate it with a jolt of electricity. The two cells then fuse to make an embryo which is 99.9% human and 0.1% animal. Embryonic stem cells extracted from the embryo could be grown into nerves and other tissues, giving scientists insight into how the disease develops. Under existing laws, the embryos must be destroyed no later than 14 days old and cannot be implanted.

Using plentiful animal eggs will allow the researchers to overcome a major stumbling block caused by the shortage of fresh human eggs that would otherwise be needed for the work. The proposed ban has already drawn criticism from scientists, including Sir David King, the government's chief science adviser, the Human Genetics Commission and the Medical Research Council and Wellcome Trust.

Plans to outlaw the research were revealed in December by the public health minister, Caroline Flint, in a white paper which has become the basis of a wide-ranging overhaul of fertility laws. It recommends a blanket ban on the creation of embryos which are part-animal, part-human, with a provision for some research in the area to be conducted under licence.

The Department of Health defended the proposal by citing a public consultation in which many respondents said they were opposed to the research.

The committee's report calls for the proposals to be dropped from the fertility draft bill, due to be published on May 8. It concludes: "We have found the government's published proposals for future regulation in this area to be unacceptable and potentially harmful to UK science."

At a briefing in London, the committee chairman, Liberal Democrat MP Phil Willis, criticised the public consultation exercise used to defend the ban. The consultation attracted around 300 responses, with 277 opposed to the research, but many came from groups opposed to any research on embryos, he said.

The MPs called for permissive legislation, allowing research into human-animal embryos to go ahead under licence after scrutiny by the fertility regulator, the Human Fertilisation and Embryology Authority. The technique was pioneered by Hui Sheng, a developmental biologist in Shanghai. Scientists at Newcastle University and King's College London have already applied to the HFEA to create animal-human embryos for stem cell research, but their licences are not expected to be granted until the authority completes its consultation in September.

In a statement, a spokesman for the Department of Health said: "Whilst we have proposed an initial ban in general terms, we recognise that there may be potential benefits from such research and are certainly not closing the door to it."

How are hybrid and chimeric embryos made?

There are three different types. Hybrid embryos are made by fertilising an egg with the sperm of another species, the same technique used to make a mule. For a hybrid to fertilise, the egg and sperm have to come from very closely related species. Chimeric embryos are made by injecting cells or genetic material of one species into the embryo of another. Scientists at Stanford University plan to use this to create a mouse with 10% human brain cells.

The third type of embryo is called a cytoplasmic hybrid, created by inserting a cell, or DNA, from one animal into the hollowed-out egg of another species. Scientists in London and Newcastle hope to create these by fusing human cells with cow and rabbit eggs. All research embryos must be destroyed within 14 days and it is illegal for them to be implanted.

Ban on human-animal embryos is unacceptable, MPs say, G, 5.4.2007, http://www.guardian.co.uk/science/story/0,,2050279,00.html

Patients put at risk

by delays in cancer care

April 3, 2007
From The Times
Nigel Hawkes, Health Editor

More than half of all cancer patients needing lifesaving radiotherapy are waiting longer than the Government’s “maximum acceptable delay” for treatment, according to a damning report.

The Times has been told that the paper shows huge variations in the delivery of treatments around the country, with many “black holes” where services are extremely poor.

The study, by the National Radiotherapy Advisory Group, has not been published and ministers have not indicated that it will be. But Professor Karol Sikora, a cancer specialist, said that it should provoke “an outcry for better provision”.

It mirrors a survey by the Royal College of Radiologists which concludes that radiotherapy waiting times are “unacceptable” and delays “reduce the chance of a cure and worsen outcomes in some patients”.

There has been an outcry over the availability of new cancer drugs but radiotherapy is often forgotten. “It’s the unsexy part of cancer treatment,” Professor Sikora said. “It’s as good as the drugs but isn’t thought of as being as exciting.”

The college’s audit shows that only a minority of patients are treated within even the targets set by the Government. In 2005, only 47 per cent of patients needing postoperative radiotherapy got it within the “maximum acceptable delay” of four weeks. In Wales the figure was a mere 26 per cent.

The audit followed earlier ones, in 1998 and 2003, and shows that waiting times have become longer since 1998, when around a third of patients waited for more than four weeks. The delays worsened considerably between 1998 and 2003 and have improved slightly since then.

The audit concludes: “It is imperative that waits for radiotherapy are reduced for all patients to maximise their chance of a cure.” The authors, led by Michael Williams, of Addenbrooke’s Hospital in Cambridge, added that “achieving this will require a planned programme of investment in staff, training and equipment.”

Professor Sikora, who has been clinical director of cancer services at Hammersmith Hospital and chief of the World Health Organisation’s cancer programme, said: “Systematic delays abound. Three months’ waiting time for radiotherapy is common.”

Yet cancer is seen by the Government as one of its successes. Cancer mortality in people under 75 fell by 16 per cent between 1996 and 2004 and an extra £639 million was invested in the three years up to 2004. “The year-on-year increase in funding has been staggering,” Professor Sikora said, adding that far more is needed.

Professor Sikora has recently set up CancerPartnersUK, which is talking to hospitals about building a chain of privately-funded cancer care units with the aim of reducing the distance patients must travel. Maps based on population density and existing services show where the need is greatest.

“Black spots” for cancer treatment (above) where people have to travel long distances, abound around the M25, the South Coast, in the North West and North East of England.

    Patients put at risk by delays in cancer care, Ts, 3.4.2007, http://www.timesonline.co.uk/tol/life_and_style/health/article1605142.ece

3.15pm

Smoking banned in Welsh public spaces

Monday April 2, 2007
Guardian Unlimited
Steven Morris and Mark Oliver

A ban on smoking in enclosed public spaces came into force in Wales today, with the introduction of £50 on-the-spot fines for anyone caught flouting the new law.

The ban, which officially began at 6am, has been introduced by the Welsh Assembly three months earlier than in England, where it will come into effect from July 1. There are already public smoking bans in Scotland and Northern Ireland.

Ministers in Wales argue that the new legislation - which will be backed by a big advertising campaign fronted by rugby star Gavin Henson - could prevent 400 deaths from passive smoking a year.

Landlords and managers of pubs, clubs, cafes and bars which do not display adequate no-smoking signs will be fined £200 under the new rules. They could also face a fine of up to £2,500 if they allow people to smoke on their premises. Anyone issued with a penalty notice can challenge it in court in the same way as a speeding ticket.

Reaction today from the public was mixed, with members of the public in urban areas appearing to be more enthusiastic than those in rural areas.

This morning, at Cooper's Cafe, in the Cardiff suburb of Whitchurch, the majority of customers said they supported the ban. Giovanni Bacchetta, 82, who smokes 30 cigarettes a day, said he did not miss being able to have a smoke with his cup of tea. "I used to smoke in here, but it doesn't bother me," he said. "We've got to accept it and that's it."

However, in the Gwent valleys the ban was met with a sense of anger amongst many smokers and concern amongst the owners of premises where people are accustomed to lighting up.

At the Ex-Servicemen's Club in the town of Crumlin, chairman, Ron Morgan, and secretary Brian Morgan - no relation - were to be found leaning against a wall having a lunchtime cigarette - and bemoaning the ban.

Ron said: "I think it's a personal right they are taking away. I would say 40% of our members are smokers and most are very unhappy. People have always had a drink and a smoke in this area. It's part of who we are and that is being taken away."

Brian said: "I think some people will try to light up, probably the old codgers and the younger crowd. We'll just have to tell them not to in as polite a way as possible. But it's a concern it could lose us money."

The club is a typical valleys social club, the long room dominated by a dartboard, a karaoke kit in the corner. But the ashtrays have gone from the tables and have been piled up in the cellar.

Smart bars in Cardiff, Newport and Swansea have spent money on providing outside areas for smokers, with umbrellas and outside heaters. Philip Lay, retail director at SA Brains, Wales's biggest independent brewer and pub operator, said one licensed premises had even lifted the roof off part of the building to create a courtyard.

But at the Ex-Servicemen's Club, smokers will only have the choice of the street corner or a sheltered spot outside the games room.

Outside a nearby betting shop, Jeff Dwyer was having a cigarette and worrying he'd be missing the start of the next race. "I think it's a disgrace," he said. "It's singling out us smokers. The government ought to be kicked out over this."

Mindful of some of the resistance from the public, Wales's health minister, Brian Gibbons, insisted that the ban would not be heavy handed.

He said: "There is not going to be a punitive, draconian approach to this. We felt as an assembly government we should strive to get this ban in place seeing as the view of the assembly has been known on this for quite a long time.

"I would be shocked if there is anybody who this is likely to affect in Wales who doesn't know that the ban is coming in."

Welsh Conservatives' health spokesman, Jonathan Morgan, described the ban as the "greatest public health reform in Wales for generations".

He said: "This is not an anti-smokers measure. It is a measure to protect non-smokers who legitimately want to enjoy a night out without running the risk of developing a smoking-related disease."

Wales was the first part of the UK to call for a ban, but because of the assembly's limited law-making powers it had to wait until parliament passed legislation last February. Ministers had initially been split on how far a smoking ban should go - with plans to exempt clubs and pubs not serving food - but MPs voted by a margin of around 200 votes to impose a ban on smoking in all enclosed spaces.

Welsh theatregoers will also notice a difference. There is no exemption for actors on stage and on film sets if their character is directed to smoke. When the ban comes into effect in England, actors will be allowed to smoke during performances, but not during rehearsals.

Campaigners against the ban say more people will smoke at home, possibly harming children's health, and in the street, creating more litter from cigarette stubs. Opposition politicians have called for the ban to be backed up by proper smoking cessation schemes. Forest, the smokers' rights campaign group, argues that the best place to smoke is a "well ventilated" bar or restaurant. It claims the majority of smokers will not quit because of the bans.

However, last week the Scottish executive heralded its year-old ban as a success when it said there had been more than 46,000 attempts to quit smoking since it began.

The ban in Wales follows the scrapping of prescription charges yesterday. The two flagship health policies have been introduced in the run-up to Welsh assembly elections on May 3.

    Smoking banned in Welsh public spaces, G, 2.4.2007, http://www.guardian.co.uk/smoking/Story/0,,2048415,00.html?gusrc=ticker-103704

British team

grows human heart valve

from stem cells

Tissue for transplants
could be available within three years
if trials are successful

Monday April 2, 2007
Guardian
Alok Jha, science correspondent

A British research team led by the world's leading heart surgeon has grown part of a human heart from stem cells for the first time. If animal trials scheduled for later this year prove successful, replacement tissue could be used in transplants for the hundreds of thousands of people suffering from heart disease within three years.

Sir Magdi Yacoub, a professor of cardiac surgery at Imperial College London, has worked on ways to tackle the shortage of donated hearts for transplant for more than a decade. His team at the heart science centre at Harefield hospital have grown tissue that works in the same way as the valves in human hearts, a significant step towards the goal of growing whole replacement hearts from stem cells.

According to the World Health Organisation, 15 million people died of cardiovascular disease in 2005; by 2010, it is estimated that 600,000 people around the world will need replacement heart valves. "You can see the common pathway of death and suffering is heart failure," said Prof Yacoub. "Reversing heart failure could have a major impact."

Growing replacement tissue from stem cells is one of the principal goals of biology. If a damaged part of the body can be replaced by tissue that is genetically matched to the patient, there is no chance of rejection. So far, scientists have grown tendons, cartilages and bladders, but none of these has the complexity of organs, which are three-dimensional structures of dozens of different types of cells.

To crack the problem, Prof Yacoub assembled a team of physicists, biologists, engineers, pharmacologists, cellular scientists and clinicians. Their task - to characterise how every bit of the heart works - has so far taken 10 years. The progress of his team and that of colleagues around the world will be published in August in a special edition of the journal Philosophical Transactions of the Royal Society.

Prof Yacoub said his team's latest work had brought the goal of growing a whole, beating human heart closer. "It is an ambitious project but not impossible. If you want me to guess I'd say 10 years. But experience has shown that the progress that is happening nowadays makes it possible to achieve milestones in a shorter time. I wouldn't be surprised if it was some day sooner than we think."

Currently, many people suffering from heart valve disease have artificial replacement valves. Though they save lives, the artificial valves are far from perfect. They perform none of the more sophisticated functions of living tissue, children need their valves replaced as they grow, and patients need a lifetime of drugs to prevent complications after surgery.

"The way a living valve functions, it anticipates haemodynamic events and responds and changes its shape and size. It's completely different from an artificial valve which will just open and shut. The heart muscle itself will appreciate something which will make it free to contract properly," said Prof Yacoub.

Adrian Chester, one of the lead scientists at the Harefield centre, has focused on characterising the valves in the heart. "You have mediators in blood or released locally in the valve that can make parts of the valve contract and relax. That work has then extended into looking at the incidence of nerves in the valve - these can cause the types of contractions and relaxations in a very specific way."

By using chemical and physical nudges, the scientists first coaxed stem cells extracted from bone marrow to grow into heart valve cells. By placing these cells into scaffolds made of collagen, Dr Chester and his colleague Patricia Taylor then grew small 3cm-wide discs of heart valve tissue. Later this year, that tissue will be implanted into animals - probably sheep or pigs - and monitored to see how well it works as part of a circulatory system.

If that trial works well, Prof Yacoub is optimistic that the replacement heart tissue, which can be grown into the shape of a human heart valve using specially-designed collagen scaffolds, could be used in patients within three to five years.

Growing a suitably-sized piece of tissue from a patient's own stem cells would take around a month but he said that most people would not need such individualised treatment. A store of ready-grown tissue made from a wide variety of stem cells could provide good matches for the majority of the population.

Prof Yacoub's inspiration has come not only from other scientists but also from an unexpected source - the celebrated British artist, Antony Gormley, who has donated a sculpture to the heart science centre. "We need a lot of experts from different fields but we also need a lot of imagination and a lot of understanding of how form interacts with function," said Prof Yacoub. "Art gives a lot of inspiration and beauty. And beauty is part of science."

Mr Gormley, who has also contributed to the upcoming special issue of the Philosophical Transactions of the Royal Society with an article on the relationship between form and function in sculpture, said he admired the universalism with which Prof Yacoub approached his work. "He manages to do the Robin Hood job in a very important way for the benefit of all humanity. I found in him a fellow traveller in terms of trying to do things at the fringes of the possible with the highest levels of input in terms of technology and intelligence. Everybody breathes air, everybody pumps blood."

    British team grows human heart valve from stem cells, G, 2.4.2007,
    http://www.guardian.co.uk/medicine/story/0,,2048062,00.html