History > 2007 > UK > Health (III)

1.5m wrongly told

they risk heart disease

Misdiagnosis has led
to massive over-prescribing of drugs
- BMJ study

Friday July 6, 2007
Guardian
Polly Curtis,
health correspondent


Thousands of people have been wrongly told they are in danger of developing life-threatening heart diseases because of flaws in the way doctors routinely calculate the risk, according to a study of more than a million people published today.

Current estimates of the number at risk of cardiovascular diseases are 1.5 million too high, the report says, suggesting the anti-cholesterol drugs statins are massively and needlessly over-prescribed, inflating the £2bn annual bill to the NHS.

The study in the British Medical Journal made a series of other significant discoveries. It found that white middle-aged men have a lower risk of heart disease than previously thought and women from poorer backgrounds have a significantly higher risk. It also found one in three women in their 60s are at risk of heart disease, a figure previously thought to be one in four.

Concern over the misdiagnosis of heart disease will be compounded by a separate study due today from the Healthcare Commission. It will raise concern over the way the 300 healthcare trusts in England and Wales are monitoring the problem. A third of them were unable to provide details of the treatment being given to patients.

The HC said the number reported as having heart failure was 140,000 fewer than expected. While it is unsure whether the shortfall is a statistical blip, the study from the BMJ highlights how many thousands of people will probably be given the wrong treatment anyway.

Julia Hippisley-Cox, lead author of the study, said: "We are potentially missing the right people for treatment. If we use this new score it would increase treatment to deprived areas and especially to women. They are being under-treated across the board." She added that research was urgently needed into the risks for people from ethnic minorities amid fears that the current assessment scores, which were originally modelled on white populations in the US, are discriminating.

The researchers tracked 1.28 million healthy men and women aged between 35 and 74 over a period of 12 years to April 2007 and used GP records from 318 general practices.

The traditional way of calculating the risk from heart disease involves a score based on smoking, blood pressure and "good" and "bad" cholesterol, along with age and sex. The BMJ study compared this measure against a new, more sophisticated test, which also takes into account social deprivation, genetic factors and weight. It found that the former over-predicted the number of people at high risk of developing cardiovascular diseases by 35%.

It concludes that 3.2 million adults under the age of 75 are at risk of developing cardiovascular illnesses compared with the 4.7 million previously estimated.

Statins are widely prescribed at £2bn a year to try to reduce some of the 100,000 annual deaths from heart illnesses. Michael Summer, of the Patients Association, said the scoring system needed revisiting: "Anyone with any doubts should go back to their GP with this study to make sure that they really need statins."

Prof Hippisley-Cox said: "If people are being put on treatment when they don't need it, not only could there be side effects but they will be experiencing unnecessary anxiety."

The National Institute for Health and Clinical Excellence published recommendations last week that all people over 40 should be considered for statins and offered them if they are at a 20% risk of becoming ill within 10 years, though they should first be advised on healthy lifestyle programmes. Last night a spokesman said the BMJ study was published too late for the consultation. "We are currently looking at it [the research] and will determine what action to take."

June Davison, a cardiac nurse at the British Heart Foundation, said: "The most important thing is that people go to their doctors and get their cholesterol and blood pressure tested."

1.5m wrongly told they risk heart disease, G, 6.7.2007, https://www.theguardian.com/society/2007/jul/06/
health.medicineandhealth

Alzheimer's sufferers

have their day in court

over NHS drug veto

· Medicines advisory body faces first legal challenge
· Patients and carers stage protest as case begins

Monday June 25, 2007
Guardian
Sarah Boseley, health editor


People with Alzheimer's disease and their carers will today protest outside the high court at the start of a major legal challenge to the body that decides which drugs people may be given on the NHS.

A judicial review lasting four days is being brought by the drug companies making and marketing Aricept, a drug which the National Institute for Health and Clinical Excellence says does not work well enough to justify the cost to the NHS of giving it to people with mild Alzheimer's. Nice ruled it should not be used until the disease progresses.

The Alzheimer's Society, representing patients and their carers, is supporting the drug companies in the first judicial review of a Nice decision since the body was launched eight years ago. The society has demanded for the last three years that all patients should be allowed Aricept or one of the two other drugs in the same class on the NHS. The cost is about £900 a patient a year.

"People with Alzheimer's disease and their carers have fought long and hard for their day in court. These treatments have benefited so many families already - where is the justice in Nice's decision to snatch them away?" said Neil Hunt, chief executive of the society. "Another 100,000 people will develop dementia this year alone and the result of this case will affect not only them but their families too. We have to fight Nice's fatally flawed process, which has failed to recognise the benefits these treatments have for carers."

Although hugely emotive, the case will hang on technicalities. The drug companies will not contest Nice's calculations of the benefit patients get from the drugs - which for most is very slight.

Tests that show improvements in patients are clinical assessments, conducted in doctors' offices. Most show that patients perform better on a cognitive scale - they may be better able to name objects on a table, for instance - but there is little proof that the drugs help them perform tasks such as making tea.

There is scant evidence that the drugs enable people to stay in their own homes for longer. But it is accepted that some people do better on the drugs than others - a professor of neurology will say that about 15% get real benefit. Nice says the best way to get most value for money is to give them to those with moderate disease, but not mild. Nobody argues they work in people with severe disease.

Eisai, which markets Aricept, and Pfizer, which owns the patent, will argue in court that the mathematical model used by Nice to determine cost-effectiveness is flawed. They say it is unfair that Nice will not allow them to alter the calculations in the model by putting in their own figures. Nice will argue that it has changed the numbers frequently after representations from the companies and the patient groups.

One figure contested by the Alzheimer's Society is the cost of full-time institutional care. If the drugs delay the move of a patient into care, there will be savings to the NHS. Nice originally said the cost was £355 a week - then changed it to £368 a week in 2004. The Alzheimer's Society argued it was £520 a week. But when the higher figure was added into the model, it made little difference to the overall cost-effectiveness of the drugs.

The society will argue that Nice has not taken into account the benefit that carers get when their spouse or parent is put on the drugs - something Nice will deny.

"Our consultation, decision-making and appeals processes are transparent and fair," said Nice chief executive Andrew Dillon, who says help and support other than drugs is needed for patients and carers.

    Alzheimer's sufferers have their day in court over NHS drug veto, G, 25.6.2007, http://society.guardian.co.uk/health/news/0,,2110577,00.html

12.15pm

Teenage terminations raise abortion rate

Tuesday June 19, 2007
Guardian Unlimited
Mark Tran

The number of abortions in England and Wales rose 3.9% to 193,700 in 2006, the department of health reported today.

The previous year had seen just a 0.4% increase .

The figure for teenagers - among the highest in Europe - was also up last year. The abortion rate per 1,000 women was 3.9 among under 16s and 18.2 among under 18s. The rate was highest at 35 per 1,000 for women aged 19.

The British Pregnancy Advisory Service (BPAS), which provides contraception and abortion services, said the increase came as no surprise.

"A rise in numbers of this scale does not surprise us, as BPAS' doctors saw around 55,000 women for abortion care in 2006," said Ann Furedi, chief executive of BPAS. "We also know that conceptions are up overall in England and Wales.

"A rise in the number of abortions is not the problem in itself - the real problem is the number of women experiencing unintended pregnancy. For some of these, abortion will be the solution to the very serious problem of being faced with an unplanned, unwanted pregnancy."

The health minister, Caroline Flint, welcomed the fact that a higher percentage of abortions were taking place at an early stage, with almost two-thirds occurring before 10 weeks' gestation and most under 13 weeks.

"It is important that women have early access to abortion services as the earlier the abortion, the lower the risk of complications," she said.

"We have invested £8m to improve early access and set a standard of a maximum waiting time of three weeks. However, the NHS needs to work harder to reduce the demand for abortions by improving access to contraception."

Ms Flint said primary care trusts have received an extra £40m over 2006/08 to improve access to contraceptive services - part of the extra investment for sexual health announced in the public health white paper.

"In addition, we are producing best practice guidance on reproductive healthcare for commissioners and providers," she said. "For the first time, primary care trusts' performance will also be measured in this area."

The Royal College of Obstetricians said the rise was "disappointing" and showed a failure to deal with the problem of unplanned pregnancies.

The Society for the Protection of Unborn Children (Spuc) blamed the rising abortion trend on the government's efforts to cut NHS waiting times.

It argued that this was leading to an increasing number of young, single women being pressured into having 'social' abortions, and having them in 'short order'.

"Gordon Brown should end the Labour government's policy of rushing women as quickly as possible through the abortion mill in its frenzy to cut waiting times," said Paul Tully, general secretary of Spuc.

"He should also end the policy of promoting secret abortions on teenagers without telling their parents, and he should stop the counter-productive sex education programmes that the pro-abortion lobby promotes widely."

    Teenage terminations raise abortion rate, G, 19.6.2007, http://society.guardian.co.uk/health/story/0,,2106494,00.html

New breast cancer genes identified

Most significant advance in decade

Monday May 28, 2007
Guardian
Polly Curtis, health correspondent

The most significant advance in the understanding of breast cancer for a decade was announced last night with the identification of a new group of common genetic markers for the disease.

Scientists have discovered four genes which, if faulty, can increase a woman's chance of developing breast cancer - by up to 60% in the case of two of the genes. This helps explain why women with a close relative with breast cancer are twice as likely to develop the disease, and offers the hope of a test in the near future. The scientists also believe the techniques used will help them unravel other cancers.

Karol Sikora, a leading cancer specialist, said of the studies published online in Nature and Nature Genetics last night: "This set of incredible papers points to the future understanding [of] the genetics of cancer."

It is the most significant discovery in the field since the 1990s, when scientists identified two rare genes, BRCA1 and BRCA2, which make carriers likely to develop breast cancer. An international coalition of researchers led by Cancer Research UK at Cambridge University has proved the theory that geneticists have been working on ever since: that most familial patterns of breast cancer can be explained by myriad smaller genetic effects.

Breast cancer is twice as common in those who have a close relative who develops it due to a fault in a gene, although the presence of a faulty gene does not mean that cancer will definitely occur.

The scientists trawled large parts of the genome in 800 people. They identified 11,000 "tags", or blocks of DNA which point to genes, which were more common in women with breast cancer and studied them in 8,000 more women. In the final process, which involved 40,000 women, they narrowed the search down to five tags which were significantly more common among women with breast cancer than those without. The tags pointed them to four genes which they believe are responsible for the increased breast cancer risk among the patients studied. Scientists expect that they will find a fifth.

Two of the genes identified, FGFR2 and TNRC9, are thought to increase the risk of breast cancer by about 20% in women who carry one faulty copy of a gene and by between 40% and 60% in those who carry two faulty copies. The lifetime risk for women with two faulty copies in either of these two genes would rise from one in 11 to around one in six or seven. The other two genes increase risk by 10% if there is one fault.

A maximum 10% of breast cancers have a genetic element, and the genes scientists know about so far account for 25% of these. The genes identified today account for a further 4% and are responsible for only a small number of breast cancers - up to 179 of the 44,000 diagnosed every year.

The ultimate aim is genetic screening that would band women according to risk. But scientists warn this could create an army of "worried well". They stress that the findings do not merit genetic testing immediately.

The findings do, however, hint at a different cause of familial breast cancers. Three of the new genes are involved in the control of cell growth or cell signalling, mechanisms which have never been linked to breast cancer before.

The author of the study, Douglas Easton, director of Cancer Research UK's Genetic Epidemiology Unit in Cambridge, said: "We're very excited by these results because the regions we identified don't contain previously known inherited cancer genes. This opens the door to new research directions." The techniques used are similar to those which helped identify the genes for obesity last month.

    New breast cancer genes identified, G, 28.5.2007, http://www.guardian.co.uk/medicine/story/0,,2089635,00.html

Number 10 hiding blood scandal facts

Inquiry finds the truth on shredding was withheld
after infected transfusions killed 1,700 patients

Sunday May 20, 2007
The Observer
Jo Revill, Whitehall editor

An independent public inquiry into how thousands of haemophiliacs contracted HIV or hepatitis C from contaminated blood discovered last night that Downing Street is withholding crucial information about how hundreds of relevant documents were shredded.

More than 1,700 patients died and many more are now terminally ill as a result of one of the biggest medical disasters of recent times, when haemophiliacs were given infected blood clotting products during the late Seventies and early Eighties. The products came from American prisoners who were allowed to sell their blood even though there were fears about the risks of contamination.

But it has since emerged that many of the files detailing the scandal were shredded by civil servants in the Nineties. This week, the second hearing of the contaminated blood inquiry, chaired by the former Solicitor-General, Lord Archer of Sandwell, will ask why the results of an internal inquiry into the destruction of crucial files are being withheld.

Jenny Willott, Liberal Democrat MP for Cardiff Central, has discovered that Downing Street is holding back the report, carried out by the Department of Health in 2000, when Alan Milburn was Health Secretary. Some of the destroyed documents detailed meetings between the blood transfusion service, health boards, government officials and consultants during the Seventies and Eighties. The records also contained information on when precisely the government became aware of the risks from imported blood and what measures were taken to warn patients.

The Haemophilia Society said last night that Downing Street's decision was 'incomprehensible, given the public interest'. In 1989, the society brought legal action on behalf of thousands of patients who had become infected with HIV after being given the clotting product Factor 8. Haemophilia is a rare hereditary condition in which the blood does not clot properly. British doctors used the American products despite some senior scientists knowing that there was a risk. Compensation was then agreed with the Tory government in 1990 and thousands of patients received one-off payments of between £21,000 and £80,000.

However, it then transpired that hundreds of documents relating to the case were shredded, allegedly by accident, by junior civil servants. It is now known that there were two separate instances of documents being destroyed, or mislaid, at some point between 1990 and 1998. Some copies of documents had been made by a solicitor's firm, and these were returned to the government, but others are thought to have been lost forever. The total number of destroyed documents is not known. In 2000, the Department of Health held the audit but it was never published.

An email from the Department of Health passed to The Observer revealed that an official has confirmed that the audit has been withheld at the request of no 10. Yesterday, it remained unclear why Downing Street had blocked moves to put it into the public domain. The Observer was still awaiting a reply last night from No 10 officials about the reasons for the lack of disclosure.

Willott said: 'We discovered that this internal audit had happened through the Freedom of Information Act, and asked to see a copy of it. We now find that No 10 have withheld it. That raises the very big question about whether there is incriminating evidence in there.

'We were always told that the documents were shredded by mistake by a junior civil servant. It is very important that we know because it's hard to hold an inquiry when you are not getting the full picture. There are thousands of people living with the results of this terrible disaster who deserve to know the truth.'

One of them is Gareth Lewis, chairman of the campaign group Tainted Blood, and a trustee of the society, who became infected with HIV and Hepatitis C in 1984.

'I'm 48 years old, and I've lived with this nightmare for more than two decades,' he said. 'I find it very hard to understand why a government minister would not want to know the whole truth about this, and not want us to know. I have been to 98 funerals of haemophiliacs who have died as a result of receiving contaminated blood. We really owe it to them to be open and honest about what went wrong.'

    Number 10 hiding blood scandal facts, O, 20.5.2007, http://observer.guardian.co.uk/uk_news/story/0,,2083842,00.html

11.30am update

Hybrid embryos get go-ahead

Thursday May 17, 2007
Guardian Unlimited
David Batty


The government has overturned its proposed ban on the creation of human-animal embryos and now wants to allow them to be used to develop new treatments for incurable diseases such as Parkinson's and Alzheimer's.

The proposal, in a new draft fertility bill published today, would allow scientists to create three different types of hybrid embryos.

Scientists would be allowed to grow the embryos in a lab for no more than two weeks, and it would be illegal to implant them in a human.

The first kind of hybrid allowed under the bill, known as a chimeric embryo, is made by injecting cells from an animal into a human embryo. The second, known as a human transgenic embryo, involves injecting animal DNA into a human embryo.

The third, known as a cytoplasmic hybrid, is created by transferring the nuclei of human cells, such as skin cells, into animal eggs from which almost all the genetic material has been removed.

This is this type of human-animal embryo that is being developed in British universities. Scientists say that developing these embryos will provide a plentiful source of stem cells - immature cells that can develop into many different types of tissue - for use in medical research.

The move is a U-turn on proposals to outlaw all types of human-animal embryos set out by ministers in a white paper published last December.

But the new proposal would not allow the creation of "true hybrid" embryos, which would involve fertilising a human egg with animal sperm or vice versa.

The government was criticised by the Commons science and technology committee for proposing an outright ban after objections were raised by pro-life groups opposed to any research on embryos.

The draft bill, which also covers fertility treatment, will overhaul the Human Fertilisation and Embryology Act 1990.

British scientists have already applied to the Human Fertilisation and Embryology Authority, which regulates embryo research, for a licence to use human-animal embryos for medical research.

Professor John Burn, head of the human genetics institute at Newcastle University, welcomed the government's U-turn.

"I'm delighted that common sense has prevailed. I fully understand the knee-jerk reaction that creating human-animal embryos is worrying," he said.

"But what we're talking about here are cells on a dish not a foetus. We're talking about something that looks like sago under the microscope. And it's illegal to ever turn these cells into a living being."

A team led by Lyle Armstrong at Newcastle University's stem cell institute has applied to the HFEA to use cow eggs to develop stem cells for the treatment of diabetes and spinal paralysis.

Another team led by Professor Stephen Minger, director of the stem cell biology laboratory at King's College London, wants to use human-bovine embryos to study degenerative neurological diseases such as Parkinson's and Alzheimer's.

    Hybrid embryos get go-ahead, NYT, 17.5.2007, http://www.guardian.co.uk/medicine/story/0,,2081755,00.html

Cancer: The good news

Survival rates soar as cancer treatments improve

Published: 16 May 2007
The Independent
By Jeremy Laurance, Health Editor

Cancer is no longer the death sentence that it once was. Our most feared disease is turning into a condition that people live with, rather than die from, figures published yesterday show.

In the past 30 years, overall survival rates from cancer have doubled, thanks to better treatments, earlier diagnosis and greater public awareness of the warning symptoms.

Almost half of patients (46.2 per cent) diagnosed in 2000-01 were expected to live 10 years, compared with a quarter (23.6 per cent) of those diagnosed in 1971, according to the charity Cancer Research UK.

Ten-year survival is a benchmark of success in cancer treatment and is regarded as close to a cure.

The breakneck progress, that has accelerated in the past decade, is set to continue, experts predicted. Among 10 goals announced yesterday, Cancer Research UK set a target of 66 per cent overall five-year survival by 2020, up from 50 per cent in 2001.

However, Britain still trails Europe in terms of cancer survival, despite the recent improvement. The last European survey of cancer , Eurocare-3, published in 2003 showed British patients died sooner than in most other European countries.

Professor Michel Coleman, a cancer epidemiologist at the London School of Hygiene and Tropical Medicine, who calculated the latest figures, said cancer was still a "major public health problem" that would affect one in three people during their lifetimes.

"Survival rates for many cancers have been lower in the UK than in many comparable countries. The differences may be less when Eurocare-4 is published later this year - I am hopeful we may have caught up," he said.

Professor Mike Richards, the Government's national cancer director, said: "I await Eurocare-4 with interest. I am optimistic we will see a narrowing of the gap [in survival rates]. We have seen an acceleration in survival in the 90s [in the UK] and I have every hope that will be continued."

A key reason for Britain's past poor performance has been delays in diagnosing patients - hence their cancers were more advanced when treatment started - compared with other countries. But extra investment in the NHS since 2000 has boosted the number of cancer specialists and shortened waits for treatment. About 250,000 patients are treated for cancer in Britain each year and more than 99 per cent are now treated within the Government target of two months.

Professor Richards admitted that uptake of new cancer drugs was slower in Britain than in other countries, as highlighted in a report by the Karolinska Institute, Stockholm, last week. Most of the drugs had been approved for use by the National Institute for Clinical Excellence (Nice) and efforts had been made to speed its assessment process. But he added: "Drugs are only one part of the answer."

Early detection of cancer, greater use of specialist surgery, screening programmes to detect cancer at an earlier stage and advances in chemotherapy and radiotherapy have all helped to increase survival rates.

Cancer is not one disease but many and the chances of survival vary widely with the type of illness. A patient who has pancreatic cancer, the most lethal form of disease, has a 2.5 per cent chance of living five years, compared with testicular cancer which has a 95 per cent survival rate.

There have been big gains in survival rates for some cancers while almost no progress has been made against others. Five-year survival rates for breast cancer have increased from just over 50 per cent to almost 80 per cent over the period. But pancreatic cancer and lung cancer have seen zero improvement with survival rates remaining below 5 per cent.

Harpal Kumar, who was appointed chief executive of Cancer Research UK last month, said there was "a lot to celebrate" in the survival figures but also "a lot further to go".

"Cancer scientists agree we are at the dawn of a new era in cancer research," he said. "New diagnostics and new treatments are on the way and there will be a pay-off in terms of improved survival. Great strides are being made thanks to the basic research done in the past."

Dr Kumar set out 10 goals to be achieved by 2020 against which progress could be measured. They include reducing the number of adult smokers by four million (from 12 to 8 million), reducing the incidence of cancer in under-75s by a quarter, doubling the use of better targeted treatments with fewer side effects and increasing the proportion of patients who are diagnosed at an early stage from the present 45 per cent to 66 per cent.

He said: "Our goals are as broad as they are ambitious. They recognise the importance of furthering our fundamental biological understanding of cancer while, at the same time, taking that knowledge out of the lab and turning it into new treatments."

Jo-Anne Tedd, accounts officer: 'I feel like I have got a new lease of life'

It was a fortnight before her wedding when Jo-Anne Tedd was diagnosed with bowel cancer in 2002. She had consulted her GP for haemorrhoids and he referred her to the local hospital in Warwickshire where she lives.

"It was a shock - it is not what you expect. I got an appointment pretty quickly and the consultant reassured me it could be treated."

Two days after her wedding, Ms Tedd, 44, was in hospital having her bowel removed in a procedure known as an ileostomy. The honeymoon had to wait.

"I had always feared having a colostomy bag. However, since my surgery I have done things I never thought I would." She had suffered for years from ulcerative colitis, a disorder in which the lining of the bowel becomes inflamed. Although unrelated to cancer it had made her feel unwell and restricted what she could do. Removal of her bowel solved that problem overnight.

"I am fitter, stronger, and in better health than before. I do more now than ever. If you have a positive outlook it makes it easier - you deal with it. But you still have your moments," she said.

She has bought a 600cc Suzuki Bandit motorbike to join her husband, Peter, an engineer and keen motorcyclist, on outings to the Cotswolds. She has also learned how to snowboard and does fun runs.

Ms Tedd works as an accounts officer for a large organisation and the couple have four grown-up children from previous marriages. She said: "I was devastated to find out I had cancer. However, I feel like I have got a new lease of life. Of course not everyone is as fortunate as me."

    Cancer: The good news, I, 16.5.2007, http://news.independent.co.uk/uk/health_medical/article2548751.ece

Junk food nation

3.6 million people in Britain suffer from malnutrition
Hospitals see 44% rise in cases as cost to the NHS hits £7.3bn

Published: 06 May 2007
The Independent on Sunday
By Marie Woolf, Political Editor

Alarming levels of malnutrition have been recorded in Britain, The Independent on Sunday has learned, prompting further medical concern at the effects of the nation's addiction to salty, fatty, junk food.

Despite high-profile campaigns by the Government and celebrity chefs to improve eating habits, new figures reveal that there has been a 44 per cent increase in hospital cases of malnutrition over the past five years.

Amid estimates that up to 3.6 million people are suffering from malnutrition, including conditions found in sub-Saharan Africa, MPs and doctors last night called for action to tackle poor diets, and for all patients to be screened for malnutrition. They called for the Government's National Institute for Health and Clinical Excellence (Nice) guidelines to be made compulsory.

In 2002, 2,729 people in English hospitals were diagnosed with malnutrition. Last year, the number had risen to 3,931.

The British Association for Parenteral and Enteral Nutrition estimates malnutrition costs the NHS more than £7.3bn a year, double the annual obesity bill. Doctors estimate that up to 6 per cent of the population could be suffering from malnutrition and serious vitamin and mineral deficiencies caused by poor diet. Most do not have their conditions identified.

Experts said a reliance on pre-prepared food and failure to eat enough fresh fruit and vegetables is depleting levels of essential micro-nutrients. The deficiencies are found in teenagers, the elderly, adults and babies as young as 18 months. They warn the balance of nutrients is also disturbed by binge drinking, excess sugar and drug use.

The Conservative peer Lord Hanningfield, who obtained the hospital figures, said it was "deeply disturbing that the number of patients suffering from malnutrition has almost doubled in the last five years. Far too many patients leave hospital less nourished than when they were admitted.

"It is time patients were routinely screened for malnutrition, and offered specialist nutritional support."

Dr Mike Stroud, senior lecturer at the Institute of Human Nutrition, University of Southampton, who chaired the group that drew up the Nice malnutrition guidelines, says the health service is not taking the problem seriously enough. "The modern diet is not providing enough vitamins. Malnourishment is going to make you more vulnerable to illnesses and less able to cope with them. The medical profession is only just beginning to take on board the implications of nutrition in patients."

The hospital figures show malnutrition is found in all age groups. Forms of malnutrition found among famine victims in the developing world, typified by wasted limbs and pot bellies, are being diagnosed in UK hospitals. Symptoms are also being picked up in pregnant women and newborn babies.

Anna Denny, a nutrition scientist, said she was surprised at the acute diagnoses of malnutrition in British hospitals. "We don't often see overt nutritional deficiencies. You only see these diagnoses normally in the developing world.

    Junk food nation, IoS, 6.5.2007, http://news.independent.co.uk/uk/health_medical/article2516769.ece

We are eating ourselves ill:

Treating malnutrition

costs NHS more than obesity

We are continually warned about the need to watch our weight,
but many of us are not eating enough nutrients to stay healthy.
Cole Moreton on the hidden sickness in our fast-food nation

Published: 06 May 2007
The Independent on Sunday

Britain is fat. We know that. Chefs and doctors, footballers and even pop stars tell us over and over again, in campaigns against the obesity epidemic. But now, as The Independent on Sunday reveals, new data show that an alarming number of Britons actually suffer from malnutrition.

Doctors estimate that more than three million people are malnourished. Most do not realise it, although diagnosis rates in hospitals have soared by 44 per cent over the past five years. The most extreme cases echo symptoms found among famine victims in the developing world. Wasted limbs and pot bellies are being seen in British hospitals, where 40 per cent of patients are thought to be malnourished. Marasmus, the protein deficiency most often seen in Africa, has been found among anorexic women here.

But the majority of cases are people who lack the vitamins and nutrients vital for the body to function properly. Malnourishment has recently been recognised as a major problem for the sick, elderly and frail, but new statistics gathered for the Department of Health show it affects pregnant women and newborn babies, schoolchildren and adults who believe themselves to be healthy.

One woman who vomited frequently during pregnancy developed a vitamin deficiency that went undiagnosed. She suffered brain damage. The calcium shortage found in 8 per cent of young people can lead to crumbling or brittle bones.

"If you are young and well, you can still end up malnourished," said Dr Alistair McKinlay, consultant gastro-enterologist at Aberdeen Royal Infirmary and one of the country's leading authorities on the condition. "In 75 per cent of people, the problem is not identified."

Malnutrition costs the NHS £7.3bn a year according to the British Association for Parenteral and Enteral Nutrition, the experts in the field. That figure is more than double the estimated cost of obesity.

Alcohol and drugs can disturb the balance of our bodies - but the main cause, doctors believe, is a poor diet. So how can this be? When there is so much food about, from low-fat diet meals to high-fat takeaways, how can so many people be short of the nutrients essential for a healthy life? What has gone wrong between the British and our food?

Gordon Ramsay, one of the best chefs in the world, blames habits learned in the home. "If we are going to be a healthy nation then you've got to discipline the parents," he told the IoS in a rare interview. "The only way to implement severe standards now is if their kids become obesely overweight and out of control. Then I would seriously fine [the parents] and threaten them with a court appearance, because they often don't realise what they're doing."

Children need to be given a strong lead, he said. "Children eat with their eyes. They're lazy. If you don't tell them about what they're eating, trust me, they will eat as much crap as they can when they get home. They get connected to junk food in a way that becomes obsessive."

The Michelin-star winning father of four gave his children tripe the other week, in a stew with red peppers, tomato and garlic. He didn't tell them what it was. "It was absolutely delicious. They said, 'What was that?' I showed them a picture of a cow, and took out the stomach bag, and their faces dropped. But they asked for it again."

Ramsay was full of praise for the efforts of Jamie Oliver to improve school dinners. "He helped to make every parent feel guilty, for the first time, about what their children were eating at school. He woke everyone up."

Oliver said: "I think many parents are unaware of how much junk their kids are eating and drinking." He added: "As well as the frightening rise in obesity there's a growing number of kids, of whatever shape and size, that simply aren't getting fed enough nutrients like iron, calcium and vitamins. It's having a huge effect on their brainpower, behaviour and ability to concentrate and learn at school."

Adults may not realise they have serious problems. The national diet and nutrition surveys carried out by the Department of Health show two-thirds of women are short of vitamin B2, riboflavin, which can cause a range of illnesses (so are nearly a quarter of pre-school infants). Young men and women alike have high levels of the amino acid homocysteine, which indicates their vitamin levels are disturbed. Doctors believe our drinking culture must take part of the blame.

People are eating less home-cooked food and more junk, said Dr Colin Waine, chairman of the National Obesity Forum formed to tackle the epidemic. Fast food can not only make you fat, it can also leave you malnourished. "I would definitely question the vitamin and mineral trace of some fast food outlets."

Hospital food also came under severe attack last year when the Government admitted that many elderly people were not getting enough vitamins, nutrients and fatty acids. The trouble is that most doctors were trained during a time when malnutrition appeared to have died out, said Dr Waine. "The best diet we had was during the First World War when we had a good rationing system - people had the right nutrients in the right amounts."

Bianca Incocciati's GP did not realise her patient's skin problems were a result of micronutrient malnutrition. "You think it happens to starving children in the third world," said Ms Incocciati. "You don't expect it to happen to you. It's scary."

The doctor she went to for a second opinion asked what she had been eating. Ms Incocciati was studying English at Warwick University and waitressing at a French restaurant in the evenings, scoffing late at night and unable to face breakfast. After closing, the restaurant's chefs sometimes whipped up a rich dinner, heavy on cheese and creamy sauces, for the staff. At other times she would snack at home on pasta or toast. She was also a self-confessed crisp addict.

"I felt I had no energy at all," she said. "I was always tired and constantly had a cold. I had spots all the time too." Ms Incocciati was shocked to be told she had very low levels of vitamin A, vitamin B12 and iron. "Eating late, you're not digesting food properly. Getting up late, having a coffee, you're running on empty."

After two weeks of increasing her fruit and vegetable intake and eating more regularly Ms Incocciati had more energy and felt more "with it". After four months she had lost weight. Eighteen months since she was diagnosed, she is a reformed character. "Where I'd been going wrong was that I wasn't cooking food at home, wasn't making sure I was having vegetables and fruit."

Her parents had given her an example Gordon Ramsay would approve of. "They were always really good about having dinner together and having cooked meals." But despite their best efforts she grew into bad habits. "Once you leave home, it's easy to buy rubbish."

Ms Incocciati was not alone. Despite all the campaigns to educate people about healthy eating, as our reports today show, for three million malnourished people the message still hasn't got through.

What is malnutrition?

Malnutrition is caused by a deficiency, excess or imbalance of energy, protein and other nutrients. The condition may result from an inadequate or unbalanced diet, digestive difficulties, absorption problems or other medical conditions. It is a chronic condition, which can injure the spleen and stomach. Malnutrition can occur because of a chronic lack of one key vitamin or because the body isn't getting enough food. Starvation is an extreme form of malnutrition and can occur even in people who are clinically obese.

The symptoms of malnutrition include acute weight loss, losing hair, muscle wastage, a swollen abdomen, a dull yellow complexion and dry, crinkled skin. Sufferers also have dull eyes, listlessness, tiredness, cravings and brown stained teeth. In extreme cases it can be fatal and lead to anaemia, beri-beri, goitre, scurvy and rickets.

Student diet that led to malnutrition

Caffeine, crisps and takeaways fuelled student Bianca Incocciati's days of university work and late nights waitressing, but left her malnourished. This was her diet on an average week.

MONDAY

No breakfast. Black coffee, two sugars. Can of regular Coke at midday. Lunch of sandwich and salt and vinegar crisps. Dinner of takeaway pizza with a couple of glasses of wine.

TUESDAY

No breakfast. Lunchtime at restaurant. Black coffee, two sugars, at 11.30am. No lunch, but snack of bread and butter. Pie from dessert trolley, Coke, at end of shift. Buttered toast and Marmite after the pub.

WEDNESDAY

No breakfast. Orange juice and black coffee, two sugars. Lunchtime shift at restaurant, snacks of bread then meal with staff, Coke. Afternoon snack, crisps, Coke. Evening shift at restaurant. Bread and butter at 11.30pm.

THURSDAY

No breakfast. Lunch of jacket potato. Coke and crisps in afternoon. Coffee. Dinner of Chinese takeaway, wine.

FRIDAY

No breakfast. Coke. Baguette for lunch. Afternoon snack, crisps. Dinner, cheese on toast. Evening - four or five beers, Big Mac with fries and Coke .

SATURDAY

Breakfast at 11am - two fried eggs, fried bread, two rashers of bacon, two sausages. Black coffee with two sugars. No lunch. Late afternoon, cheese and tomato on toast. At restaurant from 6.30pm. Bread and butter, then at 11.30pm banoffee pie with cream from dessert trolley.

SUNDAY

Breakfast of bacon sandwich and coffee. Dinner of roast chicken, roast potatoes, carrots, gravy. Wine. Evening at restaurant. Bread and butter, cheeseburger and chips on the way home.

Sadie Gray

Changing diet over the decades (if you're lucky)

2007

Breakfast: fruit salad, muesli, yoghurt, smoothie, coffee

Lunch: chicken caesar salad/ chorizo and roast pepper sandwich/lentil pasta salad, passion fruit juice, mango

Dinner: Stir-fried noodles with organic chickenand crispy vegetables. Tomato and onion salad on the side.

1997

Breakfast: banana, breakfast bar, toast and Marmite, sugar-coated cereal/bacon sandwich, orange juice

Lunch: bacon, lettuce and tomato roll/coronation chicken sandwich, crisps, nectarine

Dinner: lasagne, green salad, rhubarb crumble.

1987

Breakfast: toast and jam eggs, bacon and fried tomato, orange juice

Lunch: hamburger and fries, Mars bar, Coke, an orange

Dinner: microwave meal: macaroni cheese/frozen breadcrumbed turkey burgers, Wall's vanilla ice cream an apple.

1977

Breakfast: Quaker porridge oats with full-fat milk, a boiled egg and toast.

Lunch: canned ham and pickle sandwiches, followed by an apple.

Dinner: homemade meatloaf with boiled potatoes, boiled cabbage, a bowl of homemade rice pudding.

We are eating ourselves ill: Treating malnutrition costs NHS more than obesity, IoS, 6.5.2007, http://news.independent.co.uk/uk/health_medical/article2516741.ece