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Medical briefings and expert opinion for Medical Sales Professionals

A Tour around Passive Smoking
(Date published: 20/12/04)

Passive smoking – not dangerous? Just ask the estimated 17,000 children admitted to hospital in the UK every year as a result of  illnesses caused by it. So, before lighting up at this year’s festive bash, spare a thought for those around you. The controversial question of the danger of passive smoking has already led to bans in places as diverse as Ireland, New York and California; the government’s White Paper on health suggests that England, Scotland and Wales may well follow suit and forbid smoking in public places by 2008. [Read article]

A Tour around Panic Disorder
(Date published: 06/12/04)

"It came upon me by surprise. I began to feel wave after wave of fear and my stomach gave out on me. I could hear my heart pounding so loudly I thought it would come out of my chest. Pains were shooting down my legs. I became so afraid I couldn’t catch my breath. What was happening to me? Was I having a heart attack? Was I dying?" This account of a panic attack shows just how frightening one can be. They are also surprisingly common; according to the Merck Manual they affect more than a third of the population in a single year. [Read article]

A Tour around Obesity
(Date published: 19/11/04)

Some 300 million people around the world are obese and most suffer from weight-related illnesses, according to leading specialists at the recent meeting of the International Association for the Study of Obesity, who concluded that the global obesity epidemic is completely out of control. In South Africa more than 30% of men and 50% of women are overweight, obesity in Japanese men has risen by 100% since 1982, and huge numbers of overweight children in the Middle East are developing diabetes. The knock-on effects are enormous and sometimes surprising. For example, health costs arising from excess weight account for 9.1% of total US medical expenditure ($78.5 billion), and because the average weight of Americans rose by 10 lbs (4.5 kg) during the 1990s, US airlines burned 350 million more gallons of fuel in 2000 than in 1990, releasing an extra 3.8 million tons of CO2 into the atmosphere. [Read article]

Influenza
(Date published: 17/11/04)

Influenza is a global disease which imposes a huge medical and economic burden inevery country of the world. The UK is no exception with one caveat - the virus is probably monitored and tracked more in the UK than any other country around the globe. Over the years, GPs have played a leading role in estimating the quantitative impact of influenza. This started with the pioneering work of William Pickles in the Wensleydale villages and continued with Edgar Hope-Simpson in Cirencester. Now the torch is held by Douglas Fleming at the Royal College of General Practitioners Unit in Birmingham. Certainly, the disease predominates in primary care, with an estimated 95% of cases being seen and treated by GPs. In an epidemic year, attack rates can affect up to 15% of the entire population. [Read article]

Depression
(Date published: 17/11/04)

Depression is an extremely common, debilitating condition that affects around 8% of the general population at any one time, with the lifetime risk being considerably higher. The magnitude of this disorder is such that up to half of women and one-quarter of men will be affected by depression at some point during their lives. Depression frequently becomes chronic, with at least 20% of sufferers remaining ill 2 years after an initial diagnosis. In addition, the recurrence rate is greater than 90%. Not surprisingly, such a prevalent condition has a significant impact on the health service resources and the global economy. Consequently, one of the main challenges faced daily by GPs is how to identify, diagnose and treat this large section of the population. [Read article]

Hypertension & cardiovascular disease
(Date published: 09/11/04)

Disappointingly, data from the England Health Survey in 1998 showed that blood pressure control was being achieved in less than 6% of patients. Subsequently, the new General Medical Services (GMS) GP contract has incorporated the audit standard of 150/90 mmHg as one of the key quality targets. Clearly, the government feels that a lot of the blame for a failure to achieve these targets rests with primary care! However, much of the blame must also be shouldered by hypertension specialists and opinion leaders who have designed ever more complicated trials, pitting one class of drug against another and examining benefits in higher and higher risk groups. The overall message, however, could not be simpler - blood pressure lowering, even in moderate amounts, results in significant reductions in cardiovascular mortality. For example, it has been shown that reductions of 10 and 5 mmHg in systolic and diastolic blood pressure, respectively, are associated with a 40% reduction in stroke incidence and a 20% reduction in the incidence of coronary heart disease. Analysis of recent hypertension trials by the Blood Pressure Lowering Treatment Trialists’ Collaboration have shown that reductions in systolic blood pressures of under 5 mm/Hg are associated with significant differences in cardiovascular endpoints. [Read article]

A Tour around Capillaries
(Date published: 05/11/04)

Have a guess at the total length of capillaries in the human body. Ten miles, a hundred, a thousand? No – the answer is approximately 25,000, or the equivalent of a trip around the equator. Here is another interesting statistic, particularly for anyone whose weight tends to fluctuate; according to this science radio show some 200 extra miles of these vessels develop for every pound of weight gained. [Read article]

A Tour around Myopia (Short-Sightedness)
(Date published: 22/10/04)

Could there be any truth in the archetypal image of the boffin who wears thick glasses to combat short-sightedness caused by hours of study? It appears there is no definitive answer to this question. According to this article from the New Scientist, a review of 40 studies found that the massive increase in myopia in east Asia (in Singapore the incidence in army recruits has increased from 25% to 80% over the last 30 years) is due solely to changes in lifestyle. The evidence appears compelling; for example, 70% of 18 year old Indian males in Singapore are myopic compared to 10% in India itself, and boys attending Israeli schools which concentrate on reading religious texts have myopia rates of 80%, compared to 30% for state schools. However, other research has found that the most important determining factor is family history. [Read article]

A Tour around Mumps
(Date published: 08/10/04

How about this for a Trivial Pursuit question - "What is the origin of the word 'mumps'?" The answer can be found at one of the sites on this tour, but in the meantime, this picture will bring back painful memories for a fair proportion of the older readership. Classically, mumps is an acute infection of one or both parotid salivary glands, although many other organs may become involved, including the sublingual or submandibular salivary glands, testes, pancreas and meninges. If you need to brush up on the relevant anatomy, there is a good structural diagram here. The salivary glands produce mucus and digestive enzymes in different proportions; the parotid secretes mainly enzymes, the sublingual mainly mucus, and the submandibular both - as is clear from their microscopic structure. [Read article]

Lipid Disorders
(Date published: 27/09/04)

Within the space of a decade, the treatment of raised serum cholesterol has moved from the province of a few specialists to the very heart of everyday medical practice. Furthermore, our view of what constitutes an unhealthily high cholesterol level has undergone a radical change, as has how we select patients for statin treatment from amongst the myriad with undesirably high cholesterol levels in countries like Britain, where the average cardiovascular risk is high. [Read article]

A tour around basal cell carcinoma
(Date published: 24/09/04)

Most members of the public have probably never even heard of basal cell carcinoma (BCC), or 'rodent ulcer' - yet it is the commonest of all cancers. Approximately one third of primary cancers affect the skin, and of these the vast majority are BCC, which develops from the cells at the base of the epidermis. Fortunately, lesions rarely metastasise, but they are locally invasive and can become quite large. [Read article]

A Tour around Asbestos-Related Disease
(Date published: 13/09/04

Strange as it may seem, there is a direct connection between this futuristic figure in protective clothing and one of the biggest threats to insurers and corporate industry in the developed world. He is a specialist worker removing asbestos during building refurbishment, while compensation costs for asbestos-related disease could reach $275 billion in the US and $80 billion in Europe, according to the Financial Times. Moreover, these estimates do not take into account the ability of lawyers to win compensation for people with only the potential to become ill - so-called "unimpaired" cases. [Read article]

A Tour around Endometriosis
Date published: 31/08/04

Endometriosis has a surprisingly low profile, given that it affects millions of women around the world - more than AIDS according to some authorities - and the symptoms can be severe. In order to appreciate how the various pelvic structures can be affected, it might be a good idea to start by revising the organs that make up the female reproductive system, and the precise relationships between them. Basic facts about the condition can be gleaned from the Endometriosis Association or the US National Women's Health Information Center. They explain that endometriosis occurs when the tissue lining the uterus (the endometrium) is found elsewhere in the abdomen, usually on the ovaries, fallopian tubes, the ligaments that support the uterus, the area between vagina and rectum, and the lining of the pelvic cavity. [Read article]

A Tour around Leptospirosis
(Date published: 13/08/04

Britain's rats are currently enjoying a somewhat pampered existence, and their numbers are increasing accordingly - not surprising when a single pair can produce a colony of 2,000 within a year. Today the UK plays host to more than 60 million of them. The causes of their proliferation include mild winters, a cutback in expenditure on pest control and the increased discarding of junk food in the street. One reason this population explosion is important is that feral rats are the main animal reservoir for Leptospira interrogans, the causative organism of leptospirosis, which is occasionally fatal. About 30 cases occur each year in Britain. Warnings about rat numbers were issued by the National Pest Technicians Association as long ago as November 2000, a year after high concentrations of the bacteria were found at stations on Glasgow's subway system. [Read article]

A Tour around Squint (Strabismus)
(Date published: 30/07/04)

It may seem unlikely, but Abraham Lincoln, Barbra Streisand, Ben Turpin and Marty Feldman have something in common; they all started life with a pronounced squint. This is not unusual: 2-3% of babies are born with eyes that point in different directions, due to either refractive abnormality or eye muscle imbalance, and in most cases this can be corrected if treated early. Older children and adults can also develop a squint, or strabismus; usually as a result of injury to the eye or brain, diabetes, stroke or infection. [Read article]

A Tour around Phenylketonuria
(Date of publication 19 July 2004)

When the Vikings popped back home after a quick bout of burning and pillaging some 1000 years ago, in addition to battle trophies it appears they brought something else: Celtic slaves carrying the metabolic disorder phenylketonuria. Today, the high incidence of the condition in Ireland and Scotland is matched by that in Iceland, but decreases as one moves to Denmark and then on to Norway and Sweden, as the proportion of inhabitants of Celtic extraction declines. Moreover, Norwegians who bear the mutated gene responsible are significantly different from the general population serologically, indicating descent from a completely assimilated Celtic sub-population. [Read article]

A Tour around Constipation
(Date of publication 06 July 2004)

Most people experience constipation at one time or another, with estimates as high as 10% of the adult population at any one time. The proportion increases dramatically with age; up to 26% of men and 34% of women over 65 are sufferers, and more than 75% of >elderly patients in US hospitals or nursing homes use laxatives to regulate bowel function. In that country alone, constipation-related complaints account for more than 2.5 million visits to the doctor each year, the population spending more than $400 million dollars on laxatives in the same period. However, the definition of constipation differs dramatically from person to person. Although studies have shown that 95% to 99% of a healthy population defaecate at least three times per week, ‘normal’ can be anything from three times a week to three times daily depending upon the individual. Some people worry entirely unnecessarily if they do not pass a motion every day. [Read article]

A Tour around Cystitis
(Date of publication 18 June 2004)

Statistically, at least 20% of women reading this will be familiar with the symptoms of cystitis: a need to urinate frequently, pain in the lower abdomen, discomfort during urination and blood in the urine. Bacteria are the most frequent culprit - cystitis is the single most common bacterial infection in humans - but mycobacteria, fungi and bacteria may also be responsible, and there are non-infectious causes such as radiation, chemicals and autoimmune reactions. Patient information from Harvard Medical School explains why women, especially those who are sexually active, are more susceptible than men, and incorporates a section on prevention. Suggestions include drinking plenty of fluids, urinating after intercourse and avoiding feminine hygiene products which may act as irritants. [Read artcle]

A Tour around Stammering
(Date of publication 04 June 2004)

If you have Quicktime installed on your computer, just click here and listen. Does it seem possible that Winston Churchill, considered the best orator in Parliament, was a stammerer? Many famous people have stammered (or stuttered), including Isaac Newton, Lewis Carroll, Aneurin Bevan, John Updike and Bruce Willis. Marilyn Monroe's exaggerated mouth movements and breathy speaking style (to re-acquaint yourself click here) seem to have been taught by a speech coach to control her stammering, while Churchill wrote his speeches well in advance and then memorised them both forwards and backwards so that he could practice them assiduously before delivery. [Read article]

A Tour around the Thyroid Gland
(Date of publication 21 May 2004)

This gland in the front of the neck plays an important role in regulating the metabolism of nearly all the tissues of the body. In health it is small and butterfly-shaped, consisting of right and left lobes connected across the midline by a narrow isthmus, but the magnitude of pathological enlargement can be spectacular. The anatomy of the thyroid and its associated parathyroid glands is outlined here, but the descriptions here are very brief - this site is primarily worth visiting for the photographs and microscope slides, which clearly illustrate the thyroid's distinctive microscopic structure. Epithelial cells, responsible for synthesising thyroid hormones, are arranged in thyroid follicles filled with colloid, the hormone precursor thyroglobulin. In the spaces between follicles are parafollicular cells that secrete calcitonin, which lowers serum levels of calcium and phosphate. [Read article]

A Tour around Erysipelas
(Date of publication 06 May 2004)

Erysipelas has three patron saints - Anthony the Abbott, Benedict and Ida of Nivelles - who date back to the early days of Christianity, indicating that this condition has afflicted mankind since antiquity. It was originally known (as was ergotism) as St Anthony's Fire, the said saint having a reputation for reducing the inflammation and itching of skin diseases. According to Steven Lehrer's book 'Explorers of the Body', the term erysipelas was originally coined by the Ancient Greeks from the redness which developed around an infected wound. It is worth reading the chapter that mentions this, available online, for the chilling account of the lightning-fast surgeon Robert Liston, who, in a moment of regrettable over-exuberance during a leg amputation, accidentally removed one of his patient's testicles and two of his assistant's fingers. [Read article]

A Tour around MRSA Infection
(Date of publication 23 April 2004)

There is no doubt that MRSA (methicillin-resistant Staphylococcus aureus) is one of the outstanding bacterial success stories of our time, and its tabloid nickname 'superbug' is well deserved. The UK Health Protection Agency recently reported that the number of deaths involving this bacterium increased more than 15-fold between 1993 and 2002, and the incidence of MRSA bacteraemia increased 24-fold over the same period. In March 2004, researchers at St George's Hospital in London reported an alarming 19-fold increase in MRSA infection rates in children between 1990 and 2001, and the same BBC News item cites evidence from the USA that up to 60% of childhood cases are acquired outside hospital, suggesting that MRSA is circulating in the community. [Read article]

A Tour around Neuropathic Pain
(Date of publication 02 April 2004)

When we suffer burns, sprains, bruises or inflammation, nearby receptors transmit pain signals via the peripheral nerves and spinal cord to the brain. This gives rise to the nociceptive pain which everyone has experienced; typically it is localised, constant, often has an aching or throbbing quality and is time-limited, so that when the lesion heals the symptoms disappear. However, another type of pain, often long-lasting, originates in the nervous system itself - neuropathic pain. Burning, lancinating or ‘electric shock’ qualities may be present and patients may experience allodynia (pain resulting from a non-noxious stimulus such as touch) or hyperalgesia (increased sensitivity to painful stimuli), sometimes in a region of the body remote from the pain. Bizarrely, it may even appear to originate from outside the body. [Read article]

A Tour around Syncope
(Date of publication 19 March 2004)

We are all familiar with the unfortunate Victorian heroine who falls to the ground when confronted by something unexpected and deeply shocking, such as the sight of a naked male chest. However, emotional stress is only one of many different causes of fainting, or syncope. [Read articles]


A Tour around Bile
(Date of publication 05 March 2004)

Bile has had a very bad press over the years. According to the humoral theory of medicine developed by the Ancient Greeks, the body consisted of four fluids (or humours), each of which gave off a specific vapour that ascended to the brain and defined the personality. Of the humours, yellow bile was associated with irritability and bad temper, while black bile was linked to depression. This theory persisted until the 17th century and the primary form of medical treatment was bloodletting to remove 'bad' humour, a complicated process in which the phlebotomy site was critically important. However, irascibility and melancholy are not the whole story. We now have considerable scientific knowledge of the function of bile, and the humble sea lamprey appears to have a very positive view of one of its constituents, as we shall find out. [Read article]

A Tour around Measles
(Date of publication 20 February 2004)

"Measles - a childhood illness that more or less died out decades ago" just about sums up the public attitude to the disease in the developed world - and it is very mistaken. In Africa, measles remains the single leading cause of vaccine-preventable death among children, killing approximately half a million each year or 51 every hour. This is more than AIDS, tuberculosis or malnutrition. The Measles Initiative featured here aims to vaccinate 200 million African children and prevent 1.2 million deaths over five years. A similar campaign has been waged in North and South America for some years, and the Pan American Health Organization provides extensive coverage of it, including a weekly bulletin of confirmed cases in the region. [Read article]

A Tour around Angina Pectoris
(Date of publication 06 February 2004)

The pain of angina has been described as "like having a refrigerator sitting on your chest and hot pokers burning the backs of both arms". The chances are that this description will be familiar to a sizeable number of readers, because the incidence of the condition is high; for example, in the USA it affects more than 6,000,000 individuals. The cause is myocardial ischaemia, or reduced blood flow to the heart muscle, usually as a result of atherosclerosis. The Cardiology Channel site describes the two main types. In stable angina, pain is brought on by increased physical activity that increases the heart's requirement for oxygenated blood, but subsides if the patient rests. Unstable angina is more serious and constitutes a medical emergency; the pain is more frequent, lasts longer, can occur at any time and may lead to a heart attack (myocardial infarction). [Read article]

A Tour around Tapeworms
(Date of publication 23 January 2004)

Let us begin this tour with some rather startling statistics about these flatworms which make up the class Cestoda. The broad fish tapeworm Diphyllobothrium latum is the longest human tapeworm, capable of attaining 15 metres and producing 1,000,000 eggs every day, but its presence often goes unnoticed by the host. By contrast, Echinococcus multilocularis is only 1-4 mm long but may give rise to parasitic tumours in the liver, lungs, brain and other organs, which can prove fatal. Furthermore, in some parts of the world infestation with the larval form of Taenia solium is the predominant cause of epilepsy. [Read article]

A Tour around Indigestion
(Date of publication 09 January 2004)

With the over-indulgence of the festive season still fresh in our memories, many of us are probably familiar with the unpleasant symptoms of indigestion, or dyspepsia: abdominal discomfort, a feeling of fullness or bloating, and nausea. Fortunately it is rarely a serious health problem; the US National Library of Medicine states that it often results simply from consuming certain foods, drinking carbonated beverages, eating too quickly or too much, and that the condition is exacerbated by anxiety or depression. [Read article]

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