Saturday, 14 February 2015

Flu jab is not a 'waste of time'

Crabsallover comment: As the Public Health England Press Release says 'The research, based on the results from 1,314 patients presenting in primary care across the UK, found that vaccine effectiveness in preventing laboratory confirmed influenza was estimated to be 3% overall. This compares to approximately 50% vaccine effectiveness that has typically been seen in the UK over recent years.'
PHE also says" In the UK, influenza A(H3N2) is the predominant subtype circulating this season to date, and H3N2 viruses similar to A/Texas/50/2012 are the strains that the vaccine currently protects against. Analysis conducted by PHE has shown a large proportion of flu viruses circulating have shown evidence of either antigenic or genetic drift from A/Texas/50/2012, and were similar to another H3N2 strain; A/Switzerland/9715293/2013. The A/Switzerland/9715293/2013 strain has been recommended for inclusion in the southern hemisphere influenza vaccine to be used in 2015.'

'The World Health Organization monitors influenza globally and each year recommends the strains of flu virus that should be included in the flu vaccine for the forthcoming flu season. It takes from February through to August / September to produce sufficient quantities of the flu vaccine. If a change in the virus is detected once production has started it is not possible to change it.  Throughout the last decade, there has generally been a good match between the strains of flu in the vaccine and those that subsequently circulate, so it’s crucial that these results do not discourage people in at-risk groups from having flu vaccination now, or in the future.'

Interesting comparison of what is in seasonal H3N2 flu vaccines.
Friday February 6 2015
Vaccine makers are locked in an 'arms race' with mutating strains
This year’s flu jab may still protect against other strains
“Flu jab given to millions is 'useless',” and "Flu jab is a waste of time," are the irresponsible headlines in The Daily Telegraph and the Daily Mail.
While recent research shows that the currentseasonal flu vaccine only has 3% protection against the main circulating strain – A(H3N2) – in adults, it can still protect against other strains.
Both papers also ignore the fact that another version of the flu vaccine, in the form of a nasal spray designed forvulnerable children, is also available.
Discouraging parents of vulnerable children from getting vaccinated could increase the risk of serious childhood illnesses and possible hospitalisation.

Why is the flu vaccine not working?

There are many strains of the influenza virus and each one can mutate. It takes time to develop and produce vaccines against them. Global surveillance is used to predict which strains are likely to be circulating the following winter, and in February the World Health Organization (WHO) announces which strains the flu vaccine should cover. Last year, it decided to cover three flu varieties:
  • Influenza A (H1N1), also known as “swine flu"
  • Influenza A (H3N2)
  • Influenza B
In March, the WHO Global Influenza Surveillance and Response System detected a new strain of influenza A (H3N2), but this was too late to change the production of the vaccine.
It was also not known whether this particular strain would be the predominant strain this winter, which it has been, and so the vaccine is not effective against it.

‘A Jack Bauer car chase’

“Trying to predict which seasonal flu vaccine to produce each year must be a bit like a Jack Bauer [hero of the TV thriller series '24'] car chase in Los Angeles.
“At any intersection, the fugitive has three choices of direction. Bauer can’t catch up, and he doesn’t know the ultimate destination, so he has to try to guess the likeliest turns, and place his limited team in side streets where they’re most likely to block the fugitive, to slow him down or capture him. Even with Jack Bauer’s experience, this is bound to prove somewhat hit and miss.”
Dr Michael Skinner, Reader in Virology, Imperial College London (and fan of ‘24’).

How effective is it?

The vaccine is effective against the other strains of influenza, but not the new strain of influenza A (H3N2). The mid-season vaccine effectiveness rate is just 3.4%. Vaccination against this new strain and other possible mutations will be considered at the WHO meeting this February for next winter.

Reactions to the news

Dr Michael Skinner, Reader in Virology, Imperial College London said: “The current type of seasonal influenza vaccine is, at the moment, the best we have. Annually it saves tens of thousands of lives. Unusually, but not uniquely, this year one (H3N2) of the four targeted viruses ‘drifted’ (mutated) in an unanticipated direction after the vaccine was formulated for production, so that the vaccine offers little protection against the drifted H3N2.
"Even so, the vaccine still protects against the other three components (pre- and post-2009 H1N1 and B). And it does at least stop the virus drifting back along the path that had been predicted. To describe it as ‘useless’ would be misguided.”

Should you still get the jab?

The other strains can still cause infection so the vaccine is still recommended for pregnant women, people aged over 65 and those with any of the following conditions:

When to visit your GP

If you are otherwise fit and healthy, there is usually no need to visit your GP if you have flu-like symptoms.
The best remedy is to rest at home, keep warm and drink plenty of water to avoid dehydration.
You can take paracetamol or ibuprofen to lower a high temperature and relieve aches.
If you are in any of the high risk groups listed above then you should visit your GP.
Depending on your circumstances, your GP may recommend a short course of antiviral medication, such as Tamiflu (oseltamivir). 
Antivirals are not used for everyone with flu because this would lead to further mutations in the viruses and drug resistance, making them ineffective.
If you suspect you have the flu it is important to take steps to prevent it spreading; especially to one or more of the vulnerable groups listed above.
  • make sure you wash your hands regularly with soap and water
  • clean surfaces such as your keyboard, telephone and door handles regularly to get rid of germs
  • use tissues to cover your mouth and nose when you cough or sneeze
  • put used tissues in a bin as soon as possible
Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.
Analysis by Bazian
Edited by NHS Choices
reposted (unedited) from:
crabsallover highlightskey pointscomments / links.

Sunday, 18 January 2015

Lack of Exercise is twice as deadly as obesity

crabsallover highlightskey pointscomments / links.

How many deaths can theoretically be avoided if inactive people became more active, compared to how many could be avoided if obese people lost weight?

If activity levels were increased so that no-one was classed as inactive, then this could reduce early deaths by more than 7%. This compares to avoiding obesity, which could reduce deaths by nearly 4%.

In 2008, 676,000 deaths were attributable to physical inactivity, compared with 337,000 deaths attributable to obesity. This large study also found that among inactive individuals, even small increases in activity may be of benefit, whatever their weight or waist size.

So should we concentrate purely on physical activity and stop worrying about losing weight?


Link to science (Open Access):

Free pdf:

Wednesday, 7 January 2015

23andMe - Personal Genome Service arrives in UK

reposted from:
crabsallover highlightskey pointscomments / links.

23andMe is a Personal Genome Service (PGS) that started marketing in the UK December 2nd 2014. The test costs £125.

Customers provide a saliva sample which is analysed by partial SNP Genotyped.  

SNP genotyping is the measurement of genetic variations of single nucleotide polymorphisms (SNPs) between members of a species. It is a form of genotyping, which is the measurement of more general genetic variation.

The FDA banned 23andMe PGS for sale in USA in December 2013 and Nature commented on the ban.

The UK's Medicines and Healthcare Products Regulatory Agency (MHRA) says the 23andMe spit test, which is designed to give details about a person's health risks based on their DNA, can be used with caution.

The UK Department of Health set up Genomics England 100,000 Genomes Project.

Several competitors to 23andMe here.

Published on 25 Jun 2014
With new technologies we can now examine the whole of a person's DNA -- their genome -- quicker and cheaper than ever before. In this video, Vivienne Parry OBE introduces the fundamentals of genomics and its growing importance for healthcare. Health Education England is developing a substantial education programme to inform healthcare professionals about the impact of genomics on clinical practice. This video is the first educational resource from the programme.

Friday, 2 January 2015

How to read health news by Dr Alicia White (Bazian)

crabsallover highlightskey pointscomments / links.

Bazian is the company who trawl the newspapers for NHS Direct then write their perseptive commentaries on the health news articles. This is an unedited copy of the article. 

  • 12/23/2014
  •  5:09 pm

If you’ve just read a health-related headline that has caused you to spit out your morning coffee (“Coffee causes cancer” usually does the trick), it’s always best to follow the Blitz slogan: “Keep Calm and Carry On”. On reading further, you’ll often find the headline has left out something important, such as: “Injecting five rats with really highly concentrated coffee solution caused some changes in cells that might lead to tumours eventually (study funded by The Association of Tea Marketing).”
The most important rule to remember is: don’t automatically believe the headline. It is there to draw you into buying the paper and reading the story. Would you read an article called: “Coffee pretty unlikely to cause cancer, but you never know”? Probably not.
To avoid spraying your newspaper with coffee in the future, you need to analyse the article to see what it says about the research it is reporting on. Bazian (the company I work for) has appraised hundreds of articles for Behind the Headlines on NHS Choices, and we’ve developed the following questions to help you figure out which articles you’re going to believe and which you’re not.

Does the article support its claims with scientific research?

Your first concern should be the research behind the news article. If an article touts a treatment or some aspect of your lifestyle that is supposed to prevent or cause a disease, but doesn’t give any information about the scientific research behind it, then treat it with a lot of caution. The same applies to research that has yet to be published.

Is the article based on a conference abstract?

Another area for caution is if the news article is based on a conference abstract. Research presented at conferences is often at a preliminary stage and usually hasn’t been scrutinised by experts in the field. Also, conference abstracts rarely provide full details about methods, making it difficult to judge how well the research was conducted. For these reasons, articles based on conference abstracts should be no cause for alarm. Don’t panic or rush off to your GP.

Was the research in humans?

Quite often, the "miracle cure" in the headline turns out to have only been tested on cells in the laboratory or on animals. These stories are regularly accompanied by pictures of humans, which creates the illusion that the miracle cure came from human studies. Studies in cells and animals are crucial first steps and should not be undervalued. However, many drugs that show promising results in cells in laboratories don’t work in animals, and many drugs that show promising results in animals don’t work in humans. If you read a headline about a drug or food "curing" rats, there is a chance it might cure humans in the future, but unfortunately a larger chance that it won’t. So there is no need to start eating large amounts of the "wonder food" featured in the article.

How many people did the research study include?

In general, the larger a study the more you can trust its results. Small studies may miss important differences because they lack statistical “power”, and are also more susceptible to finding things (including things that are wrong) purely by chance.
You can visualise this by thinking about tossing a coin. We know that if we toss a coin the chance of getting a head is the same as that of getting a tail – 50/50. However, if we didn’t know this and we tossed a coin four times and got three heads and one tail, we might conclude that getting heads was more likely than tails. But this chance finding would be wrong. If we tossed the coin 500 times - i.e. gave the experiment more "power" - we'd be more likely to get a heads/tails ratio close to 50/50, giving us a better idea of the true odds. When it comes to sample sizes, bigger is usually better. So when you see a study conducted in a handful of people, treat it with caution.

Did the study have a control group?

There are many different types of studies appropriate for answering different types of questions. If the question being asked is about whether a treatment or exposure has an effect or not, then the study needs to have a control group. A control group allows the researchers to compare what happens to people who have the treatment/exposure with what happens to people who don’t. If the study doesn’t have a control group, then it’s difficult to attribute results to the treatment or exposure with any level of certainty.
Also, it’s important that the control group is as similar to the treated/exposed group as possible. The best way to achieve this is to randomly assign some people to be in the treated/exposed group and some people to be in the control group. This is what happens in a randomised controlled trial (RCT) and is why RCTs are considered the "gold standard" for testing the effects of treatments and exposures. So when reading about a drug, food or treatment that is supposed to have an effect, you want to look for evidence of a control group and, ideally, evidence that the study was an RCT. Without either, retain some healthy scepticism.

Did the study actually assess what’s in the headline?

This one is a bit tricky to explain without going into a lot of detail about things called proxy outcomes. Instead, bear in mind this key point: the research needs to have examined what is being talked about in the headline and article (somewhat alarmingly, this isn’t always the case).
For example, you might read a headline that claims: “Tomatoes reduce the risk of heart attacks.” What you need to look for is evidence that the study actually looked at heart attacks. You might instead see that the study found that tomatoes reduce blood pressure. This means that someone has extrapolated that tomatoes must also have some impact on heart attacks, as high blood pressure is a risk factor for heart attacks. Sometimes these extrapolations will prove to be true, but other times they won’t. Therefore if a news story is focusing on a health outcome that was not examined by the research, treat it with a pinch of salt.

Who paid for and conducted the study?

This is a somewhat cynical point, but one that’s worth making. The majority of trials today are funded by manufacturers of the product being tested – be it a drug, vitamin cream or foodstuff. This means they have a vested interest in the results of the trial, which can potentially affect what the researchers find and report in all sorts of conscious and unconscious ways. This is not to say that all manufacturer-sponsored trials are unreliable. Many are very good. However, it’s worth seeing who funded the study to sniff out a potential conflict of interest.

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