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Vaginal birth and Caesarean: Differences in babies’ bacteria

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The UK scientists say these early encounters with microbes may act as a “thermostat” for the immune system.

And they may help explain why Caesarean babies are more likely to have some health problems later in life.

The researchers stress women should not swab babies with their vaginal fluids – known as “vaginal seeding”.

How important are gut bacteria?

Our bodies are not entirely human – instead we are an ecosystem with around half our body’s cells made up of microbes such as bacteria, viruses and fungi.

Most of them live in our gut and are collectively known as our microbiome.

The microbiome is linked to diseases including allergy, obesity, inflammatory bowel disease, Parkinson’s, whether cancer drugs work and even depression and autism.

This study – by Wellcome Sanger Institute, UCL, and the University of Birmingham – assessed how the microbiome forms when we leave our mother’s sterile womb and enter a world full of bugs.

Regular samples were taken from the nappies of nearly 600 babies for the first month of life, and some provided faecal samples for up to a year.

The study, published in the journal Nature, showed vaginally born babies got most of their early bacteria from their mother.

But Caesarean-section babies had high levels of hospital bugs such as Klebsiella and Pseudomonas.

“What surprised me and scared me was the amount of healthcare bugs showing up in these children,” Dr Trevor Lawley, from the Wellcome Sanger Institute said.

“It could be 30% of their total microbiome.

“But what excites me is we have an amazing body of data now that we can build on, to think about how to properly establish the human ecosystem, starting at birth.”

The microbiome

  • You’re more microbe than human – if you count all the cells in your body, only 43% are human
  • The rest is our microbiome and includes bacteria, viruses, fungi and single-celled archaea
  • The human genome – the full set of genetic instructions for a human being – is made up of 20,000 instructions called genes
  • But add all the genes in our microbiome together and the figure comes out at between two million and 20 million microbial genes
  • Our microbiome is also known as our “second genome”

Does this affect the baby’s health?

It is already known that children born by Caesarean are at higher risk of some disorders such as type 1 diabetes, allergies and asthma.

An errant immune system – the body’s defence against infection – can play a role in all of them.

Differences between vaginally-delivered and Caesarean babies faded over time and largely evened out by their first birthdays.

So a leading idea in the field is that the bugs which first colonise us are crucially important and help train our immune system to tell friend from foe.

“The hypothesis is that the moment of birth might be a sort of “thermostat” moment, which sets the immune system for future life,” says researcher Dr Nigel Field from UCL.

The study – the Baby Biome Project – will continue to follow the babies through childhood, and should provide more clarity.

How else can you alter a baby’s microbiome?

The method of birth had the biggest impact on the babies’ microbiomes, but antibiotics and whether or not mothers breastfed their babies, also altered the fledgling relationship between our microbial and human halves.

Previous research in this field has led to a trend for “vaginal seeding” in which mothers rub vaginal fluid on the face and mouth of their babies after a Caesarean.

However, the study showed that even vaginally-born babies were getting no more vaginal bacteria than Caesarean babies.

Instead, the bacteria passed from mother to baby were coming from contact with the mother’s faeces during labour.

The researchers said vaginal seeding risked exposing babies to dangerous Group B strep.

In the future it might be possible to give Caesarean babies a cocktail of good bacteria at birth, so that their relationship with the microbial world starts on the right path.

“These are bugs that are dedicated to us and we’re dedicated to them,” said Dr Lawley.

“My main interest is – what are the bugs that are passed from mother to child? This isn’t an accident, these bugs are deeply evolved with humans.

“That’s what we want to understand and preserve – that form of kinship between mother and child.”

What should pregnant women do?

Dr Alison Wright, the vice president of The Royal College of Obstetricians and Gynaecologists, said the findings were groundbreaking, but should not deter women from having a Caesarean.

She said: “In many cases, a Caesarean is a life-saving procedure, and can be the right choice for a woman and her baby.

“The exact role of the microbiome in the newborn and what factors can change it are still uncertain, so we don’t think this study should deter women from having a Caesarean.”

Labour pledges free personal care for over-65s in England

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Currently, state help with the cost of home or residential help is available for those with assets below £23,250.

Labour says the pledge, costing an estimated £6bn a year, will double the number of those not having to pay.

It would bring England into line with Scotland, where personal care is free for those with the most severe needs.

In his keynote speech to the Labour conference on Monday, shadow chancellor John McDonnell said the move would be funded out of general taxation.

A future Labour government would pass legislation to enshrine a right to free personal care for those most in need, consulting on “eligibility criteria to ensure this system works for all”.

Labour said it would give more details of how it would be paid for in its election manifesto but the Conservatives said the opposition’s already extensive spending commitments meant “there simply won’t be enough money to pay for it”.

In anticipation of a general election this autumn, Labour has already pledged this week to axe prescription charges in England and remove the charitable status of private schools as a first step to “integrating” them into the state sector.

But the leadership remains under pressure over Brexit, with delegates set to vote on a motion pushing for a clearer Remain stance in a future EU referendum if Labour wins power.

Prime Minister Boris Johnson has promised to solve the crisis in social care, which has bedevilled previous Tory and Labour governments due to its cost and complexity.

Mr McDonnell said cuts to care funding since 2010 had left a million people not getting the care they need and “87 people dying a day waiting for care”.

Subsidising the cost of basic tasks such as getting in and out of bed and going to the toilet will enable more people to continue to live independently in their homes, he said.

Free personal care is something campaigners have long been calling for in England.

Scotland has already introduced it and Wales and Northern Ireland each provide some level of universal entitlement. In Wales the cost of home care is capped, while in Northern Ireland the over-75s get it for free.

Both the Tories and Labour have been talking about reforming the system for over two decades – Tony Blair came to power in 1997 promising to look at it.

But neither has managed it. Why? The cost and complexity have proved to be insurmountable barriers.

What is more, how much impact the policy has depends on the threshold that is set for accessing it. Even in Scotland, Wales and Northern Ireland the bar for getting help is set very high. Only those with the most severe needs get it.

The devil, as always, will be in the detail.

Based on Scottish figures, Labour said the move could save those currently self-funding their care almost £10,000 a year while 70,000 fewer families would be liable for “catastrophic” lifetime care costs in excess of £100,000.

Removing the distinction between health and care needs, Mr McDonnell argued, will most help families of dementia sufferers, who face the highest costs and, in many cases, have been forced sell their homes to pay for care.

“I believe the right to dignity in retirement is a part of that right to health at any stage of life,” he said. “The truth is our social care sector is a national scandal.

“The next Labour government will introduce personal care free at the point of use in England

“Funded not through the Conservatives’ gimmicky insurance schemes But, like the NHS and our other essentials, through general taxation.”

The pledge goes beyond what Labour promised in its 2017 election manifesto – in which it vowed to raise the minimum asset threshold for free care, cap the amount anyone has to pay during their lifetime and support free end of life care.

Under the current means-tested system, if an individual has assets worth more than £23,250, including property, they must pay the full cost of residential care without help from the council.

Those with assets above £14,250 have to contribute, but may get some help from state.

Labour, whose long-term aim is to provide free personal care to all working age adults, says support for over-65s will alleviate the pressure on the NHS by reducing delayed transfers of care from hospital and admissions to care homes and hospitals.

‘Catastrophic costs’

Mr McDonnell also pledged to close the gap in social care funding – Labour has already pledged to spend an extra £8bn a year over five years – and give local authorities extra support to provide care so services are not outsourced to private firms.

The King’s Fund think tank has estimated that free personal care could cost £6bn a year in 2020-21, rising to £8bn by 2030.

The organisation said Labour’s announcement was a welcome step but “it is not the same thing as free social care, and some people would still be left facing catastrophic costs.”

In its Spending Round earlier this month, the government announced a further £1.5bn in extra funding for social care and promised to look at giving councils more leeway to raise extra funds via council tax bills.

‘Cancer treatment broke my heart, but I’ve survived’

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When diagnosed with breast cancer in 2013 at 33, she had just settled back into working life after getting married and spending a year backpacking round the world.

“I noticed one of my nipples was inverted and when I Googled for answers, I thought: ‘Oh God, this can’t be me.'”

Three years later, after surgery to remove one breast, chemotherapy, radiotherapy and another major reconstructive operation, Kreena felt she was out of the woods.

She had even arranged to have some of her eggs harvested, so that embryos could be created and frozen in case the cancer treatment made her infertile.

But then on a trip to Canada “to celebrate the end of my life with cancer”, she felt grim.

She was tired, her chest was tight and she was struggling to breathe. Hospital doctors were baffled, until one cardiologist made a crucial link.

“He told me to squeeze his hand if I remembered having a red liquid during chemotherapy treatment,” Kreena recalls.

She did. The diagnosis was acute heart failure and she was rushed to intensive care.

Heart damage risk

Thanks to advances in treatments, more patients than ever are surviving cancer – but one in 10 are developing serious heart conditions, sometimes soon after finishing treatment, others years later.

The problem is caused by chemotherapy drugs damaging the heart muscle, meaning it can no longer pump properly – and this can lead to heart failure.

It’s even given rise to a new medical specialty called cardio-oncology, which focuses on delivering cancer treatments safely.

But working out which patients will get heart damage, and which won’t, has proved really tricky up until now.

Scientists knew that the very young and the elderly were at high risk, but they’ve now found out that faulty genes also play a role in increasing risk in other people.

“Some have a gene to cause heart failure and they get a second hit from the chemo,” explains Dr Alex Lyon, a consultant cardiologist at the Royal Brompton Hospital and Imperial College London.

“Most patients are told there’s a small risk of heart problems.”

A study of 200 cancer patients with cancer-therapy-induced cardiomyopathy, or CCM, by Imperial College London researchers has pinpointed the genetic risk factors, paving the way for testing of patients before they start chemotherapy to find out who is at risk.

The good news is that drug treatments can reduce the risk of heart damage in these patients and close monitoring can pick up potential problems early, Dr Lyon says.

‘Pregnancy too dangerous’

Even patients like Kreena, who were left fighting for breath, can return to live a normal life.

“My recovery is incredible,” she says. “I didn’t think I’d be coming home.”

During two weeks in a Canadian hospital, she sent voice messages back to relatives, preparing them for the worst.

After a two-month stay in the country on a no-salt diet and being cared for by her husband, her heart function had improved from 6% to 12%.

It was enough to allow Kreena to fly back to the UK, but that was just the start of her journey to recovery.

Medication and intense rehab followed, which allowed her heart to creep back into a normal range of function.

But there was one thing she was told was too dangerous – having a baby would put too much strain on her heart.

“So we started to look at other options,” she says.

‘I’m very grateful’

A surrogate was found, and using her own embryos, her daughter was born and is now 16 months old.

“Next month, I’m climbing in the Himalayas. I’m living an extraordinary life and I’m very grateful,” Kreena says.

“I thought I wouldn’t see my 40th birthday, but now it’s just two weeks away.”

Her expedition is part of of push to raise awareness of breast cancer in young women from the charity Coppa Feel, a cause that’s important to her.

“More people are surviving cancer after chemo and more are getting secondary diseases.

“There’s work to do educating patients and doctors.”

Mediator: French weight-loss drug trial over ‘up to 2,000’ deaths begins

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Servier, the drug’s manufacturer, is accused of deceiving users over the killer side effects of a drug later used to treat overweight diabetics.

Believed to be one of France’s biggest healthcare scandals, the firm is on trial for manslaughter and deceit.

Servier has denied the charges, saying it did not lie about the side effects.

French health experts believe the drug known as Mediator could have killed anywhere between 500 and 2,000 people before it was finally taken off the market in 2009.

The country’s state drug regulator, accused of not acting to prevent deaths and injuries, is also on trial.

The trial will involve more than 2,600 plaintiffs and 21 defendants, and is expected to run over the course of six months.

It will also look into why the drug, which was introduced in 1976, was allowed to sell for so long despite various warnings.

Lawyers representing the plaintiffs argue that the drug manufacturer purposely misled patients for decades, and that this was bolstered by lenient authorities.

Servier has been accused of profiting at least €1bn ($1.1bn, £880m) from the drug’s sales.

“The trial comes as huge relief. Finally, we are to see the end of an intolerable scandal,” Dr Irene Frachon, a pulmonologist credited with lifting the lid on the side effects, told Reuters news agency.

Dr Frachon’s research drew on medical records across France and concluded that there was a clear pattern of heart valve problems among Mediator users. This prompted many more studies which ultimately led to the drug’s ban.

One study concluded that 500 deaths could be linked to Mediator between 1976 and 2009. A second one put the figure at 2,000.

Those numbers have been disputed by Servier, which has said that there are only three documented cases where death can be clearly attributed to the use of Mediator. In other cases, it says, aggravating factors were at work.

Servier has said it will continue to compensate victims and has paid almost €132m to patients.

“There is a series of circumstances highlighting how all this took place,” a lawyer for the drug company told Reuters.

Several European countries, like Spain and Italy, banned the drug in the early 2000s.

Based on a molecule called benfluorex, Mediator was first developed in 1976 as a lipopenic – a drug to lower fat levels in the blood.

Later, it was prescribed to diabetics to help them lose weight.

But as its appetite-suppressant properties were recognised, family doctors began offering Mediator as a general treatment. Anyone worried about putting on the pounds could be offered a course of the drug – even though legally it was authorised for diabetics alone.

By the time it was taken off the market, it is believed that some five million people had taken Mediator, making it among the 50 most-prescribed drugs in France.

Medical cannabis product approved for epilepsy

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Doctors can prescribe Epidyolex – an oral solution of cannabidiol, which comes from the cannabis plant – if they think it will help sufferers.

It has been approved for use in the UK and other European countries, but the NHS does not currently recommend it.

But some parents want alternatives that contain a component not in this drug.

Last month, the UK’s National Institute for Health and Care Excellence made an initial decision not to recommend prescribing Epidyolex, due to lack of evidence of long-term effectiveness.

What is Epidyolex?

The drug does not contain any of the psycho-active component of cannabis, a compound called tetrahydrocannabinol (THC).

Some parents, who have travelled to the Netherlands to buy cannabis medicines, feel the treatment will not help many children because it does not contain THC, which they argue has helped their children.

Epidyolex has been approved as a treatment option for children as young as two with Lennox-Gastaut syndrome or Dravet syndrome – difficult-to-treat conditions that can cause multiple seizures a day.

The medication, developed by GW Pharmaceuticals, will be used in combination with another epilepsy medication called clobazam.

What about other medical cannabis products?

There are many different medical cannabis products. The use of ones containing THC was legalised across the UK in November 2018.

These treatments can be prescribed only by specialist doctors in a limited number of circumstances where other medicines have failed.

Few of these unlicensed prescriptions have been made on the NHS.

There are some other cannabis-based medicines that are licensed in the UK.

Nabilone is a medicine, taken as a capsule, that has been developed to act in a similar way to THC.

Doctors can give it to people having chemotherapy to help with nausea.

Sativex is a cannabis-based medicine that contains THC and CBD and is licensed in the UK for people with multiple sclerosis.

Recreational use of cannabis remains illegal.

What do experts say?

Ley Sander, Medical Director at the Epilepsy Society and Professor of Neurology at University College London, said: “This new drug will bring hope for some families and EU approval feels like a positive step. Medicinal cannabis, however, still remains a medical minefield and there are many hurdles ahead.

“CBD was not recommended by NICE for prescription on the NHS. It is important that the pharmaceutical industry continues to work with the medical advisory body to ensure that drugs are cost effective and that its long-term effects are clear.”

‘Revolutionary’ new class of cancer drugs approved

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Tumour-agnostic drugs do not care where the cancer is growing in the body as long as it has a specific genetic abnormality inside.

UK doctors testing the drugs said they were “a really exciting thing”.

They said the approach had the potential to cure more patients and cut side-effects.

The drug that has been approved is called larotrectinib.

Charlotte Stevenson, a two-year-old from Belfast, was one of the first patients to benefit.

She was diagnosed with infantile fibrosarcoma, a cancer of the body’s connective tissue.

She has been treated with larotrectinib as part of a clinical trial at the Royal Marsden Sutton, in London, for the past year.

Her mum, Esther, said: “We knew that our options were limited [so] we decided to give it a try and are so glad that we did.

“We have been able to watch Charlotte develop and grow at a rapid rate, making up for lost time in so many ways and amazing us all with her energy and enthusiasm for life.

“She can now have a relatively normal life and, best of all, the drug has had an incredible impact on the tumour.”

Charlotte’s tumour was caused by a genetic abnormality known as an NTRK gene fusion.

One part of her DNA accidentally merged with another and the alteration in the blueprint for her body led to the growth of her cancer.

But NTRK gene fusions are not unique to sarcomas – they also appear in some brain, kidney, thyroid and other cancers.

“It is a really exciting thing, as is it works across a range of cancers. It’s not confined to one,” Dr Julia Chisholm, a children’s cancer consultant at the Royal Marsden Hospital said.

NTRK mutations are relatively rare, but other targeted therapies are in development.

‘Kinder treatments’

It marks a move away from treating a “breast cancer” or “bowel cancer” or a “lung cancer” and towards precision medicine that takes advantage of the genetic make-up of each patient’s tumour.

Dr Chisholm said: “The beauty is it targets the abnormality.

“There are a number of biochemical pathways that are common in many different tumour types.

“I think this is the way things are going and this is about better outcomes, curing more patients and producing kinder treatments with reduced side-effects.”

The decision by European regulators does not mean it will be instantly available for patients in the UK.

But earlier this year, NHS England described tumour-agnostic drugs as a “revolutionary” and “exciting new breakthrough” in cancer and said preparations were under way to ensure patients were given access to them.

“The benefits for patients – in particular children – of being able to treat many different types of cancers with one drug is potentially huge, helping them to lead longer, healthier lives,” NHS England chief executive Simon Stevens said at the time.

Prof Charles Swanton, Cancer Research UK’s chief clinician, said the drugs were “exciting”.

He added: “The NHS will need to ensure the right genomic testing is available across the country to identify patients who could benefit so it’s good that the NHS is already thinking about how to get this to patients with cancer as soon as possible.”

Dr Brendon Gray, from Bayer, the drug company that developed larotrectinib, said: “As the first tumour-agnostic medicine approved in Europe, larotrectinib represents a real shift in cancer treatment.”

Obesity not caused by lack of willpower – psychologists

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It calls for changes in language to reduce stigma, such as saying “a person with obesity” rather than an “obese person”.

And it says health professionals should be trained to talk about weight loss in a more supportive way.

A cancer charity’s recent ad campaign was criticised for “fat shaming”.

Obesity levels rose by 18% in England between 2005 and 2017 and by similar amounts in Scotland, Wales and Northern Ireland.

This means just over one in four UK adults is obese while nearly two-thirds are overweight or obese.

But these increases cannot be explained by a sudden loss of motivation across the UK – it is a lot more complicated than that, according to the British Psychological Society report, which concludes it “is not simply down to an individual’s lack of willpower”.

Stress and trauma

“The people who are most likely to be an unhealthy weight are those who have a high genetic risk of developing obesity and whose lives are also shaped by work, school and social environments that promote overeating and inactivity,” it says.

“People who live in deprived areas often experience high levels of stress, including major life challenges and trauma, often their neighbourhoods offer few opportunities and incentives for physical activity and options for accessing affordable healthy food are limited.”

Psychological experiences also play a big role, the report says, with up to half of adults attending specialist obesity services having experienced difficulties in childhood.

And stress caused by fat shaming – being made to feel bad about one’s weight – by public health campaigns, GPs, nurses and policymakers, often leads to increased eating and more weight gain.

Comedian James Corden recently spoke out against fat shaming, saying: “If making fun of fat people made them lose weight, there’d be no fat kids in schools.”

Psychologists can use their expertise to help train health professionals to communicate better on obesity, says Dr Angel Chater, report author and reader in health psychology and behaviour design at the University of Bedfordshire.

“If the treatment for obesity was easy, we wouldn’t be here and wouldn’t have written this report,” she says.

“You might have the best willpower in the world, but if you don’t have access to the right food, the right environment, the best start in life… it will be tough.”

Learn from smoking

The government should approach the problem of obesity in the same way as smoking, the report says.

British Psychological Society chief executive Sarb Bajwa said: “It has taken action at all levels for decades, from government policy to helping individual smokers, but we are now seeing significant reductions in the level of smoking and the health problems it causes.

“Psychologists have the science and clinical experience to help the health service do the same for obesity.

“We can help, not just by devising ways of helping individuals, but also by advising on public policy which will help create an environment in which people find it easier not to become obese in the first place.”

However, the psychologists are not in favour of obesity being classed as a “disease”, because, they say, this could take the focus away from behavioural changes that could succeed.

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