Coull Quartet to perform on 15th May for national children's cancer charity CLIC-Sargent.

The Coull Quartet are to perform at a charitable musical evening to be held at the 12th Century Ashow Church on Thursday 15th May 2014, in support of children with cancer.

To order tickets or to express interest in attending or otherwise supporting this charity event, please email worstedweavers@gmail.com.

Tickets cost £25 per person – £20 per person for orders of 10 tickets.

Go to PayPal link for online ticket payments – hosted by the Hippocrates Society

The musical performance will be held in Ashow Church, beginning with a concert by the internationally famous chamber group – the Coull Quartet, followed by a reception in the adjacent Ashow Village Centre.

Address: The Church of the Assumption of Our Lady, Ashow, Kenilworth, Warwickshire

Link to map for Ashow Church

Programme

6.30 pm Ashow Church – arrival 

7 pm Coull Quartet

- Schubert D87;

- Ravel Quartet;

- Borodin Quartet No.2.

8 pm   Reception – Village centre/marquee

9 pm Close

Founded in 1974, and Quartet-in-Residence at the University of Warwick since 1977, the CoullQuartet has performed and broadcast extensively throughout the UK, the USA and Western Europe, and has also toured China, India, the Far East, South America and Australia. The Coull Quartet – Roger Coull violin, Philip Gallaway violin, Rose Redgrave viola, Nicholas Roberts cello - has appeared at most of the major music societies and festivals in the UK, and gives an annual series of recitals at Warwick Arts Centre, where it is actively involved in the University’s flourishing musical life.

The event is being organised jointly by the City of Coventry Worsted Weavers guild and the national children’s cancer charity  CLIC-Sargent – the UK’s leading cancer charity for children and young people, and their families. CLIC-Sargent provides clinical, practical, financial and emotional support to help them cope with cancer and get the most out of life. CLIC-Sargent aims to help the whole family deal with the impact of cancer and its treatment.

NICE and wider use of statins?

In the UK it is currently recommended that a statin should be prescribed to lower cholesterol for a
patient in whom the risk of developing cardiovascular disease in the next 10 years is 20% ie 1 in 5.

NICE - the National Institute for Health and Care Excellence - is now consulting on its proposal to reduce the threshold for prescribing a statin to a 10% ie 1 in 10 risk of cardiovascular disease in the next 10 years.

Here are my comments within the 12th February 2014 Science  Media Centre briefing on this new draft guidance from NICE:

"Heart disease, strokes and other serious disorders of the circulation are a major cause of premature ill health and death. 

Statins can help to prevent and reduce the severity of these serious medical problems. 

This initiative from NICE is important in extending to many more people protection from serious cardiovascular risk. 

Clear information will need to be made available on two key points: the need to combine statin use with a healthy lifestyle and addressing the other risk factors commonly present in people with high cholesterol, and information on the balance of risk versus benefit for these powerful medicines."

More comments from the SMC briefing.

The NICE draft proposal on statins.

Entries from 31 countries for the 2014 Hippocrates Prize for Poetry and Medicine

Entries are now closed for the 2014 Hippocrates Prize for Poetry and Medicine, for which

over 1000 entries have been submitted. With a 1st prize for the winning poem in the Open and in the NHS category of £5,000, the Hippocrates prize is one of the highest value poetry awards in the world for a single poem. 
Short lists for the Open, NHS and Young Poets Awards in the Hippocrates Prize will be announced on Thursday 3rd April.
The 2014 Hippocrates Awards will be presented at the close of the 5th International Symposium on Poetry and Medicine in London on Saturday 10th May.

Competing poets for the 2014 Hippocrates Awards came from 31 countries from 6 continents around the world. Entries have arrived from throughout the United Kingdom and the United States, and from Australia, Brazil, Canada, China, Czech Republic, France, Germany, India, Ireland, Israel, Italy, Kenya, Malta, New Zealand, Nigeria, Norway, Pakistan, Poland, South Africa, Singapore, Slovakia, Sri Lanka, Switzerland, The Netherlands, Trinidad and Zimbabwe.

Members of the  judging panel for the 2014 Hippocrates Open and NHS Prize are poet Philip Gross, a winner of the TS Eliot Prize, distinguished barrister Robert Francis QC, and Mumsnet Editor Sarah Crown. The 2014 Young Poets Award will be judged by poet Kit Wright. 

In our new Young Poets Awards, to be judged by poet Kit Wright, entries were received from England, Ireland, and Scotland in the UK, and from Israel, Italy, Nigeria, South Africa and the USA.

Register for the 2014 Hippocrates Awards

Register for the 2014 International Symposium on Poetry and Medicine

Submit an abstract for the 2014 International Symposium on Poetry and Medicine to be held in London on Saturday 10th May:

- oral abstract deadline: 1st March

- poster abstract deadline: 31st March

Awards are in three categories:

- a £5000 first prize in the Open category, which anyone in the world may enter;

- a £5000 first prize in the NHS category, which is open to UK National Health Service employees, health students and those working in professional organisations involved in education and training of NHS students and staff;

- a £500 prize for the Young Poets category in the international Hippocrates Prize for an unpublished poem in English on a medical theme. Entries are open to young poets from anywhere in the world aged 14 to 18 years.

The Hippocrates Initiative began in 2009 as the Hippocrates Prize for Poetry and Medicine for an unpublished poem on a medical subject. The Hippocrates Initiative now also includes the international Hippocrates Society for Poetry and Medicine, annual international symposia at which the Hippocrates awards are also presented, an international research forum for poetry and medicine, The Hippocrates Press, and workshops, the first held in Venice in September 2013.

Since its launch in 2009, the annual Hippocrates Prize has attracted thousands of entries from 61 countries, from the Americas to Fiji and from Finland to Australasia.

 

Policy, pharmacology and the European Association of Clinical Pharmacology and Therapeutics

The EACPT is in a prime position to foster an environment of exchange between research and policy within the field of clinical pharmacology and therapeutics.

The European Association of Clinical Pharmacology and Therapeutics (EACPT) includes all

the national scientific and professional organisations and societies for clinical pharmacology and therapeutics in Europe. It aims to provide educational and scientific support for the more than 4,000 individual professionals interested in clinical pharmacology and therapeutics throughout the European region.

All medicines have risks of adverse effects, in addition to their expected health benefits. The EACPT is very well placed to provide up-to-date briefings and recommendations to policy makers on how pharmacology can contribute positively to human health and wealth, through a clear understanding of the clinical and cost benefit/risk ratio of medicines.

The EACPT is also in a strong position to advise on the support needed for clinical pharmacology and therapeutics, and its underpinning pharmacology, to ensure that established experts and emerging CPT professionals in academia, the clinical domain, governance, industry and other roles can continue to develop and use medicines effectively to meet current and new challenges to human health.

Read the full article

For more information on the Policy Community journal where this article was published please visit www.paneuropeannetworks.com

Judges for 2014 Hippocrates Prize for Poetry and Medicine

Members of the judging panel for the 2014 Hippocrates Prize are poet Philip Gross, a winner of the TS Eliot Prize, distinguished barrister Robert Francis QC, and Mumsnet Editor Sarah Crown, and for the Young Poets category Kit Wright.

The Hippocrates Prize is for an unpublished poem in English of up to 50 lines text, excluding title and line spacing.

With a 1st prize of £5,000 both for the winning poem in the Open International category and for the NHS category, the Hippocrates Prize is one of the highest value poetry awards in the world for a single poem. There is also an international category for Young Poets aged from 14 to under 19 years. This £500 award was launched in 2012, and is for an unpublished poem of up to 50 lines in English on a medical theme.

In its first 4 years, the Hippocrates Prize has attracted around 5000 entries from 55 countries, from the Americas to Fiji and Finland to Australasia.

Entries are now open for the 2014 Hippocrates Prize for poetry and medicine, deadline 31st January 2014. There is no limit to the numbers of entries by any poet.

Awards will be presented at the 5th International Symposium for Poetry and Medicine, to be held on Saturday 10th May, 2014 in London.

Philip Gross’s The Water Table won the T.S.Eliot Prize 2009, I Spy Pinhole Eye Wales Book of The Year 2010, and Off Road To Everywhere the CLPE Award for Children’s Poetry 2011. Deep Field (2011) deals with voice and language, explored through his father’s aphasia, and a new collection, Later, is due from Bloodaxe in Autumn 2013. He has published ten novels for young people, including The Lastling, has collaborated with artists, musicians and dancers, and since 2004 has been Professor of Creative Writing at Glamorgan University, where he leads the Masters in Writing programme. [Photo by Stephen Morris]

Robert Francis QC is a distinguished barrister who specialises in the NHS and medical negligence. He has been a Queen's Counsel for 21 of his 40 years at the bar. He has been involved in many inquiries into the NHS, both as barrister and as chair, most recently chairing the inquiry into the Mid Staffordshire Hospital. According to Peter Walsh, chief executive of the patient safety charity Action against Medical Accidents, Robert Francis has a "passion for justice in healthcare and improving healthcare more generally".

Sarah Crown is editor of Mumsnet. She was editor of Guardian Books from 2007-2013. Previous poetry awards for which she has been a member of the judging panels include the Forward prizes and the Picador poetry prize.

The 2014 Hippocrates Young Poets Prize for Poetry and Medicine will be judged by poet Kit Wright, one of the most acclaimed poets for adults and children. Kit Wright is the author of more than twenty-five books, for both adults and children, and the winner of awards including an Arts Council Writers' Award, the Geoffrey Faber Memorial Prize, the Hawthornden Prize, the Alice Hunt Bartlett Award and (jointly) the Heinemann Award. After a scholarship to Oxford, he worked as a lecturer in Canada, then returned to England and a position in the Poetry Society.

The Hippocrates poetry and medicine initiative received  the Award for Excellence and Innovation in the Arts in the 2011 Times Higher Education awards.

Winners of the 2013 Hippocrates Prize:

Harvard poet and physician Rafael Campo wins Hippocrates Open International Prize for Poetry and Medicine

Psychotherapist Mary V Williams wins Hippocrates NHS Prize for Poetry and Medicine
English poet 

Rosalind Jana awarded international Hippocrates Young Poets Prize for Poetry and Medicine

For email enquiries about the Hippocrates Prize:  hippocrates.poetry@gmail.com

Hippocrates website: http://hippocrates-poetry.org

First test of new French artificial implantable heart

A first patient has been fitted with a new French artificial heart. 

Watch interview on @AJEnglish:  

Heart failure is one of the commonest causes of urgent admission to hospital. Modern drugs – and their effective use in combination - have dramatically improved treatment of heart failure. However in many patients heart failure is a progressive disorder and perhaps 100,000 patients in USA and Europe alone are candidates for a new heart. Conventional organ transplantation is limited by availability of a donor heart, the complexity of immunosuppression and other major risks of the procedure.

The dual ambition of the company behind this new technology is an implantable heart which will both allow return to good quality of life for at least 5 years, and be subject to a lower risk of serious complications then earlier devices.

Implanting an artificial heart while awaiting a heart transplant is not a new idea. The first sustained success was for the Jarvik device, first used over 30 years ago. And current implantable devices have been reported to be successful for almost 4 years.

The new Carmat heart is lined with a combination of synthetic polymers and treated tissues from the heart sac (pericardium) of the cow. This aims to reduce the chance of blood clotting on the internal lining of the heart – an important potential risk from an artificial heart. And partnership with aerospace engineers has lead to new biofeedback sensors in the Carmat device.

If experience over the next year or so of the heart in patients confirms the promise of laboratory studies, patients and health professionals might have access to the new device for clinical use by 2015.

However it will of course take at least until 2020 to confirm whether, in general use, the hoped for 5 year lifespan of the device is confirmed for patients who have severe heart failure.

For the benefit of patients, health services and policy makers, there will need to be serious engagement with the biotech industry to ensure that economies of scale in clinical practice reduce dramatically the current huge cost per device - estimated at 140-180,000 €  ie around $240,000.

Four schools receive 2013 Healthy Heart Awards from Mediterranean Diet researcher Ramon Estruch

The 2013 Healthy Heart Awards have been awarded to Chevening CE Primary School in Kent, Corpus Christi Catholic Primary School in Lambeth, Dulwich Hamlet Junior School in Southwark, and St Nicholas CE Primary School in Chislehurst.

The Awards were presented in London on Thursday 5th December 2013 by Mediterranean diet researcher Professor Ramón Estruch from Barcelona.

The aim of the 'Healthy Heart Awards' is to engage young and older school and college students in the health of their hearts. Entries included a short video, artwork, games, and poems about how to keep the heart healthy.

The Healthy Heart Awards were founded in 2010 by healthy heart charity the Cardiovascular Research Trust (CVRT).

Awards co-founder and CVRT trustee Professor Donald Singer said: “The Awards provide an innovative way for young people to make an active contribution to the future health of their own hearts and those of children of all ages from around the world.”

Fellow Awards co-founder and CVRT trustee John Jackson added: “The Healthy Heart Awards also provide new opportunities within the curriculum for teaching and learning about science and health”.

Awards co-organizer Wendy French said: “We are delighted that participating pupils enjoyed taking part, while learning more about keeping the heart healthy”. She added: “Comments from the pupils included:

'It brought us together as a class.'

'It gave me something exciting to think about. I like inventing.'

'It made us solve puzzles about how things could work and sometimes they didn't!'

'I didn't know learning could be such fun.'“

The Awards ceremony, which included readings by Dr Raphael Shirley of winning entries, took place at an international CVRT symposium on ‘Diet, Active Lifestyle and Cardiovascular Health’ on Thursday 5th December 2013.

Symposium speakers included Professor Dame Carol Black, Cambridge, on working for a healthier tomorrow, Professor Ramon Estruch, Barcelona, on protecting cardiovascular health by following a Mediterranean diet, Dr Ingmar Wester, Finland, on plant bioactives to reduce cardiovascular risk, and Professor Chris Imray, Coventry, on exercise to improve outcomes of surgery.

Notes for editors and schools

For more on the Healthy Heart Awards including pictures from the day, contact the Cardiovascular Research Trust on cvrtrust@gmail.com

Information for entries to 2014 Healthy Heart Awards.

The Cardiovascular Research Trust (CVRT) is a registered charity, which supports research and education aimed at prevention and treatment of premature disease of the heart and circulation: http://cvrt.org.uk/

Awards Symposium topics and speakers

Working for a Healthier Tomorrow: Professor Dame Carol Black, DBE, FRCP, Principal of Newnham College Cambridge, Adviser on Work and Health at the Department of Health, England, Chair of the Nuffield Trust and Chair of the Governance Board, Centre for Workforce Intelligence. Spearheaded by Carol Black as National Director, ‘Health, Work and Wellbeing’ is a joint initiative across government to improve the health and well-being of working age people.

Mediterranean diet and cardiovascular health: Professor Ramón Estruch, Medical Professor at the University of Barcelona. He leads Thematic Networks evaluating the effects of the Mediterranean Diet and its main components on primary prevention of cardiovascular disease in high-risk patients. He is also a member of the Advisory Committee of the EU European Foundation for Alcohol Research.

Healthy Heart Awards co-organizer: Wendy French was head of the Maudsley and Bethlem Hospital School for fifteen years and now works with people with aphasia/dysphasia, helping them to recover their use of language through poetry. With fellow poet Jane Kirwan, in 2013 she published Born in the NHS, a passionate defence of the NHS and a social history – families in sickness and health, the changing roles of health professionals – over the last seventy years.  Her prizes in international competitions include first prize in the NHS category of the Hippocrates Prize in 2010 and second prize in 2011.

Exercise and improving outcome of surgery: Chris Imray, Professor of Vascular Surgery at the University Hospital in Coventry. He is interested in the effects of extreme altitude on the cardiovascular system, in prevention and treatment of carotid artery stroke syndromes, and in strategies for improving outcomes of vascular surgery.

Reader of entries for the Healthy Heart Awards: Dr Raphael Shirley performed at the Edinburgh Festival in 2012 and 2013. For more see Raph’s website: http://www.raphshirley.com

Diet and exercise to reverse overweight: what works? Donald Singer, Professor of Clinical Pharmacology & Therapeutics at the University of Warwick. Professor Singer is interested in prevention and treatment of cardiovascular disease, and in public understanding of the benefits and risks of medicines.

The Lifestyle Heart Trial: 23 years on. Dr Ellen Storm, is a medical doctor training in paediatrics and child health. She has a Masters Degree in public health and has a particular scientific interest in the causal relationships between diet and disease.

Plant stanols, blood lipids and cardiovascular health: Dr Ingmar Wester, R & D Director at Finnish company Raisio. He discovered plant stanol esters in 1995 and has researched their cardiovascular benefits.

Personalising medicines: good or bad for health of the public

"Me Medicine vs. We Medicine: reclaiming biotechnology for the common good".
Donna Dickenson. Columbia University Press, New York. 2013.

The key premise of this seductive book by Donna Dickenson is that 'we medicine' - medicine aimed at maximizing the health of the nation, and 'me medicine' - medicine customised for individual patients, are mutually exclusive. The author, an Emeritus Professor of Medical Ethics and Humanities at the University of London, chooses to focus on new molecular diagnostics, including  pharmacogenetics and pharmacogenomics, as the major relevant examples of personalised medicines. The author bases much of her argument on her perception of the polarity that 'genetics and genomics reveal more profound truths than other sciences'. However there is no clinical consensus that these are disciplines that operate in isolation. Genetics and genomics complement other medical sciences.

Good therapeutic practice concerns applying a wide range of clinical and laboratory tools to select the right drug(s) for the right disease and the right patient, at the right time, at the right dose, by the right route of administration, and for the right duration. Personal biomarkers of treatment response which should be used as a regular part of good medical practice include age, gender, ethnicity, lifestyle, co-morbidity, concomitant prescribed and non-prescribed regular and occasional medicines, and key lab phenotypes, such as renal and liver function, in addition to emerging pharmacogenetic and pharmacogenomic tests. By using these tools to apply a personal approach to patient management, prescribers are more able to select effective treatment options, and less likely to select treatments that may cause serious adverse effects ..

For more, see my review in Pharmacology Matters, a publication of the British Pharmacological Society.

Drugs and Pharma: a matter of trust?

Medicines have significant costs, both financial and in terms of serious adverse effects. Treatment

should therefore only be prescribed and continued when the benefit outweighs the risk. This presupposes that health professionals, patients, and policymakers have trustworthy evidence to support clinical use of medicines.

It is vital that research on medicines is objective in order to show whether proposed treatments are effective for improving clinically meaningful outcomes for patients, how they compare to existing remedies, and the relative and absolute cost implications of adopting the treatment.

In his seductive polemic Bad Pharma, psychiatrist and 'Bad Science' Guardian columnist Ben Goldacre raises major concerns about the quality of evidence on the efficacy and safety of specific drugs and classes of treatment in clinical use. His book has added to recent public concern about medicines, their safety, and the probity of pharmaceutical companies.

This background concern for the public has been inspired both by works of fiction, for example the film Side Effects, set within a corrupted psychotherapeutic sector, and John Le Carre's African novel The Constant Gardener, which raises important questions about the ethics of clinical research on anti-infective agents in developing countries.

And by a series of very large fines imposed on major pharmaceutical companies for a wide range of reported major errors of omission and commission, including concealed data on safety, and encouragement of doctors to prescribe off-licence, i.e. to patient groups for whom there is no or insufficient evidence on effectiveness or safety of medicines.

See more in reviews in the Reinvention Journal

Ben Goldacre Bad Pharma: How drug companies mislead doctors and harm patients.
London: Fourth Estate. Reprinted with edits: February 5, 2013 | ISBN-10: 0865478007 | ISBN-13: 978-0865478008

Not so smart drugs: concerns about modafinil

Modafinil has been in medical use since the late 1980s to improve alertness.

Because of concerns about serious medical risks, medical use has been restricted to treating narcolepsy since 2010 by the European Medicines Agency and the UK's Medicines and Healthcare products Regulatory Agency.

Students and employees, young and old, are being tempted to use 'smart' drugs to try to improve their academic or professional performance. This use of modafinil is not medically licensed - the aim of improving the effectiveness of learning and performance in exams, and other educational assignments.

The drug is reported to be in widespread use by students in Germany, the UK, the US and elsewhere in the hope that it will improve studying, learning and exam performance.
 

How is modafinil thought to act? Its mode of action is unknown. Suggested mechanisms include orexin-mediated enhancement of a range of brain activation neurotransmitters (norepinephrine, dopamine, histamine, serotonin) in brain arousal centres; and increased gap junction communication from brain cell to brain cell.

Does modafinil improve intellectual performance? At best, it is considered no substitute for a healthy sleep pattern. There have been two types of formal study – those in well-slept healthy young or older subject; and studies in sleep deprived subjects. Typically, studies are of a single dose, and medical or psychiatric disorders, and use of other medical drugs, or recreational drugs (including caffeine, alcohol and nicotine) are reasons for exclusion from studies of modafinil.

Studies of possible effects of modafinil on studying and learning are typically based on artificial tests – ie do not test for possible benefits of the drug on what students may be trying to learn, or results of the types of exams students may be sitting. Results are conflicting. In high IQ young subjects, performance of highly complex psychological tests, but not less complex tasks, may be improved. More focused study, with however increased response time has also been reported.

Anecdotally, students have reported that the drug appears to lead to more efficient completion of a deadline but not improvement in content. However these perceptions are vulnerable to placebo responses.

Only a handful of good quality studies have been performed on the possible effects of modafinil on cognition. These have involved psychological model tests, not studies of how well students learn course or professional materials. There remains the need for study of effects and risks of repeated use of modafinil in real world settings using tests relevant to the study activities of students.

Side effects? There are many – from loose bowels, to loss of effectiveness of the oral contraceptive pill, leading to unwanted pregnancy, and rare but life-threatening and fatal skin reactions Stevens-Johnson Syndrome).

Further important side effects include sleep disturbance and neuropsychiatric disorders indirect reasons why performance might be impaired by the drug.

There are also reports by users that in response to modafinil too much focus on details may make it difficult both to complete an assessment and to consider a broad enough range of issues to give a complete answer.

Risks of modafinil may be greater if there are unrecognized problems, in particular if the user has a medical history of cardiovascular or psychiatric problems. Use without clinical advice may mean that important underlying conditions are not identified, for example high blood pressure, disorders of heart rhythm, and psychiatric risk; and potential important interactions with other drugs (including other stimulants) may not be considered.

Modafinil has clinically significant effects on the activity of liver enzymes and drug transporters which are important in the handling and clearance of a wide range of common drugs, including digoxin and warfarin.

Older people are more likely to have medical disorders and to be on treatment which might lead to increased risk from modafinil. A particular concern is that these markers of increased risk may not be considered when off-licence supplies are being sought in the hope that there may be benefit for professional work, or as an aid to studying – for example for revalidation.

  
Is use of modafinil any different from using caffeine? Because of the lack of convincing evidence of real world benefit from modafinil and concerns about serious risks, the drug is not approved for use in the absence of a specified medical condition. There are to date no convincing studies showing a benefit from modafinil in long-term use or for specific types of learning or testing relevant to students.

As for other drugs, the balance between risk and benefit must be considered by prescriber and user. In the event of any benefit for studying from the drug, others not using it are put at a disadvantage. 

In contrast caffeine is widely available for those who chose to use it. Too much caffeine, or sensitivity to caffeine can cause troublesome symptoms, including anxiety, tremor, sleep disturbance and palpitations.

Risks from accessing modafinil  from internet pharmacies? For the above reasons, licensed pharmacies would not supply modafinil in the absence of specified medical conditions. Unlicensed internet pharmacies should be avoided. The quality of medicines is not reliable, with serious risk of being supplied poorly active or counterfeit or contaminated medicines. And medical contra-indications need to be identified and discussed to minimize the risk of preventable serious adverse effects.

Fairness and coercion There are also a number of ethical concerns including: the need to protect students and others from using so-called ‘smart drugs’ in response to pressure to compete, both in exams and in professional life; being fair to other students who do not have access to the drug, or do not wish to use what may be a medically harmful pharmacological aid to improving performance in examinations or to meeting challenges at work.

See also
- June 2009: Opposing opinions in the British Medical Journal from John Harris and Anjan Chatterjee

-  Methylphenidate (Ritalin) – does use by ‘healthy’ students matter?