Flu Vaccine 2018
2018/19 FLU VACCINATION Programme is now under way. Please note the "over 65" age group are being advised to have the trivalent vaccine FLUAD which is available from mid November. The quadrivalent is available now.
To reserve or book your vaccine please contact Laura@drjackedmonds.co.uk or email@example.com. Alternatively telephone 020 7935 5050 to book your 2018 flu vaccination available from October 2018 to February 2019.
Regulation of Medical Devices
Doctors are often castigated for shoddy or compromised research leading to poor quality data which is sometimes biased because funding comes from sources with vested interests in the outcomes of trials. But, did you know that the regulatory authority for medical devices, MHRA (Medicines and Healthcare products Regulatory Agency) and similar bodies throughout Europe, are under no obligation to demonstrate due diligence and care before authorising the use of medical devices in humans? Indeed when pressed for information by researchers (BMJ December 1, 2018) they cite issues of “commercial confidentiality “ and refuse to release details of testing and outcomes before permission is granted for use in patients.
Shockingly, this means that for example, a new heart defibrillator device was sanctioned for use after a trial on only 33 patients. Another device used to correct curvature of the spine had no trials in humans at all but received licence for use, and NICE recommendation, based solely on data collected from experiments in pigs and cadavers.
This lack of properly collected, unbiased, scientific information has been responsible for the medical scandals surrounding the use of mesh in pelvic surgery, poor silicone breast implants and metal on metal hip replacements.
Despite pressure from world respected sources such as the BMJ, academics, patient groups and consumer organisations, moves to bring device regulation under control equal to that of the European Medicines Authority have failed. New medications are subjected to very stringent scrutiny before obtaining a license for use yet medical devices are by and large given a green light on very dubious grounds and moreover without any scrutiny . How can we trust MHRA when they obfuscate? How can we trust similar regulatory authorities throughout Europe when it is clear they are influenced by lobbying from manufacturers, trade associations, notified bodies, other government bodies with political axes to grind and “experts” from industry? Multiple requests for answers to questions posed under freedom of access to information have been turned down in 16 different countries. Meanwhile, injuries and malfunction reports have trebled in the last 10 years.
Along with many colleagues I call for an end to secrecy, publication of injury and malfunction reports, transparency about the methods used by MHRA to judge that a medical device is safe and clear indications if there are conflicts of interest. If it`s good enough for the pharmaceutical industry then it should be good enough for MHRA.
BLOOD PRESSURE READINGS
Understanding blood pressure readings can be baffling so here is a simple summary to understanding what low, normal and high blood pressure readings are:
The readings are measured as systolic (heart beating and pumping blood) over diastolic (when your heart is filling with blood).
Low blood pressure – Lower than 90/60 mmHg.
Only one of these numbers needs to be lower than this to count as low BP.
Normal blood pressure – Between 90/60 and 140/90 mmHg.
This is the current normal range but there is a suggestion it should be lowered to 120/80.
Hypertension in the UK requiring medication starts at 140/90mmHg.
High blood pressure is 140/90mmHg or consistently higher over several weeks. Likely to require medication.
If just one of these figures is raised for a few weeks you may also have high BP.
Obvious ways to reduce blood pressure is to limit your salt intake to 6g/day which may also benefit feeling bloated. Eat less processed foods. Potassium rich foods are recommended with a daily intake of 3,500 mg.
If you have high blood pressure take the following steps: Lose excess weight, take more exercise, reduce alcohol intake, quit smoking, watch stress levels and take prescribed medication.
Benzodiazepines - Zopiclone and Zolpidem
Drug Alert - A recent article in the medical press highlights the potential problems with the benzodiazepine “Z” drugs (Zopiclone and Zolpidem) prescribed for insomnia. I would like to take this opportunity to remind our patients about these dangers.
Benzodiazepines are approved only for short-term use, in part because of the demonstrated loss of therapeutic effect as early as 4 weeks, and because of the risks for cognitive impairment, falls, fractures, and car accidents, as well as the abuse and dependence liability associated with the drugs, especially in the elderly. Benzodiazepines have also been implicated in the development of dementia, infections, pancreatitis, cancer, and exacerbation of respiratory disease. Nonetheless, long-term use of benzodiazepines is common and markedly increases with age.
If anyone reading this has concerns I would be delighted to hear from you. Gradually tapering the dose of medication with the aim to discontinue completely is invariably successful.
Travel Vaccinations for your trips abroad
If you are planning to travel abroad don't forget to check out what vaccinations are required remembering to allow a lead time of approximately 2 weeks for vaccines to become effective. Some vaccines are in short supply so be organised in advance as they need to be ordered.
Should we screen for Vitamin D Deficiency?
Vitamin D is a trendy health subject. Much airtime and many column inches have been devoted to the subject but is there any real value in measuring Vitamin D levels?
The first problem is to decide whether there are natural variations to be taken into account. Most Vitamin D – 80% - is made by the action of sunlight on melanocytes in the skin. Obviously, if you don’t feel the sun you don’t make Vitamin D. People who come from communities where exposing your skin is not recommended (especially women) will never be sufficiently exposed to sunlight to make enough Vitamin D. People who live in the northern hemisphere will have lots of exposure in the summer and very little in the winter.
So, where you live, your community ethics and the time of year all combine to make a Vitamin D reading very variable and of dubious validity.
This is compounded by the uncertainty of what “normal” means in Vitamin D terms even after taking account of other variables. It would seem that the range of Vitamin D is very large. Consensus has now been reached that if the blood level of 25(OH)D is less than 50 nmol/l bone health is compromised and less than 75 nmol/l is possibly injurious to health. The challenge is to make accurate measurements which requires standardization of methodology in all laboratories everywhere.
So we know that as much of 33% the US population have very low Vitamin D and maybe as much as 77% of the population may have less than 75 nmol/l Vit D3 levels. Does this mean that three quarters of the population need Vitamin D supplements and what would the benefit be? The answer is that we do not know and therefore there is no basis on which to recommend routine screening for Vitamin D or routine supplementation.
What does Dr Jack recommend?
- Adding Vit D measurement to routine screening is not advised
- Measuring Vit D in special circumstances is still valid. If bone health and metabolism are compromised then bone screening and Vit D measurements are essential and replacement of D3 and minerals must be prescribed.
- There is poor level evidence that low Vit D is associated with muscle fatigue and even poorer evidence that deficiency is associated with mental tiredness and poor intellectual performance. Nevertheless, people presenting with TATT (“tired all the time”) should have Vit D measurement and supplements prescribed if levels are low.
- 15 minutes of sunshine a day is good for you and boosts Vit D levels. You do not have to strip off completely – exposing your arms and legs is sufficient. Everyone will still need sunblock and hats and avoid sunburn as before – skin cancer is lethal. We don’t know enough about low Vitamin D levels but we can certainly say it is not life threatening. Have a good summer!!
Dementia – Worried about someone?
The Alzheimer’s Society has a free “Staying Connected Kit” designed to help someone with dementia live a more connected life. It provides a better understanding of the condition and information about all the support services the Alzheimer’s Society is able to give people with dementia and their carers.
Request your FREE Staying Connected Kit and help someone with dementia live a more connected life.
Diabetes – Oral Health
People with Diabetes are 2-3 times more likely to develop Periodontal Disease. If you have Diabetes, you may have been told about the importance of looking after your diet, your eyes and your feet, but what about your oral health? Periodontal disease (gum disease) is another common complication of Diabetes Mellitus. Other manifestations include dry mouth, fungus and caries. Management of these conditions is very important so make sure you discuss your condition with your dentist to improve your quality of life.
VACCINATIONS - Are you prepared?
Going on holiday? Remember to check out what vaccinations you may require and get vaccinated 2-3 weeks before you go travelling for full protection.
Meningitis B Vaccine
Supplies of Meningitis B vaccine are only available through the NHS of which there are very limited supplies. More supplies expected summer 2016.
Meningitis B Vaccine (Bexsero) – There has been an unprecedented request for this vaccination in the last week We have attempted to obtain supplies directly from GSK unsuccessfully. The NHS is also short of supplies. Apparently the situation should improve in the summer of 2016 and apparently should be better in 2017. Meanwhile please remember that in an average year there are probably only 160 cases of Meningitis B in a population of 300 million in the US (a rate of 5 cases in 10 million population – a rare illness) and that most cases respond to antibiotics. The risk to your children from Men B is extremely low.
25 February 2016
First reversal agent for non-coumarin oral anticoagulant
First reversal agent available for non-coumarin oral anticoagulant and
New heart failure combination tablet 'could replace ACE inhibitors as mainstay of treatment'. To read the full article click here.
Travel vaccinations - sun protection
Are you up to date with all your travel vaccinations? Vaccinations best given 2-3 weeks prior to departure for full protection. Sun screen is very important not forgetting your head too with a hat and also sunglasses with a good UV filter to protect your eyes.