91Èȱ¬

Is it right that seriously obese patients should get bariatric, or weight loss surgery, on the NHS? A new report shows that there was a ten-fold increase in the surgery between 2000 and 2007.

In pure economic terms it appears to make sense. A report in the today quoted studies which suggest that bariatric surgery reduces hospital admissions and cuts the long term costs to the health service. So a procedure that costs upwards of £7,000 actually saves money in the long term.

The says the surgery should be available to the morbidly obese - those with a Body Mass Index (BMI) of 40+ or patients with existing health problems who have a BMI of at least 35 - and where all other treatment options have failed. The resulting weight loss leads to fewer health problems such as type 2 diabetes, high blood pressure and cardiovascular disease.

Surgeons and patients I have spoken to have all said it is not an easy option or a quick fix. Patients have to demonstrate a commitment to weight loss and go through a lengthy procedure before the operation is approved. One obesity expert said the requirement to have a very high BMI created a perverse incentive to gain weight in order to become eligible for the procedure.

I can understand that for medical teams dealing with obesity, weight loss surgery is a vital tool. But it does raise some wider issues about how we tackle our growing obesity problem. Bariatric surgery deals with the consequences of obesity, rather than the causes. Exercise and a balanced diet remain the best solutions to the epidemic of weight gain which is sweeping the globe.

I met a delightful woman today who recently had a gastric bypass. She has type 2 diabetes and her daily insulin intake has fallen by 75% since the surgery. Doctors no longer fear that she will need a kidney transplant. So she is a medical success story.

But I wonder what parents of children with type 1 diabetes will think? Some have been unable to persuade PCTs to pay for insulin pumps which cost around £3000. These have been shown to improve glucose control and so reduce the risks of complications, such as heart and kidney disease and blindness. These conditions can take decades to surface and so may be less pressing problems for the NHS.

Many cancer patients may also have a view. Earlier this week NICE refused the drug Avastin for people with advanced bowel cancer because it costs almost £21,000 per patient and typically adds an extra six weeks of life.

Bariatric surgery may make sound economic sense and produce significant benefits. But others denied treatment may feel that, somewhere along the line, the NHS has got its priorities wrong.

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Let's talk about sex. To be more specific, let's talk about sexually transmitted infections. This was the task I set myself in Hackney, east London.

Why Hackney? It had just emerged as the area in England with the highest rate of sexually transmitted infections (STIs) per head of population. Not far behind were Lambeth and a string of other London boroughs, plus Nottingham, Liverpool, Manchester and Brighton.

The disease mapping experts at the Health Protection Agency said they have several common factors: all are urban with pockets of deprivation and crucially, they have a high proportion of young adults.

Broadway market in E8 is a trendy spot in Hackney and there were plenty of young, affluent young adults out and about. One woman, who was flat-hunting, said it didn't feel like a deprived area given the cost of housing. Another said Hackney had shuffled off its reputation for drugs and crime, but now would have another unpleasant label. As she unkindly put it: "We've gone from Crackney to Clapney." Let's hope the label doesn't stick.

I confess I was surprised at the willingness of young people, when accosted on the street, to talk openly about sexually transmitted infections. Admittedly they were not telling me about their own problems, but about the youth culture which has seen a steady rise in STIs over the past decade.

Safe sex messages may seem dull and repetitive when you have heard them again and again. But they are important. Bear in mind that each year sees another million or so young people becoming sexually active. Last year almost half a million STIs were diagnosed - a record total. Part of that increase is due to increased screening and better tests. But the past decade has seen a relentless rising trend in infections.

The peak age for an STI is between 19 and 20 for women and 20-23 for men. And re-infection is a serious problem. Of all 15-24 year olds diagnosed with an STI last year around one in ten will become re-infected within a year. Around two thirds of new STI diagnoses in women were in those under 25 while in men it was more than half of new infections.

Dr Gwenda Hughes from the HPA said the figures show poor sexual health is a serious problem among the UK's young adults and men who have sex with men:

"These figures also highlight the vulnerability of young women. Many studies have shown that young adults are more likely to have unsafe sex and often they lack the skills and confidence to negotiate safer sex."

...or no sex at all, which is obviously another option. Alcohol and other drugs often go hand-in-hand with risky sexual behaviour. Add to that teenage pregnancy and HIV infection and a range of serious social issues present themselves.

So what more can be done?

There is clearly concern among those in the sexual health field that the area will experience cuts. Natika Halil from the Family Planning Association said:

"The message from this data to the new Government is that they mustn't be tempted to cut services and campaigns in sexual health, and ignore the urgent need for statutory sex and relationships education in schools."

The Health Minister Paul Burstow said:

"We're going to look at what more can be done to increase young people's awareness of risks, to prevent infection and to access screening and treatment. The message is clear - whatever your age - to protect yourself from a sexually transmitted disease always use a condom."

Whether young people in Hackney or elsewhere are listening to Mr Burstow is another matter. Clearly this is not just an issue for government or schools but society as a whole.

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We are losing the war on drugs according to Professor Sir Ian Gilmour. His personal comments made to doctors as he steps down as President of the Royal College of Physicians, are made from a clinical perspective. As a doctor he says he has seen many more addicts hospitalised by dirty needles and contaminated heroin, than from the drug itself.

He is calling for the decriminalisation of drug use. He backs the views of the UK Bar Council chairman Nicholas Green QC when he called for drug laws to be reconsidered. In July, Stephen Rolles from the Transform Drug Policy Foundation set out a detailed argument for decriminalisation in the . That article pointed to experiences in Portugal, some US states and the Netherlands to support its central theme that current drug enforcement policies are failing.

Decriminalisation has been flatly rejected by the 91Èȱ¬ Office which points to the immense harm caused by heroin, cocaine and cannabis. Last year the UK's chief drugs adviser Professor David Nutt was sacked by the then Labour government after criticising drug policy. He accused ministers of distorting scientific evidence when it reclassified cannabis to Class B from C.

Sir Ian Gilmour's comments will re-open the debate on how and if the war on drugs can be won.

Although decriminalisation maybe a step too far for the coalition government, it will be interesting to see how it adapts current policy - a major review is due to end in December.

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