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INSIDE HEALTH 鈥� Programme 8.

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TX:听 27.02.18听 2100鈥�2130

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PRESENTER:听 MARK PORTER

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PRODUCER:听 FIONA HILL

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Porter

Hello. 听Coming up in the next half hour:听 Antidepressants 鈥� Margaret McCartney takes a closer look at the research behind recent headlines extolling their virtues.

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And stem cell therapy to repair cartilage 鈥撎� I visit a centre harnessing the healing power of nature to help people with damaged knees.

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But first, diabetes and new figures showing that the number of people with the two main forms of the condition in the UK has doubled in the last 20 years to nearly four million.听 And while nine out of 10 cases are the Type 2 variety most commonly associated with being overweight and older, there has also been a worrying increase in the insulin dependent Type 1 variety too. 听Indeed, the UK now has one of the highest rates of Type 1 diabetes in the world, and it seems to be developing earlier with more young children being affected.

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Managing Type 1 diabetes requires careful monitoring of blood glucose levels and constant adjustment of insulin and/or carbohydrate intake to try and keep levels in the healthy range. Too high and it can make you very unwell and increase the risk of long term complications like blindness and kidney disease, too low and it can lead to coma, seizures and even death. So, checking sugar levels using finger prick blood tests 鈥� often through the day and night 鈥� are a routine for many people with Type 1.

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But new technology is changing all that and leading to a revolution in the diabetes world. Inside Health鈥檚 Margaret McCartney has been learning more in her home city of Glasgow.

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McCartney

We can鈥檛 say for sure why there鈥檚 been a five-fold increase in Type 1 diabetes over the past 40 years but what we do know is that it鈥檚 easily missed and once diagnosed it is often challenging to manage.听 Around a third of children with Type 1 diabetes aren鈥檛 diagnosed until they鈥檙e critically ill with the extremely high sugar levels, a life-threatening condition called threatening condition called ketoacidosis.

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Dr Kenneth Robertson is a Consultant Paediatrician who鈥檚 led NHS Greater Glasgow and Clyde鈥檚 Diabetes Service for children for the past 25 years.听 Good management of Type 1 diabetes in childhood, he says, reaps rewards later on.

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Robertson

If you have good blood glucose control for a period of time, years probably but certainly many months, it seems to reset something in your body which means that even if you have a rocky time later on, let鈥檚 say in adolescence, which is common, you have less complications than somebody who hasn鈥檛 had that period of good control.听 And there is a big change because when I was a boy and started looking after children with diabetes there was a view that it didn鈥檛 much matter before puberty.听 That has been completely squashed and it matters a very great deal.

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McCartney

So, for Dr Robertson, here at his clinic at the Royal Hospital for Sick Children in Glasgow, careful monitoring of glucose levels in blood is the bedrock of good control and management of diabetes.

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But until recently, the only way to do that was by multiple finger prick tests using glucose strips a minimum of four times a day but often 10 times or more. 听It鈥檚 a lot of finger pricking and parents testify to the difficulties of doing that multiple times a day on their children 鈥� especially during the dip in blood sugars that usually happens overnight.

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So, the development of new technology that remotely senses glucose, not directly in the blood vessels but in the 鈥渢issues鈥� using sensors placed under in the skin, seems to be a game changer.

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Ben鈥檚 young son, George, has recently started using a continuous glucose monitor 鈥� a system that alarms when blood glucose levels are dropping.

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Ben

He鈥檚 six years old, loves playing with Lego and he鈥檇 had a really bad cold, so we were just finger pricking him every hour or so, we bought him a Lego set and his fingers hurt so much he couldn鈥檛 play with his Lego and that was really what flipped us.听 We were looking at constant glucose monitors and the various options out there and just decided to go with it after that and it鈥檚 an absolute life changer.

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McCartney

So, what were you doing before that then?

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Ben

Finger pricks.

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McCartney

Through the night?

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Ben

Through the night yeah.听 My wife鈥檚 generally up one, three, five, I don鈥檛 know how she works on no sleep, but she鈥檚 an absolute superhero.听

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McCartney

So, it sounds as though it鈥檚 made a big difference to you.听 Are you paying for this just now?

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Ben

Yes, and it is extremely expensive.听 The sensors are 拢205 a month and then every now and again you have to replace the transmitter, which is another 拢75 or so.听 We鈥檙e looking at funding but it鈥檚 a bit of a postcode lottery at the moment.

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McCartney

There鈥檚 also a new cheaper glucose monitoring system that鈥檚 making a big noise in diabetes care called flash glucose monitoring. 听Freestyle Libre is the company involved and unusually, it was marketed directly to patients. 听It came on NHS licence at the end of last year and Dr Robertson explains the differences between the two.听

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Robertson

Continuous glucose monitoring and flash glucose use essentially the same way to measure the tissue juice glucose.听 But the fundamental differences between them are that the flash glucose is not linked to anything, so it can鈥檛 control a pump and there are no alarms.听 And so, the essence of the technology is that you have to swipe a reader across your arm, across the sensor, in order to pick up the data that are stored there.听 And it doesn鈥檛 matter what the data show, if you don鈥檛 swipe you don鈥檛 know.

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Matthew

I鈥檓 Matthew, and I鈥檝e been Type 1 diabetic for about 10 years and I have the Freestyle Libra.听 It鈥檚 like a wee canula, you insert it into your arm and then when you鈥檝e done that you can just scan your bloods anytime you want without having to finger print all the time.听

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McCartney

Can I have a wee look at your scanner?听 So, it looks like an iPod type size, like one of those mini-iPod type things.

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Matthew

Yeah, so you press the wee blue button to scan, you just go over your arm.

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McCartney

Through your clothes.

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Matthew

Yeah you can do it through your clothes as well and then it tells you what your bloods are now and it shows you a graph of how they鈥檝e been over the past few hours.

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McCartney

Right okay.

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Matthew

It means that at night I sit and check my graphs and it means that I can change what insulin needs adjusted there from running high overnight or anything.

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McCartney

Do you still have to test your finger prick?

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Matthew

Yeah you do it maybe about once a day and if it comes up on it saying that your bloods are low then you 鈥� because it鈥檚 got a 15-minute kind of delay, so you do a finger prick check and if you鈥檙e low then you have your Lucozade and your biscuits.

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McCartney

So, it tells you what your sugar level was 15 minutes ago.

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Matthew

Yeah and it gives you an arrow telling you like if it鈥檚 going to be steady or if it鈥檚 going to come down or go up.

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McCartney

And Barbara your Matthew鈥檚 mum?

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Barbara

Yes.听 It鈥檚 been life changing, Matthew鈥檚 quite a deep sleeper, so if we feel that his blood sugar鈥檚 been a wee bit variable then we can check him overnight or if we know he鈥檚 going to have a longer lie in the morning then I can go in and scan him very early just to make sure that his bloods are okay and adjust if necessary.听 And the difference to his fingers has just been fantastic in just a few short months.

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McCartney

So, would you stick with this then, is this something you鈥檇 like to continue with?

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Matthew

Yeah definitely.

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McCartney

And are you getting this funded just now by the NHS?

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Matthew

Er no, I鈥檓 funding it myself.听 It鈥檚 about a 拢100 a month, but I鈥檓 really looking for the NHS to be funding it soon.

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McCartney

It鈥檚 easy to see how people like Matthew are rightly enthusiastic about the life-changing impact of this technical revolution on the management and control of their diabetes. 听But can we demonstrate that this is an evidence based, cost effective spend?

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Robertson

The political pressure to fund these new technologies is great and as a diabetologist who wants to have access to these technologies I understand that political pressure but as a scientist, as a professional, I have to be very careful that we don鈥檛 just run between technologies because otherwise we鈥檙e going to be into a VHS/Betamax type situation.听 And so just jumping on the next bandwagon is not a good idea but we must implement these things well, safely, in a controlled way and in partnership with our patients who must use these things to best advantage.

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Porter

Dr Kenneth Robertson talking to Margaret McCartney in Glasgow.

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Despite this new technology being broadly welcomed by NICE and the NHS there鈥檚 currently marked variation across the UK when it comes to funding.听 Even for those who meet the eligibility criteria for continuous glucose monitoring.听 And as we鈥檝e just heard some have even resorted to paying for it for themselves.听

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It鈥檚 a similar situation with the more recently approved and cheaper flash glucose monitoring.听 Nikki Joule is Policy Manager for Diabetes UK.

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Joule

There are some areas that have said absolutely no, they are not going to allow access for anybody at the moment.听 And there are areas where access is quite reasonable.

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Porter

And looking across the UK is any one country doing better than the others?

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Joule

Wales were pretty much first and ahead of the game and more consistent I think and Northern Ireland managed to put together a system very quickly.听 In Scotland we were told that they were waiting on a technology appraisal that鈥檚 being done in Europe but actually Lothian have just announced that they鈥檙e allowing access and I think one of the other health boards too.听 We know that people are making sacrifices to be able to afford this.听 I鈥檝e spoken to a mother who was doing extra shifts as a nurse so that she could afford to fund it for her child.听 I saw somebody this morning was saying that they鈥檇 spent 拢3,000 so far.

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Porter

And what sort of benefits are they telling you that they鈥檙e getting because I mean if you鈥檙e spending 拢3,000 and you鈥檙e having to work extra shifts there鈥檚 got to be some obvious tangible benefit?

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Joule

Exactly.听 The things that people say are that they understand what鈥檚 going on with their blood sugar levels, that they actually feel they鈥檙e in control of their diabetes.

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Porter

Because a lot of these patients are very interested, I mean doctors and nurses might think their own diabetes but the individuals own their own diabetes.

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Joule

Yeah and that鈥檚 really why we took it up as an issue because people were coming to us and saying this is one of the most revolutionary things that鈥檚 happened in diabetes, it empowers us.听

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Porter

You鈥檝e got a map where people can see what鈥檚 happening in their area in terms of access, I mean is there partly you trying to shame people into doing the right thing, as far as you see it?

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Joule

Yes, we want to give information to people about what鈥檚 happening in their local area but there is certainly part of that is to say look next door 鈥� in the next area to you they鈥檝e got access and you haven鈥檛.听 So, yes, there is a certain amount of that.听 We鈥檒l certainly be opposing blanket bans.听 Were this has been considered locally and a decision has been made not to allow access, there鈥檚 no real justification for that.

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Porter

And as far as you鈥檙e aware there are some parts of the country that have put a blanket ban on or are they saying at the moment not in the foreseeable future?

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Joule

It varies.听 Some areas have said that there鈥檚 a ban at the moment until they鈥檝e reviewed it and they鈥檙e waiting for evidence or guidance.听 But these areas aren鈥檛 so different from each other.听 So, the population of Hereford isn鈥檛 that different from the population on the other side of the Welsh border, so there鈥檚 no justification for that really.听 So, we will be opposing those.听 And then there鈥檚 areas where they鈥檝e said that they鈥檙e not going to review it for a year, I think we would see that as unreasonable.

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Porter

Too long?

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Joule

Too long.听

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Porter

Nicky Joule.听 Whatever the pace of uptake most people in the diabetes world agree that it鈥檚 the start of a revolution, a generational shift in the way blood glucose levels are measured.听 Dr Partha Kar is Associate National Clinical Director for Diabetes at NHS England.

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Kar

We have moved on from dipping urine to finger pricking in the 鈥�70s, 鈥�80s and this probably is the next generation of checking your glucose levels, so that鈥檚 where it probably will stand over the course of time.

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Porter

The flash technology has been unusual in that it鈥檚 been directly marketed to patients and patients have run with it, I mean a lot of them are funding this themselves.听 Does that concern you or is it something we should welcome?

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Kar

I think it鈥檚 been interesting to see how it鈥檚 gone but some people have bought it and as one of the roles of NHS England is to try and make the appropriate technology available to people irrespective of their ability to buy and that鈥檚 the course of the NHS.听 So, with that in mind we laid out the policy and negotiated it being on the tariff and that鈥檚 what we鈥檙e trying to encourage is better uptake, irrelevant about whether it鈥檚 being bought by people or not.

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Porter

I get the impression, speaking to some patients who are using this technology, some of them are using technology that piggy backs on the back of it, they seem to be running away with it and far ahead of us doctors in many cases.

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Kar

Absolutely, I think lots of people are looking at this technology.听 My personal view is that we should encourage this, anything that keeps people better or keeps them safe, there鈥檚 obviously the regulatory side of things which we need to be mindful of, but if patients are doing it and are better that鈥檚 something we all need to learn from.

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Porter

Fears have been raised by some doctors, including Dr Robertson, who we interviewed earlier, that we have to be careful that just because technology is new that we don鈥檛 jump on the wrong bandwagon, he used the example of Betamax and VHS, that we need to appraise this technology very carefully.听 We do need to proceed with some caution do we not?

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Kar

Absolutely.听 So, it鈥檚 a bit like buying a new car but without quite the skills to drive it.听 Any technology is as good as the person using it with the education base they have.听 So, when we talk about flash glucose the guidelines published is very clear that this should be given to people in whom they have some level of education, the healthcare professional has the education, the patient has the education and most importantly shows some benefit.听 So, there is a trio of conditions there as well which makes sense and quite rightly too.听 Technology, as you say, needs to be used based on the education you have.

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Porter

From a purely cost basis, I mean I know there鈥檚 no such thing as an average person with Type 1 diabetes, but from a purely cost basis if I鈥檓 testing say eight to 10 times a day is this likely to cost that much more?

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Kar

No, I think that鈥檚 where the national guidance has been set, that if you鈥檙e testing more than eight times a day it鈥檚 looked to be cost neutral.听 As regards other costs, if you improve your quality of life, if you improve your admissions or be able to stop yourself from going into lower blood sugar readings then we would expect some more financial benefits over the course of time.

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Porter

Is there any evidence yet that this sort of monitoring improves control to the extent that we might reduce the risk of medium to long term complications, which in themselves are very costly not only to the individual 鈥� I mean heart disease, stroke, kidney problems, eye problems 鈥� but also very costly to the NHS.

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Kar

Yes, but there is a real-world study done in about 50,000 patients who have used flash glucose monitoring and if you look at the data it clearly says that there is a significant drop in HP01C or the marker for diabetes control.听 And the important thing there is the more you scan the more you seem to improve you overall control.听 So, evidence is accumulating and most importantly as we have started to encourage more pick up of this technology in the UK we have also encouraged that a national audit be done and we鈥檒l be analysing the data hopefully to see what benefit it shows and glucose control will be one of them.

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Porter

Diabetologist Partha Kar, ending Margaret McCartney鈥檚 report on how technology is changing diabetes.

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Margaret is in our Glasgow studio now because she has also been taking a closer look at the research behind recent headlines about antidepressants. 听A large meta-analysis of over 500 clinical trials of the drugs, published in the Lancet, concluded that they work well and resulting media coverage suggested more people should be taking them.听 Some of you have asked if the study was funded by pharmaceutical companies 鈥� it was not 鈥� others, including Dr David Stevenson, have been in touch to point out that this research centred on major depression, not the more common mild to moderate forms.听 Margaret?

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McCartney

Well that鈥檚 a really good point and this study hasn鈥檛 got full information about which patients are most likely to benefit from the drugs.听 And while I have no doubts that they do help some people, we also have quite clear evidence that they don鈥檛 make a big difference to the vast majority of people with mild to moderate depression.听 And that鈥檚 why NICE, for example, don鈥檛 recommend that they鈥檙e used first line for people with mild depression, they recommend other treatments instead.听 And this study, of course, only looked at antidepressants as a treatment for depression, they did not look at the psychological interventions that we know work really well, at least as good as, or better, than antidepressants for many more people.

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Porter

One of the surprising findings for me was the difference in how well these drugs worked.听 I mean looking at this meta-analysis amitriptyline, one of the oldest antidepressants, came out way on top whereas citalopram, that鈥檚 one of the newer generation of Prozac-type drugs came close to the bottom, and that鈥檚 the one we鈥檙e using mostly these days.

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McCartney

Yes, I mean one of the reasons why we don鈥檛 use amitriptyline so much now, I think it鈥檚 two-fold.听 One is it鈥檚 what I would describe as a bit of manky drug, it鈥檚 got lots of side effects, for example sedation, constipation, dry mouth, people just generally not feeling great on it at the high doses that we need for depression.听 We still use it quite a lot but in much smaller doses for chronic pain.听 So that鈥檚 one of the reasons why we don鈥檛 use it so much.听 And the other reason is that it鈥檚 very, very toxic in overdose, there are many fatalities due to amitriptyline taken in overdose by people who are depressed has largely been avoided now because we hardly use it for depression.

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Porter

But the takeaway message from this research is that the modern drugs may be better tolerated but they鈥檙e perhaps not as effective?

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McCartney

The researchers tried to look at this in terms of a sliding scale of effectiveness and one of the methods they used was depression questionnaires asking people to plot on a tick box questionnaire how bad their symptoms were and then giving them a score.听 And you can have high statistical significance when you get clear differences between the drugs in terms of what the questionnaire showed, how many points people got from their depression score, to say that one is different from the other but these might not be clinically significant.听 So, a small change in points might be statistical proven, it might be something that you鈥檙e quite certain about looking at the analysis but it might not make a really big difference to patients.听 And that鈥檚 the bottom line 鈥� are these drugs clinically effective enough for people to put up with the side effects.

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Porter

So, these differences might not translate into real world benefits.听 And talking of the real world the other thing that struck me about this was the average duration, when they looked at the antidepressants in the study, was just eight weeks and you and I know that the average course, in fact the minimum course, is probably something more like nine months.

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McCartney

Or at least and one of the big problems that we have, as yet unanswered, is what is the effect of taking these drugs perhaps on and off or mainly on for years at a time.听 And that鈥檚 where we have real deficits in our information.听 It鈥檚 really tragic that so many trials have been done looking at the short-term when the real-life use is of months and even of years.听 It鈥檚 really appalling that decades have passed without us asking the fundamental questions of how we鈥檙e using them today and whether that鈥檚 safe and effectively good practice or not.

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Porter

Thank you Margaret.

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And for those of you keen to do your own critique there is a link to the Lancet antidepressant meta-analysis on the Inside Health page of the Radio 4 website.听 Where you can also subscribe to our podcast service meaning you will never miss an episode again.

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Nearly 200,000 hip and knee replacements are performed every year in the UK, the vast majority of them on middle aged or elderly people with osteoarthritis.听 What if we could repair damaged cartilage in younger people and prevent them developing arthritis that requires a new joint later in life?

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Well, that is one of the aims of researchers harnessing stem cell therapy to grow new cartilage to reline damaged joints. 听But it鈥檚 a complex process that, up until recently, has involved two stages 鈥� one to harvest the stem cells and grow them into cartilage, and another to put the new tissue back into the injured joint.

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But now a team at the Royal National Orthopaedic Hospital in Stanmore has developed a one stop operation that means the stem cells can be collected and put back into injured knees within a couple of hours.

George Bentley, Emeritus Professor of Orthopaedics at University College London, has been leading the work.

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Bentley

Yes, well in the knee the surfaces are lined with articular cartilage, which is unique in the sense that it鈥檚 extremely tough.听 Now the problem is that there鈥檚 no blood supply nor even nerve supply to the cartilage.听 And so, if it gets damaged it doesn鈥檛 repair.听 So, it鈥檚 crucial for the joint and if the cartilage breaks down for any reason then the joint becomes painful and gradually and progressively deteriorates.

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Porter

So, the function of cartilage within the joint, it鈥檚 a sort of slippery resilience, slightly softer surface than the bone, that allows the joint to work smoothly?

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Bentley

Yes, and it鈥檚 extremely slippery.听 The normal joint is probably three or four times more slippery than the best artificial joint that we have.

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Porter

So, because it lacks blood supply, cartilage doesn鈥檛 repair itself effectively, so as a result of injury or other diseases processes if you get a defect in your cartilage you鈥檙e in trouble?

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Bentley

Yeah, yeah absolutely.听

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Donaldson

My name is James Donaldson, I鈥檓 one of the Consultant Orthopaedic Surgeons at the Royal National Orthopaedic Hospital in Stanmore.听 We鈥檙e talking about the articular cartilage, which is the end of the thigh bone in the knee and the top of the shin bone in the knee.

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Porter

How would people injure that?

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Donaldson

It can be from trauma, so one of the commonest reasons is an athlete that damages their knee.听 Everyone knows about damaging the ligaments or the meniscus but what isn鈥檛 fully appreciated is an injury to the actual articular cartilage, the lining of the knee joint.听 In the past the treatment of that has been less effective.听 One of the techniques is to drill into the bone and encourage healing the scar tissue, which is what we call micro-fracture.听 That heals with a fibro cartilage which isn鈥檛 as mechanically sound as normal articular cartilage.

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Porter

Sort of scar tissue.

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Donaldson

It鈥檚 a scar tissue, so it鈥檚 a scar tissue repair.听 That does give symptomatic improvement for about five years but after that the results tail off and then they end up again in the osteoarthritic situation requiring further surgery.

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Brown

So, I鈥檓 approaching 40 this year and in my early 30s I started to get a lot of knee problems after playing rugby my whole life basically, just through wear and tear.听 Had a couple of cartilage operations but nothing seemed to really work.听 And then the doctor said to me your next step really is to have your whole knee replaced and as a 30 something chap I was thinking oh this is not looking good, I really wanted to try to do everything I could to not have to go through that at such a young age.

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Bentley

Everybody knows that stem cells can grow into any sort of other cell.

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Porter

A sort of universal starting point.

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Bentley

A universal donor cell, yes, I mean it can be neurological tissue or it can be nerve tissue or it can be cartilage.听 And so, what we do is we take cells from the bone marrow, which is within the bone of the pelvis, and when you centrifuge it you can recognise a layer of cells which are precursors of the stem cells.听 And so, we separate those out.听 We also use a high uronic acid matrix, which is of mesh work, and we put the stem cells, precursors, into the matrix and it takes about 30 minutes at maximum to prepare this blood and stem cells and then the matrix.听 And so, in the meantime we open the joint, clear the defect and where we had put in cells by injection before we now put in this matrix with the stem cells.听 The advantage of that is that it鈥檚 also very quick because you can actually secure this transplant of cells and mesh work with glue and so you don鈥檛 need to do any suturing.听 And so, the procedure with all of that that I鈥檝e mentioned takes probably a maximum of an hour and a half.

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Brown

The immediate reaction of a lot for people is what are you going to have a mouse growing an ear on the back or something like that, like some sort of Frankenstein operation.听 But as I read more and more about it it鈥檚 actually you鈥檙e using your own cells to repair your own body.听 So, my head got around it quite quickly I think and I鈥檝e realised actually this is a great idea, great opportunity because if my only other opportunity is to have my knee replaced with metal, which would then have to be replaced again in 10 or so years鈥� time, let鈥檚 give it a go.

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Donaldson

Well we have data coming up to 18 months to two years now and in the correct patient the results are comparable to the two-stage process that has been written about in the literature.听 The results are probably in the region of 75% effective in reducing patients鈥� pain and improving their outcome.听 So, improving their function.听

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Porter

You鈥檙e a specialist unit here, you鈥檝e been involved in the research, I can see your patients having access to it, what about people in other orthopaedic units across the country?

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Donaldson

Regenerative cartilage procedures are expensive or have been expensive in the past.听 NICE at the National Institute for Clinical Excellence, has recently said that autologous chondrocyte implantation is a useful first line procedure for a cartilage injury in a young patient.听 That procedure 鈥� the ACI 鈥� costs in the region of 拢15-16,000.听 We have moved on slightly from that, doing this in a one-stage procedure and we think we can reduce the cost of the procedure to about 拢3 or 拢4,000, although any of these procedures are done in specialist units and they need to be done as part of a research trial so that we can monitor the patients, ensure the right patients are having the right operation and looking at the long term outcome.

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Brown

Came out of the operation and just had a leg brace, like fixed leg brace, a leg out straight.听 It was just like that for a couple of days and then they fitted me with a hinged, like Velcro leg brace, and encouraged me to move the leg as much as possible.听 But it was three months non-weight bearing, so not putting any weight through my leg.听 Then after three months it was do partial weight bearing, so that was walking with crutches and putting 50% weight through it.听 So, it was a slow recovery 鈥� so it was about six months before I could probably walk without crutches.

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Porter

From a personal and professional point of view I mean how do you feel about the procedure?听 It feels a bit like a dawn of a new horizon, we鈥檝e been there before though.

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Donaldson

We鈥檝e been there before, there鈥檚 always dawns of new horizons in medicine.听 I think medicine and particularly orthopaedics are going to go down a regenerative route, looking to the future and trying to delay the need for more expensive and invasive procedures like joint replacement surgery.听 So, it鈥檚 not just the knee that this is applicable, so the foot and ankle, shoulder, all have very similar cartilage defects and if we can show this is a useful tool, a useful procedure with long term data then it can applied in all parts of the body.

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Brown

My father had really bad rheumatoid arthritis, so he could never run around with my brother and I when we were younger and so one thing in my head was I really want to try and be able to run around with my little boy.听 And so now, yeah, I can do that, we go to rugby training on a Sunday morning, he鈥檚 only four but he gets involved in rugby tots and it鈥檚 just great to be able to experience this growing up with him.听 And I could run for a train if I want to, I could go dancing with my wife if I want to.听 The physio said I could start skiing again, I鈥檝e started jogging.听 So, it really has gone from just being able to walk in lots and lots of pain and have to take ibuprofen and paracetamol quite regularly to move at any speed I like to now.听 It鈥檚 really changed my outlook on life really.听 So yeah, I鈥檓 really pleased with it.

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Porter

Nick Brown who seems very happy, so far, with the experimental new stem cell treatment being trialled by George Bentley, James Donaldson and the rest of the team at Stanmore.

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Just time to tell you about next week when, among other things, I will be finding out why half the people who have heart attacks in the UK are still missing out on an established therapy that could dramatically improve their odds of survival. 听And it doesn鈥檛 involve a pill. 听Join me then to find out more.

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ENDS