Lost in translation

In 2017, we can study the unimaginably small and share unimaginably vast amounts of data. But, as a GP involved in the day-to-day delivery of primary health care, I often wonder why, if so much is known, we can do so little? Why is there such a lag between the headline scientific discoveries and what a local GP can offer? Bridging that gap as speedily and effectively as possible is the aim of an emerging field of biomedical science called translational medicine. Scientists, healthcare professionals, pharma and funders are collaborating to translate science into solutions, or “bench to bedside”. The mantra for governments and agencies that fund health services across the world is “value-based care” – basically, payment by results. To be fair, it’s not all about cutting costs: the idea is to stop funding poor-value healthcare, and move towards an era of “precision medicine” in which your genomics, epigenomics (chemicals that tell the genome what to do), environmental exposure (eg pollution) and other factors guide the care you are offered.

Computer assisted medicine

Precision medicine – or, indeed, any form of modern medicine – is no longer possible without data. Data from your body is increasingly being collected by wearable devices; not just footsteps but measurements of weight, blood pressure, heart rate and temperature. Platforms such as IBM’s Watson can mash up your personal data with information from “big data” – vast repositories of information from universities, scientific institutions and publications as well as commercial companies. Algorithms will deliver tailor-made advice to you via an app, such as Nutrino, that provides guidance about diet. The system “learns” from your input and gets ever cleverer. Meanwhile, online avatars are being trialled to help people with schizophrenia and have been used to detect early signs of depression in servicemen and women in the field. An immersive virtual reality therapy that helps people with depression to be less critical of themselves has also reported promising results.

Go for the gut

Analysis of your gut biome will become increasingly popular. We have 100tn microbes (mostly bacteria) in and on our body; most live in our gut, the rest on our skin and elsewhere. That’s 10 times more than our own human cells. The genetic information carried in these microbes is thought to play a major role in producing chemicals that drive vital processes such as healing, metabolism and immune function. The holy grail is understanding what a healthy biome looks like, how to feed ourselves to nourish it and which foods or supplements will restore an ailing biome to prevent or treat ill health. If you want to know how your biome compares to other family members and other volunteers, you can take part in The British Gut Project.

The next public health challenge?

Alcohol is now the leading risk factor for early death, ill health and disability among 15- to 49-year-olds, according to a new report from Public Health England [pdf]. Setting a minimum price for alcohol helps to cut drinking but the alcohol industry obviously opposes it. Overall, smoking, poor diet, obesity and untreated high blood pressure all trump alcohol when it comes to risk factors that contribute to disease in the UK. Legislation banning smoking in cars carrying under 18s has proved hard to enforce and campaigners will be looking for convictions to drive the message home. Vaping remains controversial, but seems to help people to quit and stay off the fags. Critics’ fears that widespread vaping would trigger a rise in smoking among the young haven’t been realised. Tight EU legislation controls vaping and tobacco industries; but smokers looking for looser controls as a result of Brexit may be disappointed. The most pressing public health challenge must be closing the health gap; life expectancy in England has increased from 75.9 years in 1990 to 81.3 years in 2013. But behind this piece of good news lies a shameful fact; rich men live nine years longer and rich women seven years longer than their poorest compatriots.

Zika virus

Last year saw the first UK case of a woman who got zika from her partner who had been on holiday in an area where it’s rife, and with international travel and no specific treatment, we’re likely to see more cases in the UK this year. The virus can cause microcephaly with associated developmental delay if a woman gets it while pregnant. Men returning from a zika area are advised to use condoms or abstain for six months; women should avoid getting pregnant and use barrier methods for eight weeks.

Is scurvy coming back?

The number of people with scurvy in the UK is small but growing and many more are at risk because of poor diet that lacks the fruit and veg that contain vitamin C. Alcoholics, drug users and the homeless are most vulnerable. Scurvy is caused by a lack of vitamin C, which is needed for collagen. Severe deficiency causes bleeding gums, dry skin, poor healing and muscle pains. You need 40mg a day – that’s equivalent to half a large orange, a kiwi fruit, a small red pepper or a 50g portion of sprouts. Frozen and tinned fruit and veg retain their vitamin C. Women who are pregnant and breastfeeding need a bit more (50mg a day in pregnancy, 70mg a day while breastfeeding).

Will ketamine replace morphine for severe pain?

The anaesthetic drug ketamine can be given as a nasal spray and provides good pain relief, compared with an injection of morphine. On the street, it’s a class B drug, popular for the dissociative feelings it induces, but at higher doses it can cause a “K-hole”, which is a longer, deeper detachment from reality, often with hallucinations. At lower doses, it may be increasingly prescribed for severe pain. Currently, it is used mostly as an anaesthetic in children, who don’t seem to be as susceptible to its mind-altering effects.

Will this year see proper treatments for dementia?

There was disappointment that the trial into injectable antibody solanezumab failed to live up to expectations. But now there is excitement about the drug brimonidine. It is currently used to lower eye pressure in glaucoma, which reduces amyloid protein in the retina of the eye. The hope is that it may have a similar effect in the brain, where toxic amyloid deposits are implicated in the nerve damage and death that occur in Alzheimer’s disease.

Will the UK get the artificial pancreas for type 1 diabetes?

The artificial pancreas is a wonderful piece of kit that continuously monitors the blood glucose levels of people with type 1 diabetes and links to their insulin pump to deliver the correct dose of insulin. This is exactly what happens in the body naturally in non diabetics who have a functioning pancreas. It has FDA approval in the US and, with several trials underway, may be available in the UK soon.