Sensors that could be implanted in the body to collect data about fracture healing are being developed by Turkish and American researchers.

“More than 10 per cent of fractures do not heal properly, but doctors are not able to see the bones healing, instead they have to make educated guesses,” said Emre Unal, a nanotechnologist at Bilkent University in Turkey.

X-ray of fractured femur. Image credit: Smitha Mundasad

In experimental models, sensors are applied to metal plates, similar to ones used by surgeons to fix fractures in place. The wireless sensors can then pick up information on the strain applied to them.

The nanotechnologists hypothesise that, over time, as bones heal and patients start to become mobile, less strain will be detected by the sensors as more will be taken up by the healing bone. When fully developed, they suggest, a doctor could monitor strain data over time to check whether a fracture is healing as expected. This important information could be obtained without scans and invasive procedures.

Experiments are currently taking place on sheep metatarsals in the US, which show promising results.

There are still, however, many barriers that need to be overcome if this is to become a clinically useful tool. “Sensors will need to be made of biocompatible material, and tests will have to take place on human bones,” explained Unal.

“Nanotechnological advances are set to make a huge contribution to medicine,” said Mohan, a Bristol surgeon.

In defence of a state they helped to create, thousands of pensioners gathered in force to fight for protection of the welfare state at the 10410 demonstration.

“The same generation that fought fascism, the same generation that built the welfare state is now calling this demonstration,” said Bob Crow, of the National Union of Rail, Maritime and Transport Workers.

Protecting the NHS played a prominent part in the rally, which was organised by the National Pensioners Convention and gained support from a diverse range of public sector workers and trade unions, from the British Medical Association, and National Union of Teachers to Medway Pensioners Forum.

Dr Hamish Meldrum, chairman of the British Medical Association said: “Never has it been a more important time to speak out in support of the NHS, when public services are facing unprecedented financial strain.”

Commenting that the major political parties in England “seem obsessed with marketed healthcare”, he asked the crowd, “isn’t it ludicrous that while we have nationalised banks, we are privatising the NHS?”

Dr Rob Galloway, an Accident and Emergency doctor of eight years said: “Patients are not commodities, they are people. But despite that, there has been a raft of policies to commercialise the NHS which has led to inefficiencies and decreased productivity”.

This was a unique event, bringing together people from all major public sectors. “We are not in competition with each other. Those who are in competition are the ones who purchase and make a profit out of our services,” said Dot Gibson, an organiser of the event and general secretary of the National Pensioners Convention.

Standing within breathing distance of several beautiful, magnificent cows, it was hard for me to stomach the fact that people once forced these natural herbivors to eat bits of animal brains, kidneys and other organs. The effort to bulk them up led to the spread of  bovine spongiform encephalitis (mad cow disease), and its human form, Creutzfeldt-Jakob disease.

These diseases are puzzling. While most infectious diseases are transmitted by bacteria and viruses, BSE and CJD are caused by misshapen proteins (prions). Ever since the plague struck in the 1980s, scientists have been trying to figure out exactly how it spreads.

Nan King, Paul Rodgers and I spoke to Professor Nigel Hooper of the University of Leeds whose team has discovered a key step in turning normal proteins into infectious ones.

A British baby is the first newborn in the world to receive xenon gas treatment, in an attempt to reduce the chances of brain injury.

Over 1,000 babies born at full term each year are at risk of suffering from brain injuries or death as the result of a lack of oxygen or blood supply at birth.

Baby Riley was born with no spontaneous respiratory effort. In need of urgent resuscitation, he was given the rare xenon gas at St Michael’s Hospital in Bristol by Prof. Marianne Thoresen.

An illustration of Xenon gas being given to a child

In combination with a cooling treatment, Thoresen believes that this could prevent brain injuries that are associated with conditions such as cerebral palsy.

The treatment has been developed over a number of years by Thoresen of the University of Bristol and John Dingley of Swansea University.

“In 2002, John Dingley and I realised the potential xenon and cooling might have in combination to further reduce disability,” said Thoresen.

The team has shown that in laboratory studies xenon gas adds to the protective effect of cooling on the brain.

“However we faced the challenge of how to successfully deliver this rare and extremely expensive gas to newborn babies,” continued Thoresen.

This was solved by the use of a machine invented by Dingley, who has also developed equipment to allow the use of xenon gas for adult anaesthesia.

Dingley said: “A key design feature of this machine is that it is very efficient, using less than 200ml of xenon per hour – less than the volume of a soft drink can. As even newborns breathe many litres of air per hour, any xenon-based treatment would be impossibly expensive without an economical delivery method.”

The gas has been authorised for use in a clinical trial, funded by the children’s medical research charity Sparks, and will be given to at least 12 babies over the coming months. If this feasibility trial is completed successfully, it is hoped that the gas will become available on a wider scale.

“I want to save lives and help people” is the one phrase that thousands of hopefuls have been told not to say at an interview for a place at medical school. This answer is deemed to be too idealistic, and too superficial. Medicine has a lot of challenges; it is not about the chummy hilarity of Scrubs, or the steamy store-cupboard romance of Casualty. But it is about doing more good than harm… right?

A laryngoscope.

Over the last few weeks, more than one million NHS employees have had to face a difficult fact. Sometimes, in the very act of saving a life, they are endangering someone else’s.

Young children around the world are working in sweatshops to make the surgical instruments that are used in our operating theatres, according to Mahmood Bhutta, a surgeon in Oxford.

“There is evidence that children as young as seven are risking their lives to supply us with equipment to save British lives” he said.

During his honeymoon, on a stopover in Pakistan, Mr Bhutta was invited to explore Sialkot’s maze of manufacturing workshops. Many of these workshops are the backrooms of small houses.

Making surgical instruments

Making surgical instruments involves forging, filing, grinding and using chemicals such as sulphuric and nitric acid. In England, workers are issued with adequate protective gear. Mr Bhutta, however, saw children and adults working in dangerous environments, without appropriate protection.

“Some of the workers in the developing world who make medical supplies bound for the NHS are exposed to hazardous working conditions where they risk serious injury and even death,” Mr Bhutta said.

He told me that after witnessing these conditions, he spent the next six months grappling with the ethics of doing or not doing something about this situation. For many of the employees this work puts food on the table. And for some children, this is a job that could give them skills for life. Furthermore, in a market that is highly competitive, firms in Pakistan need to keep prices low.

From Pakistan to the NHS

Manufacturers in Pakistan often lack the infrastructure to market or sell their goods directly to the NHS. Middlemen in European countries often buy these goods from Pakistani firms. A substantial mark-up in price is then added, before these instruments are sold to the NHS.

According to an article by Mr Bhutta, which appeared in the British Medical Journal (BMJ) in 2006, “a pair of fine surgical scissors will cost $1.00 to produce, will be exported from Pakistan to Germany at the price of $1.25 and will probably be sold to a hospital for nearer $80.00”. Mr Bhutta was told these figures via personal communication, but as he points out in the article, there has not been a systematic examination of NHS procurement.

A complex system

Procurement in the NHS is complex – it happens on many levels, from the NHS who negotiates national contracts on products, to independent procurement done by individual hospital trusts.

What is the solution?

According to Mr Bhutta, this is not an issue of blame. He told me that when he approached the NHS, they were unaware of these practices.

Finding a solution is difficult. As Mr Bhutta mentions in the BMJ article boycotting these goods would reduce trade in the region and heighten poverty, the very problem that underlies this issue.

Mr Bhutta continues in the article: “the solution lies in purchasers insisting on fair and ethical trade when sourcing instruments. Pressure must be applied to suppliers in the developed world to be transparent about where their instruments have been manufactured and for them to ensure that the labourers have been paid a fair wage for their work and that basic international labour and health and safety standards have been followed”.

The Fair and Ethical Medical Trading Initiative

In 2007, two years after the honeymoon visit, the British Medical Association and Mr Bhutta set up the Fair and Ethical Medical Trading Initiative. Working with the Department of Health, the NHS Supply Chain, a number of nongovernmental organisations and academics, this group recently produced a set of guidelines for doctors who wish to tackle the issue.

The group is calling on doctors to:

Ask their chief executive to adopt ethical procurement into their institution’s policy

Ask health care suppliers where, and under what conditions, they produce their goods

Form an ethical trade interest group within their institution

Tell others

What has been done so far?

The NHS Purchasing and Supply Agency, in a partnership with the Ethical Trading Initiative has produced a guide to ethical sourcing in the NHS.

The NHS Supply Chain has also produced guidelines.

With NHS funding cuts threatened in the near future, it is difficult to predict the impact of these guidelines. Bringing change to such an ethically complex situation is likely to take time, care and commitment.

The Medical Fair and Ethical Trade Group is now working to ensure that “this is not just a paper exercise”.

The question is, how will our world-renowned health care system react to this situation? Will the NHS choose to be morally cheap? Or will we stand up and fight for global health?

A spoon full of humour to help the homeopathy go down… a comic report from the 10:23 event, brought to you by Smitha Mundasad, Nan King and Paul Rodgers.

Also read Paul’s thoughts on homeopathy, and a news report by Smitha.

A mass overdose of homeopathic pills, involving thousands of people across the globe, took place on 30 January 2010 at 10.23am in an attempt to prove that homeopathy is ineffective.

“What we are really trying to do is just to make that key point to the public that homeopathy – there is nothing in it,” said Martin Robbins, press officer of the so-called 10:23 campaign. “10:23 comes from Avogadro’s number which is 6 times 10 to the 23. It is a number you can use to calculate how many molecules of something are in a certain amount of it.”

This name is in reference to the method of dilution used in homeopathic practices. Remedies are prepared by a serial dilution of a certain active substance. According to widely held homeopathic beliefs the more diluted a mixture becomes, the more powerful it is deemed to be. Skeptics argue, however, that due to serial dilution, there can be no active ingredients left.

The 10:23 event was prompted by an on-going evidence check by the Science and Technology parliamentary sub-committee into the use of homeopathy. “I have no evidence to suggest before me that they [homeopathic remedies] are efficacious,” said Paul Bennett, professional standards director of Boots, at the committee’s meeting in November 2009.

While this comment shocked protesters such as Robbins, Evan Harris, the science spokesman of the Liberal Democrats, questions the use of homeopathy in the NHS. “Why it is that the NHS is spending millions of pounds on that particular therapy when it cannot afford to provide treatments for very serious conditions which have proven efficacy in serious trials,” he asked the protestors gathered in central London.

“Homeopathy is still in the NHS and we are fighting to keep it in the NHS as this is about choice,” said one of the few homeopaths present at the event. “We have over two hundred years of homeopathy working. It is used in India in major hospitals for example. …People get better with homeopathy; people still want to use it.”

Asked how he was feeling after the overdose, Evan Harris said: “The serious point is you cannot overdose on homeopathy because there is no active ingredient… clearly if you dilute something so much that there is nothing left and then say this is effective then I think you are relying on people’s gullibility or desperation.”

Dave Gorman, the British comedian, who also took part in the proceedings, commented: “I’m taking arnica, I should never bruise again.”

Twitter activity around the world, suggests that weeks on, the so-called placebocide has caused the overdosers no harm. According to Evan Harris, the select committee will announce the conclusions of its evidence check in the near future.