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Dr Maure operated on patients illegally, investigators say

A French cosmetic surgeon accused of having mutilated or endangered the lives of dozens of patients has been arrested in Spain.

Michel Maure had gone missing after standing trial in Marseille in June, accused of false advertising, deception and causing involuntary injury.

He was arrested in Rosas, north-eastern Spain, on Tuesday. An international arrest warrant had been issued for him.

Prosecutors called for four years’ jail and a 75,000-euro (59,000) fine.

He was struck off the French medical register in January 2007 after numerous complaints about his procedures. He had practised illegally since 1995, investigators say.

There were 96 complaints from former patients against Dr Maure, 59, including allegations that he had carried out painful procedures under local anaesthetic, in a dirty clinic.

He had claimed to be “one of the best plastic surgeons in the world”.

The verdict was planned for September and he was subject to a French court order restricting his movements. He had been told to report to police every week. He now faces extradition from Spain.

NEW YORK (AP) — Scientists say they’ve found an efficient way to make red blood cells from human embryonic stem cells, a possible step toward making transfusion supplies in the laboratory. The promise of a virtually limitless supply is tantalizing because of blood donor shortages and disappointments in creating blood substitutes.

Red blood cells are a key component of blood because they carry oxygen throughout the body.

Experts called the new work an advance, but cautioned that major questions had yet to be answered.

The research, published online Tuesday by the journal Blood, was reported by scientists at Advanced Cell Technology in Worcester, Mass., the University of Illinois at Chicago and the Mayo Clinic in Rochester, Minn.

The researchers said the cells they made behaved like natural red blood cells in lab tests, and that their process could be used in large-scale production. The results suggest that embryonic stem cells could someday supply type O-negative “universal donor” red cells for transfusion, they wrote.

Mohandas Narla, director of the Lindsley F. Kimball Research Institute at the New York Blood Center, called the results “a very good start.”

Now it will be important to show that the complex lab process really can pump out red cells on a large scale, and that the cells will survive long enough in the human body to be useful, he said. Natural red cells circulate for an average of 120 days.

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On the Net:

Journal Blood: http://bloodjournal.hematologylibrary.org/

Blood facts: http://www.nybloodcenter.org/bloodfacts/index.do?sid02&sid119&page-id39

CHICAGO (AP) — A new analysis of government data is the first to link low-level arsenic exposure, possibly from drinking water, with Type 2 diabetes, researchers say. The study’s limitations make more research necessary. And public water systems were on their way to meeting tougher U.S. arsenic standards as the data were collected.

Still, the analysis of 788 adults’ medical tests found a nearly fourfold increase in the risk of diabetes in people with low arsenic concentrations in their urine compared to people with even lower levels.

Previous research outside the United States has linked high levels of arsenic in drinking water with diabetes. It’s the link at low levels that’s new. The findings appear in Wednesday’s Journal of the American Medical Association.

“The good news is, this is preventable,” said lead author Dr. Ana Navas-Acien of Johns Hopkins Bloomberg School of Public Health in Baltimore.

New safe drinking water standards may be needed if the findings are duplicated in future studies, Navas-Acien said. She said they’ve begun a new study of 4,000 people.

Arsenic can get into drinking water naturally when minerals dissolve. It is also an industrial pollutant from coal burning and copper smelting. Utilities use filtration systems to get it out of drinking water.

Seafood also contains nontoxic organic arsenic. The researchers adjusted their analysis for signs of seafood intake and found that people with Type 2 diabetes had 26 percent higher inorganic arsenic levels than people without Type 2 diabetes.

How arsenic could contribute to diabetes is unknown, but prior studies have found impaired insulin secretion in pancreas cells treated with an arsenic compound.

The policy implications of the new findings are unclear, said Molly Kile, an environmental health research scientist at the Harvard School of Public Health. Kile wrote an accompanying editorial in the journal.

“Urinary arsenic reflects exposures from all routes - air, water and food - which makes it difficult to track the actual source of arsenic exposure let alone use the results from this study to establish drinking water standards,” Kile said.

Also, the findings raise a chicken-and-egg problem, she said, since it’s unknown whether diabetes changes the way people metabolize arsenic. It’s possible that people with diabetes excrete more arsenic.

The United States lowered arsenic standards for public water systems to 10 parts per billion in 2001 because of known cancer risks. Compliance was required by 2006, years after the study data were collected in 2003 and 2004.

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On the Net:

JAMA: http://jama.ama-assn.org

Arsenic Map: http://water.usgs.gov/nawqa/trace/arsenic/

EPA: http://www.epa.gov/safewater/arsenic/index.html

Analysis

Percentages might make news stories stand out, but without a connection to the human experience, can become meaningless. Wouldn’t it be good to have the mental agility to separate the wheat from the chaff? In his third lesson of a weekly series, author Michael Blastland gives some hints for percentages.

Lesson Three: Percentages

The story: Vitamin E can kill. Supplements cause a 14% increase in mortality, said the man on telly, standing in front of a huge “14%”, propped up on a number like the bar of the local.

The flaw: Funny, but wasn’t my risk of mortality quite high already? Like, 100%? But no, it’s even worse than that. Vitamin E supplements apparently make the end more than certain. For death has become like a footballer, giving it 114% out there today, Brian.

The lesson: Journalists and percentages mix like ball bearings in souffle. They say their preference is for real life over boring, abstract figures. Not with percentages, it’s not.

Often these digits become no more than that: digits, fetishised, but separate from human meaning and, in the case of risk, frequently reported only if they can be made to look big or scary.

We need to reconnect them with human experience. Here are two ways.

First, we need to remember that not much in life is either/or. According to the research, there’s something in the claim that Vitamin E supplements can be harmful. But, as with the consumption of salt, or even water, much that can kill is also essential to good health.

The world does not divide easily into what’s toxic and what’s not, what’s safe and what isn’t. Risk is simply a way of measuring where we stand on the messy middle ground - which is almost everywhere.

What matters in that messy middle is the relevant human quantity: how much supplementary vitamin E? A little won’t do any harm (or, probably, much good). A lot, especially if you are getting on in life, might.

So a 14% increase in risk of death does mean something, but only if you say at what dose (high), for which group (the elderly), over what period (a single year, not in a lifetime).

The second common problem with any percentage increase like this, also crying out for a dose of real life is: what’s it increased from? Because 14% might be a lot if you start somewhere big, next to nothing if you start somewhere small.

A 100% increase from one in a million becomes two in a million. So what?

A 100% increase in the number of bullets in a revolver - if you are playing Russian roulette - well, that makes a difference.

How can supplements cause a 14% increase in mortality?

So let’s get human again and ask where we begin. What is the risk of dying, this year, for a 75-year-old man? And let’s keep percentages out of it, as far as we can.

The answer is that in every 100 men aged 75, four or more will typically die in the next year. If all 100 of them tuck heartily into Vitamin E, maybe five will.

That is, according to this research, there’ll be less than one (actually 0.6) extra death per 100 people if all are on high doses of vitamin E. At low doses, there’s almost no change.

That’s what 14% turns out to mean: 0.6 of a death per 100, or six deaths per 1,000. I wonder if a large daily dose of salt is any worse?

For 60-year-olds, the risk of death this year is so much smaller to begin with that even an extra 14% risk (from a high dose of Vitamin E) makes almost no difference at all.

Junk rating: Four out of five. There’s some salvation in the fact that this was part of a report on all kinds of teenage cancers, some of which are a real concern, but this was the one that had the attention. Yet the human numbers are so small they might well be the result of nothing more than random variation.

A little context can make a lot of difference to a percentage. Another simple example is the story that young Americans can’t afford to move out and are all now stuck with the folks.

Since 1970, when 12.5 million 18-34 year olds lived with their parents, the number has apparently risen by 48%, to more than 18.6 million.

Except that the American population has also risen in that time - by about 32%, or roughly 75 million people. So, in figures easier to translate to real life, the number of 18-34 year olds still living with the folks has gone from a bit more than one in five to not quite one in four. Still a real increase, but nothing like 48%.

The biggest part (though not all) of the explanation for increasing numbers of Americans living with their parents is… that there are increasing numbers of Americans.

Or take what it means to be 99.9% effective. In the NHS it might mean 135 botched operations and 13 babies given to the wrong parents, every week. (Thanks to writer Anne Miller for that example).

A percentage is not really a number, it is a share. The simple question to keep in mind is one that always strives to put it into a proper, human context: “A share of what? A share of a lot - or a share of a little?” Better still: “A share of who?”

Keep it real.

Next week, Lesson Four: Averages

Michael Blastland is the author, with Andrew Dilnot, of The Tiger That Isn’t.

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The 55 camera was placed inside one of the teddy bear’s eyes

A forensic science graduate and her father caught his terminally ill mother’s care assistant stealing by putting a camera in a teddy bear’s eye.

Robert Sampson, 46, and Emma, 21, fixed the tiny camera in the Liverpool home of his mother Thelma Sampson, 75.

Last week, care assistant Yvonne Allen, 28, of Halewood, Liverpool, was sentenced to six months in prison after pleading guilty to two counts of theft.

Mr Sampson said his mother, who has cancer, was pleased about the sentence.

Mr Sampson and his daughter, who has just graduated from the University of Central Lancashire, set up the camera when Mrs Sampson noticed money going missing from her purse at her home in Walton.

Mr Sampson said: “My mother has end-stage leukaemia and we had to get a carer in who worked for the primary care trust (PCT).

“The next day my mum said 40 had gone out of her purse.”

“Emma wrote down the serial numbers on three 20 notes in my mum’s purse and we got a 55 camera from the local DIY store.

“Emma said the camera lens was just like the eye of the teddy bear in the house so we put the camera inside.

“We thought it would be a long process but she was greedy.

“We called the police and showed them the footage and gave them the serial numbers.”

New carer

Allen has agreed to pay 60 compensation to Mrs Sampson.

Mr Sampson said: “She (Thelma) has seen justice before she dies. She was glad to hear the sentence.”

Mr Sampson also said his mother now had a new carer.

Bernie Cuthel, managing director of Liverpool PCT Provider Services, said: “We can confirm that a former health care assistant, employed by the Provider arm of Liverpool Primary Care Trust has been arrested and convicted of stealing from a patient.

“Liverpool Primary Care Trust has fully supported Merseyside Police in this investigation and the member of staff involved was immediately suspended following their arrest.

“Following information from the courts that the employee involved was pleading guilty to all charges, an internal disciplinary hearing was held and this person is no longer employed by Liverpool PCT.”

LOS ANGELES (AP) — Eighteen hospitals in California were fined for state health code violations in which patients died from various mishaps such as an improperly inserted tube and a ventilator that wasn’t turned on. Other violations include surgical tools left inside patients after surgery.

The fines made public Monday stem from investigations by the California Department of Public Health that found shoddy care had either killed or endangered the lives of several patients. The hospitals were each fined $25,000 - the latest of dozens of penalties the state has issued in recent years to more than 40 hospitals.

“The number of penalties will decrease and the quality of care will dramatically improve as hospitals take action to improve,” said Kathleen Billingsley, director of the health department’s Center for Healthcare Quality. “The entire intent of these fines is to improve the overall quality of care in California.”

The report detailed a death at a La Mesa hospital in which a worker failed to turn on a ventilator for a patient who was being transferred. Another patient in Los Alamitos died after falling from a wheelchair with no seat belt on, and a Santa Ana hospital lost a patient from a medication overdose.

At Doctors Medical Center in San Pablo, a registered nurse improperly inserted a catheter into a patient’s neck vein on Sept. 1, and the patient died as a result of an air bubble from the tube. The report found the nurse had not completed a required anatomy class or the hospital’s training on protocol.

Defending himself in the report, the unidentified male nurse told investigators, “I am the pro of the hospital. The other nurses call me to put in IVs that they cannot get in.”

A message seeking comment from the medical center was not returned Monday.

In other cases, patients had surgical instruments or sponges left inside their bodies during surgery, requiring a second surgery to retrieve the misplaced items. The report also found some patients experienced surgical awareness during their procedures due to improper anesthesia.

The state has issued 61 such penalties to 42 hospitals, Billingsley said.

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On the Net:

http://www.cdph.ca.gov/certlic/facilities/Pages/Counties.aspx

By Hywel Griffith
BBC News
Valerie Hobbs had to wait for three years for funding for the surgery

A patient who spent three years campaigning for surgery to help her control a debilitating brain condition has finally had her operation.

Valerie Hobbs of Tenby, Pembrokeshire, suffers from chronic cluster headaches - sudden bursts of pain that strike two or three times a day.

She had now had an Occipital Nerve Stimulator implant fitted.

It connects her brain to a battery emitting an electrical pulse which has been shown to help reduce pain.

Her friends now call her ‘bionic woman’ following the surgery at a clinic in London.

“It’s the end of a long road,” said Mrs Hobbs.

“But it is also the start of another one, because there’s no way of predicting what will happen to me afterwards.”

Cluster headaches cannot be cured, but the electric nerve treatment has been shown to help reduce pain levels in many patients.

“I’m hoping it will be sufficient for me to think about working again - which at the moment is impossible,” Ms Hobbs said.

“I never know when I’m going to have another attack - it would be great if I could reduce that enough to live a reasonably normal life.”

The procedure works by implanting a battery pack into the patient’s abdomen and tunnelling a wire through the body.

It is then connected to the occipital nerves at the back of the head.

The operation was carried out by Consultant Neurosurgeon, Laurence Watkins, at the National Hospital for Neurology and Neurosurgery in London, on Friday, who has treated dozens of patients suffering from chronic headaches.

Mrs Hobbs had needed oxygen to breathe after an attack

“There’s an abnormality deep inside the brain,” Mr Watkins explained.

“And we’re just lucky that nature has provided us with these nerves which connect into that system.

“By stimulating them in a particular way, we can affect the abnormality and hopefully improve the headaches.”

Until this year Ms Hobbs had been denied funding for the treatment by Health Commission Wales - the body responsible for specialist procedures.

She had considered moving to England, in the hope that a Primary Care Trust across the border would be willing to pay the 15,000 cost.

The only other way Ms Hobbs had of controlling the headaches was through repeatedly taking injections and using oxygen to help her breathe after every attack.

If the Occipital Nerve Stimulator is shown to be successful, she hopes other patients will also now receive funding for treatment.

By Jane Elliott
Health reporter, BBC News

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Elana Kelly says make-up has been her lifeline

Few of Elana Kelly’s friends have seen her without make-up.

But that isn’t because she can’t face the world without lipstick and mascara.

Elana has vitiligo and has rings round both eyes that are lacking skin pigment.

She has worn make-up every day since she was a small child - but she has decided to take all her make-up off for adverts to raise awareness of the reality of her skin condition.

Now hundreds and thousands have seen her face, but Elana says she still feels too sensitive to stop wearing her “camouflage” in her daily life.

“There were periods when I wished I was able to tell people about my condition,” she said.

“But now, even at the age of 29, I don’t want to go out on the streets without my make-up.

‘Too exposed’

“There are millions of people who do wear make-up each day for different reasons and I am just one of them, but I don’t feel I could go out without my vitiligo covered up, which sounds pretty sad.

“But it is just the way it is for me.

“Wearing no make-up for the ads was good. I had been in front of strangers without make-up for a short-time, but with the video a much wider range of people have seen it.

“Of course my family have seen me before without make-up, as has my boyfriend and some very close friends.

“But even people I work with haven’t, so doing the advert was a big deal for me.”

Psychological damage

The advert, by the Vitiligo Society aims to raise awareness of the condition, which affects half a million Britons like Elana.

It leaves them increasingly vulnerable to the damaging effects of the sun and can also often have a dramatic psychological effect.

Elana’s parents got her make-up before starting school

Elana, an admin worker from Essex, said the family first noticed she had a problem when she suffered a cut above the eye at the age of three.

The scab healed, but the pigment never returned and gradually the problem grew worse, eventually affecting both eyes.

She said her parents were keen to protect her from any bullying and so researched make-up.

“As a child of four, I have to admit that I was blissfully unaware of any difference between other children and myself.

“I never experienced any animosity, cruelty or name-calling and for that I must be eternally grateful, as not everyone is so fortunate.

“It is only when you are a teenager and start staying over at other girls’ houses that it becomes a bit of a pain having to put the make-up on and take it off, and I did not feel comfortable telling people who were not in my family.

“And when you are a teenager it is all about how you look,” she said.

Treatment options

In her 20s, Elana tried laser treatment to see if it could offer her a permanent treatment, but it did not work so she decided to stick with the make-up.

“The colour match was so perfect that it meant I didn’t have to tell anybody unless I wanted to.

“However by not being honest with people other than my family I still was not accepting the fact that this was likely to be with me for the rest of my life and I still had never asked myself if this was something I could cope with forever,” she said.

Elana’s make-up covers her vitiligo

Psychologist Linda Papadopoulos said the psychological effects of vitiligo could be crippling, especially in the early years.

“Teenagers and people in their early 20s are the most susceptible to psychological and emotional trauma experienced at the onset of the condition.

“People with vitiligo don’t tend to go swimming or wear a summer dress because of the taboos associated with the skin and because of our obsession with a perfect body and especially the skin.”

She added: “Vitiligo is not so much physically handicapping, but psychologically handicapping.”

See what Sandi Thom could look like in 30 years if she used sunbeds three times a week
Enlarge Image

An image showing singer Sandi Thom with deep-set wrinkles and discoloured, saggy skin is being used to warn young people about the dangers of sunbeds.

Cancer Research UK used ageing technology to show how the 27-year-old Scot might look with severe skin damage, as well as natural aging.

The charity said it wanted a shocking image to make youngsters think.

The Sunbed Association said there was no link between the responsible use of sunbeds and overexposure to UV rays.

Thom, from Aberdeen, who admitted using sunbeds up to three times a week while at university in Liverpool, said: “The thought of looking like this when I’m 57 is terrifying.

“Having seen these images, I can honestly say I am never going to use a sunbed again.

“You can so easily get brown from a bottle these days, there is just no point in ruining your looks and risking skin cancer by using sunbeds.

“I hope the horrible image of me will make other young people think twice before they next use a sunbed.”

The images were created by using a recent picture of Thom, and taking into account her lifestyle, images of her parents, and her typical UV exposure.

One image indicated how she could look in 30 years with skin damage that could be caused by overexposure to UV rays.

In contrast, another image suggested how she might look at 57 with natural age progression, and 70% fewer wrinkles.

UV exposure

Caroline Cerny, of Cancer Research UK, said August was a busy period for sunbed use in the UK, with people keen to keep their holiday suntan.

“While young people may be using sunbeds as they think they make them look good now, in the long-term they are doing serious damage to their looks,” she said.

She added that using a sunbed before the age of 35 increased the risk of skin cancer by up to 75%.

Kathy Banks, CEO for The Sunbed Association said there was no link between the responsible use of sunbeds and overexposure to UV rays.

“Sandi Thom only used sunbeds three times a week, which we would not regard as causing overexposure to UV rays,” she said.

“Sunbed users are very aware of the risks associated with UV overexposure, and most have less than 20 sunbed sessions a year.

“The greatest source of UV exposure is from the sun - not from sunbeds.”