Category: trials

A short history of non-medical prescribing

It had long been recognised that nurses spent a significant amount of time visiting general practitioner (GP) surgeries and/ or waiting to see the doctor in order to get a prescription for their patients. Although this practice produced the desired result of a prescription being written, it was not an efficient use of either the nurses’or the GPs’time. Furthermore, it was an equally inefficient use of their skills, exacerbated by the fact that the nurse had usually themselves assessed and diagnosed the patient and decided on an appropriate treatment plan.

The situation was formally acknowledged in the Cumberlege Report (Department of Health and Social Security 1986), which initiated the call for nurse prescribing and recommended that community nurses should be able to prescribe from a limited list, or formulary. Progress was somewhat measured, but The Crown Report of 1989 (Department of Health (DH) 1989) considered the implications of nurse prescribing and recommended suitably qualified registered nurses (district nurses (DN) or health visitors (HV)) should be authorised to prescribe from a limited list, namely, the nurse prescribers’formulary (NPF). Although a case for nurse prescribing had been established, progress relied on legislative changes to permit nurses to prescribe.

Progress continued to be cautious with the decision made to pilot nurse prescribing in eight demonstration sites in eight NHS regions. In 1999, The Crown Report II (DH 1999) reviewed more widely the prescribing, supply and administration of medicines and, in recognition of the success of the nurse prescribing pilots, recommended that prescribing rights be extended to include other groups of nurses and health professionals. By 2001, DNs and HVs had completed education programmes through which they gained V100 prescribing status, enabling them to prescribe from the NPF. The progress being made in prescribing reflected the reforms highlighted in The NHS Plan (DH 2000), which called for changes in the delivery of healthcare throughout the NHS, with nurses, pharmacists and allied health professionals being among those professionals vital to its success.

The publication of Investment and Reform for NHS Staff –Taking Forward the NHS Plan (DH 2001) stated clearly that working in new ways was essential to the successful delivery of the changes. One of these new ways of working was to give specified health professionals the authority to prescribe, building on the original proposals of The Crown Report (DH 1999). Indeed, The NHS Plan (DH 2000) endorsed this recommendation and envisaged that, by 2004, most nurses should be able to prescribe medicines (either independently or supplementary) or supply medicines under patient group directions (PGDs) (DH 2004). After consultation in 2000, on the potential to extend nurse prescribing, changes were made to the Health and Social Care Act 2001.

The then Health Minister, Lord Philip Hunt, provided detail when he announced that nurse prescribing was to include further groups of nurses. He also detailed that the NPF was to be extended to enable independent nurse prescribers to prescribe all general sales list and pharmacy medicines prescribable by doctors under the NHS. This was together with a list of prescription-only medicines (POMs) for specified medical conditions within the areas of minor illness, minor injury, health promotion and palliative care. In November 2002, proposals were announced by Lord Hunt, concerning ‘supplementary’prescribing (DH 2002).

The proposals were to enable nurses and pharmacists to prescribe for chronic illness management using clinical management plans. The success of these developments prompted further regulation changes, enabling specified allied health professionals to train and qualify as supplementary prescribers (DH 2005). From May 2006, the nurse prescribers’extended formulary was discontinued, and qualified nurse independent prescribers (formerly known as extended formulary nurse prescribers) were able to prescribe any licensed medicine for any medical condition within their competence, including some controlled drugs.

Further legislative changes allowed pharmacists to train as independent prescribers (DH 2006) with optometrists gaining independent prescribing rights in 2007. The momentum of non-medical prescribing continued, with 2009 seeing a scoping project of allied health professional prescribing, recommending the extension of prescribing to other professional groups within the allied health professions and the introduction of independent prescribing for existing allied health professional supplementary prescribing groups, particularly physiotherapists and podiatrists (DH 2009).

In 2013, legislative changes enabled independent prescribing for physiotherapists and podiatrists. As the benefits of non-medical prescribing are demonstrated in the everyday practice of different professional groups, the potential to expand this continues, with consultation currently under way to consider the potential for enabling other disciplines to prescribe.

The bigger issues that come with preventing hearing loss

Is there cause for optimism when it comes to preventing hearing loss? Certainly the latest research into this suggests that if positive effects experienced by mice could be transferred to humans and maintained for the long term, then hereditary hearing loss could be a thing of the past.

It has always been assumed that hearing loss is always down to old age. The commonly held view is that as people grow older, their muscles and body functions deteriorate with time to the point that muscle function is impaired and eventually lost. But hearing loss is not necessarily down to age, although there are cases where constant exposure to loud noise, over time, causes reduced sensitivity to aural stimuli. Over half of hearing loss cases are actually due to inheriting faulty genetic mutations from parents.

How do we hear? The hair cells of the inner ear called the cochlea respond to vibrations and these signals are sent to the brain to interpret. The brain processes these signals in terms of frequency, duration and timbre in order to translate them into signals we know.

For example, if we hear a high frequency sound of short duration that is shrill, our brain interprets these characteristics and then runs through a database of audio sounds, an audio library in the brain, and may come up with the suggestion that it has come from a whistle and may signify a call for attention.

What happens when you have a genetic hearing loss gene? The hairs on the inner ear do not grow back and consequently sound vibration from external stimuli do not get passed on to the brain.

With progressive hearing loss too, the characteristics of sound also get distorted. We may hear sounds differently to how they are produced, thereby misinterpreting their meaning. Sounds of higher and lower frequency may be less audible too.

How does that cause a problem? Imagine an alarm. It is set on a high frequency so that it attracts attention. If your ability to hear high frequencies is gradually dulled then you may not be able to detect the sound of an alarm going off.

As hearing gradually deteriorates, the timbre of a sound changes. Sharper sounds become duller, and in the case of the alarm, you may hear it, but it may sound more muted and the brain may not be able to recognise that it is an alarm being heard.

Another problem with hearing loss is the loss of perception of volume. You may be crossing the road and a car might sound its horn if you suddenly encroach into its path. But if you cannot hear that the volume is loud, you may perceive it to be from a car far away and may not realise you are in danger.

The loss of the hairs in the inner ear is a cause of deafness in humans, particularly those for whom hearing loss is genetic. Humans suffering from hereditary hearing loss lose the hairs of the inner ear, which result in the difficulties mentioned above. But there is hope. In a research experiment, scientists successfully delayed the loss of the hairs in the inner ear for mice using a technique that edited away the genetic mutation that causes the loss of the hairs in the cochlea.

Mice were bred with the faulty gene that caused hearing loss. But using a technology known as Crispr, the faulty gene was replaced with a healthy normal one. After about eight weeks, the hairs in the inner ears of mice with genetic predisposition to hearing loss flourished, compared to similar mice which had not been treated. The genetic editing technique had removed the faulty gene which caused hearing loss. The treated mice were assessed for responsiveness to stimuli and showed positive gains.

We could be optimistic about the results but it is important to stress the need to be cautious.

Firstly, the research was conducted on mice and not humans. It is important to state that certain experiments that have been successful in animals have not necessarily had similar success when tried on humans.

Secondly, while the benefits in mice were seen in eight weeks, it may take longer in humans, if at all successful.

Thirdly, we should remember that the experiment worked for the mice which had the genetic mutation that would eventually cause deafness. In other words, they had their hearing at birth but were susceptible to losing it. The technique prevented degeneration in hearing in mice but would not help mice that were deaf at birth from gaining hearing they never had.

Every research carries ethical issues and this one was no different. Firstly, one ethical issue is the recurring one of whether animals should ever be used for research. Should mice be bred for the purposes of research? Are all the mice used? Are they accounted for? Is there someone from Health and Safety going around with a clipboard accounting for the mice? And what happens to the mice when the research has ceased? Are they put down, or released into the ecosystem? “Don’t be silly,” I hear you say, “it’s only mice.” That’s the problem. The devaluation of life, despite the fact that it belongs to another, is what eventually leads to a disregard for other life and human life in general. Would research scientists, in the quest for answers, eventually take to conducting research on beggars, those who sleep rough, or criminals? Would they experiment on orphans or unwanted babies?

The second, when it comes to genetics, is whether genetic experimentation furthers good or promotes misuse. The answer, I suppose, is that the knowledge empowers, but one cannot govern its control. The knowledge that genetic mutation can be edited is good news, perhaps, because it means we can genetically alter, perhaps, disabilities or life-threatening diseases from the onset by removing them. But this, on the other hand, may promote the rise of designer babies, where mothers genetically select features such as blue eyes for their unborn child to enhance their features from birth, and this would promote misuse in the medical community.

Would the use of what is probably best termed genetic surgery be more prominent in the future? One can only suppose so. Once procedures have become more widespread it is certain to conclude that more of such surgeons will become available, to cater for the rich and famous. It may be possible to delay the aging process by genetic surgery, perhaps by removing the gene that causes skin to age, instead of using botox and other external surgical procedures.

Would such genetic surgery ever be available on the NHS? For example, if the cancer gene were identified and could be genetically snipped off, would patients request this instead of medical tablets and other external surgical processes? One way of looking at it is that the NHS is so cash-strapped that under QALY rules, where the cost of a procedure is weighed against the number of quality life years it adds, the cost of genetic surgery would only be limited to more serious illnesses, and certainly not for those down the rung. But perhaps for younger individuals suffering from serious illnesses, such as depression, the cost of a surgical procedure may far outweigh a lifetime’s cost of medication of anti-depressant, anti-psychotics or antibiotics. If you could pinpoint a gene that causes a specific pain response, you might alter it to the point you may not need aspirin, too much of which causes bleeds. And if you could genetically locate what causes dementia in another person, would you not be considered unethical if you let the gene remain, thereby denying others the chance to live a quality life in their latter years?

Genetic editing may be a new technique for the moment but if there is sufficient investment into infrastructure and the corpus of genetic surgery information widens, don’t be surprised if we start seeing more of that in the next century. The cost of genetic editing may outweigh the cost of lifelong medication and side effects, and may prove to be not just more sustainable for the environment but more agreeable to the limited NHS budget.

Most of us won’t be around by then, of course. That is unless we’ve managed to remove the sickness and death genes.

Ethically spending a million pounds on useful research

Does offering financial incentives encourage mothers of newborns to breastfeed? While this may seem incredulous, a study actually was implemented in parts of England to see if this would be the case.

More than 10,000 mothers across regions such as South Yorkshire, Derbyshire and north Nottinghamshire took part in the trial, where mothers were given a hundred and twenty pounds if they breastfed their babies, and a further eighty pounds if they continued up to the point the babies were six months old. That is to say mothers received two hundred pounds if their babies were breastfed up to the age of six months.

But why was this implemented in the first place? One of the reasons the study was done was to see if financial incentives would help raise the rate of breastfeeding in the UK. In some parts of the UK, only one in eight babies are breastfed past eight weeks. The early suspension of breastfeeding causes later problems in life for babies, and this was a study to see if it would be possible to save a reported seventeen million pounds in annual hospital admissions or GP visits.

How were these women chosen? They were picked from areas which were reportedly low-income ones. There was a suggestion that in low-income areas, mothers feel obliged to return to work quickly and breastfeeding is inconvenient and a reason why mothers stop it.

The financial incentive did result in a rise of six percentage points, from 32% to 38%. This meant that over six hundred more mothers in the ten thousand breastfed their babies for up to six months instead of the hypothetical eight week line.

Should we get excited about these results? Caution is to be exercised.

As a few leading academics noted, there was no way to monitor a reported increase. The mother’s word was taken at face value but there was no way to monitor that a prolonged breastfeeding period actually took place. It would not be inaccurate to say that of these six hundred mothers, some merely reported they had breastfed for longer but without actually doing it. If you live in an income-deprived area, and were offered two hundred pounds of shopping at a time when you needed it, without having to do much apart from saying “Yes, I breastfed”, wouldn’t you take the easy money?

It was mentioned that if the results did have a high percentage of trustworthiness to them, in other words, if mothers breastfed as they said they had done, it would help normalise breastfeeding in regions where it might cause embarrassment to the mother. Why might breastfeeding cause embarrassment? For example, in some social situations it might be slightly awkward to reveal normally covered parts of the body in public.

How much did the scheme cost? If we assume that 38% of 10000 mothers breastfed and claimed these financial vouchers, that’s around 4000 mothers each claiming two hundred pounds, at a cost of eight hundred thousand pounds.

Wow. Eight hundred thousand pounds of free shopping for which an outcome cannot be undisputably proven. Where does all the money come from?

The Medical Research Council was funded to the tune of up to seven hundred and fifty-five million pounds in 2016/17, or which nearly half was provided as grants to researchers. But while all that may sound as a lot of money, surely there should be more accountability in how the money is used. Using up nearly a million pounds of that money for a trial whose results cannot be justified is not a good use of money.

But perhaps the babies’ height, weight and other factors pertaining to breastfeeding could have been taken? For example, if we know that breastfeeding has benefits in certain areas, such as in growth charts, perhaps the babies that were breastfed in that study could have been measured against babies who had not been breastfed to see if there had been any positive gain, and something that could correlate to breastfeeding over the six month period?

Imagine if this had been a study about literacy. Imagine that mothers who read two stories to their child up to the age of four years would receive two hundred pounds. Surely, at the end of the period, the research scientists would not merely be going to the mothers and saying “Did you read to your child? Yes? Here’s two hundred pounds.” They would try to assess the child, perhaps by means of a literacy test of some form, to see if any reading had actually taken place.

Otherwise it is just money down the drain for results which cannot be proven and cannot be relied on. In that case, what is the purpose of spending money on hearsay?

Did giving eight hundred thousand pounds encourage mothers in income-deprived areas to breastfeed for longer periods? Who knows? The only thing we can be sure of is that eight hundred thousand pounds made them say they did it.

Migraines could be a headache of the past

Is there hope for the many millions of migraine sufferers in the United Kingdom and around the world? Researchers at King’s College Hospital certainly believe that this is the case. While they are cautious about the findings of their latest research, the results certainly are one that point towards optimism for migraine sufferers.

It is estimated that the number of migraine attacks everyday in the UK number over 190,000. This figure was estimated by the Migraine Trust, and it was probably obtained by taking a sample size of the population, taking into account the number of migraine attacks experienced within that group and then multiplying it by the general population in the United Kingdom. This of course means two things: firstly, the figure was proposed by a group that has an interest in promoting awareness about migraines and is hence slightly biased, probably over-estimated. Secondly, bearing in mind that the UK population is over 66 million, and it is unlikely that the Trust surveyed 1 million people – or even anywhere near that – any differences could have been amplified by over 66 times.

What is the difference between a migraine and a normal headache? A migraine is a headache which happens frequently. Migraines themselves are classed as two types. Headaches which happen more than 15 days a month are known as chronic migraine, while episodic migraine is a term used to describe headaches which happen less than fifteen times a month.

The research uncovered that a chemical in the brain was involved both in the feeling of pain and sensitivity to sound and light. This chemical is known as calcitonin gene-related peptide, or CGRP. If CGRP is neutralised, or if part of a brain cell which it interacts with is blocked, then pain receptors are dulled and migraines are reduced.

There are currently four drug companies in the race to develop a CGRP neutraliser.

Race is an accurate term, for the company that develops and trials the drug successfully may win the patent for developing and marketing the drug over twenty years. Drug companies or pharmaceuticals are normally granted that period to reward them for the time and cost invested into research.

One such company, Novartis, trialled an antibody, erenumab on episodic migraine sufferers. Those who took part in the trial suffered migraines on an average of eight days a month.

955 patients took part in the trial and half of those who received injections of erenumab successfully halved their number of migraine days per month. 27% of patients also reduced their number of migraine days without treatment. The results suggest that the drug was successful, particularly as it worked for over 450 people, and that if it were used for those with chronic migraine it might be equally successful. Even if the same percentage were maintained (50% vs 27%), the number of working days saved by migraine prevention could have significant savings for the economy.
Another pharmaceuticals company, Teva, produced another antibody, fremanezumab, and trialed it on 1130 patients. Unlike Novartis’s trials, the participants in Teva’s were those with chronic migraine, with over 15 or more attacks each month. In the Teva trial, 41% of patients reportedly halved the number of days that they suffered migraine attacks. 18% reported the same effect, so the confidence interval in the trial is pretty high and suggests a high degree of positive use.

The study is very important and useful because of the understanding it offers in treating migraine, and the medical products can reduce the frequency and severity of headaches. It makes for fewer days lost to the disease and more positive, functioning people.

Besides CGRP antibodies, there are other current treatments for migraine such as epilepsy and heart disease pills. Even botox is sometimes used. However, all three come with side-effects and are not necessarily the best for everyone.

The hope is that CGRP antibodies, which are traditionally more expensive to manufacture, will in the long term be available at a more affordable cost, and would benefit those who currently get no benefit from existing therapies.

If the estimation that one in seven people live with regular migraine is accurate, migraine reduction could have significant life-improvement effects for humans. Chronic migraine is in the top seven disabling conditions and improvements in understanding it and how to manage it would not only improve the quality of life for those who suffer with it, but also in reducing the number of work days lost for the economy. But the benefits do not just remain with migraine sufferers. Having to live with chronic disabling conditions often leads to other symptoms such as depression. Who knows? Perhaps CGRP antibodies may even negate the effect of depression, resulting in a secondary effect. It may be possible that those who suffer from migraine alongside depression may even not require treatment for the latter if the CGRP antibodies prove to be effective.
Can you imagine a world without anti-depressants? At the moment millions live on some pain-relief medication of some sort. It would be great if they could be phased out. Although it might not be so great for the economy!

Should we be excited about the results? Well, yes. The combined large sample size of both studies, of over 2000 migraine sufferers showed that there was some weight behind the study compared to if – for example – it had been done only on one hundred participants. Secondly, while the research was undertaken by pharmaceutical companies, the outcome was actionable, meaning that it produced a result that was useful, rather than one that merely formed the prelude to a more extensive study. In previous posts I demonstrated how some – such as the coffee umbrella review – did not produce any significantly useful outcome. But we know from this particular research that it may work to neutralise either CGRP, or lessen its interaction with the particular brain cells in order to lower the effect of migraine.

Did the media have a field day with this? Unsurprisingly, no. You see, good research does not lend itself to sensationalist headlines.

Health umbrella reviews mask the real issues

You have to wonder why the breakfast tea doesn’t get the same level of attention. Or perhaps whether in France, the humble croissant is elevated to the same status. Or maybe the banana could soon be the star of another media show. But unfortunately it is coffee that headlines tomorrow’s fish and chips papers.

“Drinking three or four cups of coffee a day could have benefits for your health”. As we have seen previously, this kind of headline bears the hallmarks of a media health report:

1) repackaging of common information requiring little or no specialist examination;

2) use of a modal auxiliary verb (could) to conveniently justify or disclaim an

attention-grabbing headline – which, by the way, is point number three.

The health reports in the media also incorporate:

4) a statistically small group of trial participants, whose results are then blown up in proportion as if to be representative of the 7 billion people on the planet.

5) Assumptions. A media report about health could simply include assumptions.

Why dwell on coffee? For starters, it is a commonly consumed drink and so any meaningful research would potentially have bearings on millions of people. It is common media practice to focus on common food and activities because of the relevance to daily life.

But if you examine this carefully, why not tea? Why not write about tea? While conspiracy theories may be slightly far fetched, it is possible that – unless it is a speciality tea – coffees cost more, and any potential health benefits would lead people to spend more, hence generating more for the economy in the forms of tax. Perhaps this is why media writers don’t waste too much ink on researching the potential life-saving benefits of bananas, even though they are widely consumed. The research isn’t going to drive people to buy bananas in bulk, and even so, the extra revenue generated from a low priced item isn’t going to raise much extra tax.

Are there any notable similarities or differences in style across different countries? One wonders whether Parisian newspapers, on a regular basis, churn out headlines such as:

“Eating two or more croissants a day could reduce your chances of heart disease.”

“Pan aux raisins linked with dementia”.

The research done was an umbrella review to potentially examine whether further research should be undertaken into researching the effects of coffee and its role in preventing liver cancer. An umbrella review meant that no actual research was undertaken, but that existing research was examined and analysed to glean insights.

The problem with umbrella reviews is that they are very generalised, no actual research is done, and they are only brief analyses of existing research. This means that first of all, an umbrella review could arrive at a particular conclusion, but in no way should that be taken as the final conclusion.

In fact, the findings of an umbrella review are only the preliminary to more detailed investigation. If an umbrella review suggested that drinking coffee could prevent cancer, then what it is saying is more research needs to be undertaken, and the media needs to be ethically responsible by not reporting “Coffee prevents Cancer”, because there are people that look at newspapers and television as the source of their information and assume just because it has been released in the public domain, it is truth. Who could conceive that newspapers spend time and resources to publish trivial information and that television is pure rubbish?

The second problem with umbrella reviews is that the outcomes are only as good as the original sources. If someone gave you a set of grainy photos, then asked you to make a collage with them, then your collage is going to be as good as the grainy photos will allow. If the original sources were not thorough or exact in their investigation, are any subsequent findings based on these merely just a waste of time?

The third issue with umbrella reviews is that under closer scrutiny, the overall picture is distorted by over focussing on small statistical variances, or sometimes minute errors are magnified and lead one down the wrong path.

If you took a picture on your phone and then blew it up to the size of a mural covering the side of your house, the picture becomes very dotty. You might see big patchy squares. But if you started looking for that big patchy square from the image in your phone… one has to wonder what the purpose of that is.

The fourth is that because umbrella reviews are a prelude to a more thorough investigation, their end results are slightly skewed from the outset. If an umbrella review is bound to provide a few avenues for later time-consuming research then it is fundamentally biased into having to provide one in the first place. Why, in that case, have such reviews in the first place? Some may point out that the flaw in the system is that umbrella reviews are relied on by those in academia and research to warrant the continued longevity of their positions. In other words, if researchers had nothing to research, they might be out of a job, so they best find something to stick their noses in.

Have you ever read the London newspaper Metro and come across some research news such as:

“Going to bed angry can wreck your sleep” (25 Sept 2017)

It is the sort of headline that makes you think “Why bother doing the research in the first place?”

It is likely that you have read a media report of an umbrella review.

What were the findings of the original coffee review?

Drinking coffee was consistently linked with a lower risk of death from all causes and from heart disease. The largest reduction in relative risk of premature death was seen in people consuming three cups a day, compared with non-coffee drinkers.

Now, when an umbrella review mentions drinking coffee is linked with a lower risk of death, it is important to be clear about what it specifically means. And what it is stating is that those who had a lower risk of death all happened to drink coffee. It might have nothing to do with the coffee itself. It might have been that they took a break to slow down a fast-paced lifestyle, and the taking of a break gave them a lower risk of death. By that logic of association, tea could also be linked with a lower risk of death.

Coffee was also associated with a lower risk of several cancers, including prostate, endometrial, skin and liver cancer, as well as type-2 diabetes, gallstones and gout, the researchers said. The greatest benefit was seen for liver conditions such as cirrhosis of the liver.

Again, to be clear, the above link means that those who were at lower risk of those cancers happened to drink coffee. But it is not necessarily stating the coffee had anything to do with it.

And coffee is such a commonly consumed drink, that it is easy to use it to draw links to anything.

If people who died from car accidents happened to drink coffee, an umbrella review might state that drinking coffee is linked with higher incidences of car accidents.

The findings can be summarised by a health analyst:

“Does coffee prevent chronic disease and reduce mortality? We simply do not know. Should doctors recommend drinking coffee to prevent disease? Should people start drinking coffee for health reasons? The answer to both questions is ‘no’.”

We should perhaps add a further third question: Did the umbrella review produce any actionable findings, and should it have been undertaken in the first place?

Probably not.

Is there any truth about the benefits of Classical music?

Is there any truth to the commonly accepted notion that listening to classical music improves mental capacity? Somehow it has been accepted in modern society that classical musicians have larger frontal cortices, better mental reasoning powers and perhaps intelligence quotients. Over the last two decades or so this idea has fuelled a rise in the number of pregnant mothers listening to classical music – whether or not they like it – and parents enrolling their children into music classes. The music of Mozart, in particular, has enjoyed a resurgence as its classical form is deemed to be more logical and organised, compared to music of other periods, assisting in triggering patterns of organisation in the brain amongst its listeners.

How did this idea about Classical music come about? In the 1990s scientists conducted a series of experiments where one group of students were played one of Mozart’s piano sonatas before a spatial reasoning test, while another group sat in silence. The group that was played the music beforehand performed better on that task than the control group. The effect on the control group was temporary and only lasted fifteen minutes, meaning that after the fifteen minute mark the disparities between the results were minimal and statistically the same. The results of the group found also that while music primed the individual particularly for mathematical tasks, after an hour of listening to Classical music, the effect on the brain was lost.

That piece of research was pounced on by the media and other individuals and seemingly perpetuated to promote the listening of Classical music. One governor of the state of Georgia even decreed that newborn babies be given a copy of a CD of Mozart’s works upon leaving the hospital. The Mozart Effect, to give it its common name, was written about in newspapers and magazines, and this began the spur of Mozart-related sales of music as well as the trend of mothers playing such music to their children in and out of the womb.

The most important question we need to ask is whether there is any truth in such research, and whether it can be corroborated.

We know that some forms of music has a soothing, calming effect on individuals. Playing the music to the students may have calmed that so they were not nervous, allowing them to perform better on the task. However, relaxation need not take them the form of Classical music. Any activity that promotes calm before a task – reading a light magazine, playing computer games, talking with a friend – can also hence be said to have the same effect as the classical music that was played.

What if the students in the group had read a joke book or comic beforehand, been less worried about the test and scored better? It might have prompted a deluge of articles claiming “Reading Archie (or The Beano – insert your own title here) improves your IQ”.

Or if the students had been offered a protein drink beforehand, it would not be inconceivable that someone would latch to that piece of research and declare that “Protein Drinks not just good for your body, but for your brain too”.

Mozart’s music has been said to embody the elements of classical music as we know it. Organised formal structures, chords and harmonies through related keys, use of contrasting tunes, contrasts in volume all feature in his music. But the music of other composers have such features too. Imagine if the composer Josef Haydn had been the lucky beneficiary of the experiment and his music had been played instead. The sales of his music catalogue would have hit the roof!

Subsequent scientists all found that listening to music of any form caused improvements, and the genre of music – whether rock or Classical – was irrelevant. But studies today still quote Mozart.

Is it ethical that the media promotes unsubstantiated research by reporting without closer scrutiny? As we have seen in previous blogs posts, the media reports on things without necessarily scrutinising the evidence, and entrusts so-called experts to corroborate the evidence, while it fills column inches and air time with modal auxiliary verbs? Huh? In simple terms, it means that if there is a sniff of a link between A and B, the media reports that “A could cause B”. Never mind whether it does or not, there is always the disclaimer of the word “could”.

In this instance, students performed better on a spatial reasoning task after listening to Mozart; hence the headline “Mozart could improve mental powers”. Diluted over several recounts, you could get “According to XXX newspaper, Mozart improves brain power” before arriving at “Mozart improves brain power”. Unfortunately, this is when the headline is then pounced on by anyone who would stand to profit from espousing this theme.

Who would profit from this? The Classical music world – performers, writers, musicians – can use this “research” to entice people into taking up lessons and buying CDs and magazines. If you read any music teacher’s website you may find them espousing the benefits of learning music; it is rare if you find one that advises it is a lot of effort.

The media will profit from such “research” because it means there is an untapped well of news to report and bleed dry in the quest for filling column inches and air time. News exclusives will be brought out, and so-called experts will also profit for appearing on the news and programmes, either monetarily or in the form of public exposure.

One must question the ethics of incorrect reporting. Unfortunately unsubstantiated research leads to more diluted misreporting, which can then form the basis of new research – research that uses these claims as the groundwork for investigation.

It is scary to think that all the medical research that has been done into effect of music and health could be biased because of the so-called effect of classical music. Could musical activities such as learning the piano help reduce Parkinson’s disease? Could listening to the music of Beethoven reduce the incidence of higher cases of Alzheimer’s disease? Could it all be wrong – have we all been sent down the wrong tunnel by an avalance of hype reporting?

It may be fair to say the human impulse is to buy first and consider later, because we are prone to regret. If we have missed an opportunity to improve the lives and abilities of our children, then we will be kicking ourselves silly forever with guilt.

So if you are still not convinced either way about whether classical music – either in the listening or the practice – really does have any effect, you could at least mitigate your guilt by exposing your child to piano music, for example that has predictable patterns in the left hand. Sometimes, listening to structurally-organised music such as from the Baroque may be useful, but it is also good to listen to Romantic music because the greater range of expression arguably develops a child that has more emotionally subtlety and intelligence.

You may find that ultimately, any truth in the research about Classical music and its mental benefits is not due to the blind passive listening, sitting there while the music goes on around your children. It is in the child’s inner drive to mentally organise the sounds that are heard, the trying and attempts to organise background sounds that really triggers the mental activity in the brain. It is more the practised ability in the inner mind to organise musical sounds that causes better performance in related mental tasks.

Physical and Mental Contamination

Is there a need to start worrying about your kitchen? I don’t mean in the home improvement context, never mind that the island unit is looking a bit worse for wear, and that your swanky appliances need upgrading so you can have two ovens to cook for your little army; or maybe you are thinking you could expand beyond the microwave and gas cooker. Or perhaps you are considering the option of creating an open plan kitchen. Whatever the physical changes you are considering, they are beyond the scope of discussion. Danger lurks in your kitchen.

It doesn’t come in the form of masked strangers brandishing kitchen implements. Or ruthless critics in the form of master chefs or children. No, the hidden danger in your kitchen is more subtle, more soft, yet potentially more lethal.

The kitchen sponge.

Scientists estimate that the kitchen sponge contains the highest concentration of bacteria than anywhere in the house. On the face of things, this is not an unrealistic statement. The kitchen sponge is in contact with remnants of food as it passes over the crockery and cutlery, and while the latter are clean, microscopic elements of food have merely been transferred to the sponge. And even if you take the effort to rinse out the sponge, or go a step further by microwaving the sponge, trace elements of food bacteria will remain.

According to the Mail Online, one of the more sensationalist newspapers in the United Kingdom, there are 54 billion cells of bacteria residing on the humble sponge. But of course the Mail Online would say that – it is taking a simple fact and blowing it out of proportion in order to create a purchasing headline. (And what is a purchasing headline? It is one that intrigues you enough to make a financial physical purchase to discover more, or hook you in enough to commit your time to reading more, never mind that the headline was slightly manipulated in the first place.) The fact is, bacteria exist all around us. They are on the surfaces of things around us. But it is important to distinguish between good and bad bacteria. The majority of bacteria around us are harmless. The remaining bacteria can do us harm if they enter our bodies, which is why it is a good idea to wash hands before eating. This ensures the harmful bacteria on our hands, either from touching door knobs or taps or other contaminated surfaces, does not rest on food that we ingest. It is also a good idea to cover up exposed cuts so that bacteria does not enter the bloodstream.

Bacteria is all around us but we can’t live life in fear of it.

Can you imagine if the word bacteria was substituted with the word humans? It would give a better perspective.

The headline would read that something like “A higher concentration of criminals found in [name of city]”. But you can’t live like every human in that city will do you harm. You can only take necessary steps to avoid being negatively affected.

Just like bacteria.

The current guidelines around hand washing recommend that we  our hands with water and soap for at least 20 seconds, after instances such as using the toilet, handling raw food like meat and vegetables. It is advised that we wash our hands before eating or after contact with animals.

Does washing with specialist soaps make any difference? A study by Rutgers University and GOJO Industries in the US found that there was little difference, which suggests the science between Brand X and Brand Y is as manufactured as the products themselves.

The study involved twenty volunteers and examined variables of hand washing such as brand, volume and time elapsed. A non-harmful strain of the bacteria e-coli was placed on the hands of the volunteers and then examined after washing to see how much remained.

The study found that there was little to distinguish between normal soaps and anti-microbial formulations. In fact, as long as volunteers washed their hands with soap for thirty seconds, the difference in results after washing were negligible.

There were a couple of minor limitations to the study conducted by Rutgers and GOJO Industries.

Firstly, that sample size is too small. Secondly, volunteers could not ethically be asked to handle deadly bacteria so the results may have only be applicable to that particular strain of bacteria.

There was a major stumbling block to the research however. GOJO Industries manufactures hand soaps.

We have already examined in the past how it is not a good idea if pharmaceutical companies run their own tests because the authenticity cannot be guaranteed completely if there is a bias from the outset. If a pharmaceutical company or any other manufacturing company is going to invest time, money and effort into production, it is going to choose results which have a positive bias, rather than those with a negative one which either force further research, impacting on production time and costs, or one that cause the complete abandonment of results.

Is there anything we can trust anymore? The dilemmas we have are that the media distorts reporting, and research is funded with an agenda which produces an expected outcome. It is difficult to secure funding for research if there is no meaningful purpose behind it beyond sales.

Returning to the original issue of bacteria, as long as we take necessary precautions, that is the best we can do. These precautions include replacing the sponge regularly, and not leaving unwashed dishes in the kitchen, and washing our hands to avoid contamination.

And take in what you read and hear about health and news with a pinch of objectivity. Avoid contaminating your mind too!