Month: January 2025

Blood Biomarkers for Alzheimer’s Disease: What do they mean for the NHS?

The Challenge of Diagnosing Alzheimer’s

Alzheimer’s disease (AD) is a leading cause of death in the UK as well as affecting nearly a million people. Currently, the diagnostic pathway for AD is based on clinical symptoms that emerge late in the disease, often after 20 years of progressive accumulation of intracerebral pathological AD features.  When memory, mood, or personality changes are noticed, individuals or their family usually seek advice from a general practitioner, who may perform some cognitive tests along with some general blood tests.  If cognitive decline is suspected, the patient is often referred to a memory clinic or to Old Age Psychiatry Clinics within Mental Health Trusts for further evaluation, aimed at confirming cognitive decline and ruling out reversible causes.

The Promise of Blood Biomarkers

Recent advances in blood-based biomarkers hold promise for transforming AD identification and care.  These biomarkers have shown similar sensitivity and specificity to positron emission tomography (PET) scan and cerebrospinal fluid (CSF) tests in specialist settings.  If reliably predictive blood tests were to become available at low cost in primary care, this could be transformative for AD identification.

The NHS and Blood Biomarkers

The UK’s National Health Service (NHS) is exploring how to adopt and integrate these innovations into its care model.  Initiatives like the Davos Alzheimer’s Collaborative (DAC) International Initiative, the AD RIDDLE study, and the UK’s Blood Biomarker Challenge aim to pilot real-world implementation and validation of blood-based biomarkers, with hopes of integrating them into the NHS within the next few years.

The Future of Alzheimer’s Care

Blood-based biomarkers have the potential to revolutionize early detection of Alzheimer’s disease, making diagnosis more accessible and affordable.  This could lead to earlier intervention and better outcomes for patients.  With a focus on affordability, accessibility, and robust post-launch monitoring, an Alzheimer’s care framework that is more effective, equitable, and capable of transforming the lives of those affected by the disease can be created.

Read more in our article in the Journal of the Royal Society of Medicine.

Why has prescribing of antidepressants increased over the last 30 years?

In a recent post on the platform X, Elon Musk claimed that antidepressants were over-prescribed. In many countries, the prescribing of antidepressants has increased significantly over the past 30 years. During the 1990s, public health campaigns aimed at reducing the stigma surrounding depression encouraged more people to seek treatment. This contributed to a rise in antidepressant prescriptions in countries such as the UK.

Additionally, antidepressants – particularly selective serotonin reuptake inhibitors (SSRIs) – are now widely used not only for depression but also for other conditions such as anxiety disorders, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), and chronic pain. This expanded range of indications has been a significant factor in their increased use in recent decades.

One concern regarding antidepressant use is their potential toxicity and their role in suicide. SSRIs are generally considered safer than older antidepressants, such as tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs), which are more likely to be associated with fatal overdoses.

Because of their better safety profile, doctors are more willing to prescribe SSRIs than the older antidepressants. Their relative safety has made SSRIs the preferred choice of drug for many doctors and is also a factor in the increased prescribing of antidepressants.

Antidepressants do play an essential role in managing depression and some other mental health conditions, but over-prescription may occur in some cases due to system-wide barriers like limited access to psychological therapies. Addressing the wider determinants of health is also important. This would include areas such as poverty, housing and access to green spaces and other leisure facilities.

The increase in antidepressant prescribing in the UK has sparked debate about whether they are being over-prescribed. However, antidepressants are a clinically effective option for moderate to severe depression and are now used for a broader range of conditions, such as anxiety disorders and chronic pain. Ensuring a balanced approach, where pharmacological and non-pharmacological treatments are accessible and appropriately used, remains a key goal for improving mental health care in the UK and elsewhere in the world.

Using Mobile Apps for Diabetes Self-Management: A Review of Patient Perspectives

Diabetes is a chronic disease that affects hundreds of millions of people worldwide. Self-management is crucial for people with diabetes to maintain their health and prevent complications.  Mobile applications have emerged as promising tools to help people with diabetes self-manage their condition. Our recent article in the journal BMJ Open – What are the perceptions and experiences of adults using mobile applications for self-management in diabetes? A systematic review – reviewed some of the the research literature in this area to obtain patient perspectives on these apps.

What are the benefits of using mobile apps for diabetes self-management?

Our systematic review explored the perceptions and experiences of adults with types 1, 2, and gestational diabetes using mobile applications for self-management.  The review included 24 qualitative studies that interviewed or surveyed people with diabetes who used mobile apps for self-management.

We found that people with diabetes generally have a positive view of mobile apps for self-management.  App features that were particularly valued included:

  • Monitoring blood glucose, diet, and exercise
  • Receiving reminders about blood glucose checks, medication, and mealtimes
  • Learning about the interrelationship between blood glucose, diet, and exercise

What are the challenges of using mobile apps for diabetes self-management?

We also identified several challenges that people with diabetes face when using mobile apps for self-management. These challenges include:

  • Uploading excessive information
  • Monitoring device incompatibility
  • Episodic app crashes
  • Telephone handling issues

What are the implications of this research?

We concluded that mobile applications are promising tools to help people with diabetes self-manage their condition.  However, it is important to address the challenges that people with diabetes face when using these apps. We also recommended that future research should:

 

  • Include healthcare professionals (HCPs) to get their views on the apps
  • Explore the long-term usage of mobile apps
  • Evaluate the role of AI in providing interactive support for self-management

Conclusion

Mobile apps have the potential to improve diabetes self-management. By addressing the challenges and incorporating the recommendations of this research, we can develop apps that are truly beneficial for people with diabetes.

Tackling Drug Shortages: An Urgent NHS Priority

The NHS in the UK is grappling with a worsening crisis, drug shortages, as we discuss in our recent article in the British Medical Journal. These shortages have doubled since 2022, with supply disruptions affecting vital medications like antibiotics, diabetes treatments, and hormone replacement therapy. The implications for patient safety and healthcare services are profound, making it imperative for the UK government and the NHS to address this challenge .

Why Are Drug Shortages Happening?

The root causes of these shortages lie in both global and local factors. Disruptions in international supply chains — driven by the COVID-19 pandemic, geopolitical conflicts like the Ukraine war, and rising energy costs — have hampered the production and transport of essential pharmaceutical ingredients. Domestically, the NHS faces challenges such as manufacturing inefficiencies, logistical delays, and regulatory hurdles.

Brexit has also compounded the problem, introducing new trade barriers, customs checks, and currency depreciation, which have made importing medicines more costly and time-consuming. Moreover, economic measures like the Voluntary Scheme for Branded Medicines Pricing and Access (VPAS) have created financial disincentives for pharmaceutical companies to prioritize the UK market.

Impact on Patients and Healthcare Providers

The repercussions of drug shortages are far-reaching. For patients, unavailability of essential medications can lead to delayed treatments, reduced efficacy, and increased risks. For example, shortages of anti-epileptic drugs such as sodium valproate have heightened seizure risks for affected patients. Healthcare providers, meanwhile, face mounting workloads as they try to find alternatives, often dealing with stressed and anxious patients.

Pharmacists, in particular, bear the brunt of these challenges. Many have had to ration medicines or pay inflated prices, which are not fully reimbursed by the NHS. This financial strain comes at a time when community pharmacies are expected to play a larger role in easing the burden on GPs.

Solutions: Immediate and Long-Term Strategies

Addressing drug shortages requires a multifaceted approach:

Regulatory Reforms: Streamlining approval processes and easing restrictions on drug imports could help bridge the gap in supply. Aligning more closely with the European Medicines Agency could mitigate post-Brexit barriers.

Strengthening Supply Chains: Developing better forecasting tools and stockpiling strategies would help anticipate and respond to demand spikes. Investment in domestic pharmaceutical manufacturing, particularly for generic drugs, is also crucial to reducing reliance on global supply chains.

Support for Healthcare Providers: Allowing pharmacists greater flexibility in prescribing alternatives can prevent delays in patient care. Price concessions for scarce medications would also alleviate financial pressures on community pharmacies.

Patient-Centric Interventions: Providing online resources and national helplines to guide patients during shortages can help reduce anxiety and improve adherence to alternative treatment plans.

Looking Ahead

The drug shortages crisis underscores the need for robust policies that prioritise patient care and support healthcare providers. With timely interventions and strategic investments, the NHS can overcome these challenges and safeguard the health of the UK population. Building a healthier population through prevention and reducing demand for medications must also remain a long-term goal. Tackling drug shortages must be a priority for the NHS. Patients deserve reliable access to the medications they need, and healthcare providers need to certain that access to key drugs remains uninterrupted.

Staying healthy and making more effective use of the NHS in 2025

s we enter the new year, here are some tips on how to stay healthy and well and to make better use of the NHS in 2025:

1. Exercise regularly, aiming to include outdoor activities for sunlight exposure, which can help with physical fitness and improve mood, especially for those affected by Seasonal Affective Disorder (SAD).

2. Don’t smoke. Smoking is a major risk factor for diseases such as lung cancer and heart disease. Quitting smoking significantly reduces these risks.

3. Take-up the offer of any NHS vaccinations that you are eligible for. If you have young children, make sure they are also up to date with their NHS vaccinations.

4. Sunlight exposure may be limited in Winter, so consider vitamin D supplementation if you are in a group that this is recommended for.

5. Attend for NHS health screening appointments when invited.

6. Eat five portions of fruit & vegetables every day and eat plenty of high-fibre foods. Eating a nutritious diet is important for maintaining a healthy weight and reducing the risk of chronic diseases.

7. Limit your sugar and salt intake.

8. Limit your alcohol intake to a safe level.

9. Take time to improve your mental health; including by meeting regularly with friends and family. Mental health is just as important as physical health, and it is important to take steps to protect and improve your mental well-being.

10. Use the NHS app to book appointments, view your GP medical record and order repeat prescriptions.

11. Attend for appointments for medication reviews and for the management of long-term conditions when invited. This helps to ensure that your medication is up-to-date and that your condition is being managed effectively.

12. Be aware of the range of options for NHS care – including opticians, pharmacists, self-referral services (e.g. Pharmacy First, podiatry, IAPT, smoking cessation), and NHS 111.

13. Use the NHS electronic prescription service so that your prescription is sent directly to a pharmacy.

14. For queries about hospital care, contact the hospital Patient Advice and Liaison (PALS) team rather than your general practice. The PALS team is there to help patients and their families with any concerns or questions they have about their hospital care. The contact details are usually present on the hospital’s website.

15. Apply for online access to your hospital records if this is available

16. Check your own blood pressure. Blood pressure machines are now relatively cheap. In some parts of England, the NHS may be able to provide you with a machine. High blood pressure is a major risk factor for stroke and heart disease, so it is important to monitor your blood pressure regularly.

17. Take your medication as prescribed.

18. Get a good night’s sleep.

19. Reduce the risk of injury by wearing seatbelts and bike helmets, and driving or cycling safely

20. Listen to experts on health issues and not uninformed people on social media. There is a lot of misinformation about health issues circulating on social media, so it is important to get your health information from reliable sources, such as the NHS website or healthcare professionals.

21. Use telehealth options for accessing healthcare when appropriate, to save time and minimise exposure to potential infections.

22. Keep a well-stocked first aid kit and know how to use the basic items. This can be particularly useful for minor injuries and illnesses.

23. Keep your home safe. Falls and accidents are common during the winter due to icy conditions. Making your home slip-proof can prevent unnecessary hospital visits.

24. Keep Emergency Numbers Handy. Important contact numbers should be easily accessible, whether it’s on your fridge or saved in your phone.

25. Regular Hand Washing. Promote good hand hygiene, especially if interacting with vulnerable populations like the elderly or very young.

26. Ensure food is stored safely to reduce the risk of food-borne illnesses such as gastroenteritis.

27. Know the Signs of More Serious Conditions: Understanding the early symptoms of conditions like strokes, heart attacks, and other acute illnesses can save precious time in an emergency.

28. Improve indoor air quality. Try to keep up the air quality in your home and at work; for example, through ventilation.

29. Community Support. If possible, check on neighbours and family members who might be vulnerable during the winter months, whether due to age, health conditions, or social isolation.

30. Use of Over-the-Counter (OTC) Medication. Understand when to use OTC medications for minor illnesses and when to seek professional advice.

Let me know about any other suggestions for staying healthy.