Understanding addiction

25 July 2011 Last updated at 13:30 GMT Amy Winehouse's struggle with drink and drug addiction was well known, reflected in her music and widely reported in the media.

But how much do we understand addiction?

What causes it and why do some people become addicts while others do not?

Addiction is naturally associated with drink and drugs, but that is not the whole story.

The NHS points out that people can "become addicted to anything, from gambling to chocolate".

First contact

Addiction has to start with exposure, and at some point casual use shifts to dependence.

Dr Gillian Tober, president of the Society for the Study of Addiction, said all addiction has to start with first use.

"It is usually for social reasons - boyfriend, girlfriend, group of friends - it's usually not pleasant but there is a social reward."

This then becomes reinforced. "People say their first cigarette is disgusting. Some say never again, some break through and reveal the pharmacological effect."

Drugs directly feed the reward circuitry of the brain, and even in cases such as gambling the brain can learn to look forward to the thrill.

The brain adapts to the drug, becomes tolerant to it and demands more each time. Physiological dependence - addiction - emerges.

Resisting addiction

But not everyone becomes addicted. A great many people drink, even fewer are heavy drinkers, and even fewer become dependent.

Ilana Crome, a professor of addiction psychiatry at Keele University, said great progress had been made in recent years in understanding why that is.

"We're beginning to understand the variety of mechanisms in the addictive process, but do we know exactly what causes addiction? We don't.

"It seems to touch the very essence of behaviour, making it very difficult to research and understand."

Doctors cannot point to a 'single cause' of why addictions develop. There are however some risk factors.

The chair of the Faculty of Addictions at the Royal College of Psychiatrists, Dr Owen Bowden-Jones, puts the risks into three categories.

"One way to describe addiction is to think about it as a disorder with biological, psychological and social aspects."

He said that research suggests "people who are vulnerable to addiction may be 'wired' differently" particularly in the brain's orbito-frontal cortex.

"This part of the brain is involved in the weighing up of the pros and cons of a particular action, in other words, decision making."

Psychological trauma, such as through childhood neglect or bereavement, is common, he said.

On the social level he lists living where drugs are easily available or having friends who are addicted as well as poor housing and social deprivation.

However there are clearly many cases which do not fit these risk factors.

Harry Shapiro, from the charity Drug Scope, said addiction was a "complicated phenomenon with a combination of risk factors".

He said it was "impossible to pick people most likely to become addicted, it's such an individual thing."

Prof Crome said: "We can't predict exactly who will become addicted, but many people who are from a difficult background who might be predicted to develop a problem don't and that is a fascinating thing."

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Drivers get organ donor 'nudge'

31 July 2011 Last updated at 00:53 GMT Less than a third of people are registered as organ donors Drivers will have to state whether they want to be an organ donor when they apply for a new or replacement licence.

The move has been put forward by the government's "nudge unit", which has been set up to encourage changes in behaviour through gentle persuasion.

The Driver and Vehicle Licensing Agency already asks if applicants want to be donors - but from Monday an online form will require that the answer is stated.

Ministers hope it will help improve organ donation rates.

Less than a third of people are signed up to be organ donors - despite research suggesting that nine in 10 would he happy to be one.

Debate

The situation has prompted much debate in recent years about how best to improve rates.

Some have called for presumed consent, where it is assumed an individual wishes to be a donor unless he or she has opted out by registering their objection.

Continue reading the main story It is an idea based on a book by Richard Thaler and Cass Sunstein which advocates influencing behaviour by altering the context or environment in which people choose. It differs from traditional approaches to changing lifestyles which tend to be more overt.Conventional measures might include steps such as bans, using tax to increase price or promotional campaigns.But nudge tends to be more subtle, perhaps involving the provision of information about social norms or changing the environment, such as installing fewer lifts in a building to encourage people to use the stairs more.As well as working on organ donation, the Cabinet Office "nudge unit" will be looking at tax self-assessment and stop smoking services.The government has so far rejected presumed consent and instead the Cabinet Office's behavioural insight team has suggested the driving licence idea as part of its "nudge" drive.

The DVLA's existing scheme is already responsible for about half of the 1m new donor registrations each year.

As well as becoming compulsory to answer the question, the section will be moved from the end to the start of the DVLA process, so when applicants from England, Wales and Scotland apply for new or replacement licences they will have to say whether they want to become an organ donor or not.

When a similar scheme was introduced in the US state of Illinois, donor registration jumped from 38% to 60%.

Public health minister Anne Milton said the move was aimed at encouraging people to discuss the issue more and make it easier for them to sign up.

"Being an organ donor is a truly selfless act and a life-saving gift to someone in need," she added.

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'Super antibody' fights off flu

29 July 2011 Last updated at 07:49 GMT By James Gallagher Health reporter, BBC News A jab protecting against all flu viruses is considered a holy grails of vaccine research The first antibody which can fight all types of the influenza A virus has been discovered, researchers claim.

Experiments on flu-infected mice, published in Science Express, showed the antibody could be used as an "emergency treatment".

It is hoped the development will lead to a "universal vaccine" - currently a new jab has to be made for each winter as viruses change.

Virologists described the finding as a "good step forward".

Many research groups around the world are trying to develop a universal vaccine. They need to attack something common to all influenza which does not change or mutate.

Human source

It has already been suggested that some people who had swine flu may develop 'super immunity' to other infections.

Scientists from the Medical Research Council's National Institute for Medical Research at Mill Hill and colleagues in Switzerland looked at more than 100,000 samples of immune cells from patients who had flu or a flu vaccine.

They isolated an antibody - called FI6 - which targeted a protein found on the surface of all influenza A viruses called haemagglutinin.

Sir John Skehel, MRC scientist at Mill Hill, said: "We've tried every subtype of influenza A and it interacts with them all.

"We eventually hope it can be used as a therapy by injecting the antibody to stop the infection."

Professor Antonio Lanzavecchia, director of the Institute for Research in Biomedicine, Switzerland, said: "As the first and only antibody which targets all known subtypes of the influenza A virus, FI6 represents an important new treatment option."

When mice were given FI6, the antibody was "fully protective" against a later lethal doses of H1N1 virus.

Mice injected with the antibody up to two days after being given a lethal dose of the virus recovered and survived.

This is only the antibody, however, not the vaccine.

A vaccine would need to trigger the human body's immune system to produce the antibody itself.

Sir John said the structure of the antibody and how it interacted with haemagglutinin had been worked out, which would help in the search for a vaccine, but that was "definitely years away".

Professor John Oxford, a virologist at Queen Mary, University of London, said: "It's pretty good if you've got one against the whole shebang, that's a good step forward."

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NHS funds 'moved to rich areas'

31 July 2011 Last updated at 08:32 GMT The Department of Health says NHS spending will rise in real terms this year Labour is accusing the government of moving NHS spending in England away from poorer areas towards richer parts of the country.

It says this is because of changes to the funding for primary care trusts.

For years, areas which have higher incidences of poor health have been given a higher per-capita funding but this weighting is set to be reduced.

Health Secretary Andrew Lansley called the claims "nonsense" and said all areas were getting budget increases.

He said NHS spending was going up in real terms across England as a whole and that Labour would not have matched that commitment if it had won the election.

"We're not taking money away from any parts of England, we're increasing the budget for the health service in England," said Mr Lansley.

"The average increase in each primary care trust is 3%, compared to [its] provision the previous year.

"The minimum increase is two and a half percent, and actually the minimum increase is going to Kingston upon Thames in London, which is hardly a poor area."

Labour, however, says the changes will mean less well-off areas such as Manchester and Tower Hamlets in east London losing out in the allocation of health funding, while more prosperous parts of the country - such as Surrey and Hampshire - will benefit.

Its claims are based on an assessment of funding changes made by public health bodies in Manchester.

Shadow health minister, Diane Abbott, stood by the report and said the NHS was under pressure because of a "misconceived reorganisation" by the Conservative-led government.

"A responsible government, which cared about health and equalities, that cared about the health of the poor, would not be taking money away from inner city areas.

"This isn't politics. This is about people's lives. This is about how quickly you can expect to get an operation, whether you get it as quickly as possible, whether you're made to wait artificially long - 15 weeks - rather than as quickly as possible."

The government said the funding changes were based on independent advice and that Labour's figures were misleading.

The Department of Health said the primary care budgets in Surrey and Tower Hamlets would, in fact, increase this year by a similar amount.

It added that a greater emphasis on the prevention of illness in future would assist those living in poorer parts of England.

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Child health

29 July 2011 Last updated at 13:29 GMT By Dominic Hughes Health correspondent, BBC News The Teddy Bears' Picnic in Lister Park is an annual event for the Born in Bradford families In Bradford's Lister Park, hundreds of families are getting ready for a summer picnic.

On the grass next to the Edwardian splendour of the Cartwright Hall art gallery they lay out their picnic rugs under a sunny West Yorkshire sky.

But these are no ordinary families.

For this is the annual Teddy Bears' Picnic for families taking part in one of the country's biggest research projects, studying the health of around 14,000 children born in the city.

It is an attempt to get to the bottom of why illness blights the lives of so many families in Bradford, which is home to some of the most deprived communities in the UK.

Blood samples

Between 1996 and 2003, the number of children dying in Bradford before they reached their first birthday was almost double the average for England and Wales.

Levels of childhood illness are higher as well, along with much higher rates of heart disease, diabetes, cancer, obesity, asthma and eczema in the city's population as a whole.

Jacob Robinson, the youngest and final recruit to the Born in Bradford project, takes a well-earned snooze

So the project, known as Born in Bradford, is looking at every aspect of a child's development to try to get an idea of how factors like environment, education, diet, ethnicity and genes interact together to affect our health.

Since March 2007, every pregnant woman who attended the Royal Bradford Infirmary has been asked to take part and - amazingly - nearly nine out of 10 said yes.

Parents give blood and saliva samples, babies are measured and weighed and their progress will be tracked across the years.

Future health

Making his first appearance at this year's picnic is Jacob Robinson, born at the beginning of June to Nicola and Duncan.

Jacob is the last recruit to the study and his parents are thrilled to be taking part.

"I just think it is an incredible study," says Nicola.

Continue reading the main story

The more we understand about adult health the more we understand how important the early origins of illness are”

End Quote Prof John Wright Born in Bradford "The fact they are speaking to so many mums across the whole area and compiling all of the data and using it for the future health of babies, I just thought it was a really important study so I was quite excited to be involved."

By lunchtime, more than a thousand people have gathered in the park where stalls promote everything from the Bradford Bulls rugby league side to how to practise good teeth-cleaning.

At the centre of it all, chatting to parents and children, is Professor John Wright, the man in charge of the project.

"Bradford's got some major health problems. We have some of the highest infant mortality rates in the country, we have high levels of childhood asthma, childhood obesity, and we have a diabetes epidemic that is happening in this city as we talk.

"So what we wanted to do was to set up a study to understand what the causes of this were and in particular the early origins of these diseases, as they track through to adulthood.

Ethnic diversity

"The more we understand about adult health the more we understand how important the early origins of illness are.

Ali and Battul Agha and their youngest son Rayan are taking part in the project

"There is particular interest in the first origins of early development of disease - in the womb and the first couple of years of life - and these seem to predict who gets sick later on in life."

The Born in Bradford families reflect the city's ethnic diversity and around half of them are from an Asian background, a community that has some distinct health problems.

For example, around a quarter of Asian adults in Bradford are diabetic, while another quarter are pre-diabetic, putting them at high risk of developing the disease.

Battul Agha is one mother for whom diabetes is a serious worry.

Her son Rayan is one of the Born in Bradford children, but his mum says diabetes has already affected the family.

"I had gestational diabetes while I was pregnant but generations have got it - my children's grandparents, my own grandparents, my mum, some uncles have even developed it.

"So therefore we are particularly cautious about the children's health and what we feed them. We try and give them as much exercise as we can - lots of outdoor time and a healthy lifestyle."

So now the last families have been recruited, the hard work for the researchers begins.

Over the coming years they will track lives of thousands of children across Bradford and hope to provide some clues about the illnesses that affect many more millions of adults.

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DVT linked to video gamer's death

30 July 2011 Last updated at 15:44 GMT Chris Staniforth would spend up to 12 hours playing on the console. A man whose son died after playing video games for long periods is campaigning for greater awareness of the risk posed by their excessive use.

Chris Staniforth, 20, who would play his console for up to 12 hours, died in May from deep vein thrombosis (DVT).

His father David believes the condition may have been triggered by long gaming sessions.

DVT can form during long periods of immobility and can kill if the clots travel to the lungs.

Computer records showed his son would sometimes play online on his Xbox for periods up to 12 hours.

The coroner said a clot formed in Chris' left calf before moving to his lungs.

Once there, it caused a fatal blockage, known as a pulmonary embolism.

Mr Staniforth said: "After my research I saw there was no difference to Chris sitting at a desk on his Xbox and someone on a long-haul flight.

"Sitting still is literally the danger zone. Chris loved to play and would stay up all night.

"Millions of people worldwide are playing these games for hours, and there is a risk."

While Mr Staniforth has no problem with games consoles, he wants to highlight the heightened risk of DVT associated with being immobile, and is in the process of setting up a website.

In a statement, Microsoft, who manufacture the Xbox console, said: 'We have always encouraged responsible game play through our education campaigns such as Play Smart, Play Safe.

"We recommend that gamers take periodic breaks to exercise as well as make time for other pursuits."

David Staniforth calls for greater awareness of DVT after the death of his son, Chris

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Wellcome at 75

25 July 2011 Last updated at 01:53 GMT

When Sir Henry Wellcome died on 25 July 1936, his will made provision for the establishment of a trust that would invest in biomedical research and into the history of medicine.

The resulting Wellcome Trust grew to become one of the UK's biggest charities, investing ?600m each year. Ross MacFarlane from the Wellcome Library looks at the humble beginnings of the young man from America's Wild West who inspired it all.

Continue reading the main story To see the enhanced content on this page, you need to have JavaScript enabled and Adobe Flash installed. All images subject to copyright. Click show captions for image information. Music by KPM Music.

Slideshow production by Paul Kerley. Publication date 25 July 2011.

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Wellcome Trust at 75

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