Training the brain to boost self-confidence

Eating well, exercising, and being socially active are some factors that can help raise self-esteem. For some people, however, the road to confidence is much more challenging. Now, researchers suggest it may be possible to train the brain to boost confidence.

In a new study, scientists have identified brain activity patterns that can predict a person’s confidence state. What is more, they have discovered that this brain activity can be manipulated to increase self-confidence.

Study leader Dr. Aurelio Cortese, of the Advanced Telecommunications Research (ATR) Institute International in Kyoto, Japan, and colleagues recently published their findings in the journal Nature Communications.

Self-confidence is generally defined as the belief in one’s own abilities. As the University of Queensland in Australia put it, self-confidence describes “an internal state made up of what we think and feel about ourselves.”

Low self-confidence can lead to shyness, social anxiety, a lack of assertiveness, and communication problems. These can have negative implications for many aspects of life, including relationships and career progression.

Studies have shown that low self-confidence can also increase the risk of mental health problems, such as depression and bipolar disorder.

There is no one-size-fits-all approach to boosting self-confidence. Some people find making personal changes – such as adopting a healthy diet or joining a social club – can improve self-confidence, while others may benefit from mindfulness or counseling.

In the new study, Dr. Cortese and colleagues suggest it may be possible to alter brain activity as a means of boosting self-confidence.

Identifying and manipulating brain patterns to boost confidence

The researchers came to their findings through the use of a novel imaging technique known as “decoded neurofeedback.” This involves brain scans to monitor complex brain activity patterns.

The team tested this imaging method on 17 study participants as they performed a simple perceptual exercise. As a result, the researchers identified specific brain activity that was associated with low and high confidence.

“How is confidence represented in the brain? Although this is a very complex question, we used approaches drawn from artificial intelligence to find specific patterns in the brain that could reliably tell us when a participant was in a high or low confidence state,” explains study co-author Dr. Mitsuo Kawato, director of the Computational Neuroscience Laboratories at ATR.

Next, the researchers wanted to see whether they could use this information to induce high confidence states among the study participants.

All subjects took part in training sessions, in which they received a small monetary reward whenever high confidence states were detected through decoded neurofeedback.

Through these training sessions, the researchers found that they were able to unconsciously boost participants’ self-confidence. In other words, the subjects were unaware that their brains were being manipulated to make them more confident.

“The core challenge was […] to use this information in real-time, to make the occurrence of a confident state more likely to happen in the future.

Surprisingly, by continuously pairing the occurrence of the highly confident state with a reward – a small amount of money – in real-time, we were able to do just that: when participants had to rate their confidence in the perceptual task at the end of the training, they were consistently more confident.”

Dr. Aurelio Cortese

Importantly, the researchers note that they used “rigorous psychophysics” to quantitatively measure confidence among participants, as a way of ensuring that the results of the training session did not simply reflect changes in mood or self-reporting.

As well as shedding light on the brain processes responsible for self-confidence, the authors believe that their findings may bring us one step closer to uncovering new ways to improve self-confidence and other important mental states.

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Highly drug-resistant infections rising among American children

A new review of surveillance data reveals that rates of highly drug-resistant infections are on the increase among children in the United States. The findings reinforce the need for better ways to track, prevent, and treat these serious infections in children and for bolstering stewardship programs.

The researchers came to this conclusion after analyzing a large reference-laboratory database of samples collected from pediatric patients all over the U.S. between 1999-2012. The samples were of an important infection-causing bacteria called Pseudomonas aeruginosa.

P. aeruginosa is a common cause of healthcare-associated infections that can result in prolonged illness, require longer hospital stays, and, ultimately, raise the risk of death.

The researchers report their findings in the Journal of the Pediatric Infectious Diseases Society.

First and corresponding author Latania K. Logan, assistant professor at Rush University Medical Center in Chicago, IL, says:

“Infections with P. aeruginosa can be serious and are associated with significant morbidity and mortality.”

Antibiotics have transformed medicine – they have made it possible to treat once deadly infections and paved the way for advances like transplant surgery and chemotherapy for cancer. They have reduced disease and saved lives.

However, misuse of the drugs has also contributed to the increasing problem of antibiotic resistance, now a serious and growing threat to public health.

Multi-drug resistant P. aeruginosa a ‘serious threat’

The Centers for Disease Control and Prevention (CDC) include antibiotic-resistant P. aeruginosa among the top 18 drug-resistant threats to Americans.

The CDC class multi-drug resistant P. aeruginosa as a serious threat – that is, “not considered urgent” but the threat “will worsen and may become urgent without ongoing public health monitoring and prevention activities.”

Their estimates show 51,000 healthcare-associated P. aeruginosa infections in adults and children occur in the U.S. each year. This includes 6,700 cases where the bacterium is resistant to multiple types of antibiotic, resulting in 440 deaths a year.

The CDC suggest hospital antibiotic stewardship programs should contain the following core elements:

  • Commitment from leaders: dedicate the human, financial, and information technology resources necessary to implement the program

  • Accountability: appoint a single leader responsible for getting results – evidence from successful programs shows this works

  • Drug expertise: appoint a single pharmacist leader who works to improve antibiotic use

  • Action: implement at least one recommended action – such as evaluate the need for continuing treatment after a set period (for example, “antibiotic time-out” after 48 hours)

  • Monitoring: track patterns of drug prescribing and resistance

  • Informing: keep doctors, nurses, and relevant staff up-to-date about antibiotic use and resistance

  • Education: educate clinicians about resistance and optimal prescribing.

Highly resistant P. aeruginosa infections rising in children

However, the researchers behind the new study note that – despite many papers warning about rising national rates of antibiotic resistance – few investigate the trends of drug-resistant P. aeruginosa in children specifically.

They looked at data from a surveillance network of laboratories serving around 300 hospitals across the U.S. The laboratories analyze patient samples of P. aeruginosa for resistance to several types of drugs.

For their analysis, the researchers included data on children aged 1-17 who were in outpatient, inpatient, intensive care unit, and long-term care settings from January 1999 – July 2012. They excluded children under 1 year old and patients with cystic fibrosis.

The researchers found the proportion of P. aeruginosa samples that were resistant to at least three classes of antibiotics – that is, multi-drug resistant – increased from 15.5 percent in 1999 to 26 percent in 2012.

The proportion that were resistant to carbapenems rose from 9.4 percent to 20 percent over the same period. Carbapenems are a class of antibiotic that is considered a treatment of last resort for highly resistant infections.

The researchers found both multi-drug resistant and carbapenem-resistant P. aeruginosa were more common in patients in intensive care units, in children aged 13-17, in respiratory samples, and among patients in the Midwest states (Iowa, Kansas, Minnesota, Missouri, Nebraska, and the Dakotas).

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High blood pressure: Global total almost doubles in 4 decades

The largest study of its kind reveals that the number of people worldwide living with high blood pressure has nearly doubled in the last 4 decades. The huge international effort also reveals a stark contrast between rich and poor countries.

The number of people living with high blood pressure, or hypertension, worldwide has grown from 594 million in 1975 to over 1.1 billion in 2015 – mainly because of population growth and aging – says the study, published in The Lancet.

However, while average blood pressure is high and rising in less affluent countries, especially in south Asia and sub-Saharan Africa, it has dropped to an all-time low in high-income nations like Canada, the United Kingdom, and the United States.

The authors say the reason for this contrast is not clear, but they suggest a major factor could be that people in wealthier nations enjoy better health overall and eat more fruits and vegetables.

Earlier diagnosis and control of hypertension is also more likely to occur in wealthier countries. Taken together, these factors also help reduce obesity, another risk factor for high blood pressure.

Childhood nutrition could be another reason, suggests Majid Ezzati, a senior author of the study and a professor at the School of Public Health at Imperial College London in the U.K., who notes:

“Increasing evidence suggests poor nutrition in early life years increases risk of the high blood pressure in later life, which may explain the growing problem in poor countries.”

High blood pressure major global killer

Blood pressure is the pressure of the blood in the blood vessels. It is assessed from two numbers measured in millimeters of mercury (mmHg): systolic pressure and diastolic pressure.

Systolic pressure is a measure of the heart pumping blood. Diastolic pressure – taken when the heart rests between beats – measures the resistance to blood flow in blood vessels.

High blood pressure is defined as 140 mmHg systolic and 90 mmHg diastolic pressure or higher. This is normally shown as 140/90 mmHg.

Recent research suggests that the risk of death from cardiovascular diseases like ischemic heart disease and stroke doubles with every 20 mmHg systolic or 10 mmHg diastolic increase in people of middle age and older.

“High blood pressure is the leading risk factor for stroke and heart disease, and kills around 7.5 million people worldwide every year,” says Prof. Ezzati.

The condition is caused by various factors, he and his colleagues note in their paper.

These include diet (for example, eating too much salt and not enough fruit and vegetables), obesity, lack of physical activity, plus environmental factors – such as air pollution and lead exposure.

‘Major health issue linked to poverty’

For the research, the World Health Organization (WHO) teamed up with hundreds of scientists from all over the globe and looked at changes in blood pressure in every country in the world from 1975-2015.

They pooled and analyzed data from nearly 1,500 population-based measurement studies involving a total of 19 million participants.

This showed that of the whole world, South Korea, the U.S., and Canada have the lowest proportion of people with high blood pressure. The U.K. had the lowest in Europe.

The research also shows that in most countries, there are more men with high blood pressure than women. Worldwide, there are 597 million men with high blood pressure, compared with 529 million women.

The figures for 2015 show that more than half of adults with high blood pressure in the world live in Asia, including 226 million in China and 200 million in India.

Prof. Ezzati says high blood pressure is no longer a problem associated with wealthy countries but with poor countries. He says their findings show it is possible to achieve substantial reductions in rates of high blood pressure – as seen in the data from more affluent countries over the last 4 decades. He adds:

“They also reveal that WHO’s target of reducing the prevalence of high blood pressure by 25 percent by 2025 is unlikely to be achieved without effective policies that allow the poorest countries and people to have healthier diets – particularly reducing salt intake and making fruit and vegetables affordable – as well as improving detection and treatment with blood pressure lowering drugs.”


Young brains and anesthesia: Big study suggests minimal risks

Anesthesia during early childhood surgery poses little risk for intelligence and academics later on, the largest study of its kind suggests.

The results were found in research on nearly 200,000 Swedish teens. School grades were only marginally lower in kids who’d had one or more common surgeries with anesthesia before age 4, compared with those who’d had no anesthesia during those early years.

Whether the results apply to sicker children who have riskier surgeries with anesthesia is not known. But the researchers from Sweden’s Karolinska Institute and doctors elsewhere called the new results reassuring, given experiments in young animals linking anesthesia drugs with brain damage.

Previous studies of children have been relatively small, with conflicting results. The new findings, published Monday in JAMA Pediatrics , don’t provide a definitive answer and other research is ongoing.

The study authors and other doctors say the harms from postponing surgery must be considered when evaluating any potential risks from anesthesia in young children.

The most common procedures in the study were hernia repairs; ear, nose or throat surgeries; and abdominal operations. The researchers say the operations likely lasted an hour or less. The study did not include children with other serious health problems and those who had more complex or risky operations, including brain, heart and cancer surgeries.

The research involved about 33,500 teens who’d had surgery before age 4 and nearly 160,000 who did not.

School grades at age 16 were less than half a percent lower on average in teens who’d had one childhood surgery with anesthesia versus the no-surgery group. Average grades were less than 2 percent lower among teens who’d had two or more surgeries with anesthesia.

The researchers also looked at IQ tests given to Swedish boys at age 18 upon joining the military. Scores were about the same for those with one early surgery and the non-surgery group; scores were less than 3 percent lower in boys with three or more early surgeries.

The researchers, led by Karolinska’s Dr. Pia Glatz, noted that factors other than anesthesia appeared to have a much greater impact on academics and intelligence measures, including mothers’ education level.

A journal editorial says the results mean it is unlikely that early anesthesia poses a long-term risk. The study is “reassuring for children, parents and caregivers and puts the issue of anesthetic-related neurotoxicity and the developing brain into perspective,” the editorial says.

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Water: Can It Be Too Much of a Good Thing?

Dehydration is a familiar foe for endurance athletes, and one that will be on the minds of every participant in Sunday’s New York City Marathon.

But did you know that drinking too much water can be potentially fatal, particularly if not treated properly?

And you don’t have to be an elite athlete like a marathoner to fall victim to what doctors call water intoxication.

Water intoxication occurs when a person has consumed so much water that the salt levels in the blood become diluted, said Dr. Aaron Baggish, co-medical director of the Boston Marathon.

“When sodium [salt] concentrations are low in the blood, it actually allows water to leak out of the blood into the other tissues,” a condition known as hyponatremia, added Baggish, who’s also associate director of the Cardiovascular Performance Program at the Massachusetts General Hospital Heart Center.

The brain appears to be the organ most affected by hyponatremia, and begins to swell as water leaks out of blood and into brain cells, he said.

Usually, the symptoms are mild, such as confusion, headache and nausea. But if left untreated, people might wind up suffering seizures, Baggish said.

In the worst cases, the brain continues to swell uncontrollably, resulting in a potentially fatal condition called brain stem herniation, he said.

“The brain is soft tissue that’s contained in a fixed skull. When the brain swells, there’s only one real way it can go as an exit path, and that’s down to the bottom of the skull where there’s a hole that connects the brain to the spinal cord,” Baggish said.

Death from water intoxication is very rare among athletes like marathon runners, said Dr. William Roberts, a former president of the American College of Sports Medicine.

“We’ve noted maybe a half dozen deaths out of probably 3 or 4 million finishers, so it’s not a very common cause of fatality,” said Roberts, who’s also a professor with the University of Minnesota’s Department of Family Medicine and Community Health. Marathon runners are more likely to die from a heart attack or heat stroke, he said.

Sports medicine doctors are much more likely to see cases of water intoxication or hyponatremia than family practitioners, Baggish said.

“If you’re in a marathon tent or an Ironman tent, you may see a fair bit of it,” he said. “If you’re in a routine office practice, it won’t come across your radar screen. But, anyone who works with athletes in the context of long-distance endurance sports will see it from time to time.”

But endurance athletes aren’t the only ones at risk of water intoxication.

A 17-year-old high school football player in Georgia died in 2014 after consuming too much fluid during practice.

A 47-year-old British woman died from drinking too much water while hiking the Grand Canyon in 2008.

And a 28-year-old California woman died of water intoxication after taking part in a radio station’s water-drinking contest in 2007 to win a video game.

Earlier this year, a 27-year-old man named Andrew Schlater died from hyponatremia while in the midst of a liquid cleanse, or detoxification, without medical supervision, said his father, Frank Schlater of Rowayton, Conn.

For a number of days, Schlater’s parents had noticed him drinking a lot more water than usual. Andrew seemed fine, and shrugged off his parents’ requests to stop drinking so much water.

But, early one morning in July, Frank Schlater found his son in the family’s kitchen, sipping some water. Within minutes, Andrew collapsed on the floor. He was rushed to the hospital but died several hours later, due to brain herniation.

“You just can’t imagine water would hurt you,” Frank Schlater said. “You hear that too much water can be bad for you, but you don’t know how to weigh that.”

Others at risk of hyponatremia: Older people who take diuretics and have reduced kidney function, said Roberts.

Marathoners most at risk of water intoxication tend to be those out on the course for longer periods of time, Roberts noted.

“Slower runners have more time to drink water,” he said. “If you’re out there for six hours, walking through water stops and drinking more than you need, you could end up in this situation.”

Taking in salt or sodium during a race can help reduce the risk of hyponatremia, said Dr. Robert Glatter, an emergency physician with Lenox Hill Hospital in New York City. For example, athletes can consume sports drinks containing electrolytes, he said.

Roberts and Baggish offer two pieces of advice for endurance athletes who want to avoid water intoxication:

Drink when you’re thirsty, not before. “You should be drinking if you’re feeling mildly thirsty, but if you’re not thirsty there’s no point to pound water because it’s not going to make you perform better,” Baggish said.

Figure out your water-loss rate before your event. Weigh yourself while naked, go out for an hour’s run, and afterwards weigh yourself again. “That gives you an idea how much fluid you lost,” Roberts said. “Plan on drinking about that much during your event.”

And what about the non-endurance athlete. How much water does the average person need each day?

There’s no one-size-fits-all rule. But, the Institute of Medicine recommends that men consume approximately 13 cups (3 liters) of fluids a day. For women, the recommendation is about 9 cups (2.2 liters).

But, the Mayo Clinic notes that it’s best to think in terms of “fluid” consumption each day, not “water” consumption, because all fluids count toward the daily total, as do fluids found in foods.


Some immune-boosting cancer drugs may pose rare heart risks

Doctors have found a disturbing downside to some powerful new drugs that harness the immune system to fight cancer: In rare cases, they may cause potentially fatal heart damage, especially when used together.

“The problem is, no one has this on their radar,” so patients are not routinely checked for it, said Dr. Javid Moslehi, head of a Vanderbilt University clinic specializing in heart risks from cancer therapies.

He led a report Wednesday in the New England Journal of Medicine describing two patients who died of heart trouble two weeks after receiving their first doses of two Bristol-Myers Squibb drugs, Opdivo and Yervoy, for the deadly skin cancer melanoma.

Two similar drugs also are on the market, and the study leaders believe they might pose heart risks, too.

“My sense is that this is a class effect, not limited to one drug,” Moslehi said.

The risks do not negate the huge benefits of these relatively new types of drugs, doctors stress. Called checkpoint inhibitors, they have transformed treatment of several types of cancer by helping the immune system see and attack tumors.

In rare cases, the immune system seems to attack not only the tumor but also the heart and other muscles, causing dangerous inflammation and heart rhythm problems. Patients need to be told of the risks, monitored closely and treated quickly with medicines to quell the immune response if trouble develops.

Besides melanoma, the Opdivo-Yervoy combination is used to treat some lung cancers, though at different doses. Other checkpoint inhibitors include Genentech’s Tecentriq, for bladder cancer, and Merck & Co.’s Keytruda, which former President Jimmy Carter received for melanoma that spread to his brain. Many more are in testing.

There have been occasional, previous reports of heart troubles with these drugs. After the two recent deaths, doctors asked Bristol-Myers to check patient safety records on Opdivo and Yervoy.

As of April, 18 cases of serious heart inflammation were found among 20,594 patients receiving either or both drugs, a rate of 0.09 percent. It was more severe and more common among people on both drugs, affecting 0.27 percent of those patients. Bristol-Myers scientists helped write the journal report, and some other authors consult for the company.

Studies have shown that the drug combination gives a stronger anti-cancer effect than either drug alone, but “we’ve known this is a double-edged sword” because of the risk of over-stimulating the immune system, said Dr. Jeffrey Sosman of Northwestern University in Chicago, who treated the two patients who died.

“The big question is, is there enough advantage to using the combination, which is much more toxic, than a single drug,” he said.

That’s a larger question facing the cancer field, not just with immune therapies. Some of the newer gene-targeting drugs also have produced major side effects when used in combination. Yet many doctors believe that combos may be the best way to get cancer to go into remission and stay there longer, by shutting down multiple pathways the tumor employs at once.

Dr. Michael Atkins, deputy director of the Georgetown-Lombardi Comprehensive Cancer Center, believes the heart problems with checkpoint inhibitors will turn out to be treatable in most patients.

“It just gives us a moment of pause,” said Atkins, who led a study that included one of the two patients who died. “This is a rare event … but it’s a particularly serious one.”


Hunger ‘not linked to calorie intake’

Grocery stores are now amassed with prepackaged meals claiming to suppress appetite and keep us feeling fuller for longer. But according to new research, these meals are unlikely to affect our overall calorie intake.

From a review of more than 460 studies, researchers from the University of Sheffield in the United Kingdom found little evidence of a link between how hungry we feel and the amount of calories we consume.

Study leader Dr. Bernard Corfe, from the Molecular Gastroenterology Research Group at Sheffield, and team publish their results in the journal Critical Reviews in Food Science and Nutrition.

In the United States, more than 2 in 3 adults and around one third of children are considered overweight or obese.

The primary cause of overweight and obesity is an energy imbalance – that is, more calories are consumed than the body uses, or “burns,” which results in excess weight.

As such, eating a healthy diet and sticking to the daily recommended calorie intake – around 1,600-2,400 calories for women and 2,000-3,000 calories for men, depending on physical activity – are considered key for weight loss and maintenance.

Few studies found a link between appetite and calorie intake
Appealing to the the desire of many individuals to lose weight through dietary changes are prepackaged meals that claim to have appetite-modifying properties that keep us sated for longer, reducing the need to reach for the unhealthy snacks when hunger bites.

The new study, however, indicates there is no link between appetite and calorie intake, suggesting some food manufacturers may need to rethink their claims.

Dr. Corfe and colleagues came to their conclusion after conducting a review of 462 studies that assessed both appetite and calorie consumption.

The researchers found that only 6 percent of the studies reviewed made a direct statistical comparison between appetite and calorie intake, and only half of these studies found that self-reported appetite correlated with calorie consumption.

The team says these findings indicate that how hungry we feel has no effect on the amount of calories we consume – something that food manufacturers should take into consideration.

“The food industry is littered with products which are marketed on the basis of their appetite-modifying properties. Whilst these claims may be true, they shouldn’t be extended to imply that energy intake will be reduced as a result.

For example, you could eat a meal which claims to satisfy your appetite and keep you feeling full up for a long period of time but nonetheless go on to consume a large amount of calories later on.”

Dr. Bernard Corfe

Dr. Corfe says further research is needed in order to pinpoint precisely what does influence calorie intake; are environmental or social factors involved?

“This will be important to understand how obesity occurs, how to prevent it, and how we need to work in partnership with the food industry to develop improved tests for foods that are genuinely and effectively able to satisfy appetite,” Dr. Corfe adds.


Migraines linked to bacteria in mouth

People who suffer from migraines have more of certain bacteria in their mouths

People who suffer from migraines have long complained that certain foods trigger the severe headaches. New research suggests the culprit might be the amount of bacteria in the mouth.

Researchers found that the mouths of people who suffer from migraines harboured significantly more of the microbes that break down nitrates found in certain foods.

These bacteria play an important role in processing nitrates so they can then be converted into nitric oxide in the bloodstream, which widens blood vessels and improves circulation.

While this process is helpful for cardiovascular health, the findings suggest an abundance of these bacteria may break down nitrates more quickly, causing blood vessels in the brain and scalp to dilate, triggering migraines.

Nitrates are naturally found in a variety of leafy green vegetables, and they are added to processed meat as a preservative and to improve flavour and colour.

Doctors have been telling people who suffer from migraines to avoid processed foods for years. Dr. Michael Zitney, who leads the Headache & Pain Relief Centre in Toronto, says this research strengthens their case.

“We have long since known that these kinds of foods can trigger migraines, but we haven’t really known how,” he says.

Link to cardiovascular research

The process of how nitrates break down into nitric oxide is well-studied in cardiovascular health.

Nitrate-containing drugs are prescribed to treat chest pain or congestive heart failure. But roughly four out of five cardiac patients who take the drugs report severe headaches as a side-effect.

The study’s authors hope these findings will help link existing cardiovascular research with migraines.

“It opens a full area of research and connects two areas of research that have not been connected before,” says the study’s lead author, Antonio Gonzalez, from the University of California San Diego.

Data collected from ‘citizen scientists’

This study was based on data from the American Gut Project, which crowd sources oral and fecal samples from so-called “citizen scientists.”

Researchers sequenced bacteria found in 172 oral samples and 1,996 fecal samples. They found that the nitrate-reducing microbes were slightly more abundant in the fecal samples of people who suffer from migraines, but significantly more abundant in their oral samples.

Chronic migraines are frequent, severe, pulsating headaches accompanied by nausea, vomiting, and sensitivity to light and sound. They last anywhere from a few hours to several days.

It’s estimated that eight per cent of Canadians have been diagnosed with migraines, although this likely underestimates their prevalence, as some people who suffer from migraines don’t seek professional help.

The study’s authors say they still need to determine whether the bacteria are a cause or a result of migraines, or are indirectly linked in some other way.

For now, Zitney says, the research suggests that some migraines could one day be treated by controlling the bacteria in our mouths.

“This may be just a glimmer of hope in terms of pursuing possible treatments,” he says.

The study was published earlier this week in mSystems, the online journal of the American Society for Microbiology.


Student doctor numbers to rise by 25%

The number of medical school places will increase by 25% from 2018 under plans to make England “self-sufficient” in training doctors.

The government’s plan will see an expansion in training places from 6,000 to 7,500 a year.

Ministers believe increasing the number of home-grown doctors will be essential given the ageing population.

There is also concern it will become more difficult to recruit doctors trained abroad in the future.

About a quarter of the medical workforce is trained outside the UK, but the impact of Brexit and a global shortage of doctors could make it harder to recruit so many in the future.

Prime Minister Theresa May told the BBC: “We want to see the NHS able to recruit doctors from this country. We want to see more British doctors in the NHS.”

The increase also comes after the government has spent a year at loggerheads with junior doctors over the pressures being placed on them to fill rota gaps.

Doctor workforce in numbers


doctors working in NHS

25% are foreign

9% due to retire in next five years

2% more needed each year to keep up with demand

7-10% of posts are vacant

Dr Daniel Bunce, 27, is in his third year of being a junior doctor after completing his medical degree. He is now working in a hospital in the south west in intensive care.

He says he got into medicine because he wanted to “care for people and make a difference”.

“It’s been difficult. There is so much pressure, particularly during winter. We just don’t have the time to spend with patients that we need to provide the care we want to because we are rushing around just trying to keep up.

“I’m now working in intensive care so the staff to patient ratios is much better than it was when I was on medical wards. But the workload is making people I work with think about whether this is something they want to do for the rest of their career.

“The increase in medical school places is a good move, but we will have to see what impact it has in hospitals in the long-term.”

Medical degrees take five years to complete, so it will be 2024 before the impact of these extra places is felt.

But Mr Hunt told the Conservative Party conference in Birmingham on Tuesday: “We need to prepare the NHS for the future, which means doing something we have never done properly before – training enough doctors.

“Currently a quarter of our doctors come from overseas. They do a fantastic job and we have been clear that we want EU nationals who are already here to stay post-Brexit.

“But is it right to import doctors from poorer countries that need them while turning away bright home graduates desperate to study medicine?”

Mr Hunt said the steps would mean that by the end of the next Parliament the health service in England would be “self-sufficient” when it comes to training doctors.

Analysis: Will this work?

There is widespread agreement that the NHS is facing a crisis when it comes to doctor shortages. It is one of the underlying reasons why the dispute between the government and junior doctors has been so bitter.

So news that the number of training places is to increase by 25% is certainly being welcomed by many. But whether it is enough is another matter.

The health service employs more than 150,000 doctors – a quarter more than it did a decade ago. But even that has not been sufficient – vacancy rates are said to be running at close to 10%.

This is despite huge numbers being recruited from abroad. In fact, the numbers registering to work in the NHS from outside the UK has been outstripping those graduating from medical school in recent years.

The future, of course, is fraught with difficulties. The impact of Brexit on EU doctors is uncertain, there are large numbers due to retire – a figure of 13,500 in the next five years has been suggested – and then there is the not insignificant numbers who leave the NHS for other countries or opportunities.

More doctors in training doesn’t necessarily translate to more doctors in the NHS.

The rise in training places will cost £100m from 2018 to 2020, but in the long-term the government hopes to recoup money by charging foreign students more than it does now.

Medical students will also be expected to work for the NHS for at least four years – or face penalties that could include them having to repay the cost of their training, which currently stands at £220,000 to the taxpayer over the five-year degree.

The details of how this will work have yet to be ironed out and, in particular how it will apply to doctors moving to another part of the NHS in Scotland, Wales and Northern Ireland. This announcement applies to England only.

At this stage it is thought unlikely that ministers would want to apply the four-year restriction to doctors wanting to move to other UK nations.

Doctor hands

British Medical Association leader Dr Mark Porter said the announcement “falls far short of what is needed”.

“The government’s poor workforce planning has meant that the health service is currently facing huge and predictable staff shortages,” he said.

“We desperately need more doctors, particularly with the government plans for further seven-day services, but it will take a decade for extra places at medical school to produce more doctors.

“This initiative will not stop the NHS from needing to recruit overseas staff.”

  • Each year 6,000 medical students currently graduate after five years of study
  • There are a similar new junior doctors places open for them (although some students take gap years)
  • By the third year of junior doctor training they need to choose a specialism, such as general practice or a hospital speciality like surgery
  • That is where the shortages start to emerge
  • Latest figures from Health Education England show one in 10 places remain unfilled
  • The biggest gaps are seen in psychiatry (19%), GPs (17%) and paediatrics (7%)

Nigel Edwards, chief executive of the Nuffield Trust, said: “For decades, the NHS has failed to train enough of its own staff, so increasing the number of UK-trained medical staff is long overdue.

“However, if this new announcement involves simply replacing overseas doctors with UK-trained ones, that won’t increase the total number working in the NHS, and certainly won’t solve the agency staff crisis that is affecting the NHS right now.”

Chief Executive of Dartford and Gravesham NHS Trust Susan Acott told the BBC there were shortages in specialisms including Accident and Emergency, radiology and intensive care in her hospitals.

“An expansion of medical training is very desirable,” she said. “We’re a very under-doctored country compared to European levels.”

The idea that doctors could be retained in the UK once they had trained was an “interesting” idea, she added, but there were practical obstacles.

“Doctors go abroad to develop their training and experience different health systems and techniques,” Ms Acott said.


Allergic passengers beware: Nuts on a plane

Preparing for air travel can be highly challenging for nut-allergic passengers, a Short Report published in the Medical Journal of Australia has found.

Over 90 million passengers are carried on Australian flights each year, with 1-2% reporting they have documented food allergies. Dr Mark Hew and colleagues from the Alfred Hospital conducted a survey of all domestic and international airlines that fly from Tullamarine to assess their nut allergy policies.

The researchers found that 61% of airlines had online or telephone hotline information about nut allergy policies. Only a minority of airlines were able to provide nut-free meals. “Nine airlines (27%) offered nut- free meals, two routinely and seven on request. For the other airlines, nut-allergic passengers would need to fast (only practical on short domestic routes) or bring their own food,” the authors wrote.

A third of the airlines could restrict the distribution of packaged nuts on flights if required.

Only one airline operating from Melbourne’s Tullamarine airport confirmed that emergency adrenaline was available on all flights.

For nut allergic individuals, the authors recommended that they contact their airline before travelling, develop an allergy plan with their doctor, carry their own emergency adrenaline, and consider bringing their own food. “Airlines should make their nut allergy policies more accessible and consider carrying emergency adrenaline on all flights,” the authors concluded.

Article: Airline policies for passengers with nut allergies flying from Melbourne Airport, Stephanie Stojanovic, Celia Mary Zubrinich, Robyn O’Hehir and Mark Hew, Medical Journal of Australia, doi: 10.5694/mja16.00384, published 20 September 2016