0:00:04 > 0:00:07When it comes to our health, it seems everyone has an opinion.
0:00:08 > 0:00:11But what's the health advice you can really trust?
0:00:14 > 0:00:20We're here to weigh up the evidence, and use our expertise to guide you
0:00:20 > 0:00:22through the contradictions and the confusions.
0:00:26 > 0:00:28We do research no-one else has done,
0:00:28 > 0:00:30and put your health at the heart of what we do.
0:00:33 > 0:00:36We listen to the questions you want answered,
0:00:36 > 0:00:39and ensure you get the information you need.
0:00:40 > 0:00:44We're here when you want to know the latest findings,
0:00:44 > 0:00:45and not the latest fads.
0:00:47 > 0:00:49I'm Michael Moseley, and in this
0:00:49 > 0:00:52series I'm joined by a team of doctors.
0:00:52 > 0:00:54Together, we'll cut through the hype,
0:00:54 > 0:00:56the headlines, and the health claims.
0:00:57 > 0:00:59This is Trust Me, I'm a Doctor.
0:01:05 > 0:01:07Hello and welcome to Trust Me.
0:01:07 > 0:01:09This time, we're in Glasgow
0:01:09 > 0:01:10where we're carrying out a
0:01:10 > 0:01:13fascinating experiment to find the best way to
0:01:13 > 0:01:17get an essential but often neglected nutrient into our diet.
0:01:17 > 0:01:19Iodine.
0:01:19 > 0:01:23Also in the programme, should you worry about having X-rays?
0:01:24 > 0:01:26Can stress make you fat?
0:01:26 > 0:01:27That was freaking awful!
0:01:27 > 0:01:30Oh, my God!
0:01:30 > 0:01:33And is the NHS spending your money wisely?
0:01:34 > 0:01:35But first...
0:01:37 > 0:01:40..when you think of vital nutrients you might be short of,
0:01:40 > 0:01:43then perhaps iron springs to mind, or vitamin C.
0:01:43 > 0:01:46But there is another which really doesn't make the headlines,
0:01:46 > 0:01:48and it should. Iodine.
0:01:50 > 0:01:53Iodine is absolutely essential to our health.
0:01:53 > 0:01:57It's used by the thyroid gland to produce hormones that keep your body
0:01:57 > 0:01:59working normally. Having low levels
0:01:59 > 0:02:01of these hormones is linked to weight
0:02:01 > 0:02:05gain, fatigue, and mood swings.
0:02:05 > 0:02:09Iodine is also crucial during pregnancy and for young children.
0:02:09 > 0:02:12It's key for healthy brain development.
0:02:12 > 0:02:14Astonishingly, the UK ranks in the
0:02:14 > 0:02:19top ten most iodine deficient nations in the world.
0:02:19 > 0:02:22A national study of over 700 teenagers found that more than
0:02:22 > 0:02:26two thirds have insufficient iodine.
0:02:26 > 0:02:30One reason could be down to a key change in our diet in recent years.
0:02:32 > 0:02:36In the UK, we get most of our iodine from drinking cows' milk,
0:02:36 > 0:02:37but consumption of milk has
0:02:37 > 0:02:40fallen dramatically over the last decade.
0:02:40 > 0:02:44So where else do we get iodine in our food, and is it as good?
0:02:47 > 0:02:51To find out, we've set up a brand-new experiment.
0:02:51 > 0:02:52We've recruited a group of
0:02:52 > 0:02:55volunteers to help us test three different
0:02:55 > 0:02:58foods known to contain iodine.
0:02:58 > 0:02:59Milk,
0:02:59 > 0:03:01white fish,
0:03:01 > 0:03:02and seaweed.
0:03:04 > 0:03:06On three separate test days,
0:03:06 > 0:03:10our volunteers eat a precise portion of one of these foods.
0:03:12 > 0:03:14And we'll be measuring how much
0:03:14 > 0:03:17iodine their bodies are actually taking in.
0:03:17 > 0:03:20Running the study is Dr Emilie Combet
0:03:20 > 0:03:22from the University of Glasgow.
0:03:23 > 0:03:25You know how much iodine there is in these foods.
0:03:25 > 0:03:26The question is how much of that
0:03:26 > 0:03:29iodine our bodies will actually absorb.
0:03:29 > 0:03:31We anticipate that this is going to
0:03:31 > 0:03:33be different according to the type of foods.
0:03:37 > 0:03:39After eating each food,
0:03:39 > 0:03:41our volunteers have the delightful
0:03:41 > 0:03:44task of collecting all the urine they
0:03:44 > 0:03:46pass for the next 36 hours.
0:03:49 > 0:03:53OK, so you're all going to get your urine packs.
0:03:53 > 0:03:56And in here you've got one for the first hour,
0:03:56 > 0:03:59you've got another one for the second hour, and so on.
0:03:59 > 0:04:02On day two, you've got a big one for the last 12 hours,
0:04:02 > 0:04:04so everything goes in there.
0:04:04 > 0:04:06And the toilets are just over there.
0:04:07 > 0:04:11To see how well our volunteers are absorbing the iodine,
0:04:11 > 0:04:12we're testing their urine for
0:04:12 > 0:04:15compounds that are the by-products of
0:04:15 > 0:04:16chemical reactions in our cells.
0:04:18 > 0:04:20Taking the samples up to the university,
0:04:20 > 0:04:22carrying 20 kilos of your own pee up a hill,
0:04:22 > 0:04:25it was harder than I thought it would be.
0:04:30 > 0:04:35After 12 days and countless bottles of urine, the results are in.
0:04:35 > 0:04:38And our volunteers are back.
0:04:38 > 0:04:39Hi there.
0:04:39 > 0:04:43Thank you very much for taking part in the study, and I know you've had
0:04:43 > 0:04:44to do lots of lovely things like
0:04:44 > 0:04:47collect your urine and also eat these foods.
0:04:47 > 0:04:49So, Emilie, results time.
0:04:49 > 0:04:52OK, so we looked at the graphs of the combined data from this group.
0:04:52 > 0:04:55And what we could see is that actually
0:04:55 > 0:04:59milk and fish gave us the same results.
0:04:59 > 0:05:04In the first 12 hours, 50% of the dose came out in your urine.
0:05:04 > 0:05:06So at the end of the experiment,
0:05:06 > 0:05:0990% of the dose for milk and fish came out.
0:05:09 > 0:05:13It meant that it had been absorbed and excreted again.
0:05:13 > 0:05:18The levels of iodine compounds in their urine showed after 36 hours
0:05:18 > 0:05:21our volunteers' bodies had extracted most of the iodine
0:05:21 > 0:05:23from the milk and the fish.
0:05:23 > 0:05:27Seaweed - a totally different picture.
0:05:27 > 0:05:31After 12 hours, maybe 30% of the dose came out.
0:05:31 > 0:05:33And at the end of the experiment,
0:05:33 > 0:05:36only 50% of the dose of iodine from
0:05:36 > 0:05:40the seaweed had gone in the blood and back out in the urine.
0:05:40 > 0:05:43Despite seaweed containing a similar amount of
0:05:43 > 0:05:45iodine to fish and milk,
0:05:45 > 0:05:48our results suggest our bodies don't absorb as much of it.
0:05:49 > 0:05:52So, why do we get iodine more
0:05:52 > 0:05:56readily from milk and fish compared to seaweed?
0:05:56 > 0:06:01We think that it's all in the food matrix and the type of
0:06:01 > 0:06:05compounds to which iodine is bound in those foods.
0:06:05 > 0:06:09So you can see from seaweed, it's this kind of fibrous food.
0:06:09 > 0:06:14And, potentially, our body struggles to break down.
0:06:14 > 0:06:18In our tests, all three foods were good sources of iodine.
0:06:18 > 0:06:21Our results showed little difference between milk and fish.
0:06:21 > 0:06:24Our bodies can easily absorb the iodine from both.
0:06:24 > 0:06:28Seaweed was a less effective source of iodine in our test.
0:06:29 > 0:06:31So broadly speaking,
0:06:31 > 0:06:34there is a risk on our current diet of insufficiency of iodine.
0:06:34 > 0:06:38But if you're eating adequate amounts of white fish and milk,
0:06:38 > 0:06:40that's likely to solve the problem. Is that right?
0:06:40 > 0:06:45We think people are definitely not consuming enough iodine and the key
0:06:45 > 0:06:48sources in the British diet are going to be dairy or fish,
0:06:48 > 0:06:50ideally white fish.
0:06:50 > 0:06:53Obviously seaweed's a good choice as well,
0:06:53 > 0:06:56but less easy to understand the dose that you're getting.
0:06:58 > 0:07:02I think I'm trying to consider having a better diet overall,
0:07:02 > 0:07:06and iodine's not something I considered in that,
0:07:06 > 0:07:08but I will from this point on.
0:07:08 > 0:07:12For this seaweed, I don't think I'm going to include this in my diet.
0:07:12 > 0:07:18I was surprised to hear that women have a greater deficiency in iodine,
0:07:18 > 0:07:20so, yeah, I definitely will try and
0:07:20 > 0:07:23incorporate more iodine into my diet.
0:07:27 > 0:07:30The good news is that for people who don't like or can't tolerate dairy,
0:07:30 > 0:07:32there are alternatives.
0:07:32 > 0:07:35White fish or seaweed will give you a good old dose.
0:07:35 > 0:07:38The important thing, as far as I'm concerned,
0:07:38 > 0:07:39is to make sure you're getting enough.
0:07:47 > 0:07:51We all know that lots of stress makes us feel terrible,
0:07:51 > 0:07:53but what's it doing to our bodies?
0:07:53 > 0:07:55Dr Giles Yeo has been
0:07:55 > 0:07:59investigating one of the silent side effects of stress.
0:08:00 > 0:08:02It's well-established that chronic
0:08:02 > 0:08:04stress is associated with some serious
0:08:04 > 0:08:07conditions like heart disease.
0:08:07 > 0:08:11But, surprisingly, it's now also been linked with putting on weight.
0:08:11 > 0:08:15So I want to know, why might stress be linked to weight gain?
0:08:15 > 0:08:17And is there anything we can do about it?
0:08:20 > 0:08:23To find out, I've come to the University of Leeds,
0:08:23 > 0:08:25where Dr Eleanor Scott and Dr Neil Boyle
0:08:25 > 0:08:28are going to conduct an experiment on me.
0:08:30 > 0:08:32A key risk factor in putting on weight
0:08:32 > 0:08:35is elevated blood sugar levels,
0:08:35 > 0:08:37so they're going to measure what
0:08:37 > 0:08:39happens to my blood sugar levels when
0:08:39 > 0:08:42they put me through an extremely stressful situation.
0:08:42 > 0:08:44So, I'm a bit nervous,
0:08:44 > 0:08:47but I'm about to have my mental and physical ability to handle stress
0:08:47 > 0:08:49tested. And at the same time,
0:08:49 > 0:08:51they're going to measure my glucose
0:08:51 > 0:08:52levels using this sensor over here.
0:08:54 > 0:08:57These tests are specially designed to be stressful.
0:08:57 > 0:08:59Welcome to the Maastricht Acute Stress Test.
0:08:59 > 0:09:02- OK.- Instructions for the task will be presented on the screen.
0:09:02 > 0:09:05Please read them carefully and ask any questions if you're unsure about
0:09:05 > 0:09:08anything. Press the space-bar you're ready.
0:09:08 > 0:09:10Subtract 17 from 2,043.
0:09:10 > 0:09:122043, that's 2,000...
0:09:14 > 0:09:18The first test consists of counting backwards in 17s
0:09:18 > 0:09:19from a very large number.
0:09:21 > 0:09:251,902.
0:09:25 > 0:09:27Incorrect. Please start again.
0:09:27 > 0:09:28- 2,043.- 2,000...
0:09:29 > 0:09:32I'm really feeling the pressure.
0:09:32 > 0:09:341,890?
0:09:35 > 0:09:37- Quicker, please.- 1,000...
0:09:38 > 0:09:40And as if that wasn't enough, there
0:09:40 > 0:09:43is also a physical challenge to come.
0:09:43 > 0:09:45ALARM RINGS
0:09:45 > 0:09:46Oh, my God...
0:09:46 > 0:09:48Further in, please. To the wrist.
0:09:48 > 0:09:52I'm being asked to place my hand in a bath of ice cold water,
0:09:52 > 0:09:55which will also cause a stress response in my body.
0:09:55 > 0:09:57That was freaking awful!
0:09:57 > 0:09:58Oh, my God...
0:10:00 > 0:10:03Now, that was actually very, very painful.
0:10:03 > 0:10:07I could not do basic maths. I mean, it was... It was really quite awful.
0:10:08 > 0:10:12This experiment was not just about giving me a horrible afternoon.
0:10:12 > 0:10:16The point was to measure what happened to my blood glucose.
0:10:16 > 0:10:20Both yesterday, when I wasn't stressed, and today when I was,
0:10:20 > 0:10:22Eleanor has been monitoring my levels.
0:10:24 > 0:10:27So, I wasn't stressed yesterday,
0:10:27 > 0:10:30and I was measuring my glucose. I was definitely stressed today.
0:10:30 > 0:10:33What were the differences in my glucose levels?
0:10:33 > 0:10:36What we've seen is that your glucose levels have stayed up higher than
0:10:36 > 0:10:39they should do, and they're taking
0:10:39 > 0:10:41much longer to come back down to normal.
0:10:41 > 0:10:45This graph shows what happens to my blood glucose after eating a similar
0:10:45 > 0:10:47meal on both days.
0:10:47 > 0:10:50On day one, when I wasn't stressed,
0:10:50 > 0:10:52my level rose sharply and then
0:10:52 > 0:10:54returned to normal within half an hour.
0:10:54 > 0:10:55A healthy response.
0:10:56 > 0:11:00But on day two, after being stressed out for 20 minutes,
0:11:00 > 0:11:02my blood glucose rose as before, but
0:11:02 > 0:11:04took three hours to return to normal.
0:11:06 > 0:11:08Six times as long.
0:11:08 > 0:11:12It's a startling result, but why is my body responding in this way?
0:11:13 > 0:11:15So, when you're stressed, you
0:11:15 > 0:11:18release a variety of stress hormones.
0:11:18 > 0:11:21So, cortisol is one, adrenaline is another,
0:11:21 > 0:11:27and the effect that they have is they essentially tell your liver to
0:11:27 > 0:11:30release glucose into your bloodstream.
0:11:30 > 0:11:31And the idea is that it then
0:11:31 > 0:11:34provides a very ready supply of energy for
0:11:34 > 0:11:37your muscles. So in the past,
0:11:37 > 0:11:40when we were running away from predators or whatever,
0:11:40 > 0:11:42then that would have helped us run away.
0:11:42 > 0:11:44It would have allowed us to survive.
0:11:44 > 0:11:46Of course now we're in an environment
0:11:46 > 0:11:50where we often have stress sat at a desk in an office,
0:11:50 > 0:11:53and we don't physically move away or deal with it.
0:11:53 > 0:11:56And what happens if you don't end up using the glucose that was actually
0:11:56 > 0:11:59designed for your muscles for you to run away?
0:11:59 > 0:12:01So, if it's not used immediately by your muscles,
0:12:01 > 0:12:03then you will store it in other organs,
0:12:03 > 0:12:05so some will go to your liver,
0:12:05 > 0:12:08but a lot of it will be used and stored in your fat.
0:12:08 > 0:12:09And it makes your body more
0:12:09 > 0:12:11resistant to the effects of insulin that would
0:12:11 > 0:12:13normally lower your glucose,
0:12:13 > 0:12:16and it becomes a bit of a vicious cycle.
0:12:16 > 0:12:19So what you're saying is that if you are chronically stressed,
0:12:19 > 0:12:20then you could have a little bit
0:12:20 > 0:12:22more glucose than you need in your blood
0:12:22 > 0:12:24all of the time. And if you have
0:12:24 > 0:12:26this for too long and you're susceptible,
0:12:26 > 0:12:28that could tilt you into type II diabetes.
0:12:28 > 0:12:30Yeah, that's right.
0:12:30 > 0:12:33How interesting. I mean, I'm genuinely surprised actually about
0:12:33 > 0:12:37the effect that the stress had on my glucose levels.
0:12:38 > 0:12:39The results of my test are
0:12:39 > 0:12:42consistent with larger studies that suggest
0:12:42 > 0:12:44that stress raises blood sugar.
0:12:45 > 0:12:48Because of the latest technologies such as this monitor,
0:12:48 > 0:12:51we now know more about how stress can raise our blood glucose levels,
0:12:51 > 0:12:54which can lead to really quite serious health problems.
0:12:54 > 0:12:57But there is something we can do about it.
0:12:57 > 0:12:59First, try a stress reducing
0:12:59 > 0:13:01activity such as mindfulness, exercise,
0:13:01 > 0:13:03or outdoor pursuits.
0:13:03 > 0:13:07All things that do help as long as you pick one you enjoy.
0:13:07 > 0:13:09Social contact can also help,
0:13:09 > 0:13:11so try to spend time with others.
0:13:11 > 0:13:13Then there's the diet part.
0:13:13 > 0:13:17High sugar foods are exactly what you need least when you're stressed.
0:13:17 > 0:13:19Nuts are a better choice.
0:13:27 > 0:13:29Still to come - how can you spot a
0:13:29 > 0:13:32mental health problem in a friend or colleague?
0:13:32 > 0:13:35And is the NHS spending your money wisely?
0:13:35 > 0:13:38But, first...
0:13:38 > 0:13:39Thousands of you have been sending
0:13:39 > 0:13:42in questions to the Trust Me website,
0:13:42 > 0:13:45and we've been finding answers to some of the more popular ones.
0:13:45 > 0:13:48Should I worry about getting an X-ray?
0:13:48 > 0:13:52One for GP Dr Zoe Williams.
0:13:52 > 0:13:54It's over a century since X-rays
0:13:54 > 0:13:57were discovered and first allowed doctors
0:13:57 > 0:13:59to look inside a living human body.
0:13:59 > 0:14:01Hi. Just for one, please.
0:14:01 > 0:14:04Today, the NHS in England alone carries out
0:14:04 > 0:14:06more than 22 million a year,
0:14:06 > 0:14:08and millions more are performed by dentists.
0:14:10 > 0:14:11There can't be many of us that
0:14:11 > 0:14:14haven't had an X-ray to check for fractured
0:14:14 > 0:14:17bones, or to let the dentist have a proper look at our teeth.
0:14:17 > 0:14:19They're also used in CT scans to
0:14:19 > 0:14:22build up an incredibly detailed image of our bodies.
0:14:23 > 0:14:27The seemingly magical property of X-rays comes from what they
0:14:27 > 0:14:29are made of. X-rays are a type of
0:14:29 > 0:14:32high energy radiation that can easily
0:14:32 > 0:14:34pass through most body tissues
0:14:34 > 0:14:36like muscle and fat, but they're
0:14:36 > 0:14:39blocked by denser material like bone.
0:14:39 > 0:14:43When the body's exposed to an X-ray, the skeleton casts a shadow,
0:14:43 > 0:14:45and this can be picked up by a detector.
0:14:46 > 0:14:48But the very properties that make
0:14:48 > 0:14:50them useful for seeing inside our body
0:14:50 > 0:14:52are what make them harmful.
0:14:52 > 0:14:54As they pass through us,
0:14:54 > 0:14:57these high-energy rays can damage some of our cells
0:14:57 > 0:15:00by causing changes in our DNA.
0:15:00 > 0:15:03Changes that have been linked to an increased risk of cancer.
0:15:05 > 0:15:09But the truth is we've been aware of the risks since the 1950s.
0:15:09 > 0:15:12And these days the strength, quantity,
0:15:12 > 0:15:15and duration of your exposure to radiation are controlled within very
0:15:15 > 0:15:16strict guidelines.
0:15:18 > 0:15:21So how much are we actually getting?
0:15:21 > 0:15:26It's useful to compare X-rays to the background radiation that we're
0:15:26 > 0:15:28exposed to every day from our environment.
0:15:28 > 0:15:32Radon gas from the ground, cosmic rays from space,
0:15:32 > 0:15:34and even the food - shh -
0:15:34 > 0:15:35that we eat.
0:15:36 > 0:15:40Background radiation, though unavoidable, is not harmless,
0:15:40 > 0:15:43but its effects are virtually unnoticeable.
0:15:43 > 0:15:47So how powerful are medical X-rays in comparison?
0:15:47 > 0:15:49Imagine this tasty piece of popcorn
0:15:49 > 0:15:51is the amount of background radiation
0:15:51 > 0:15:53that we're exposed to every day.
0:15:53 > 0:15:58It's also equivalent to the typical exposure from a dental X-ray.
0:15:58 > 0:16:04Now, three to four popcorns is equivalent to that of a chest X-ray.
0:16:04 > 0:16:08Put into perspective, during the average transatlantic flight,
0:16:08 > 0:16:12we're exposed to more than three times this amount.
0:16:12 > 0:16:14About 11 popcorns.
0:16:14 > 0:16:17A CT scan would give you a bit more -
0:16:17 > 0:16:19the equivalent of a whole box of popcorn.
0:16:21 > 0:16:23Most of us have had a dental X-ray.
0:16:23 > 0:16:27Even if we were to have two a year, every year of our life,
0:16:27 > 0:16:29it would only raise our chance of
0:16:29 > 0:16:32developing cancer by about 100th of 1%.
0:16:34 > 0:16:36To receive a really dangerous level of radiation,
0:16:36 > 0:16:39you'd need quite a bit more.
0:16:39 > 0:16:43This is what you would need to even come close to a lethal dose over a
0:16:43 > 0:16:46month, and there are almost a million pieces of popcorn in there.
0:16:48 > 0:16:50So, infrequent X-rays are not that
0:16:50 > 0:16:53harmful in the grand scheme of things,
0:16:53 > 0:16:57but some of us have complex medical conditions that require a lot of
0:16:57 > 0:17:00X-rays over our lifetime.
0:17:00 > 0:17:04Multiple X-rays have a cumulative effect on the body,
0:17:04 > 0:17:08so the more you have, the greater the amount of cell damage over time.
0:17:08 > 0:17:09So, when appropriate,
0:17:09 > 0:17:11your doctors will recommend
0:17:11 > 0:17:13other types of imaging that don't use radiation.
0:17:13 > 0:17:17For example, ultrasound, or magnetic resonance imaging,
0:17:17 > 0:17:23an MRI scan. But in some cases, an X-ray is the best way to do the job,
0:17:23 > 0:17:24and you and your doctor will need to
0:17:24 > 0:17:27balance the risks and the benefits of having one.
0:17:28 > 0:17:29If you're still concerned,
0:17:29 > 0:17:32then my advice is to tell your doctor about
0:17:32 > 0:17:34any previous X-rays you've had,
0:17:34 > 0:17:38and this may prevent unnecessary X-rays in the future.
0:17:38 > 0:17:42Ultimately, X-rays do have a tiny risk of increasing the likelihood of
0:17:42 > 0:17:46cancer, but in medicine, the benefits hugely outweigh the risks.
0:17:55 > 0:17:57In this series of Trust Me,
0:17:57 > 0:18:01I'm investigating some of the most controversial health questions that
0:18:01 > 0:18:04have made the headlines in the three decades I've been a medical
0:18:04 > 0:18:07journalist. This time,
0:18:07 > 0:18:10we all read stories in the paper about people who have been denied
0:18:10 > 0:18:12life-saving drugs.
0:18:12 > 0:18:15Some of you will have been personally affected by a treatment
0:18:15 > 0:18:18you need not being available on the NHS.
0:18:18 > 0:18:20So how does the NHS decide which
0:18:20 > 0:18:23drugs or treatments to fund and which not to fund?
0:18:23 > 0:18:26And what, if any, say do you have in the matter?
0:18:28 > 0:18:31First, I'm meeting Professor Karl Claxton.
0:18:31 > 0:18:36He's a health economist who believes the body that advises the NHS, NICE,
0:18:36 > 0:18:39are approving too much spending on new drugs.
0:18:40 > 0:18:44So, in your opinion, are the right treatments being funded?
0:18:45 > 0:18:47I think, overall, no.
0:18:47 > 0:18:52I think we are seeing a skew towards new, expensive
0:18:52 > 0:18:55drug treatments at the
0:18:55 > 0:18:59expense of other things the NHS does very well and could do more of.
0:18:59 > 0:19:01There's a huge discrepancy between
0:19:01 > 0:19:06what we're approving and what the NHS can actually afford.
0:19:06 > 0:19:08Imagine I'm a typical NHS patient.
0:19:08 > 0:19:11When do I become really expensive?
0:19:11 > 0:19:14You become really expensive towards the end of life.
0:19:14 > 0:19:17That's where most NHS money is spent.
0:19:17 > 0:19:23There's been a whole load of research trying to establish whether
0:19:23 > 0:19:25as a society, as individuals,
0:19:25 > 0:19:29we think we should be devoting more resources at the end of life.
0:19:29 > 0:19:30All of that research really doesn't
0:19:30 > 0:19:34show any strong social preferences for doing that.
0:19:34 > 0:19:37Nonetheless, that is what NICE currently does.
0:19:37 > 0:19:39What are cost effective things,
0:19:39 > 0:19:42things which you know you get a good bang for your buck?
0:19:42 > 0:19:44Good examples would be interventions
0:19:44 > 0:19:46in common mental health problems,
0:19:46 > 0:19:48or for example hip replacement.
0:19:48 > 0:19:50Sure. But if I'm a cancer patient,
0:19:50 > 0:19:54and they're going to give me a nice, shiny, new drug which may improve my
0:19:54 > 0:19:57chances of survival, then obviously I'm going to embrace it, aren't I?
0:19:57 > 0:19:58Of course you want access.
0:19:58 > 0:20:00The solution to this problem
0:20:00 > 0:20:05is to sort out drug pricing so that the prices reflect how much the NHS
0:20:05 > 0:20:08can afford to pay for the scale of the benefits that they offer.
0:20:08 > 0:20:09Thank you very much.
0:20:14 > 0:20:16Next, Dr Jane Adam.
0:20:16 > 0:20:21She chairs one of NICE's committees that makes recommendations to the
0:20:21 > 0:20:24NHS about funding new medications and treatments.
0:20:26 > 0:20:30Am I right in thinking the NHS puts more resources into end of life, if
0:20:30 > 0:20:33you like, the last few months of your life,
0:20:33 > 0:20:35than they do the rest of your life?
0:20:35 > 0:20:39If people are going to die of their disease within two years,
0:20:39 > 0:20:41and this new treatment will give
0:20:41 > 0:20:44them at least three months extra life,
0:20:44 > 0:20:46then that can be valued at a higher
0:20:46 > 0:20:49value that it would at other times in your life,
0:20:49 > 0:20:52on the basis that when you are dying,
0:20:52 > 0:20:55those extra few months can be particularly precious.
0:20:55 > 0:20:58That is one hell of an assumption, isn't it?
0:20:58 > 0:21:02It's for us as a society really to decide if that is correct.
0:21:02 > 0:21:04If society does value that,
0:21:04 > 0:21:07and does feel that that deserves special consideration.
0:21:07 > 0:21:11Does price play a big role in the decisions you make?
0:21:11 > 0:21:13If a drug is really,
0:21:13 > 0:21:17really good and brings a huge amount of benefit to patients,
0:21:17 > 0:21:20then the NHS will pay more for it.
0:21:20 > 0:21:23But if it is of relatively limited benefit,
0:21:23 > 0:21:25then it has to still be good
0:21:25 > 0:21:27value, which means you have to pay less for it.
0:21:27 > 0:21:31I think it would be lovely to say that every time a new drug was
0:21:31 > 0:21:35developed, however much it cost, that we could just say, "Fine.
0:21:35 > 0:21:39"Let's just buy it for everybody who might benefit from it."
0:21:39 > 0:21:44We all know that the NHS budget is not unlimited, and this is an
0:21:44 > 0:21:47opportunity to actually look really,
0:21:47 > 0:21:51really closely at a new area of spending,
0:21:51 > 0:21:54and to see if it really is value for money for the NHS.
0:21:54 > 0:21:56So do the public have a say?
0:21:56 > 0:21:58The public can comment, yes.
0:21:58 > 0:22:02Anybody can respond and make a web comment and every comment that is
0:22:02 > 0:22:05posted on the web is fed back to the committee.
0:22:05 > 0:22:06- Thank you.- Thank you.
0:22:12 > 0:22:16I am really impressed by the amount of time and effort that goes into
0:22:16 > 0:22:20trying to measure the cost effectiveness of what the NHS does.
0:22:20 > 0:22:24That said, I also think the system is clearly being set up so as to
0:22:24 > 0:22:27encourage a disproportionate spend on drugs.
0:22:27 > 0:22:29Particularly the drugs that might
0:22:29 > 0:22:32extend the end of your life by just a few months.
0:22:32 > 0:22:34I think that is hard to justify.
0:22:42 > 0:22:46Around one in six of us suffer from a common mental health disorder
0:22:46 > 0:22:49such as depression or anxiety,
0:22:49 > 0:22:52yet many do not seek help.
0:22:52 > 0:22:53So, how can you spot this problem in
0:22:53 > 0:22:56other people and what can you do about it?
0:22:56 > 0:22:58Psychiatrist Dr Alain Gregoire
0:22:58 > 0:23:01has been to Stirling to find out how
0:23:01 > 0:23:04one organisation has been tackling things.
0:23:07 > 0:23:10This is Stirling Albion Football Club.
0:23:10 > 0:23:12The club is one of the first in
0:23:12 > 0:23:14Scotland to train their staff to recognise
0:23:14 > 0:23:17some warning signs of mental health problems.
0:23:17 > 0:23:21It's a pioneering approach that has its roots in a tragedy
0:23:21 > 0:23:23that's keenly felt here.
0:23:25 > 0:23:30Chris Mitchell from Stirling became a professional footballer at 16,
0:23:30 > 0:23:33playing at clubs in Scotland and England.
0:23:33 > 0:23:36A great goal by Chris Mitchell.
0:23:36 > 0:23:39A fantastic strike by Chris Mitchell.
0:23:39 > 0:23:41What a wonderful free kick.
0:23:41 > 0:23:47On the 7th of May 2016, he took his own life, aged just 27.
0:23:48 > 0:23:52To his girlfriend Louise and father Phil, it came as a shock.
0:23:53 > 0:23:59Looking back, are there any things that might have indicated that Chris
0:23:59 > 0:24:01was really feeling very desperate?
0:24:01 > 0:24:05Genuinely didn't see anything change at the time.
0:24:05 > 0:24:08It's not really until after Chris's
0:24:08 > 0:24:11death that we've sort of picked up on things.
0:24:11 > 0:24:15The main thing is small changes in behaviour.
0:24:16 > 0:24:19Distancing himself from family, friends.
0:24:21 > 0:24:23Just trying to cover things up,
0:24:23 > 0:24:26to mask to us that things were OK
0:24:26 > 0:24:28when really they weren't.
0:24:28 > 0:24:31Although there were smaller changes in Christopher,
0:24:31 > 0:24:37never knew that what he was suffering. It was there,
0:24:37 > 0:24:39right in front of us,
0:24:39 > 0:24:41but he never portrayed that.
0:24:42 > 0:24:44In front of our noses,
0:24:44 > 0:24:48but Christopher hid it and we never,
0:24:48 > 0:24:50never came to that conclusion at all.
0:24:51 > 0:24:56Suicide is the biggest cause of death for men under 50,
0:24:56 > 0:24:58and for women aged between 20 and 34.
0:25:00 > 0:25:02So here at Stirling Albion,
0:25:02 > 0:25:04they've put in place a system to
0:25:04 > 0:25:07train the staff in what's known as mental health first aid.
0:25:09 > 0:25:13The aim is to prevent anyone here suffering in silence,
0:25:13 > 0:25:15and to identify and deal with
0:25:15 > 0:25:17problems before they become overwhelming.
0:25:18 > 0:25:22Instructor Mark Fleming has been working with the club for two years.
0:25:22 > 0:25:25So, Mark, what is it exactly that you do?
0:25:25 > 0:25:26So, I'm a mental health first aid
0:25:26 > 0:25:28instructor in various working contexts,
0:25:28 > 0:25:31but particularly within football club settings.
0:25:31 > 0:25:32And what does that involve?
0:25:32 > 0:25:35Basically involves training people to be able to spot the signs and
0:25:35 > 0:25:37symptoms of poor mental health and
0:25:37 > 0:25:40provide an appropriate first response.
0:25:40 > 0:25:42I'm not enabling them to become
0:25:42 > 0:25:45therapists or counsellors or mental health
0:25:45 > 0:25:47experts and certainly not psychiatrists,
0:25:47 > 0:25:49but just putting tools in their hands
0:25:49 > 0:25:51so that they can spot the signs and symptoms.
0:25:51 > 0:25:55Some signs that someone might be at risk include being withdrawn
0:25:55 > 0:25:57or lost in thought,
0:25:57 > 0:25:59losing their sense of humour,
0:25:59 > 0:26:02being erratic, irritable, agitated,
0:26:02 > 0:26:06tearful, or conversely, emotionless,
0:26:06 > 0:26:10changes in appetite, weight, or sleep patterns,
0:26:10 > 0:26:12and increased alcohol consumption.
0:26:13 > 0:26:16So, what are the benefits of this training, do you think?
0:26:16 > 0:26:18I think, first and foremost,
0:26:18 > 0:26:20it deals with the stigma attached to mental health.
0:26:20 > 0:26:22Especially in a football context.
0:26:22 > 0:26:25If a footballer has a twisted ankle or a pulled hamstring,
0:26:25 > 0:26:27he doesn't feel embarrassed or
0:26:27 > 0:26:29ashamed, or foolish, or useless, or weak.
0:26:29 > 0:26:32He just goes to see the doctor and gets it sorted.
0:26:32 > 0:26:34But when it comes to a mental injury,
0:26:34 > 0:26:36then there's a stigma attached that.
0:26:36 > 0:26:39There's a feeling that, "I am weak, and useless and hopeless and
0:26:39 > 0:26:41"a liability."
0:26:41 > 0:26:44I think it provides listening skills to people and it also
0:26:44 > 0:26:46gives them the confidence to approach people,
0:26:46 > 0:26:48ask appropriate questions,
0:26:48 > 0:26:51and be a bridge to the appropriate professional help.
0:26:51 > 0:26:54So, if you think someone you know might be at risk,
0:26:54 > 0:26:56what should you do?
0:26:56 > 0:27:00Start by saying that you've noticed a change in their mood or behaviour,
0:27:00 > 0:27:02without being critical.
0:27:02 > 0:27:05Say you're concerned and ask if they'd like to talk.
0:27:05 > 0:27:08Don't downplay their problems or say things like,
0:27:08 > 0:27:10"What do you have to be depressed about?"
0:27:10 > 0:27:14Listen and give them space to describe how they're feeling.
0:27:14 > 0:27:17Offer to go with them to see a health professional.
0:27:17 > 0:27:20And if you think they're at risk of suicide,
0:27:20 > 0:27:22you can call their GP for an emergency appointment.
0:27:23 > 0:27:27What they're doing for footballers here could be done in any workplace,
0:27:27 > 0:27:28group, or community.
0:27:29 > 0:27:32So if you recognise the early warning signs,
0:27:32 > 0:27:34or you know someone who's
0:27:34 > 0:27:36struggling with their mental health,
0:27:36 > 0:27:40don't be afraid to give them the opportunity to talk about it.
0:27:40 > 0:27:44Listen to them. Give as much support as you can,
0:27:44 > 0:27:47encourage them to go see their GP if they need to.
0:27:47 > 0:27:49These first steps can make an
0:27:49 > 0:27:52enormous difference to their health and their lives.
0:28:01 > 0:28:03That's it from us.
0:28:03 > 0:28:05Next time, we're in Exeter,
0:28:05 > 0:28:07where we'll be finding out if
0:28:07 > 0:28:11beetroot can give your body and your brain a real boost.
0:28:11 > 0:28:16# I just made an appointment for a special rendezvous
0:28:16 > 0:28:20# To see a man of miracles and all that he can do
0:28:20 > 0:28:25# I checked in at reception Put my hat to my lap
0:28:25 > 0:28:30# And when he walked in dressed in white I had a heart attack
0:28:30 > 0:28:32# Doctor I want you
0:28:32 > 0:28:35# Do what you want to do
0:28:35 > 0:28:37# I can't get over you
0:28:37 > 0:28:40# Doctor do anything that you want to do. #