DNA study lays bare devastating damage caused by smoking

The devastating impact of cigarette smoke on the body’s DNA has been laid bare by the first comprehensive study into the damage tobacco inflicts on human cells.

People who smoke a pack of cigarettes each day for a year develop on average 150 extra mutations in every lung cell, and nearly 100 more mutations than usual in each cell of the voice box, researchers found. More still build up in the mouth, bladder, liver and other organs.

While chemicals in tobacco smoke have long been known to raise the risk of at least 17 forms of cancer, the precise molecular mechanisms through which they mutate DNA and give rise to tumours in different tissues have never been clear.

“This is about running down the root cause of cancers,” said David Phillips, a professor of environmental carcinogenesis at King’s College London and a co-author on the study. “By identifying the root causes, we gain the sort of knowledge we need to think more seriously about cancer prevention.”

More than 70 of the 7,000 chemicals found in tobacco smoke are known to cause cancer. Some damage DNA directly, but others ramp up mutations in more subtle ways, often by disrupting the way cells function. The more mutations a cell acquires, the more likely it is to turn cancerous.

The reason why some people can smoke for years without getting cancer, while others develop the disease, is down to the way mutations arise. When a person smokes, the chemicals they inhale create mutations at random points in the genome. Many of these changes will be harmless, but others not so benign. The more smoke a person is exposed to, the greater the chance that the accumulating mutations will hit specific spots in the DNA that turn cells cancerous.

“You can really think of it as playing Russian roulette,” said Ludmil Alexandrov, a theoretical biologist at Los Alamos National Lab in New Mexico and the first author of the study. “You can miss the right genes. But if you smoke you still play the game. It’s a very strong message for people not to start smoking. If you smoke even a little bit you’ll erode the genetic material of most of the cells in your body.” Smoking is the most preventable cause of cancer in the world and accounts for more than 1 in 4 UK cancer deaths.

With researchers at the Wellcome Trust’s Sanger Institute near Cambridge and others, Alexandrov analysed the DNA of more than 5,000 cancers. The team then turned to pattern recognition software to tease apart the various mutational signatures found in tumours from smokers versus non-smokers. To find the signatures – the patterns of mutations present in cancer cells – researchers performed the genetic equivalent of recording the chatter at a party and then extracting individual conversations from the hubbub.

The scientists spotted more than 20 mutational signatures in 13 types of cancer linked to tobacco smoking. But only five of these were more common in smokers’ tumours. One pattern of mutations, dubbed signature four, was found to be a major driver for lung cancer. It is thought to be caused by benzopyrene, a chemical found in tobacco smoke.

More intriguing was how tobacco caused mutations in tissues that are not directly exposed to smoke, such as the bladder, kidneys and pancreas. The study found that chemicals from tobacco smoke found their way to different organs and tissues and then sped up the molecular clocks in the cells. This ramped up the natural rate at which mutations built up in the tissues.

“We knew there was direct damage from smoking in the lungs. What we didn’t expect was to see smoking speed up the molecular clocks inside cells,” said Alexandrov, whose study appears in the journal Science. “In bladder cancer, the only thing that causes the extra mutations in smokers is the speeding up of the clock, and that will be very dependent on the intensity of smoking. For every pack of cigarettes you smoke per year, you accumulate 18 mutations in all of your bladder cells,” he added.

Scientists hope that by understanding how the individual ingredients of tobacco smoke raise the risk of various cancers, they can develop new ways to prevent the disease. The same techniques used in the latest study will now be used to tease apart how alcohol, obesity and other factors also increase a person’s cancer risk.

“There is a message here for people who are occasional or social smokers who think it doesn’t do anything,” said Alexandrov. “If you smoke four to five packs of cigarettes in your lifetime it doesn’t sound that much, but you still get several mutations in every cell in your lungs and these are permanent, they do not go away. There are a lot of things that do revert back when you stop smoking, and this shouldn’t discourage people from giving up, but the specific mutations in the lung cells are like scars. If you stop smoking, they’ll still be there.”

DNA study lays bare devastating damage caused by smoking

NHS staff lay bare a bullying culture | Sarah Johnson

Bullying is a pernicious problem in the NHS. That’s the stark finding from exclusive research by the Guardian. The online survey of more than 1,500 doctors, nurses and other health workers in hospitals, primary care and community settings, found that 81% had experienced bullying and for almost half of them (44%), it is still ongoing. Close to nine out of 10 bullying victims who responded have been left with their cases unresolved.

Although the survey on bullying was self-selecting, the findings underline the results of the official annual NHS staff survey. The 2015 survey of nearly 300,000 healthcare professionals across England found that a quarter of staff in NHS trusts had experienced bullying, harassment or abuse in the previous 12 months.

Some 87% of respondents to the Guardian survey, carried out between August and September, think bullying is a big problem within the NHS, while almost three-quarters said they felt the health service did not take bullying seriously. “The culture is driven by exerting undue pressure on others to get things done. If you don’t, you are targeted and eventually you end up with stress and depression,” one NHS manager said.

Respondents who have been bullied take on average 108 days off work and a third have contemplated leaving their jobs

“The organisation becomes defensive and takes the corporate line to protect themselves from a legal challenge and puts it down to your perception. You are then managed out of your job through contrived actions designed to make you leave. All this leaves you broken and with no strength to fight. You go if you can find another job. Otherwise you suffer in silence.”

The devastating impact of bullying is all too apparent. A third of victims said they had been pushed out of their jobs, with many developing serious mental health problems as a result, while almost three-quarters reported increased stress and panic attacks. As a result, some 41% said they needed counselling or treatment after being bullied. The survey also shows the adverse impact of bullying on the NHS, with those respondents who have been bullied taking on average 108 days off work and almost a third (31%) saying they were signed-off sick. A further third said they had contemplated leaving their job.

Sue Covill, director of development and employment at NHS Employers, (the employers’ organisation for the NHS in England) admits the results are worrying. “Bullying is completely unacceptable and the ongoing work to tackle it is vital for all NHS organisations, leaders and staff,” she says. “To improve the working lives of our staff and deliver the best possible care to patients, we need to create supportive, positive, open and collegiate cultures in our organisations across the health system.”

According to the 1,355 anonymous survey respondents who said they had experienced or witnessed NHS bullying, the most common forms of abuse are undermining behaviour and persistent criticism. Just over a third said they were persecuted through fear or threats, saying their career was deliberately sabotaged. One in 10 bullying victims was subjected to violent behaviour and aggression.

Asked if a particular incident triggered the bullying, 55% said raising a concern prompted the abuse. Fear of reprisals means that only 54% reported the bullying. For the 43% who chose not to report it, two-thirds felt scared that to do so would make things worse. Of those who did report their bullying, 44% said it persisted afterwards, sometimes for as long as a year.

“My experience left me feeling as though I had been manipulated, that I was a liar and had made it all up,” said one NHS administrator. “I had a meeting with my bully and came away from it feeling worse than before. I’m now left feeling desperately unhappy in a job I now despise.”

Only 17% of those who reported bullying said they received pastoral support from their organisation – and less than a quarter of these were satisfied with the result.

A YouGov survey commissioned last year by the TUC showed that nearly a third of people had been bullied at work.

Concerns have been raised by health professionals and academics that the hierarchial structure of the NHS facilitates a culture where bullying can flourish.

“Medicine is a hard taskmaster but made worse by those around you who see you as a threat that rocks the hierarchy where everyone should know their place,” an anonymous hospital consultant says in response to the results of the Guardian survey. He warns: “It may well impact on patient care if those who perpetuate the abuse look for an opportunity to trip you up and blow any minor omission out of all proportion.”

Dr Anthea Mowat, chair of the British Medical Association’s representative body, says the survey results should act as an urgent wake-up call to employers. “If more staff are to speak out, they must be able to raise concerns without fear of being harassed or victimised, and there need to be clear and supportive systems of reporting in place,” she says. “We need to put an end to the climate of fear that has built up in the NHS over a number of years, with those in senior positions in the NHS leading by example to make this a reality.”

The survey, by the Guardian’s Healthcare Professionals Network, was sent out to network members via an email newsletter. It was also promoted via Twitter and Facebook. Network readers were also invited to take part through the website.

Nurse who left the NHS: the loss of my role was like a bereavement

I was an experienced nurse working in a fantastic team of staff. Following a reshuffle, our ward manager was replaced by someone who was known for being a bully. She frequently made comments and used language inappropriate for the role. Her victimisation of me began immediately. On one occasion, due to staff sickness I was expected to do the jobs of four other people and was reprimanded when I objected. I was expected to attend meetings on my days off. I was constantly ridiculed and told that medical staff had criticised me even though, when questioned, they quite clearly had not. On one occasion I was physically pushed out of the way. This went on for over a year and, along with the treatment of me that followed, had a devastating effect on my psychological health. I was having panic attacks and suicidal thoughts.

I took out a grievance and was immediately moved to an area where I had no previous experience or expertise. Unable to continue working I was signed off sick with work-related stress. My bullying complaint was not investigated properly and not upheld. I believed that I had been targeted as I had previously raised concerns about patient care. I appealed against the decision and with the support of a union representative and witnesses, I won. But the bully remained in post and I was offered a job in another area, at a lower grade. I was advised by my union that I was being constructively dismissed and not to return to work. I negotiated an exit strategy with payment of a tax-free lump sum under one of the now-outlawed compromise agreements. I am now in receipt of an NHS permanent injury benefit which guarantees me a tax-free income, in excess of what I was previously earning, for the rest of my natural life. I now work for a private company in a non-clinical setting. The loss of my clinical role has been like a bereavement and not a day goes by when I do not think about the injustice of my case.

NHS manager: the bullies have wrecked my career

There is an endemic culture of bullying at the hospital trust I work at. Colleagues have been suspended for raising concerns over unsafe patient care and allegations of abuse towards patients. One colleague had to leave her job after whistleblowing and is undergoing counselling for post-traumatic stress disorder. In my case, the bullying was incessant – my line manager would call me in the evening at home telling me to take time off work and encouraging me see my GP as, in her opinion, I was unwell – I wasn’t. She insisted that I had to contact her every morning to tell her where I was, even at work. Other senior people soon started to target me and I would be admonished for the smallest of errors and for things I hadn’t done. Because of the seniority of these people, other members of staff began to pull away, and I soon became isolated. By this time, I had gone to see my GP who had diagnosed me with severe depression. I have had suicidal thoughts – occasionally I still do. I’ve been demoted and moved into a job where I have no experience and I’ve been offered no training; I’m being set up to fail. I’m resigned to the fact that I will have to leave the trust at some point, as I can’t carry on. The bullies have wrecked my career in the NHS, and my confidence in my ability has evaporated. The whole experience has had a profound effect on me – cheerful confidence has been replaced by paranoia and distrust; I will never be the same person again. To this day I do not know what I did wrong – if anything.

NHS staff lay bare a bullying culture | Sarah Johnson

No wonder dress codes have doctors up in (bare) arms

Nunn’s objection, and that of Henry Marsh and 1000′s of other physicians, is not that they are getting needed to abide by principles, but that individuals principles are entirely meaningless. It is the utter hypocrisy and lunacy surrounding infection management in the NHS that we locate so galling. In reality, I’d go so far to say that present policy is in fact unsafe, as it obscures the true troubles in tackling hospital-acquired infections.

Along with hand-washing, the only other variable regularly implicated in hospital-acquired infections is bed-occupancy costs. The faster the turnaround of patients, the better the strain on beds and the larger the infection price. This link was emphasised in a report by the Division of Health and published virtually a decade in the past, and yet it was ignored by ministers simply because it did not fit in with its plans for the NHS to reduce hospital beds and streamline companies.

But the bare-under-the-elbows policy serves an additional perform. Increasingly, the dress code is used by managers as a way of forcing physicians – the standard figures of authority in hospitals, who are frequently seen as a risk due to the fact of their understanding and expertise – to observe the guidelines. It is a stick with which to beat clinicians, a way for managers to flex their muscle groups. And it has had unintended consequences.

Under this policy, white coats have been banned. Physicians now do not look “smart” on the ward – no ties, no lengthy-sleeved shirts and no fits. Numerous argue that they have lost their “presence” in hospitals, and patients can no longer recognize them. Even though it is true that white coats can harbour infectious organisms, in Hong Kong, exactly where they are still common uniform, the rates of hospital-acquired infection are substantially reduce than in British hospitals, as they are in other European nations.

It is not the white coats that are crucial, but the frequency and temperature of washing. Stephanie Dancer, a consultant microbiologist, wrote in the British Healthcare Journal last year that there was no proof that banning white coats had diminished infection prices in hospitals. Surely, white coats are created to be washed at large temperatures, so I employed to boil mine, even though I never ever wash my function clothes above 30 degrees, or they shrink. You do not need to have to be a brain surgeon to see that recent infection-management policies make no sense at all.

I wish the Saatchi Bill success

Congratulations to Maurice Saatchi – his Health-related Innovation Bill, which aims to cost-free doctors to try progressive strategies or drugs on individuals when all else has failed, has passed its first hurdle in Parliament following a campaign, strongly supported by this paper, that has produced widespread public support. It will now proceed to a 2nd reading in the House of Lords.

Issues that the Bill will turn into a “quack’s charter” have been tackled by Lord Saatchi, who has amended it. The Bill now makes a clear distinction in between “responsible innovation” and “reckless experimentation”. Any experimental procedures would have to be approved by a team of specialists and a “responsible officer”.

Possibly it will outcome in a remedy for cancer, possibly not. But unless we enable physicians to innovate, we’ll in no way know. I want the Bill every success in its second studying. For much more detail, see medicalinnovationbill.co.uk.

Don’t rush to blame the NHS for drips

The instances last week of newborn infants contaminated by contaminated intravenous drips have, rightly, prompted headlines and outrage.

The infants, some of them premature, were also poorly to be fed by mouth and needed a food supply delivered by way of their bloodstream.

There has now been at least one particular confirmed death from septicaemia linked to the iv drips.

Yes, the infants and their households have been tragically let down. But, whilst some headlines reported that the babies were ‘’poisoned by NHS drips”, it need to be stressed again that the NHS is not responsible for the manufacture of these products. The drips were presented by a personal company, ITH Pharma. Obligation for this tragedy will be established by the recent government investigation.

Max Pemberton’s most current guide, ‘The Medical professional Will See You Now’ is published by Hodder. To buy a copy, phone Telegraph Books on 0844 871 1515

No wonder dress codes have doctors up in (bare) arms

California Probably To Take Back Its Bare Hands Law

California is reconsidering its ban on bare-hand speak to on prepared-to-consume food at dining establishments and bars, a law that took effect in January.

The Assembly Well being Committee on Tuesday voted unanimously to repeal and revisit the regulation, AP reports.

Gov. Jerry Brown signed a non-controversial bill final year with an update requiring staff to use forks or put on gloves when dealing with ready-to-eat foods like sushi and lettuce. The U.S. Centers for Illness Management and Prevention identified that workers touching meals presented the most widespread transmission pathway for foods-originated norovirus outbreaks, according to the most recent data available. But as quickly as the law took effect, restaurants and bar owners said they had to alter the way they served the foods in a way that hindered organization.

“We heard from chefs, bartenders, waiters, everybody down the line that the law transformed how they serve food and offered a false sense of safety for people, due to the fact clean hands are greater than dirty gloves,” said Robert Abelon, district director for Assemblyman Richard Pan (D-Sacramento), in a mobile phone interview.

The law permitted for exceptions if dining establishments showed very good hygiene practices, but each and every county wellness officer was interpreting it in a different way.

“Some counties have been providing exceptions, some weren’t. A great deal of counties are understaffed and wouldn’t be ready to enforce the law, which would roll it back,” in accordance to Abelon.

In late February, Pan and Sacramento council member Steve Hansen launched a legislation, AB 2130, that would repeal the ban. The new law would try to produce more particular recommendations that were implemented gradually.

“We desired to revisit this law so that restaurant and bar owners can give secure and clean food, but not in a way that hinders what they do as a occupation,” said Abelon.

California would have joined 41 other states that have previously enforced their very own version of the law.

Pan has said it was up to regional firms and well being inspectors to work with each other to develop a safe surroundings for buyers.

Sushi chef working in a restaurant. Taken by DinkY2K (Photograph credit score: Wikipedia)

California Probably To Take Back Its Bare Hands Law