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Health News from NHS Choices

Constantly updated health news across a range of subjects.

NHS Choices News

  • Goth teens 'at increased risk of depression and self-harm'

    "Goths are three times more likely to be depressed than other teenagers, with 37% admitting to self-harming," the Daily Mail reports. 

    A new study looked at mental health outcomes in young people who said they identified with the goth sub-culture. Goths favour black clothes, stark make-up, gloomy music and an interest in the darker side of life.

    The study involved 2,000 teens and looked at whether self-identification as a goth at age 15 is linked to depression and self-harm at 18. 

    After full adjustment for prior mental health and behavioural problems in the child, the study found goths were around a quarter more likely to have depression by 18 and a third more likely to report self-harming.

    The obvious question is, does being a goth make you prone to depression, or are people already prone to depression more likely to identify with goth culture?

    It's likely the relationship between mental health and self-identity is a complex one that cannot be boiled down to a simple "X leads to Y" statement.

    And it could even be the case that for some teens who would otherwise have remained socially isolated, adopting the goth sub-culture brings a sense of peer solidarity.

    Nevertheless, the study still indicates that those who identify with goth culture may be a group with an increased risk of mental health problems. Providing support to these young people could be beneficial.  

    Where did the story come from?

    The study was carried out by researchers from the University of Oxford and other academic institutions in the UK. 

    It was funded by the Wellcome Trust and the Medical Research Council Programme, and was published in the peer-reviewed Lancet Psychiatry on an open access basis, so it can be read for free online.

    The UK media's reporting of this well-conducted research is generally accurate. But an exception to this is The Daily Telegraph, which carried the headline: "Chavs are less depressed than goths, Oxford University finds". This is unsupported by the evidence provided by the study. Rates of depression and self-harm in this group are not given in the paper. 

    What kind of research was this?

    This cohort study aimed to look at the association between teen self-identification as a goth and depression and self-harm.

    Previous research observed that deliberate self-harm is associated with goth culture in young people. However, it is unclear whether this is a direct causative association or whether this link is being influenced by other factors – for example, family, peer or life circumstances.

    The researchers aimed to try to look at the direction of effect by assessing self-identity at 15 years and then look for the emergence of new mental health problems at 18 years. 

    What did the research involve?

    This study involved children enrolled into the Avon Longitudinal Study of Parents and Children (ALSPAC). This is an ongoing study that recruited pregnant women in Avon due to have a baby between April 1991 and December 1992. All children in this study have been invited to attend follow-up assessments every year since the age of seven.

    This study included those who took a computer-based survey at the assessment at the age of 15, which asked them to self-identify as one of eight different social groups: sporty, populars, skaters, chavs, loners, keeners, bimbos, and goths.

    They were asked further questions about how much they identified with these categories. For example, "Is there a group of teens in your school or neighbourhood with the reputation of rebelling against the norm (in clothing or ideas, for example), or in attempting not to conform to social ideals (e.g. goths)?" and "How much do you identify with the goths?" – to which they answered "not at all", "not very much", "somewhat", "more than somewhat", or "very much".

    At the same time they also completed the Development and Wellbeing Assessment, which includes questions about symptoms of depression and self-harm.

    Then, at the age of 18, depression was assessed using the Clinical Interview Schedule-Revised (CIS-R), where diagnoses are made according to standard diagnostic criteria from the International Classification of Diseases (ICD). 

    This scale also assessed self-harm with questions such as, "Have you ever hurt yourself on purpose in any way (e.g. by taking an overdose of pills or by cutting yourself)?". The researchers didn't make a distinction between whether or not self-harm was associated with suicidal intent.

    The researchers looked at the association between goth identification and depression or self-harm at 18 years, adjusting for these factors at 15 years to try to better determine a causative direction of effect. 

    They further adjusted their analyses for various individual, family and social characteristics, making use of earlier ALSPAC assessments. This included the mother's history of depression, temperament and educational attainment, as well as the child's earlier history of depression, emotional or behavioural problems, or bullying. 

    What were the basic results?

    Overall, full data on self-identification and mental health at 15 and 18 years was available for 2,351 teens, who formed the sample for this analysis. This represented just under half of the potential ALSPAC cohort who were still participating in the assessments at 15 years.

    Those identifying as goths were more likely to be girls, to have mothers with a history of depression, to have reported being bullied as a child, and to have a history of depression or emotional or behavioural problems themselves.

    Depression at 18 years was associated with the extent they identified with goth culture. For example, the depression rate among those who did not identify at all was 6%, compared with 9% of those who identified "somewhat" and 18% of those who identified "very much". After adjustment for confounders, people who identified as a goth were 27% more likely to have depression at 18 years (odds ratio [OR] 1.27, 95% confidence interval [CI] 1.11 to 1.47). The confounder having the greatest influence was previous depression in the teen/child themselves.

    There was also a similar link between goth identification and self-harm, with the greater the extent of identification being associated with the highest risk. 

    After adjustment for confounders, goths were a third more likely to report self-harm at 18 years (OR 1.33, 95% CI 1.19 to 1.48). A total of 37% of those who "very much" identified as a goth had self-harmed by 18.

    As a comparison, for those who identified "very much" with other groups:

    • skaters – 11% with depression and 25% had self-harmed by 18
    • loners – 9% with depression and 26% had self-harmed by 18
    • sporty – 4% with depression and 6% had self-harmed by 18  

    How did the researchers interpret the results?

    The researchers concluded that, "Our findings suggest that young people identifying with goth sub-culture might be at an increased risk for depression and self-harm."

    They go on to say that, "Working with young people in the goth community to identify those at increased risk of depression and self-harm and provide support might be effective." 


    This cohort study has found positive links between self-identification as a goth at 15 years, and subsequent depression and self-harm at 18 years.

    The study has many strengths, including the use of a large ongoing cohort study, which has carried out regular annual assessments of the mother and child. This has allowed the researchers to adjust their analyses for prior history of mother and child mental health and behavioural problems.

    The study also used recognised assessment scales throughout, which has allowed the researchers to make valid clinical diagnoses of mental health problems.

    However, the main point is as the researchers rightly say: "Our observational findings cannot be used to claim that becoming a goth increases risk of self-harm or depression". 

    The study has made a valid attempt to explore the possible direction of effect by seeing whether identifying as a goth at 15 precedes depression and self-harm at 18 years.

    But this still can't prove cause and effect. You can't say, for example, that if this individual hadn't become immersed in goth culture, they would never have developed depression or self-harm behaviours by 18 years.

    It could still be the case that personality characteristics, family or peer relationships, or life circumstances may make the teen more likely to be drawn to the goth culture, but may also separately make them more predisposed to depression or other mental health problems.

    The self-identification categories on the survey are also quite vague. Even though the researchers made clear attempts to explore the extent the individual identifies with a particular category, each category is still likely to have captured a wide range of personality characteristics and behaviours.

    Self-identification is highly subjective, and two people who identify themselves as a goth "very much" may be quite different. It is possible that teens may not have identified particularly with any of these categories and were just having to opt for the one that seemed to be the best fit.

    It is also not known how sincerely teens may have responded – for example, people may have called themselves a "chav" or a "bimbo" only lightheartedly.

    And although the research and media attention has focused on goths, the findings suggest other groups, such as "skaters" and "loners", may also be vulnerable young people.

    Overall, this research cannot prove direct causation, but it still indicates that those identifying with the goth culture may be a group with an increased risk of mental health problems. As the researchers suggest, providing support to these young people could be beneficial. 

    Those who may be well placed to recognise young people who may be having emotional or behavioural difficulties – goths or otherwise – include family members and other peers, schools, and youth groups. 

    Depression can potentially affect all teens, whether they are goths, Directioners (especially since the One Direction break-up), chavs or sporties. Read more about the possible signs of depression in young people.

    Links To The Headlines

    Goths are THREE times more likely to be depressed than other teenagers, with 37% admitting to self-harming. Daily Mail, August 28 2015

    Chavs are less depressed than goths, Oxford University finds. The Daily Telegraph, August 28 2015

    Goth teenagers at higher risk of depression, study suggests. The Guardian, August 28 2015

    Young goths 'at risk of depression'. BBC News, August 28 2015

    Goths at risk of depression or self-harming, research says. The Independent, August 28 2015

    Links To Science

    Bowes L, Carnegie R, Pearson R, et al. Risk of depression and self-harm in teenagers identifying with goth subculture: a longitudinal cohort study. The Lancet Psychiatry. Published online August 27 2015

  • How having 'senior moments' may be a good thing

    "Senior moments? Only worry if you don't notice them," the Daily Mail reports.

    "Senior moments" is a term used to describe a sudden memory lapse, such as forgetting your PIN or a relative’s name. While these types of lapses can affect people of all ages, older people are often more concerned when they happen, in case they could be the initial symptoms of dementia.

    A new study suggests this may be an unnecessary worry – the real warning sign could be when people "forget that they have forgotten". Being unaware of failing memory could be a warning sign of impending dementia.

    The study included more than 2,000 older adults from the US and followed them over a period of 10 years. Participants had memory tests every year and were asked to rate their own memory and whether they experienced any problems. During the study period, around 10% of participants were diagnosed with dementia. They experienced a drop in memory awareness around 2.6 years before the development of dementia.

    This study highlights the importance of being memory aware – knowing when your memory has let you down on occasion. The researchers state that loss of memory awareness appeared earlier in younger participants; this may be because older people were more likely to expect their memories to fade as a normal part of ageing. Friends and family members should look out for the warnings signs and ensure medical advice is sought if they are concerned. 

    Where did the story come from?

    The study was carried out by researchers from Rush Alzheimer’s Disease Center and Department of Neurological Sciences, and was funded by the National Institute on Aging and the Illinois Department of Public Health.

    The study was published in the peer-reviewed medical journal Neurology. 

    This story has been reported both widely and accurately by the UK media. 

    The Independent offers a particularly useful report, with additional advice about ways of reducing risk of dementia and highlighting the role of friends and family in aiding medical professionals in diagnosing the condition.    


    What kind of research was this?

    This study combined people from three prospective cohort studies in the US to investigate the development of memory loss in dementia. The participants were free from dementia at study start; this is the best way to gather information on how a condition develops over time.


    What did the research involve?

    This study included participants from three longitudinal cohort studies to test whether being unaware of memory impairment is an indicator of dementia.

    The participants came from:

    • The Religious Orders Study – older Catholic nuns, priests and brothers.
    • The Rush Memory and Aging Project – older individuals from the Chicago area.
    • The Minority Aging Research Study – older black persons from the Chicago area recruited from the community and the clinical core of the Rush Alzheimer’s Disease Core Centre.

    All participants were at least 50 years old and had not been diagnosed with dementia. A number of evaluations were carried out each year. These are as follows:

    • Clinical evaluation – including a medical history, neurologic examination, and tests of memory and cognition. Dementia diagnosis was made by a doctor according to standard criteria.  
    • Self-assessment of memory – Participants were asked two questions about their memory; these were "How often do you have trouble remembering things?" and "Compared to 10 years ago, would you say your memory is better or worse?"
    • Performance testing of memory – 19 cognitive tests were carried out to support clinical classification of dementia and measure change in cognitive function. These included tests of episodic memory (e.g. immediate and delayed recall of word lists) and working memory (e.g. numerical tests).

    After death, those who had given consent during the study period had an autopsy of their brain.

    The temporal course of memory awareness in dementia was investigated for those people who developed dementia before the end of the study and who had completed at least four annual evaluations.


    What were the basic results?

    The study included a total of 2,092 older people who had no memory or cognitive impairment at study start. Around 10% of participants (239 people) developed dementia during follow-up and had four annual assessments available from which to assess the course of their memory awareness.

    These people had an average age of 79.2 years at study start and were followed up for 10.8 years. This included 7.5 years before dementia onset and 3.3 years after dementia onset. Memory awareness was stable until 2.6 years before the onset of dementia; after this point there was a rapid decline in memory awareness. Participants who were older at study start tended to have later onset of memory unawareness.

    Brain autopsy was carried out in 385 of those who died during the study period. Decline in memory awareness could be linked to brain changes that are associated with dementia – such as protein tangles (characteristic of Alzheimer’s disease) and areas where the brain has been starved of oxygen (characteristic of vascular dementia). Where these changes were not found, decline in memory awareness had not been observed.


    How did the researchers interpret the results?

    The researchers conclude that awareness of memory impairment typically begins to decline about two to three years before dementia onset and is associated with post-mortem evidence of dementia.



    This study investigated unawareness of memory loss as an indicator of dementia. The 10% of participants diagnosed with dementia during follow-up who had full assessments available experienced a drop in memory awareness around 2.6 years before the development of dementia. It was also noticed that a drop in memory awareness was associated with the characteristic features of dementia at brain autopsy.

    Strengths of this study are the large sample size and long follow-up period. However, there are limitations related to the specific US population samples used. For example, one of the cohorts included only nuns, priests and brothers; another included only people of black ethnicity. These people may have distinct health and lifestyle characteristics, meaning they are not representative of everyone.

    In practical terms, it may also be difficult to identify a clear cut-off point between the vague concepts of memory "awareness" and "unawareness". The study also has no direct implications in terms of preventing or slowing the development of dementia.

    Nevertheless, the findings highlight the role that friends and family members can have in looking out for signs of unawareness of memory loss, and to ensure medical advice is sought if they are concerned.

    Early symptoms of dementia can progress very slowly, so they may not be noticed or taken seriously, just thought to be a normal part of ageing. However, symptoms become more severe as the condition progresses. The speed at which symptoms get worse and the way they develop can depend on the cause and overall health of the person. This means that the symptoms and experience of dementia can vary greatly from person to person.

    Memory loss is one of the key symptoms of dementia, but others include:

    • increasing difficulty with tasks and activities that require concentration and planning
    • depression
    • changes in personality and mood
    • periods of confusion
    • difficulty finding the right words

    There are no certain ways to prevent dementia. However, you may be able to reduce your risk of developing dementia by following normal healthy lifestyle advice – eating a balanced diet, taking regular exercisenot smoking and drinking alcohol in moderation.

    Links To The Headlines

    Senior moments? Only worry if you DON'T notice them: Becoming oblivious to memory problems is found to be sign of the onset of dementia. Daily Mail, August 27 2015

    Dementia sufferers ‘stop noticing memory loss two years before condition develops'. The Guardian, August 27 2015

    Dementia sufferers start losing their memory up to three years before disease takes hold. The Independent, August 26 2015

    Worrying about senior moments shows mind is still in good shape. The Daily Telegraph, August 26 2015

    Do you have 'senior moments'? Research shows that might not be a bad thing. Daily Mirror, August 26 2015

    Forgetting your senior moments is sign of dementia. The Times, August 27 2015 (subscription required)

    Why senior moments show you haven’t got dementia. Daily Express, August 26 2015

    Links To Science

    Wilson RS, Boyle PA, Yu L, et al. Temporal course and pathologic basis of unawareness of memory loss in dementia. Neurology. Published online August 26 2015

  • Low vitamin D levels linked to increased multiple sclerosis risk

    "Lack of vitamin D may cause multiple sclerosis, study finds," reports the Guardian. A large study found people genetically programmed to have lower vitamin D levels are at an increased risk of multiple sclerosis (MS).

    MS is a condition where the immune system attacks the coating of nerves in the brain and spinal cord, leading to symptoms such as vision loss, fatigue, and difficulties with balance and co-ordination.

    Our body makes vitamin D under the skin in reaction to sunlight. We also get small amounts of the vitamin from our diet in foods such as eggs and oily fish.

    A link between vitamin D deficiency and an increased risk of MS has long been suspected, as the condition is more common in areas of the world with less sunlight, such as northern Scotland. But it has been difficult to prove cause and effect because other factors may be involved.

    This study used a genetic approach believed to be less susceptible to the problem of confounding – where other factors influence the results.

    The researchers learned four genetic variants influence vitamin D levels found in the blood. People can have different combinations of these genetic variations. They found people with a combination of the genetic variations giving them lower levels of vitamin D had double the risk of MS.

    But what the study does not tell us is whether MS could be prevented in those at higher risk by increasing their vitamin D levels through taking supplements or other methods.

    Find out more about the "sunshine vitamin" in our special report on the health claims made about vitamin D.

    Where did the story come from?

    The study was carried out by researchers from McGill University and the Jewish General Hospital in Canada; the University of Bristol and King's College London in the UK; and Massachusetts General Hospital and Harvard Medical School in the US.

    It was funded by the Canadian Institute of Health Research, The Fonds de la Recherche en Santé Québec, the Lady Davis Institute, the Jewish General Hospital, and the Canadian Diabetes Association.

    The study was published in the peer-reviewed journal PLOS Medicine on an open-access basis, so it is free to read online.

    The UK media reported the story accurately, and many reports included reactions to the research findings from experts such as Professor Danny Altmann, an immunologist at Imperial College London. 

    Professor Altmann said: "While it may be too much to expect therapeutic vitamin D to treat or reverse ongoing MS, this paper will add to the weight of argument for routine vitamin D supplementation of foodstuffs as a broad preventative public health measure." 

    What kind of research was this?

    This genetic study looked at whether there is an association between genetically influenced levels of vitamin D and the risk of MS.

    Previous observational studies found an association between lower levels of vitamin D and MS risk. In particular, MS is more common in people living in geographical areas with reduced sunlight – vitamin D levels are increased by exposing the skin to the sun.

    But these studies were unable to prove cause and effect. Questions remain, such as whether the low vitamin D caused MS, or whether vitamin D levels go down in people with MS because they have less exposure to the sun as a result of their condition.

    Exposure to sunlight is just one way to increase our vitamin D levels. There is also a genetic component that will have a lifetime influence. This study specifically looked for genetic variations linked to vitamin D levels and whether these genetic variations were also associated with MS risk.

    This type of study is called a Mendelian randomisation study because these genetic variations are inherited randomly (each parent will have two copies of each, which one we inherit is random). The term is named after Gregor Mendel, a pioneering 19th century scientist, widely regarded as the father of modern genetics.

    The study design means confounding by other factors is not a problem.The researchers in the study took additional steps to be sure this was the case. 

    What did the research involve?

    The researchers identified genetic variations associated with vitamin D levels using data from the SUNLIGHT study. The Study of Underlying Genetic Determinants of Vitamin D and Highly Related Traits included blood samples from 33,996 people.

    They identified four genetic variations associated with lower vitamin D levels. These were close to four genes that create products that have an effect on the level of vitamin D:

    • a protein that binds to vitamin D and carries it in the blood to target organs
    • an enzyme involved in making vitamin D in the body in response to sunlight
    • an enzyme that activates production of vitamin D
    • an enzyme that inactivates vitamin D

    They then used data from the Canadian Multicentre Osteoporosis study (CaMos) of 2,347 people to confirm the effect of these four genetic variants on vitamin D levels.

    The researchers used the results to investigate the risk of MS depending on the genetic variations a person carried and their genetically determined lifetime level of vitamin D using data from two studies:

    • the International Multiple Sclerosis Genetics Consortium (IMSGC), which has data from 14,498 people with MS and 24,091 healthy controls, all of European descent
    • the IMSGC/Wellcome Trust Case Control Consortium 2 (IMSGC/WTCCC2) study, which has data from 9,772 people with MS and 6,332 controls

    The researchers took the following factors into account when analysing the results:

    • age
    • sex
    • body mass index (BMI)
    • time of year the blood sample was taken
    • ethnicity  

    What were the basic results?

    The four genetic variants associated with reduced vitamin D levels were also associated with an increased risk of MS, with three showing stronger links than the fourth. Each variant was only associated with a relatively small increase in the odds of MS (odds ratio [OR] of 1.04 to 1.11).

    Each genetically determined standard deviation decrease in vitamin D levels doubled the risk of MS (OR 2.0, 95% confidence interval [CI] 1.7 to 2.5).

    How did the researchers interpret the results?

    The researchers concluded: "Genetically lowered 25OHD [a form of vitamin D in the blood] level is associated with an increase in the risk of MS in people of European descent."

    They said that: "These findings provide rationale for further investigating the potential therapeutic benefits of vitamin D supplementation in preventing the onset and progression of MS." 


    This study found people with a genetic susceptibility to having lower levels of vitamin D have an increased risk of developing MS.

    What the study does not tell us is whether MS could be prevented in those at higher risk by taking steps to increase their vitamin D levels. The results also may not apply to people who are not of European descent.

    Studies in healthy children and adults are now underway to explore this area. This study does not show what effect taking supplementary vitamin D would have in people who already have MS.

    Previous research into vitamin D being used as a treatment for MS and to prevent relapse has been inconclusive because of small study sizes and poor methodology, so large randomised controlled trials are required.

    Nevertheless, this piece of research adds to the growing picture that low levels of vitamin D appear to play some part in the development of MS.

    You can usually get enough vitamin D through modest exposure of the skin to sunlight (no suntanning required) and a healthy diet that includes oily fish, eggs and foods fortified with vitamin D.

    Some people may require vitamin D supplements, such as people aged 65 and over or those not exposed to much sunlight. The NHS suggests that if you take vitamin D supplements, you should not take more than 25 micrograms (0.025mg) a day as it could be harmful.

    Find out more about vitamin D.

    Links To The Headlines

    Lack of vitamin D may cause multiple sclerosis, study finds. The Guardian, August 25 2015

    Low vitamin-D genes linked to MS. BBC News, August 26 2015

    Why sunlight could protect against multiple sclerosis. The Daily Telegraph, August 25 2015

    Links To Science

    Mokry LE, Ross S, Ahmad OS, et al. Vitamin D and Risk of Multiple Sclerosis: A Mendelian Randomization Study. PLOS Medicine. Published online August 25 2015

  • Is incense smoke more dangerous than tobacco smoke?

    "Incense may need a health warning over 'toxic' smoke, claims research," The Daily Telegraph reports. Analysis of incense smoke, used in both western and Asian religious ceremonies for possibly thousands of years, found it contains many chemicals, some of which may be harmful.

    The researchers – two of whom worked for a tobacco company – tested the residue of tobacco and incense smoke directly on animal and bacteria cells in a laboratory. They did this to see whether they could induce mutations in the DNA and if the smoke was toxic to the cells.

    They found the effect of some of the incense smoke tested on the cells was greater than that of the tobacco smoke. However, only four incense sticks and one cigarette were tested, so we have to be cautious about these results.

    But incense isn't smoked and so is not drawn directly into the lungs in the way tobacco smoke is, so the effects on lung cells may be very different.

    Still, the study is a reminder that burning anything – whether it's incense, coal or tobacco – produces smoke that can irritate and damage the lungs. If you want to make your home smell nicer, we would recommend sticking to air freshener.  

    Where did the story come from?

    The study was carried out by researchers from the South China University of Technology and the China Tobacco Guangdong Industrial Company.

    No information was given about funding. However, the lead researcher worked for the tobacco company, which raises questions about the impartiality of the research.

    The study was published in the peer-reviewed science journal Environmental Chemistry Letters, and is available on an open access basis to read online or download as a PDF file.

    It was covered cautiously by the Mail Online and The Daily Telegraph, both of which included warnings about the study's links to the tobacco industry. 

    What kind of research was this?

    This laboratory research used instruments to measure and identify the types of particles and chemicals given off by burning incense.

    After measuring the chemicals, the researchers did in vitro studies of the effects of the smoke on bacteria and animal cells.  

    What did the research involve?

    The researchers burned four incense sticks and one cigarette in a machine that collected particles of smoke through a series of filters. They graded the size of the particles collected, and performed chemical analysis by gas chromatography and mass spectrometry on the contents of the filters. They then tested the smoke residues on cells in petri dishes.

    The first test, on salmonella cells, was to see whether the samples prompted mutations in the DNA of the cells. Mutations in DNA can sometimes lead to cancer. The second test used cells from the ovaries of Chinese hamsters to see whether the samples had toxic effects on the cells.

    What were the basic results?

    Smoke from burning incense created a mixture of fine and ultrafine particles, which are known to be bad for lung health. The chemical analysis found 64 compounds, taking into account all the components of all four incense sticks.

    These included chemical components of essential oils and lignin wood, which is commonly used in incense. The compounds were mostly "irritants", although some toxic compounds were found. The paper did not give the equivalent results on particle size and chemical compounds found in the cigarette tested.

    The four incense smoke samples and one cigarette smoke sample caused varying degrees of mutation in the salmonella cells. The incense and cigarette smoke was toxic for the hamster ovary cells. Toxicity was maintained at all different levels for the different samples. The incense smoke was toxic at lower concentrations than the cigarette smoke. 

    How did the researchers interpret the results?

    The researchers showed smoke from some incense samples was "higher than for the reference cigarette sample with the same dose", and said their findings suggest that, "incense smoke was more cytotoxic against Chinese hamster ovary cells" than cigarette smoke.

    However, they added: "We cannot simply conclude that cigarette smoke is less cytotoxic than incense smoke, firstly because of the small sample size analysed in this study, and secondly because of huge variability in the consumption of incense sticks and cigarettes." 


    This laboratory study found smoke from burning incense can produce fine particles and chemical compounds of a type that may irritate the lungs and damage health. This is not surprising, as most types of smoke indoors produces fine particles that are likely to have this effect, whether from cooking, smoking tobacco, or burning incense.

    The suggestion that incense smoke might be more harmful than cigarette smoke needs to be treated with caution. The four incense stick samples had different effects when tested for the ability to mutate cell DNA and toxicity to cells. These were compared with just one cigarette.

    This means we cannot draw conclusions about whether most incense sticks produce smoke that is more or less toxic than most cigarettes. Also, research using animal cells in the laboratory is not the same as research on living humans. Adding substances to cells in a petri dish can cause very different effects from what happens when people come across these substances in a dilute form in the environment.

    The way we use incense and tobacco is different. Cigarette smoke is drawn directly into the lungs and held there before being exhaled. Incense smoke is burned into the environment and inhaled from the surrounding air. The amount of smoke that gets into the lungs will depend on how much incense is burned, for how long, and on the size and ventilation of the room.

    The association of the lead researcher with a tobacco company raises another point of concern. While the researchers stop short of saying incense is more dangerous than cigarettes, it is in the interests of the tobacco company for people to think cigarette smoking and incense burning are on a par – which is not the case.

    It seems sensible that people who have lung conditions should avoid using incense, and the rest of us should limit its use for personal reasons, such as improving the smell of your home.

    Smoking tobacco, which is known to cause illness and death from conditions including heart diseaselung cancer and stroke, is something everyone should stop altogether.

    Read more advice on how the NHS can help you quit smoking.

    Links To The Headlines

    Incense may need a health warning over 'toxic' smoke, claims research. The Daily Telegraph, August 25 2015

    Could incense be more toxic than cigarette smoke? As they burn, 'sticks release compounds that are linked to cancer'. Mail Online, August 26 2015

    Links To Science

    Zhou R, An Q, Pan XW, et al. Higher cytotoxicity and genotoxicity of burning incense than cigarette. Environmental Chemistry Letters. Published online August 24 2015

  • Researchers 'a step closer' to universal flu vaccine

    "Universal flu vaccine comes closer, scientists say," BBC News reports after two independent teams of researchers each found ways to target multiple strains of the influenza virus – but, as yet, the research has only involved animals.

    Because there are many different strains of flu and they constantly change, people need to be vaccinated with a different flu vaccine every flu season. Scientists would like to be able to develop a universal flu vaccine that would be active against all strains of the virus.

    The studies developed two different vaccines. Both vaccines were able to protect mice against what would usually be a lethal dose of flu, and one vaccine reduced fever symptoms in monkeys. Both vaccines were based on the principle of attacking specific sites on the virus that are less likely to mutate as new strains come along.

    This analysis focuses on the second study, which advanced as far as testing on monkeys, as these results are more likely to apply to humans.

    We can't yet be certain that the vaccines will be effective or safe until they are tested on humans, and more animal and lab research will be needed before this can be started.

    However, it seems likely that this avenue of research could eventually lead to better flu vaccines at some point in the future. Until then, one simple way to reduce your chances of getting flu is to regularly wash your hands.

    Get more flu prevention advice

    Where did the story come from?

    One of the studies was carried out by researchers from the Crucell Vaccine Institute at the Janssen Center of Excellence for Immunoprophylaxis in the Netherlands and other research centres in the US.

    Some parts of the study were supported by the US Department of Energy, National Institutes of Health and National Institute of General Medical Sciences. Various companies provided supplies or input into early designs.

    The authors noted that Crucell Holland B.V., a Janssen company, has pending patent applications in this area of research.

    The study was published in the peer-reviewed journal Science Express.

    The second study was carried out by researchers from the National Institutes of Health in the US, BIOQUAL Inc, and Osaka University in Japan. A patent application has been filed as a result of the study. It was published in the peer-reviewed journal Nature Medicine.

    In general, UK news sources have covered the story well, pointing out that the research was in animals and that human vaccines based on this research may still take years to develop.  

    What kind of research was this?

    This laboratory and animal research aimed to develop a universal flu vaccine. There are many different flu strains and the flu virus is constantly changing.

    This has meant that people need to be vaccinated with a different flu vaccine every flu season, which is targeted at the strain or strains expected to be circulating at that time. Scientists would like to be able to develop a universal flu vaccine that would be active against all – or at least most – strains.

    This animal research is an essential first step towards developing human vaccines, identifying whether the vaccines look safe and effective enough to go on to human trials. These animal studies usually start in smaller animals such as mice, and if they are successful go on to be tested in primates, whose biology is more similar to humans'. 

    What did the research involve?

    The flu virus is shaped like a ball, with many "spikes" sticking out of its surface made of a chemical called haemagglutinin. The "stem" part of this spike does not change as much as its tip or other parts of the virus, so both of these studies aimed to develop a vaccine that targeted the stem.

    Broadly neutralising antibodies have been discovered in humans, and are active against many flu viruses. Most of them bind to the haemagglutinin stem.

    The researchers therefore wanted to create a vaccine that would mimic a section of this stem to stimulate the immune system to produce these types of antibodies. This would prepare the immune system to deal with different types of flu virus in the future.

    The first study developed various candidate molecules based on different parts of the haemagglutinin stem using a form of haemagglutinin called HA1. Researchers tested whether the molecules showed similar structures to the corresponding part of the stem in an intact virus, and whether they could bind to antibodies against the stem.

    Based on this, they picked the best candidate molecules for testing as vaccines on animals. First, the researchers vaccinated mice, then injected them with what would usually be a lethal dose of flu virus, to see whether they died. In these experiments, they used various different strains of flu to see how well the vaccine protected against them.

    The researchers then tested the best-performing vaccine in crab-eating macaques – a type of monkey found in southeast Asia. They injected six monkeys with three doses of the vaccine, and then injected them with a non-lethal dose of flu virus.

    They also injected the flu virus into 12 control monkeys. Half of the control monkeys received a human flu vaccine, while the other half received dummy inactive injections. The researchers looked at how ill-vaccinated and unvaccinated monkeys became.

    The people assessing the mice and monkeys were not blinded as to which vaccine the animals received – ideally, they would have been blinded to ensure their views could not influence the results.

    The researchers also looked at whether the antibodies the vaccinated mice and monkeys were producing bound to a wide range of different flu virus strains in the lab. The antibodies need to be able to bind to the virus strains to have an effect in fighting them.

    In the second study, researchers carried out similar experiments to develop and select a candidate molecule based on the H1 haemagglutinin stem region to use as a vaccine. This vaccine, called H1-SS-np, utilised this molecule to bind to tiny particles of a chemical called ferritin (nanoparticles). The researchers then tested it in mice and ferrets. 

    What were the basic results?

    The first study found good candidate molecules produced high levels of an immune response when injected into mice, which is needed if a vaccine is going to work. Some of the vaccines gave better protection against a potentially lethal dose of flu than others.

    One molecule, called mini-HA #4900, prevented 90% of the vaccinated mice from dying after one injection, and after two injections all vaccinated mice survived without losing weight or showing flu symptoms. It showed this protection against an H1N1 flu virus, which is a different H1 strain from the one used to develop the molecule, as well as an H5N1 strain, which has a different type of haemagglutinin.

    The researchers went on to test mini-HA #4900 in monkeys. The vaccine again produced high levels of immune response. The antibodies produced could bind to a wide range of different flu virus strains in the lab, including H1 strains and H5N1, as well as some – but not all – group 2 flu viruses. Group 2 viruses have a different haemagglutinin structure from group 1 viruses such as H1N1 and H5N1.

    Monkeys vaccinated with mini-HA #4900 had less fever in the first three to eight days after exposure to the flu virus than those vaccinated with either the dummy or human flu vaccines. One of the monkeys in the mini-HA #4900 group was excluded from the analysis because data collection failed.

    The second study also identified a candidate vaccine that could produce antibodies in mice and ferrets, which reacted against a variety of flu strains. The vaccine could fully protect mice against a lethal dose of H5N1 flu, and partially protected the ferrets. 

    How did the researchers interpret the results?

    The researchers in the first study concluded that, "These results provide proof of concept for design of [haemagglutinin] stem mimics that elicit [broadly neutralising antibodies] against influenza A group 1 viruses."

    In the second study, the researchers concluded that, "Vaccination of mice and ferrets with H1-SS-np elicited broadly cross-reactive antibodies that completely protected mice and partially protected ferrets against lethal heterosubtypic H5N1 influenza virus challenge." 


    These studies have developed two different flu vaccines that could potentially offer broader protection against a variety of flu strains than current vaccines.

    As yet, this research has only been conducted in animals, with one study showing an effect against different flu strains in mice and monkeys, and the other showing an effect in mice and ferrets.

    As monkeys are more similar to humans than mice or ferrets, the results from these experiments are likely to be the most representative of what would happen in humans.

    While the results are encouraging, it is likely that additional lab and animal research on both vaccines will be undertaken to ensure the vaccine's safety and effectiveness before they reach testing on humans. The results suggest that while the vaccines may provide broad protection, they still may not be able to protect against all flu viruses.

    As there are many different flu strains and the flu virus is constantly changing, different flu vaccines are needed every flu season. Research like this aims to get us close to a universal flu vaccine that would be active against all – or at least most – strains.

    While the vaccines tested in these studies have not yet proven to be effective in humans, it seems likely that this type of research could eventually lead to better flu vaccines. 

    Links To The Headlines

    Universal flu vaccine comes closer, scientists say. BBC News, August 24 2015

    Universal flu vaccine a step closer as scientists create experimental jabs. The Guardian, August 24 2015

    Scientists are 'one step closer' to creating a universal flu vaccine: New jab could protect against ALL strains of the virus. Mail Online, August 24 2015

    Flu: Breakthrough as multi-strain vaccine raises prospect of 'universal' protection against virus. The Independent, August 24 2015

    Links To Science

    Impagliazzo A, Milder F, Kuipers H, et al. A stable trimeric influenza hemagglutinin stem as a broadly protective immunogen. Science Express. Published online August 24 2015

    Yassine HM, Boyington JC, McTamney PM, et al. Hemagglutinin-stem nanoparticles generate heterosubtypic influenza protection. Nature Medicine. Published online August 24 2015