蜜芽传媒

James Gallagher听 0:01听

蜜芽传媒 sounds, music, radio, podcasts. Welcome to the inside health podcast with me. James Gallagher, episodes are released weekly wherever you get your podcasts, but if you live in the UK, you can listen to the latest episodes a whole week earlier than anywhere else. First on 蜜芽传媒 sounds, hello there. Later, we're going to find out whether we're all eating a credit card's worth of micro plastic every week, and we're answering your questions on hearing loss, but first, it's part three of our discussion on assisted dying. Using drugs to end a life raises a lot of issues, and here on Inside health, we've been looking at it from a medical perspective. So if you go back through 蜜芽传媒 sounds, we've looked at ensuring an assisted death is what the patient wants, as well as seeing who could potentially be eligible under the terminally ill adults end of life bill, which is being considered in Parliament now, that would apply to England and Wales, but there are similar discussions taking place in Scotland, the Isle of Man and Jersey too. So today, we're going to consider the assisted death itself. How would it happen, and what might those final moments be like? We have the same power of experts as last time, so let's meet them.

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Katherine Sleeman听 1:12听

My name is Katherine Sleeman. I'm professor of palliative care at King's College London. I have no in principle objection to assisted dying, but I have concerns about the practical implementation, in particular the risks to vulnerable people.

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David Nicoll听 1:25听

My name is David Nicoll I'm a consultant neurologist. I was actually opposed to assisted dying, but it took the death of my friend Fauci through euthanasia to teach me that sometimes modern medicine doesn't have it all, and we should think about assisted dying and respecting the dignity of those who are terminally ill who want to make one final decision on their terms.

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Erica听 1:42听

Hi, I'm Erica Borgstrom. I'm a Professor of Medical Anthropology based at the Open University when it comes to assisted dying. I don't necessarily have a position that says it's wrong or right in and of itself, but I think we need to have a lot more conversations about what it means to us as a society.

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Mark Talbot听 1:57听

And I'm Mark Talbot. I'm an adult medicine consultant in the NHS in Cardiff, when it comes to assisted dying, I would call myself a skeptic. I'm very interested in the safeguards

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James Gallagher听 2:11听

now Erica, the way the system works is that you're going to have to take the drugs yourself. So your doctor can't do it for you, partner can't do it for you, your children can't do it for you. You have to be able to do it yourself. That's a decision that has been made. What are the pros and cons of that?

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Erika听 2:28听

So that does mean people need to physically do certain things with their body still. So again, when we're thinking about who does this potential bill apply to and not that means someone's going to have to have some forms of mobility to do that. They are going to possibly have to either ingest it or inject it and do that final act themselves. For some people, that will be very liberating because it fits with a sense of control. For others, that might be quite tricky in that very last moment, and there can be hesitation, etc. It can also be, again, very different and sometimes very ambiguous and ambivalent for those who might want to actually be the one to help the family member do it, because they know it's actually something very difficult for them to do, even if it's something they really, really want. And it's often one of those things that, even in countries where assisted dying exists, that we have very little insight about what those final moments are actually like for people, and what's that lasting impact for those that live beyond that moment?

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James Gallagher听 3:24听

Is there a moral reason why it has to be the person self administering the drugs? I mean, what is the difference hypothetical scenario, Catherine drawing up the drugs and handing them to me to inject, versus Catherine just injecting them?

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Erika听 3:36听

Some of it is around intentionality, autonomous, and sometimes there is this distinction around sort of actively killing someone versus supporting them to do something they're doing themselves. Also really important to acknowledge how suicide itself is currently conceived of in our legal system, where that's been decriminalized, so we've already accepted that if someone kills themselves, that's not a criminal act. So this is kind of like an extension of that.

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James Gallagher听 4:00听

What鈥檚 the difference between taking your own life versus having an assisted death after a terminal diagnosis?

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Erika听 4:05听

On one hand, potentially nothing because the result of that action, and actually, potentially the means of that action could be the same. But you can argue it in very many different ways, depending on your world view and your moral and ethical beliefs.

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James Gallagher听 4:20听

Mark in countries where assisted dying is already legal, they'll have their own protocols for how it happens there, and they'll all be different. But can you give me a basic run through of what would happen in an assisted death?

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Mark Talbot听 4:35听

We鈥檝e got very little detail on what is proposed, but in other countries, what usually happens if it's oral administration is that you start off with an anti sickness medication. That's the first one you take, and then approximately 20 minutes later, people take a sedative, and then a little bit later, they take the medication mix, which causes cardio respiratory arrest. Is a very bitter tasting medication, so often sweetness are added, and you can't just drink half of it. You have to drink the whole amount of it, which can be quite a challenge for people. And then there's the assisted suicide via an intravenous route, where a practitioner comes in and inserts an intravenous needle, and then a pump is set up with the anti sickness medication, a sedative, and then the agent that causes the cardio respiratory arrest and then leads to the asphyxiation of event. So it's a little bit removed from the sort of romantic notion that I read a few years ago when Terry Pratchett wrote about it, saying he'd like to be in his garden, have a brandy and take a pill that some kindly doctor has provided him with. This is quite a clinical set of processes, and you need to be able to follow these instructions quite carefully.

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James Gallagher听 5:54听

Catherine, one of the appeals of an assisted death is that it's less painful. It's a nicer way to go than the alternative of, say, end stage cancer. Do we know if the reality of that matches up with the ideal?

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Katherine Sleeman听 6:11听

It鈥檚 really difficult, because actually, there hasn't been that much research looking actually at the quality of deaths. I think it's less about pain, it's less about physical suffering, and it's about control. And if the most important thing to you at the end of your life is determining where and when you die, then I can see that for you, this might be the thing that gives you the best quality of life. But this isn't about reducing pain. This is about killing the person so that pain is no longer relevant to them, which I think is quite a relevant distinction.

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James Gallagher听 6:42听

David, how is this played out in countries around the world? Because, like, this isn't a new thing.

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David Nicholl听 6:47听

No, it's not different protocols in different places. So Fabi was a friend of mine who had a rare cancer syndrome and then chose to die through euthanasia. I spoke to Fabio's partner a couple of days ago and asked him, you know, how long did it take her to die, basically, and obviously, Belgium, very different euthanasia, doctor injecting, and she was dead within a couple of minutes. Now, Australia, they're 85% self administered, I think 15% there is assistance you can apply for that now that is not in the lead budget bill. So again, that's something to think about. I'm thinking about the MND population. If you've got someone who's quadroporetic, how that would be administered. There might be technological ways of delivering that that could be looked at.

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James Gallagher听 7:33听

Mark do the drugs work all the time?

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Mark Talbot听 7:37听

It depends so if we're comparing internationally, assisted suicides versus physician administered euthanasia. We have data that in assisted suicides, where patients administer the medications themselves as a considerably higher complication rate in countries that measure this, Oregon, for instance, look at some of the side effect data. Look at what happens during the death and you get data about prolonged deaths lasting over 100 hours. You get data about deaths that have involved seizures, breathing difficulties, sickness, choking events those countries. It would be useful, as Cathy mentioned earlier, to have some more research in this area in terms of which regimens work best. So at the moment, no drugs in the world anywhere are licensed for this indication of bringing about death.

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James Gallagher听 8:28听

While no drug is specifically licensed for a sister dying, where assisted dying is legal. There are certain medications that are prescribed for this purpose, though. So David, what's your view on this?

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David Nicholl听 8:38听

Well, I know, speaking to colleagues in Australia that 95% of patients die within two hours, and when you talk about complications, if it's delayed, it's because the patient's asleep, but they all die.

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James Gallagher听 8:50听

When we first started this discussion, I introduced it all by saying that I thought a sister dying if it went ahead, would be one of those huge changes in society. Erica, if this went through, how different would England and Wales be?

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Erika听 9:08听

I think it could be a sort of a landmark change. We also must acknowledge this is happening at a time where we're also investing a lot in terms of medical interventions to try to prolong life. And so there's sort of this dynamic interplay between those things. So it's one to watch in terms of how we think about life and death.

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James Gallagher听 9:23听

Mark

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Mark Talbot听 9:24听

Advance care planning, which is an area that I'm quite close to, so planning for what you would like your death to look like. And the future is already tricky to bring up. And then I think an assisted dying law being in place might set that back by quite a considerable margin.

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James Gallagher 09:41

Katherine

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Katherine Sleeman听 9:42听

I think this bill is sometimes presented as a modest change. It's just a modest change. And I disagree. I think that this is a momentous change that will affect all of society, and the most important question for us to be considering now is around safety. It can't be 100 Safe. So how safe is safe enough?

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James Gallagher 10:02

David

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David Nicholl听 10:03

I mean, I disagree, but in a nice way, I think that this will improve the quality of end of life conversations that we have with our patients, and it's about listening to those of terminally ill. So I welcome this as a change, and even just this discussion now, discussing about end of life care in a way that wasn't the case anywhere near as much even six months ago, has been a good thing.

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James Gallagher听 10:25听

Well, thank you to our panel for today and for the past couple of episodes. Let us know what you think about what you've just heard. Do email insidehealth@bbc.co.uk well now for something a little bit different, because there have been a lot of claims about the amounts of micro plastic, so tiny fragments of plastic that we're consuming and is then ending up lodged inside our bodies. So do we really eat and drink about a credit card's worth of micro plastic every week, and if all the micro plastics in our brain were melted down, would there be enough there to build a plastic spoon. I'm joined now by Professor kit Yates from the Center for mathematical biology at the University of Bath to sense check those numbers. Kit, welcome to Inside health.

Kit Yates 11:10

Thanks for having me.

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James Gallagher 11:11

So a credit card's worth of plastic. Let's start with that claim that seems a huge amount. I'm just trying to imagine putting it in my mouth in one go. That's just a lot of plastic. Is it true?

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Kit Yates听 11:21听

I don't think it is. I think it's probably way, way too much.

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James Gallagher听 11:25听

It gets quoted a lot. Now, where did it come from?

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Kit Yates听 11:29听

So the claim originally comes from a literature review in 2021 with authors from the University of Newcastle, Australia, and they suggested actually that we could be ingesting anywhere between nought point one and five grams of microplastics per week, which is quite a big range, but this, this five grams figure was quoted by researchers at the Medical University in Vienna. They just quit this figure as a sort of throwaway at the start of their paper, so it didn't get peer reviewed. But when their paper was published, the press office said, this is a brilliant figure. Let's get this out there. And so they ran with this headline of five grams of microplastic per week, and that's how it got into all these newspapers and into the public consciousness.

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James Gallagher听 12:09听

Well, let's go back to that naught point. One to five grams. How did that number get constructed?

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Kit Yates听 12:14听

So the way that they calculate the total ingestion is to take the total amount of water that you drink, which they assume 219 litres of bottled water a year, and multiply that by the figure that they've calculated for the mass of micro plastics per litre, which seems like a sensible strategy, well, but so far, that sounds fairly okay. Yeah, absolutely. But just to maybe do a quick common sense jack to make that five grams of plastic a week, figure work out this would mean that you'd have to have over a gram of micro plastics per litre. And given the figure that they put in the paper, this would mean they would have to be, on average, 420 micro plastic particles per litre of water with an average diameter of 1.5 millimetres. You would literally see these things floating around in the water that you were drinking.

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James Gallagher听 13:03听

If this was true, do we have a better number? Then, if that one's a bit nonsense,

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Kit Yates听 13:07听

Yeah, so the figure that has been calculated by a follow up paper, also from 2021 by Mohammed Noor suggests average of about 4.1 micrograms per week consumed for adults.

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James Gallagher听 13:21听

Okay, that's a bit of a difference. So we're not talking about going from grams to milligrams, or going from grams to milligrams to micrograms

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Kit Yates听 13:28听

Exactly, a million times smaller than the figure that went viral. So if you were to try to wait long enough to eat a credit card's worth of plastic, it would take you about 23 and a half 1000 years.

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James Gallagher听 13:39听

Well, what are we roughly 40 down, another 22,960 to go

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Kit Yates听 13:44听

Exactly nearly there.

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James Gallagher听 13:49听

Okay, do we have any idea, though, from looking at the other end about how much plastic is accumulating inside the human body? Because there was another one of those slightly confusing headlines that I saw recently that the brain has a spoons worth of plastic accumulating inside it, not a teaspoon's worth, just literally, it's the spoon itself. Like it's so confusing.

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Kit Yates听 14:09听

It's very confusing but yeah, it's about seven grams of plastic that this study is suggesting is accumulating in the human brain.

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James Gallagher听 14:16听

Does that number pass the sense check?

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Kit Yates听 14:19听

It鈥檚 a little bit difficult to say, but there are reasons to be dubious about it. So the concentrations of micro plastics that they're finding are somewhere between 30 and four and a half 1000 times the concentration of those found in studies which look at the lungs or the heart or the tissues. That's not to say that that's necessarily makes it incorrect, but it should perhaps set some alarm bells ringing, but when you drill down into how the figures are calculated, there are potentially some other causes for concern. So when you're doing these studies in human tissues, you have to be really careful about how you separate out the tissue from the plastic. So usually, researchers use chemicals to digest the biological tissues, or they separate them by density and what you're. Left with you, hope is the plastic, and you can analyze that using a technique called mass spectrometry, which gives you a sort of chemical signature or fingerprint of your sample. The problem is that if your separating procedure isn't perfect, that you can get a lot of false positive stuff whose signature looks like plastic but isn't. And this is common across all of micro plastics work. But in the brain, for example, it contains lots of lipids whose mass spectrometry profile, its fingerprint looks similar to those of the plastic polyethylene. And actually, in this study, 75% of the plastics that they found in the brain were nominally polyethylene. So it suggests that these samples might not have been cleaned up properly, and what might actually be being picked up is this biological material.

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James Gallagher 15:47

It's just a fatty brain registering as plastic.

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Kit Yates 15:49

Exactly. Fatty brain equals plastic kit.

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James Gallagher听 15:51听

Thank you so much for coming on.

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Kit Yates 15:53

Thanks for having me.

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James Gallagher 15:56

Now. Earlier in the series, one of our listeners, John, asked us to investigate the state of hearing tests in the UK, and we did that. It's on 蜜芽传媒 sounds. But loads of you got in touch afterwards with more questions, so we're going to answer them with audiologist, Dr Hannah Cooper, from UCL Ear Institute, and Kevin Munro, who's a professor of audiology at the University of Manchester. Hannah, Kevin, Welcome back to Inside health.

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Hannah Cooper 16:18

Thank you.

Kevin Munro 16:19

Good to be back.

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James Gallagher 16:20

So we've got lots of questions after the last program, Hannah, can I start with you? And one from Susan, because she's curious about the difference between what she calls the NHS beige hearing aid and the ones that are widely advertised by private companies. And asks, is there any effective difference, or is it just that hearing aids cost more to be less visible.

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Hannah Cooper听 16:39听

Lots of people call it the beige banana, right? I think we have moved on from the beige banana off white. Gray is more the colour choice. I think, in terms of the hearing aids that you get from the NHS, my understanding is that they're generally a mid range private product. So they are digital hearing aids. They will have lots of digital features that will help you hear better in noisy situations, potentially so digital noise reduction, feedback cancelation, directional microphones, those kinds of things are what you're going to get from the NHS. You'll often be able to control them from an app, but yeah, independent providers will provide something maybe potentially more discreet. Might have more features on there compared to an NHS hearing aid, but definitely, you're getting a good level product from the NHS.

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James Gallagher听 17:24听

I suppose, Kevin, an NHS hearing aid doesn't really exist as it's not like the NHS is sat there mass producing hearing aids.

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Kevin Munro听 17:30听

Absolutely. So basically, all the hearing aids available in the NHS have been purchased from hearing aid manufacturers. Mine is a sort of sexy metallic grey colour, and I'm a professor of audiology, so I know a thing or two about hearing aids, and I'm perfectly happy to be using an NHS hearing aid.

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James Gallagher听 17:47听

Kevin, if you find metallic gray sexy, I'm going to keep you away from my cutlery draw. Kevin, while I'm talking to you, Barbara got in touch after hearing you on the last program. Was really curious about your Bluetooth microphone that we're using in that loud and noise Cafe we're in. I should point out at this moment that we have put a full transcript of that program up on our inside Health website, if anybody wants to follow that in more detail. But Kevin, tell us again about the Bluetooth kit that you were using.

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Kevin Munro听 18:14听

Yeah, great question because one of the main difficulties that an individual with hearing loss has is understanding speech in the presence of background noise, a fantastic way to hear better in background noise is to have a remote microphone that you can place in front of the speaker, and then the signal can be sent to your hearing aid. Almost all the big leading hearing aid manufacturers will have remote microphones. So I have a small one that's multi functional. I can clip it on my wife's lapel. So without having a meal, and it's very noisy, I can hear her without having to put in too much effort. If I'm in a meeting, I can sit on the table and it picks up speakers from around about or if I'm standing socializing with someone, I might just hold it in my hand and it will just be slightly closer to the mouth, and that will help me. The downside is you can't currently as an adult, get these via the National Health Service. So unless you have access to work or access to education scheme that will provide it, you have to go out and buy these yourself. But they're fantastic.

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James Gallagher听 19:09听

And they're compatible with your NHS hearing aid.

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Kevin Munro听 19:13听

Yes, that's right. Probably not every model of NHS hearing aid, but the one I have works with my NHS hearing aid. That's right.

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James Gallagher听 19:19听

Got a question now from Elaine, who's seen many older people whose ability to balance declines with age, and she's wondering, What's the link between loss of balance and hearing? And we actually got ear nose and throat surgeon Dr Nish Mehta to answer this when he was in the previous program, and he's answered Elaine,

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Dr Nish Mehta听 19:37听

Hearing and balance are intricately related. In fact, they are provided for by exactly the same organ, the inner ear. Your overall sense of balance is actually a very interesting special sense that receives information from your eyes, from your inner ears and from the joints in your spine, shoulders and hips. This information is then. Computed by your brain to give you an overall sense of where you are in this world and what movement you have in relation to it. When there is a condition that affects the inner ear, it not only affects hearing, but it also affects balance, and that's why people often feel that their sense of balance has got worse as their hearings got worse. As we get older, not only does the inner ear degrade, but also so does vision and our joints and our ability to compute this information, those are the key reasons why balance gets worse as we get older.

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James Gallagher听 20:33听

Hannah, can you tackle this one from Carolyn, who's curious about the loudness events, so things like sporting events and music concerts and things like that. And she's curious about the impact on children. Are we heading for future generations of people suffering with hearing loss at ever earlier ages and to greater extent?

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Hannah Cooper听 20:50听

Yeah, so I think we've been worried about this for a while, particularly with people listening to very high levels of music through headphones. And the thing about noise exposure is that it doesn't cause an instant hearing difficulty. It builds up and builds up gradually and gradually over many years, and so you don't know that you're causing damage to your hearing whilst you're doing it. So I absolutely encourage people to take breaks regularly if they're listening to Amplified music over headphones. I think Carolyn's questions about sporting events and things like that as well, if they sort of go over workplace guidance for noise exposure, then there's a possibility of you having some damage to your hearing.

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James Gallagher听 21:33听

Does it matter when you have those one off events, though, like if you go to a football match, that might be two hours of loud noise? Is that really going to do the damage in comparison to wearing your headphones and playing music every day?

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Hannah Cooper听 21:46听

I mean if you go to a lot of loud sporting events, and they're at a very loud level, then you might cumulatively get damage from doing that. But you're right. If you're listening to hours and hours of amplify music a day, and then you're going to a loud sporting event once a year, or something like that. It's unlikely that the sporting event is going to cause as much damage as the amplified headphones.

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James Gallagher听 22:06听

Kevin Keefer, an ear out for this one, because this is from Carl, and he likes going to concerts and gigs. He has his NHS supplied hearing aids. He says that they work most of the time, but what he struggles with is when he's playing his clarinet or saxophone while it's wearing them because they just give a horrible noise. Basically, he's after specialist advice for hearing aids for musicians.

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Kevin Munro听 22:26听

Well, modern hearing aids have multiple programs, so just like you can use remote control and change the television channel you're listening to, you can do the same with your hearing aid, including NHS ones, and the audiologists could set up programs that are more suitable for listening to music, and currently there's a lot of work being done with artificial intelligence, where the incoming speech signal or the music and the background noise are analysed. They're broken down. All the things that we don't want to hear are removed. The thing we want to hear is reconstituted and into someone's ear. And I know there are companies and research groups specifically working on AI for listening to music. So watch this space.

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James Gallagher听 23:04听

Hannah question from Gail. It's basically, does her ability to adapt to hearing aids decline as we age? Because her audiologist says it does, what's going on?

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Hannah Cooper听 23:13听

Yeah, so I think where we might be coming from with this is that it takes people quite a long time to seek help for their hearing. So maybe 10 years from when they first notice a problem to when they go to the GP or go to the audiologist and try to get some help for it, which is a long time, especially compared to something like vision, where you might go after a couple of years. So the thing that will happen in that 10 years is potentially that your hearing will gradually decline over the years. And so if you then get a hearing aid at that point, it might be quite a big difference between your hearing difficulty that you've been living with, but then to have the amplified sound with the hearing aid might be quite a big jump. So maybe if you get a hearing aid earlier, your hearing won't have declined so much, and therefore it won't be quite such a big change to go from your hearing with your hearing loss to your hearing with the hearing aid.

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James Gallagher 24:07

How does it take to get used to a hearing aid?

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Hannah Cooper 24:09

Oh, that's a good question as well. So I think it is a very individualized thing that so getting used to a hearing aid is very individual. It could be that you get used to it within a few hours. It might take you a few weeks or maybe even months.

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James Gallagher听 24:23听

Kevin, I've got a question here from Gail, and it really taps into this link between hearing and dementia. And she asks us, we understand social isolation as a contributing factor to brain degeneration things like dementia. Should we be making more of an effort to encourage and de stigmatize the wearing of hearing aids.

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Kevin Munro听 24:44听

We used to think hearing loss was an isolated condition, but more and more, we realize that hearing loss can co exist with a whole range of conditions. Now that's not to say that hearing loss causes dementia, but there is an association. So the chances as we get older, if you have a hearing. Course, it's slightly higher that you're going to get dementia, but as I say, we don't know that causes it. There could be some common cause. But what it does highlight for us is, and it links back to the earlier question about when should someone do something like start to where hearing is if you break a leg, you wouldn't say, I'll give it 10 or 15 years before I do something about it. And the same applies to hearing. Hearing better helps you to live better. It might help you to think better, because your brains fear to do other things instead of concentrating in background noise, to hear every single word. So if you notice the problem, the sooner you do something about it, the better.

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James Gallagher听 25:33听

A question now from Susan about air pods. So they're the bluetooth headphones you can get from Apple, because they've been in the news a lot recently, as some of the models can also function as hearing aids. Hannah, can they do the job of a hearing aid?

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Hannah Cooper听 25:48听

So this is a really recent thing. You can set up your iPhone, air pods, Pro to do a hearing test for you, and then to act as a hearing aid. So this is very recent. Just happened in the last few weeks that the UK got licensed to do this. So I think there's a few things to bear in mind. The first thing is that if you're worried about your hearing, you should definitely speak to an audiologist. However, if you think I'm not quite sure I'm having a bit of difficulty hearing I'm going to give this a go. Then I think great. Give it a try. They're not hearing aids, so you possibly won't get the added features that you might get with a hearing aid. You won't necessarily get the power that you might actually need with a hearing aid. But it might be a good starting point. So if someone is not quite ready to think about hearing aids yet, I think this might be a really good first step.

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James Gallagher听 26:41听

Difficult balancing act, do you look rude having your headphones still in because they don't look like hearing aids. They just look like headphones, but they might actually be able to make you communicate better.

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Hannah Cooper听 26:49听

So my colleague did actually look at this quite recently to see what people felt about using that kind of device in their ear while they were with friends, out socializing, things like that, and they said that they always had to explain what the device was doing in their ear, that it was trying to help them to hear. Rather than that, they were being rude and just listening to some music or listening to inside health.

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James Gallagher听 27:12听

I love that thought that everyone's out there having a wild night out with their headphones in listening to inside health.

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Kevin Munro听 27:19听

Just to finish off, the AirPod, but Hannah's right. There could be a bit of a stigma, because it looks like you listen to music and not paying attention. Also, the battery won't last all day long, like a hearing aid, but it could be a stepping stone.

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James Gallagher听 27:31听

Great questions from our audience, weren't they really great questions? They were on the ball. Yeah. Kevin Hannah, thank you very much. You're welcome, no problem. And thank you to Dr Nish Mehta as well, and to all of you who emailed in questions inside health@bbc.co.uk next week, as we get closer to Easter, we'll be asking, can you be addicted to sugar? And in the meantime, if you want to compare how other countries view different forms of assisted dying, after our discussion earlier, well, there's an interactive map produced by the Open University. Go to bbc.co.uk/insidehealth and follow the links to the Open University. See you next time you've been listening to inside health with me. James Gallagher, the producers were Hannah Robbins and Tom Bonnett. The show was a 蜜芽传媒 Wales and West production for Radio 4.