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Obituary: Vincent Marks

Sep 10, 2025Jul 18, 2025 kaitiscotlandLeave a comment

Adapted from BMJ 9-16 Dec 2023

Vincent Marks was a pioneering researcher into insulin and hypoglycaemia who became an important expert witness in cases against nurse Beverly Allitt, who was convicted of several child murders, and Claus Von Bulow, who was acquitted of the attempted murder of his wife.

Vincent Marks was born in 1930 and died of metastatic thyroid cancer in 2023.

The Von Bulow case centred around the cause of the coma suffered by his wife, Sunny. She spent 27 years in a coma prior to her death. It was alleged that her husband had injected her with insulin. She had considerable wealth compared to him. The “sleeping beauty murder” was the first major trial to be televised. Events were described in the book, Reversal of Fortune, and a film starring Jeremy Irons and Glen Close followed. Jeremy received an Oscar for his performance.

Vincent was a professor of clinical biochemistry and head of clinical biochemistry and metabolic medicine in Royal Surrey County Hospital in Guildford. His laboratory was the first to offer insulin assays to NHS hospitals throughout the UK.

A sample from Nottingham revealed that children had low blood sugar and high insulin levels and this revealed the deliberate harm done to children by nurse Beverly Allitt.

Vincent was the first to develop a method to accurately measure blood sugar at low concentrations. Up until then some patients had been given erroneous diagnoses of neurological disorders when they really had hypoglycaemia.

In 1995 Vincent retired from clinical medicine in order to devote his time to teaching medical students and post-graduates. He published widely including Insulin Murders, which spanned 50 years of legal cases.

Vincent was born in a London pub which was owned by his father. He had an elder brother John, who also became a doctor. During the war, he was evacuated to a farm in Devon. Although brought up in Judaism, he became a Humanist.

His wife Averil and he were married for 66 years, had two children, six grandchildren and four great grandchildren.

Education is a major factor in determining future health

Sep 4, 2025Jul 17, 2025 kaitiscotlandLeave a comment

Adapted from BMJ 3 Feb 2024

A study in Lancet Public Health has found that every year spent in a classroom improves life expectancy, while not attending is as deadly as smoking or heavy drinking.

Researchers from Norway and the USA examined data from 59 countries including Brazil, China, the UK, and the USA. They found that all cause adult mortality fee by 2% for every year in full time education.

Compared to no formal education, if you reached college or university level education, your total mortality fell by 34%. But not attending school was equivalent to smoking 10 cigarettes a day or drinking 5 or more alcoholic drinks a day for ten years. The effects were similar in rich and poor countries regardless of sex, social class or demography.

Money is part of this effect. Education leads to higher lifetime earnings and that in turn improves housing and diet. It also helps you access and understand information that can guide you to make better life choices.

For women, higher educational levels reduce maternal and child deaths, better child health and lower fertility rates. Educated women tend to use contraception, marry later, have fewer children and be better informed about their children’s needs.

AI history taking is as good as a real doctor

Aug 29, 2025Jul 16, 2025 kaitiscotlandLeave a comment

Adapted from BMJ 3 Feb 2024

Most doctors agree that taking a medical history from a patient not only improves rapport but is essential to accurate diagnosis.

History taking is a skill that takes time and practice. Part of this is knowing when to delve more deeply and when you can take things at face value or leave parts out. Now, AI assistants have been trained to do it too.

A randomised, controlled, double blind trial was done with actors, simulating the patients, the Articulate Medical Intelligence Explorer, and primary care physicians. To keep everyone blinded as to who was “the doctor”, text chat was used instead of face to face interviewing.

The AI machine was as good as the doctors.

My comment: I could see this being very useful in clinical practice as a way of reducing consultation times and prioritising urgency of appointments.

Testosterone replacement didn’t seem to reduce diabetes onset.

Aug 23, 2025Jul 13, 2025 kaitiscotlandLeave a comment

*Photo by SHVETS production on Pexels.com*

Adapted from BMJ 17 Feb 2024

Around a third of US adults have impaired glucose tolerance also known as pre-diabetes. Many of the men also have low testosterone levels. This is known to cause fat accumulation, insulin resistance and type two diabetes.

Testosterone therapy is known to improve muscle mass, reduce fat mass, and improve insulin sensitivity. One would imagine that giving men who have low testosterone and pre-diabetes, hormone replacement therapy, would reduce the onset of type two diabetes.

For unknown reasons, doing this didn’t work.

In men over the age of 45 with low testosterone and pre-diabetes, testosterone gel was no more effective than placebo in reducing the onset of type two diabetes after two years. (13.5% in the active group and 15.7% in the placebo group.) Glycaemic control also failed to improve.

The trial also found out that testosterone replacement therapy also didn’t reduce fractures in hypogonadal men, even though skeletal mass is known to improve with testosterone.

My comment: I’m sure the researchers were disappointed to see this result. My practice was to treat these men with TRT and I am baffled as to these results, as treatment is usually very well tolerated.

Weight training, walking and yoga are particularly good for improving depression

Aug 17, 2025Jul 11, 2025 kaitiscotlandLeave a comment

Adapted from BMJ 17 Feb 2024 Effect of exercise for depression Noetel M. Sanders et al.

We all know that exercise is beneficial in many ways. Researchers were specifically interested in what types, durations and intensity were helpful in treating major depressive disorder.

Sanders and Gallardo-Gomez performed a systematic review and network meta-analysis. The methods allowed such moderators such as intensity, dose, age, and sex to be assessed. 218 studies covering over 14 thousand people were studied.

Compared to active controls, moderate reductions in depression were found for walking or jogging, yoga, strength training, mixed aerobic exercise, and tai chi or qigong. Effects were proportional to the intensity of the exercise. Strength training, walking and yoga appeared to be the most liked and adhered to forms of exercise.

The effects seemed proportional to the intensity of the exercise, were higher when people exercised in groups. The effects were as good as psychotherapy or using drugs.

Fatty liver increases all cause mortality in type two diabetics

Aug 11, 2025Jul 8, 2025 kaitiscotland1 Comment

Adapted from BMJ 17 Feb 2024

A Korean study of more than 7 million people determined at baseline if they had type two diabetes or not, and whether they had a normal liver, a mild fatty liver or severe fatty liver. They then followed them up for over 20 years to see what effects were seen on all cause mortality, or cardiovascular disease (myocardial infarction or ischaemic stroke).

In the non diabetic population 21.2% had mild fatty liver and 10.2% had severe fatty liver. In the type two diabetes population, 34% had mild fatty liver disease and 26.73% had severe fatty liver disease.

They found that even mild fatty liver disease increased cardiovascular mortality and all cause mortality in type two diabetics. As the degree of fatty liver increased, so did the rates of death for all cause and cardiovascular disease.

6.5% of the studied Korean population had type two diabetes. Weight loss through lifestyle modifications (diet and exercise) remains the cornerstone of management of type two diabetes, fatty liver and cardiovascular disease, but is difficult to achieve and even harder to maintain.

Newer weight loss drugs have shown promise in treating type two diabetes and in reducing fatty liver, but are expensive and may need to be continued for many years.

How clean is your coffee maker?

Aug 5, 2025Jul 7, 2025 kaitiscotlandLeave a comment

*Photo by RDNE Stock project on Pexels.com*

Adapted from BMJ 10 Feb 2024

Alexei A Birkun, associate professor, Simferopol wrote a letter into BMJ:

Walker and colleagues explore whether coffee makers are a source of nosocomial pathogens (Champagne Problems Christmas 2023).

The researchers took swabs from the drip tray outlets, buttons, water tank handle, and inside the water tank of coffee makers. But what about the less accessible interior parts?

A couple of days before reading the article, I cleaned the infuser of our home coffee maker. To my surprise, a round shaped fungal colony was sitting on coffee residues left on the infuser.

While hospital fungal pathogens might invade the interior of coffee makers is unclear, but internal components are probably less commonly cleaned and could be a favourable humid environment for fungi.

Previous research has shown that coffee can be a good medium for fungal growth, and toxigenic fungal genera are well known coffee contaminants.

Fungal species living in the interior of coffee makers should not be overlooked in future research.

My comment: Anyone for tea?

Cannabis greatly increases cardiac risks

Jul 30, 2025Jul 31, 2025 kaitiscotland3 Comments

Adapted from BMJ 31 May 2025

An analysis of the medical records of 5 million adults under the age of 50 in the USA found that myocardial infarction was six times more frequent in cannabis users compared to non-users.

Ischaemic stroke was also four times more frequent.

Cannabis is also the most used illicit substance used in pregnancy. Eight new studies found that cannabis use doubled the risk of a baby being born with low birthweight.

Preterm birth and being small for gestational age was also raised.

Muscle loss as we age could be inevitable

Jul 24, 2025Jul 5, 2025 kaitiscotland2 Comments

*Photo by Andrea Piacquadio on Pexels.com*

Adapted from BMJ 17-24 May2025

As people age they tend to lose lean muscle mass. My comment: I, as well as many of us, regularly weight train, in the hope of preventing age related muscle loss, also known as sarcopenia.

A multi-national trial of two thousand adults gave disappointing results.

The group of physically active older adults was randomised to: daily supplemental vitamin D, omega 3 fatty acid supplements, and a home exercise programme undertaken three times a week, either alone or in combination.

After three years intervention, NONE of these interventions improved muscle mass or influenced the incidence of sarcopenia, as measured by dual energy X ray absorptiometry.

As exercise and vitamin D supplements have been shown to improve other important health parameters, I will continue to exercise daily.

J Am Geriatr Soc doi:10.1111/jgs.19266

Some benefits persist even if you do regain weight after a diet

Jul 18, 2025Jul 4, 2025 kaitiscotlandLeave a comment

*Photo by Jill Wellington on Pexels.com*

Adapted from BMJ 2 March 2024

One in four UK adults has obesity and one in three is overweight. These factors increase the rate of diabetes and cardiovascular disease. Although many people lose weight after starting various types of dietary intervention, they are often dismayed that weight is usually regained.

A systematic review and meta-analysis of 249 weight management programmes for adults worldwide was conducted. Intense weight management programmes were compared to less intense or no intervention at all. Intensive programmes included diet and exercise but not medications or surgery.

All trials ran for at least a year after the interventions were completed and some as far as four years afterwards. The average follow up period was 28 months.

Those who had little or no support had lost 2.1kg and those who had had intensive support lost 4.9kg. Those who lost the most weight gained it back the most quickly.

The researchers found that five years after the end of a weight management programme, people who had been offered support still weighed less than those who got little or no support. They also had lower blood pressure, cholesterol, and blood sugar levels despite the weight regain.