As Call the Midwife tackles the issue, BBC Action Line users say there is no advice on abortion.

Some early studies in mice suggest drugs can be developed to halt mental decline, say scientists.

Every year, Americans spend $22bn on chocolate, and it’s a safe bet that Valentine’s Day accounts for a decent percentage of that total.

While a heart-shaped box of chocolates may seem like the opposite of healthy, experts say it’s less about the occasional small indulgence and more about making good everyday food choices.

Most chocolate falls into one of three categories: milk chocolate, dark chocolate or white chocolate. Chocolate’s darkness is determined by the proportion of cocoa solids made from cocoa beans, mixed with cocoa butter and sugar.

Milk chocolate, the most popular type in America, typically contains about 10% cocoa liquor – the paste made from ground, roasted, shelled and fermented cocoa beans that contains both nonfat cocoa solids and cocoa butter – compared with a minimum of 35% found in dark chocolate. Shoppers can tell how much cocoa liquor is in a dark chocolate bar by looking for the “percent cacao” figure on the label. Cacao is the raw form of chocolate, while cocoa is the heated version of cacao.

White chocolate, however, contains only cocoa butter – no cocoa solids – combined with sugar and other ingredients. (And for many people, it’s not really considered a chocolate at all.)

A standard bar of dark chocolate with 70% to 85% cacao contains about 600 calories and 24g of sugar, according to the US Department of Agriculture’s nutrient database. Milk chocolate contains roughly the same number of calories but twice the sugar.

Can be part of your diet

The amount of cocoa solids in dark chocolate is important because it can be an indicator of the amount of dietary flavonoids, which are antioxidants found in fruits, vegetables and certain drinks. Research suggests consuming more dietary flavonoids is linked to a lower risk of coronary heart disease.

Most dark chocolate is high in flavonoids, particularly a subtype called flavanols that is associated with a lower risk of heart disease. Some studies suggest chocolate or cocoa consumption is associated with a lower risk of insulin resistance and high blood pressure in adults.

“While dark chocolate has more flavanols than other types of chocolate, the data to suggest there is enough to have a health effect is thin at this point,” said Alice H. Lichtenstein, the Gershoff professor of nutrition science and policy at Tufts University in Boston.

In a 2017 study that closely controlled what people ate, researchers found that eating raw almonds, dark chocolate and cocoa helped lower “bad” LDL cholesterol in people who are overweight or obese. But when investigators took the almonds away, dark chocolate and cocoa alone didn’t appear to aid heart health.

A potential explanation, researchers said, is that the flavanol dose was about half that used in earlier studies that found a beneficial effect on blood pressure 274mg of flavanols compared to 586.

But that amount of flavanols “is unlikely achievable with daily consumption of commercially available dark chocolate,” Lichtenstein said.

Researchers at Brigham and Women’s Hospital in Boston are currently studying whether a 600mg daily supplement of cocoa flavanols can reduce the risk of heart disease, stroke and cancer.

In the meantime, chocolate can still be part of an overall healthy diet.

“If you enjoy chocolate,” Lichtenstein said, “the important thing to do is choose the type you enjoy the most and eat it in moderation because you like it, not because you think it is good for you.”

Nearly 330,000 patients waited longer than four hours in A&E as hospitals struggled with a shortage of beds.

One hails from Mumbai and the other from Khayelitsha but the pair has teamed up after surviving the planet’s deadliest infectious disease: tuberculosis (TB). Toxic treatment robbed both women of their hearing and a newer, safer, drug is priced out of reach for most. Opposing the medicine’s latest patent application, they said, could mean patients no longer have to choose “deaf or dead”. 

Despite the many health crises plaguing the country, South Africa is probably the best place to live if diagnosed with drug-resistant TB (DR-TB). The reason? Nowhere else can one receive the life-saving drug bedaquiline, which comes with a hefty price-tag, provided by the government for free.

Ramifications beyond borders

Why then would South African activist and TB-survivor Phumeza Tisile be involved in the current challenge to a secondary patent application for this drug all the way in India?

Known informally as the “pharmacy of the world” India’s decision on whether or not to grant the discoverer of bedaquiline, pharmaceutical giant Johnson & Johnson (J&J), the additional patent will have ramifications beyond its own borders and will influence the entry of generic competitors to the market.

For Tisile, the success of bedaquiline in South Africa should be celebrated, but it is unacceptable that access to the drug remains almost non-existent beyond our borders.

After surviving the most deadly form of the disease, and losing her ability to hear as a result, Tisile said she will continue fight for “patients over patents” – no-matter the geographic location.

No-one deserves to be given the option presented to her; “go deaf or die”, she told Health-e News after launching the patent opposition earlier this month.

“In 2010 – I wasn’t given a choice. It was either I die or go deaf,” she said.

A little-known but devastating side-effect of standard medicines to treat DR-TB is hearing loss. One in three patients suffer partial to complete deafness from this treatment and only half of those who manage to complete the two-year-long course of toxic drugs can expect to be cured.

After years of illness, Tisile was lucky to be declared DR-TB-free but from 2010 to 2015 she could not hear and struggled with the social pressures of being deaf in her early 20s.

Access impossible

“I lost out on five years of my life. I lost out on school and only seven years later I was able to start afresh at university,” said Tisile whose hearing has returned after sourcing funds for cochlear implant surgery.

“There’s a drug that could prevent all of this but, for some reason, they’ve made accessing it impossible for those who need it most,” she said.

The drug in question, called bedaquiline, is the first anti-TB drug developed in almost half a century but costs up to $30 000 (about R410 000) for a six-month course of treatment in some countries.

The importance of this drug cannot be overstated. It not only replaces the deafness-causing injectable drugs in the DR-TB regimen but it also saves lives; cure-rates for patients taking bedaquiline have been reported at over 80%.

Last week Tisile and another TB-survivor from Mumbai, Nandita Venkatesan, filed a patent challenge in India to prevent J&J from extending its exclusive monopoly on the life-saving medicine.

J&J’s current patent expires in 2023, but if this application is successful their monopoly on bedaquiline, which prevents generic competitors from entering the market, will be extended until 2027.

“The Patents Act, 1970 in India allows ‘any person’ to challenge an application for patent. Hence, a TB-activist like Phumeza who is not a national of India could file an opposition,” said Priyam Lizmary from the Indian organisation, Lawyers Collective, which is spearheading the challenge.

A matter of policy

“Indian and South African civil society have linkages more than two decades old when they fought together for access to HIV medicines at the height of the Aids epidemic. This collaboration bolsters that continued mutual support,” she told Health-e News.

Last year South Africa became the first country in the world to offer bedaquilline to all DR-TB patients as a matter of policy, and has been praised for this move which even preceded the World Health Organisation recommendation to the same effect.

A small number of countries, including South Africa, have negotiated a greatly reduced price of $400 (R5 500) from J&J but activists have said this remains out of reach for most low and middle-income countries. To date, only 25 000 people around the world have received bedaquiline and two thirds of these patients have been in South Africa.

Doctors Without Borders (MSF) has condemned J&J’s request to extend its patent in India and noted the application, for the salt form of bedaquiline, does not deserve further intellectual property protection because it does not meet the standards for novelty and inventiveness.

According to MSF this “strategy of “patent evergreening” through filing of additional, often unmerited patents, is commonly used by corporations to extend monopolies on their drugs beyond the standard of 20 years”.

“Preventing this patent barrier [in India] is expected to encourage TB drug manufacturers from India to enter the market with generics and supply bedaquiline at lower prices to national TB programmes and TB care providers globally,” it said in a statement released in support of the two women activists.

J&J has defended its patent application and prices for bedaquiline arguing that they are necessary to recoup the investment they made in developing the drug and bringing it to market.

“Ongoing suggestions that we generate a profit from the sale of bedaquiline are incorrect and have the potential to only further damage an already fragile environment for TB research and development,” said J&J in a statement in reaction to an MSF-lead protest against the price of the drug late last year.

Refusal to provide information

Activists have told Health-e News that this is tantamount to a threat and is particularly concerning because investment in TB research and development is pitiful. This is despite the fact that the disease kills more people around the world every year than any other infectious agent.

“Most of the large pharmaceutical companies have stopped researching new TB medicines. Of total global investment in TB research and development in 2017, only 11% was from the private sector,” said Marcus Low, editor of the health publication Spotlight.

While J&J has repeatedly refused to provide information about the detailed costs of developing bedaquiline, research from the University of Liverpool estimated the drug could be produced and sold at a profit at a dramatically reduced cost of between $50 and $100 (R700 and R1 400) per course.

The issue is made even more complex as the development of bedaquiline is not J&J’s success alone and multiple other organisations and governments made substantial financial investments especially in relation to clinical trials.

While the outcome of this patent challenge in India won’t directly affect South Africa, indirectly the impact for many countries is significant. 

“Since generic competition in India will likely lead to dramatically lower prices and, even if we can’t access those prices, it could create some downward pressure by illustrating how cheap the drug really should be,” explained Low.

After nine years of development, the Department of Trade and Industry’s Intellectual Property Policy – which makes provisions for public health needs – was approved by Cabinet last year.

Yet, there has been very little action since then regarding the necessary legislative amendments needed to implement the policy.

Intellectual property reform

The very patent Tisile is opposing in India has already been granted in South Africa.

Currently, patents are granted “far too easily” in South Africa as applications aren’t rigorously assessed. The country also lacks a mechanism like the one currently being used by Tisile in India to oppose a patent before it has been granted.

“Instead challenging a patent in South Africa typically requires expensive court proceedings – thus making it much harder for the public or other third parties to challenge poor quality patents,” said Low.

He urged the government to prioritise intellectual property reform, not only for access to TB treatment but for many other diseases including cancer and diabetes that require treatment with costly, yet life-saving, medicines.

Said Low: “Too many people are still dying, suffering, or going bankrupt unnecessarily because the medicines they need are excessively priced – and needlessly so.”

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Amy Green

Certain bacteria dwelling in the human gut might feed depression, according to a new study that adds evidence to the theory.

Researchers found that among over 2 100 adults, those with depression showed differences in specific groups of gut bacteria. And people with higher concentrations of certain other gut bugs generally reported better mental well-being.

Some gut bacteria ‘consistently depleted’

The research, published online in Nature Microbiology, is the latest to uncover links between human health and the gut microbiome. The term refers to the trillions of bacteria and other microorganisms that live in the intestines.

Those microbes are believed to do much more than aid in digestion. Research suggests they are involved in everything from immune system defences to producing vitamins, anti-inflammatory compounds and even chemicals that influence the brain.

But most research on such “gut-brain” communication has been done in animals, said Jeroen Raes, the senior researcher on the new study.

So his team looked for links between gut microbes and depression among over 2 100 adults taking part in two health studies. The investigators found that levels of two specific groups of gut bacteria – Coprococcus and Dialister – were “consistently depleted” in people with depression.

Meanwhile, people with higher levels of Coprococcus, and another group of bacteria called Faecalibacterium, typically gave better ratings to their quality of life.

Both types of bacteria break down dietary fibre to produce an anti-inflammatory compound called butyrate.

None of that proves those bacteria somehow contribute to – or protect from – depression, according to Raes, a professor at KU Leuven-University of Leuven, in Belgium.

But, he said, further studies should zero in on the bugs.

Gut and mental well-being

“After all the mouse studies,” Raes said, “we now finally have robust human data that points to interesting target organisms that, in the future, may lead to drugs and novel probiotics.”

Dr Emeran Mayer is a professor at the University of California, Los Angeles School of Medicine and author of the book The Mind-Gut Connection.

Mayer said the new findings add to evidence of an association between the gut and mental well-being.

But like Raes, he said they do not prove any particular microbes cause depression.

“It’s the chicken-and-egg question,” Mayer said. “People with depression certainly have different diets, and different habits, than people without depression. And that would affect the gut microbiome.”

Mayer suspects there may be a “circular process”, where depressed people can have changes in the composition of their gut microbes – and that, in turn, “reinforces” the depression symptoms.

Raes said further research is needed to see whether there is such a “vicious cycle”. For now, he said, “We can’t say that.”

No quick fix

Studies in recent years, largely in animals, have been uncovering links between the composition of the gut microbiome and the risks of various health conditions – from other brain-related disorders, like dementia, to obesity, to autoimmune diseases such as type 1 diabetes and rheumatoid arthritis.

But the degree to which gut bacteria contribute to any human diseases remains unclear.

And even if the gut microbiome does influence depression symptoms, Mayer doubted that anything as simple as a probiotic supplement would offer a quick fix. Both the microbiome and depression are too complex.

However, he said, gut bacteria churn out metabolic byproducts – or “postbiotics”. And research into those compounds should give insight into how the microbiome may benefit or feed human ills.

Mayer said he believes that any effective therapy aimed at the gut would have to affect its microbe balance “globally” – as opposed to simply adding a bacterial strain or two.

Diet changes can do that, he pointed out.

Diversity matters

In this study, there were hints that butyrate-producing bacteria were beneficial. And, Mayer said, those bacteria make butyrate when they break down various fibres from plant foods.

“I’d say eat a diet that’s largely plant-based and highly variable in the types of plant foods,” Mayer said. “If you’re just eating tomatoes, that’s not enough.”

That’s not just for the sake of producing butyrate, either. Based on what’s known so far, Mayer said, it’s the diversity of our gut bacteria that matters: The more diverse our microbes, the better.

And a diet low in processed foods and rich in plant foods – vegetables, fruits, legumes, nuts and grains – supports a more diverse gut microbiome, Mayer said.

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Going for a free health check could flag up early signs of cardiovascular disease, health bodies say.

NHS bosses say it means patients are being seen “more quickly” and US medics gain wider experience.

Simon Fraser University and Swiss researchers are developing an eco-friendly, 3D printable solution for producing wireless Internet-of-Things (IoT) sensors that can be used and disposed of without contaminating the environment. Their research has been published as the cover story in the February issue of the journal Advanced Electronic Materials.

At the southern tip of the Himalayas, farmers in the Kangra region of India’s Himachal Pradesh graze cattle among rolling hills and forests. The forests, under management by the state or farmer cooperatives, are thriving. But a new University of Illinois study shows, unlike state-managed forests, farmer cooperatives directly benefit both forest health and farmers.