4 1GT Tuesday October 13 2020 | the times

body&soul

Dr Mark Porter

Brain tumours like Tom Parker’s

aren’t as rare as people think

health

The scientist

who says herd

immunity is

the answer

Sunetra Gupta believes new lockdowns

will be devastating. She has been

vilified as a result. By Andrew Billen

skull, and is classically severe, worse

on waking and aggravated by bending

over, coughing and physical exertion.

And unlike a hangover or migraine,

it tends to be persistent, with the

patient repeatedly coming back to

see their doctor with the same

complaint. Even then most cases will

have a less sinister cause, such as

tension or cluster headaches, and it

can be difficult to pick up brain

tumours early on.

Once the diagnosis is clinched,

treatment and outlook depend on the

individual and their tumour. Some

types are benign, slow-growing and

easy to remove, while others are

aggressive and buried deep within

the brain. Overall survival in adults

with a malignant (cancerous) type is

poor, with just one in five likely to be

alive five years after diagnosis. The

prognosis in children is better, with

a cure rate of about 75 per cent.

A glioblastoma such as Parker’s is

one of the nastier types. Despite

advances in surgery, chemotherapy

and radiotherapy, the average survival

time is 12-18 months, and only 1 in 20

people will be alive five years later.

Early diagnosis is helpful, but brain

tumours, particularly slow-growing

ones, can be hard to spot among

the millions of other less sinister

problems that GPs see (there are

300 million GP consultations

a year in England alone). Little

wonder that a third of people

with a brain tumour will have

been to see their doctor at least

five times before being

referred to a specialist

and/or for a scan.

Like any experienced

GP, I have learnt,

occasionally the hard

way, that if someone

keeps coming back with

the same complaint and

it is not responding to

treatment, it is time to

seek a second opinion.

And that brain tumours

are not that rare.

For more detailed

information on the

symptoms, diagnosis

and treatment of the

different types of brain

tumour visit

thebraintumour

charity.org.

C

ancers, particularly

high-profile types

such as breast and

prostate, are rarely

out of the headlines

as researchers and

clinicians share their

latest “game-changer”.

However, lower-profile cancers seldom

feature unless a celebrity goes public

with their diagnosis. This week it is the

singer Tom Parker from the band the

Wanted who, at 32, has been told that

he has an aggressive brain tumour.

Despite being widely considered

rare, brain tumours are responsible for

more deaths of children and younger

people than any other type of cancer.

Nearly 12,000 people in the UK will

be diagnosed with a primary brain

tumour each year, and about 4,

more will have secondaries that have

spread from cancers in other parts of

their body. Yet brain tumours account

for just 2 per cent of the UK oncology

research and development budget.

Parker’s glioblastoma — a

fast-growing type responsible for at

least one in four new diagnoses — is

reported to have been discovered

during a scan he had after having a

seizure earlier in the year. Symptoms

vary tremendously depending on the

type and site of a growth (there are

about 100 different types of brain

tumour), but include epileptic-type

seizures, headache, visual disturbance

(such as seeing double), altered

personality, loss of balance, changes

in speech, numbness or weakness

and tinnitus (noises in the ear). All

of which can be caused by myriad

other complaints.

No sensible person — patient or

doctor — would ignore a seizure,

slurred speech or a worrying change

in character (often disinhibition), but

you might not rush to your GP if

you develop tinnitus in one ear. Most

cases are nothing to do with brain

tumours, but if it is new and unilateral

it warrants referral to a specialist and

probably a scan.

Headache is the most common

presenting symptom. It is due, at

least in part, to rising pressure in the

QA

I have had an

annoying dry cough

for the past three

months. I have had

two Covid tests at

work (I work in

social care) and

they were negative.

I was diagnosed with

high blood pressure

at the beginning

of the year and

was prescribed

ramipril. Could it

be to blame?

It would be top of

my list. At least

one in ten people

prescribed an ACE

inhibitor (drugs

ending in -pril, such

as ramipril and

perindopril) for high

blood pressure and

heart problems will

develop a dry cough

and, while it often

starts within a few

months of taking the

drug, it can develop

much later too.

Put simply, ACE

inhibitors give your

cough reflex a bit of

a hair trigger, so just

breathing in and out

can be enough to

make you cough.

If I were your

GP, I would

swap you to an

alternative

treatment to

confirm what is

going on. If the

ramipril is the

cause, your

symptoms

should settle

within a

fortnight,

but in some

cases it

can take

much

longer

(up to two

to three

months).

If the

cough

doesn’t

settle, you

need further

investigation. A

new persistent

cough should

never be ignored.

If you have a

health problem,

email drmarkporter

@thetimes.co.uk

Slow-growing

brain tumours

are particularly

hard to spot

Brain tumours: the facts

6 The lifetime risk of developing

a brain tumour is about 1 in 70, and

they are becoming more common,

with a 40 per cent increase in

incidence since 1995.

6 The cause of most brain tumours

remains poorly understood, with age

being the biggest risk factor (which

partly explains the rise in incidence

as life expectancy has increased).

6 Two out of three brain tumours

occur in people over 60, but about

400 children will be diagnosed with

one this year in the UK.

6 Outcomes for children in the

best centres in the NHS are as

good as anywhere in the world —

but the survival rates for adults

lag behind America and similar

countries in Europe.

L

ast week three leading

scientists from Stanford,

Harvard and Oxford

declared that our

governments had got it all

wrong on Covid. “Those

who are not vulnerable

should immediately be

allowed to resume life as normal,” they

wrote, launching a controversial and

counterintuitive campaign with glasses

of champagne in the rooms of a free-

market think tank in Massachusetts.

Yesterday we learnt that the British

government will further curtail

normal life for huge numbers in

regions where the disease is heading

out of control. Our trio see the rising

infection rate rather differently: they

believe that Covid-19 is running its

predictable and finite course, and

were it to be left largely alone there

would soon develop an effective

degree of communal (or, trigger word,

“herd”) immunity. As it is, millions

across the world will die, victims not

of the disease, but of our response.

I am in the sitting room of the

Oxford signatory, Sunetra Gupta, a

professor of theoretical epidemiology

at the university. She is a striking,

persuasive woman who speaks

Oxford English at high-table level. I

ask how she feels about the prospect

of more restrictions.

“I feel absolutely devastated,” she

says, recalling that since she first spoke

out, in spring, it has been out of terror

of what lockdown will bring. “I was

concerned, not just for the inner-city

child sitting there out of school or

people going to die at home, give birth

on their own, worse still have

miscarriages on their own. There was

also, for me, India, which is where I

come from. Visions of horror came to

me of the people in slums. How can

you tell someone who doesn’t have a

home to stay at home?”

Her local paper, the Oxford Mail, last

month wrote an excoriating “apology”

on behalf of partying students at

Oxford Brookes University — a list of

reasons that they were “sorry”, ending:

“And if they are not sorry, they damn

well should be.” As a teacher, Gupta

hates the demonising.

“I think it’s absolutely shameful,” she

says. “I think students don’t need to

wear a facemask. There’s no risk to

Students don’t

need to wear a

facemask. There’s

no risk to them

them. Furthermore, as we’ve said and

stressed, the whole foundation of our

argument is that if these students

acquire immunity then we’ll be much

further along in protecting those who

are vulnerable.”

And those freshers, noses pressed to

the windows of flats as they await their

cold rations? “It’s criminal,” Gupta

says. “I find it absolutely staggering

that we could do that. I think students

should be able to come back.”

The main risk would be to teachers

such as herself, and it is a risk she

would willingly accept. “We must stop

assigning blame and guilt to young

people: ‘You are going to cause

Granny to die.’ Grannies and grandpas

and other people die of flu every year

in large numbers, and somebody is

giving it to them, but as a society we

absorb the blame.”

She does not choose to blame the

government for the original lockdown,

even if it was counterproductive.

The scientists at Imperial College

London who modelled that 500,

people might have died without it

could have been right. “What I think

we need to stop now is instituting

these new measures, which are really

going to cause absolute havoc.

“The good news is that actually

there is a way out that would also save

us from corona deaths, we think, and

that’s why we wrote that declaration.

The people who were involved arrived

at this conclusion completely

independently. We didn’t sit down and

discuss it. We found each other

through what we published or through

our voices on the internet or the

public domain, and decided to come

together because we felt there is a way

out. That way out is afforded by

natural immunity.”

Natural immunity is not a strategy

in opposition to a vaccine, which is

merely “a way of achieving immunity

without the costs”. Gupta is working