Why am I the short fat one?

By Dr Alexander van Tulleken Presenter, The Secret Life of Twins

Twin brothers, but not quite identical

My identical twin brother Chris is 2cm taller than me.

Barely noticeable you would think. I can see what it is like to be him by standing on tip-toes just a little and frankly the world does not look much different from up there.

Nonetheless it bothers me: I could have been that tall. I have exactly the same genes as my brother.

Genes that, in the right environment, could have made me a full 185cm tall as opposed to my current 183cm.

Something, somewhere went wrong and I got stunted. Not by much but it is a reminder of what could have been.

And that is the real problem.

It is not the height, not that trousers fit him a little better or that he does not need to reach as far to change a light bulb.

It is that I wonder how many other things I am missing out on.

Ten points of IQ here, some grey hair there. Perhaps I will need glasses at age 35 instead of 40.

Identical twins Chris and Alexander took part in a pain tolerance experiment

Most people do not have any way of knowing whether or not they are getting the most out of their genes but if you have a twin sibling then you have an exact comparison.

So how did these differences arise?

The differences between identical twins - people who should be exactly the same - are becoming increasingly useful to medical researchers interested in everything from mental illness to our ability to do maths.

Long term changes

Most people are used to thinking of our DNA as a fairly fixed code, a bit like a blueprint for a building.

We know that some things can change the code itself - exposure to radiation can cause mutations that lead to an increased risk of cancer for example - but usually the code remains the same.

Finnish twins Miia (left) and Noora (right) are 24-years-old Noora weighs 17kg more than Miia due to their different lifestyles But Miia is also likely to put on weight if she becomes less physically active

However, production of the molecules for which our genes are responsible - things like digestive enzymes and muscle protein - is constantly getting switched on and off.

And it seems that some environmental influences can have much more lasting effects - permanently activating or inactivating certain genes.

It is becoming apparent that this aspect of genetic control - a process dubbed epigenetics - is very important in human health.

In 1944 there was a severe famine in Holland. The children born during this period are more susceptible to diabetes, obesity and heart disease compared to siblings who were older during the famine.

It seems that the period of starvation prompted their bodies to switch certain genes on or off to cope with the lack of food.

These changes may, in subsequent times of plenty, have made them gain weight and get diabetes.

This change in the particular genes we express is controlled chiefly through a process called "methylation" in which chemical groups are attached to the DNA molecule to tell the body whether or not to use the "methylated" genes.

It is one of the ways in which our bodies' attempt to adapt to changing environments.

Twins play a key role in discovering more.

In the summer of 2009 Chris and I joined the twin research study at St Thomas's Hospital where we were investigated in great detail.

They measured our height, weight, bone density, grip strength even ability to hear if a nursery rhyme is in tune.

All these are traits that are to some extent genetic.

Other differences

It turned out that we are different in more ways than height.

For a start I was 15kg heavier than my brother.

What about my missing 20mm of height? It is probably an epigenetic effect caused by some long forgotten environmental difference when we were little

Of the thousands of twins enrolled in the research program only 10 were more different in weight than us.

Professor Tim Spector who leads the research unit was frank: "You're (he meant me) a disgrace."

My excess weight, unlike my brother's excess height, is easily explained.

I have been living in America and eating too much. So far no surprises.

But environmental exposure to a lot of cheap, high-fat food in America may have caused more than temporary weight gain.

It may have permanently altered the way my genes are expressed.

Scientists are only just beginning to understand these processes but it is possible that I may have permanently altered my metabolism to accommodate those extra pounds: the health effects could last a long time.

Key role in disease

Epigenetics seems to play a role in a large number of diseases.

Twins studies show us that some cancers are not caused by DNA mutations but by epigenetic changes, which potentially offers new targets for drugs.

Similarly with heart disease or diabetes we might one day be considering therapies that change our epigenetics.

This is a long way off but twin studies are beginning to shed new light on how our bodies react to the environment.

What about my missing 20mm of height? It is probably an epigenetic effect caused by some long forgotten environmental difference when we were little.

I will never get it back but if it is of use to medical science I can live without it.

The Secret Life of Twins is on BBC One on Wednesday 30 September at 2100 BST.

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Court order served over Twitter

Mr Blaney believes it is the first time a order has been served via Twitter

The High Court has given permission for an injunction to be served via social-networking site Twitter.

The order is to be served against an unknown Twitter user who anonymously posts to the site using the same name as a right-wing political blogger.

The order demands the anonymous Twitter user reveal their identity and stop posing as Donal Blaney, who blogs at a site called Blaney's Blarney.

The order says the Twitter user is breaching the copyright of Mr Blaney.

He told BBC News that the content being posted to Twitter in his name was "mildly objectionable".

Mr Blaney turned to Twitter to serve the injunction rather than go through the potentially lengthy process of contacting Twitter headquarters in California and asking it to deal with the matter.

UK law states that an injunction does not have to be served in person and can be delivered by several different means including fax or e-mail.

Danvers Baillieu, a solicitor specialising in technology, said it was possible for anyone to approach the court about any method of serving an injunction if the traditional methods are unavailable.

"The rules already allow for electronic service of some documents, so that they can be sent by e-mail, and it should also be possible to use social networks," he said.

Mr Blaney decided to use Twitter after a recent case in Australia where Facebook was used to serve a court order.

The blogger, who is also a lawyer and owns the firm serving the order, said that he thought that it was the first time Twitter had been used to deliver a court order.

The injunction - known as the Blaney's Blarney Order - is due to be served at 1930 BST and will include a link to the text of the full court order.

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Social isolation 'worsens cancer'

Stressed mice grew larger tumours

Social isolation may make cancer more deadly, US research on mice suggests.

Researchers found the social environment can modify the biology of the disease - and lead to significant differences in outcome.

Female mice stressed because they were separated from their mothers developed more and larger mammary gland tumours than more contented animals.

The University of Chicago study appears in the journal Cancer Prevention Research.

It is now widely recognised that stress plays a part in illness, but no-one really knows how much Oliver Childs Cancer Research UK

Previous research has suggested that social support can improve health outcomes for patients with breast cancer, while social isolation has been linked to an increased risk of death from several chronic diseases.

The Chicago team worked with mice genetically predisposed to mammary gland cancer.

They found changes in the activity of genes that play a role in tumour growth in the stressed animals, suggesting that they may have been directly influenced by surging levels of stress hormones.

The researchers said more work was needed to pin down exactly which cell types are affected.

New treatments

But researcher Dr Suzanne Conzen said the study raised hopes of new ways to block cancer growth.

She said: "Given the increased knowledge of the human genome we can begin to objectively identify and dissect the specific alterations that take place in cancer-prone tissues of individuals in at-risk environments and that will help us to better understand and implement cancer prevention strategies."

Dr Caryn Lerman, editor of the journal, said: "This study uses an elegant preclinical model and shows that social isolation alters expression of genes important in mammary gland tumour growth."

Professor Thea Tlsty, of University of California San Francisco, said it had long been known that psychological factors could influence disease, but not how.

She said the study added to growing evidence that chemicals circulating in the blood - such as stress hormones - could influence the development of cancer by turning genes on and off within cells with the potential to turn malignant.

Previous work has also suggested that depression can have a negative effect on cancer prognosis.

Oliver Childs, of the charity Cancer Research UK, warned against drawing any firm conclusions.

He said: "These experiments were carried out in mice, so certainly do not prove that the stress caused by social isolation causes cancer to get worse in humans.

"It is now widely recognised that stress plays a part in illness, but no-one really knows how much and there is no good evidence from controlled studies that stress contributes to cancer progression."

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C. diff rise due to 'gene switch'

Most deaths from C. difficile occur in the over 65s

The rise in Clostridium difficile infections in recent years is due to genetic changes rather than dirty hospitals, say UK researchers.

Comparison of an historic strain and a strain from the outbreak at Stoke Mandeville hospital in 2003 found it had evolved to be more virulent.

It can spread more easily and cause more severe symptoms, the team reports in Genome Biology journal.

NHS trusts have a target to cut C. difficile infections by 30% by 2010/11.

The bacteria is present in the gut of as many as 3% of healthy adults and 66% of infants.

It rarely causes problems in healthy people but can lead to illness when the normal balance of bacteria in the gut is disrupted, for example with use of certain antibiotics, and it is the leading cause of hospital-acquired diarrhoea.

The deep clean programme was never going to work against this organism in the long term Professor Brendan Wren

In the past five years, a new group of highly virulent C. difficile strains has emerged - PCR-ribotype 027 - which cause more severe diarrhoea and a higher rate of deaths.

Analysis of the full genome of the "hypervirulent" strains and an older strain showed the bacteria has acquired genes which enable it to survive better in the environment, spread more easily and make patients more severely ill.

In all, five different genetic regions appear to have accumulated in the bacteria in past couple of decades, the team reported in Genome Biology.

Fighting back

The number of cases of C. difficile has risen dramatically since the 1990s, although latest figures show cases are now consistently falling.

Stoke Mandeville Hospital saw two major outbreaks of C. difficile between 2003 and 2006 that caused 35 deaths.

Study leader Professor Brendan Wren, from the London School of Hygiene and Tropical Medicine, said the study would help scientists understand how C. difficile became so aggressive.

"These strains came from nowhere and the sudden rise in C. difficile was due to their spread.

"The bugs are fighting back and the one clear thing that comes out of this study is it is not down to cleaning but that the strain has evolved with new chunks of DNA.

"The deep clean programme was never going to work against this organism in the long term."

Hygiene measures are still needed to keep the infection under control, he added.

A spokeswoman for the Health Protection Agency said it closely monitored the evolution of C. difficile strains.

"All strains of C. difficile require intervention and control - the intervention involved when dealing with the 027 strain is no different than how any other strain is treated.

"All C. difficile requires treatment and vigilant infection control procedures in order to reduce rates of infection."

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California mulls legalising marijuana

Emilio San Pedro BBC News

The Bulldog Cafe is allowed to sell marijuana for medicinal purposes

In 1996, voters in California approved a referendum that made it legal for the first time in decades in the US for people to consume cannabis for medicinal purposes.

More than a dozen states have followed suit since and several others - the most recent of which is Massachusetts - have approved laws decriminalising the possession of small amounts of the drug.

Now, there are moves afoot in California to go further to fully legalise marijuana.

Evidence of the impact that the approval of medicinal marijuana has had on some areas of California is clear in Oakland.

Across the bay from San Francisco, it has come to be known as Oaksterdam, in a nod to the symbolic global capital of marijuana deregulation, Amsterdam.

The relaxed approach to marijuana use in this part of Oakland has led to the opening of several marijuana dispensaries.

They are establishments in this once deprived area of town which sell a broad array of cannabis related products, from food products such as brownies and cereal bars laced with cannabis to traditional marijuana for smoking.

Oaksterdam University

"This is where it all started," says Richard Lee, a leading advocate for the legalisation of cannabis, pointing to a building where the first ever dispensary was opened in 1996.

His sense of excitement is palpable as he shows me around Oaksterdam, which beyond dispensaries is also home to a facility where state residents can go through the process of getting the ID needed for their right to use cannabis for medical purposes.

Richard Lee runs Oaksterdam University which opened in 2007

The area is also home to the Oaksterdam University, which Mr Lee runs.

He shows me around the student union of the university, which he describes as a trade school for all of those interested in finding a place in the thriving cannabis trade that medicinal marijuana has spawned.

Mr Lee tells me that making cannabis use legal makes economic sense but would also help in the fight against the Mexican drugs cartels.

"According to some estimates, the Mexican cartels get about 60-70% of their money - their profit - from cannabis," he tells me.

"So if we cut that out of the equation then theoretically 60-70% of the violence they perpetrate would be cut out, because they'd have less money for the guns and weapons and ammunition to kill people and to spend on bribing officials and all the rest," Mr Lee says.

Trailblazing

That perspective, along with the fact that the California state authorities estimate that marijuana could bring in nearly $1.5bn a year in much needed tax revenue if it were legalised, has led to an increased support among the state's voters for the full legalisation of the drug.

And, politicians like Tom Ammiano, who represents one of the most liberal districts of San Francisco in the California state assembly, have been paying close attention.

Mr Ammiano came into politics as a trailblazing gay rights activist in the 1970s and has long advocated greater tolerance for cannabis use.

Earlier this year, he took that approach one step further and introduced a bill in the California state assembly, which, if approved, would grant cannabis the same legal status in the state as alcohol and tobacco.

We like to say prohibition is chaos and regulation is control Tom Ammiano California State Assemblyman

That would put California ahead of even Amsterdam, where marijuana use is tolerated but not altogether legal.

Sitting with him in his office in the state government building in San Francisco, with its sweeping views of the city, it becomes very clear that his proposal is far from a flight of fancy.

He tells me he has been finding that more and more of his colleagues in the state assembly are coming around to seeing why moving towards legalisation makes perfect sense.

'Lighten up'

"People across the board, whether they're conservative or liberal, have come to realise that the so-called war on drugs has failed and failed miserably," Mr Ammiano says.

"In fact, it's costing us money instead of saving us money. This new approach would be a way for the policing efforts to be focused on the big bad guys, the cartels, with their violence and murder, and lighten up on the more minor offenses. We like to say prohibition is chaos and regulation is control," he adds.

"On the streets a drug dealer does not ask a kid for his ID before selling him cannabis," he concludes with an acerbic, humorous tone that serves as proof that he has, beyond politics, also had some success in his other career as a stand-up comedian.

But, despite his optimistic tone, Mr Ammiano says that he knows that those who oppose his proposal, including key figures in the medical and law enforcement community, are armed with statistics pointing to the damaging long-term effect of the drug and have the stamina and resources to wage a major fight to ensure that the bill never gets signed into law.

One of those opponents of the proposal is Ronald Brooks, the president of the National Narcotic Officers' Associations' Coalition, which represents more than 70,000 narcotics enforcement officers in the US.

We meet in the town of Redwood City, south of San Francisco, and as I get in his car, we drive past what appears to be a nondescript office building.

'Seriously flawed'

However, he tells me that, in the 1980s, it was a bank - the place where his partner on the police force was killed in front of him by a ruthless marijuana dealer, who was carrying out a bank robbery to fund his drug business.

He says experiences like that have strengthened his resolve that America can't allow itself to take on a more lenient approach to marijuana.

"This argument of freeing up law enforcement so that we can take on the cartels is seriously flawed," he tells me.

Ronald Brooks is firmly against the proposed change in the law

"This is really a hoax being perpetrated on the voters of California to authorise their political agenda - that is to legalise marijuana as one step to legalise drugs in America because they simply don't think that the government ought to control drugs," he adds.

"The people who are going to lose if this gets approved are the taxpayers because we're going to have increased costs associated with this, both healthcare and law enforcement costs, and the people who have to drive on the state's highways who are going to be in danger from being hit by someone intoxicated from using cannabis. This is simply a reckless public policy," he concludes.

Back across the San Francisco Bay in Oakland, specifically Oaksterdam, the patrons of the Bulldog Cafe are enjoying their legally sanctioned right to consume marijuana for medicinal purposes.

Emerging industry

Gary has travelled from Texas for the weekend to attend a seminar on the cannabis trade at the Oaksterdam University across the street.

He is in his 50s, but says he is hoping to take the information he has picked up in his course on the cannabis business and make a life-transforming move in the coming months to California.

"My girlfriend and I are interested in moving to California from Texas to become a part of this here. We're not quite sure where we fit in but we want to get into the business itself. We feel it's an emerging industry, and this is where I feel compelled to come," he tells me as the smell of cannabis wafts through the room.

Like Gary, there are hundreds of others participating in the courses at the Oaksterdam University on any given week.

Beyond that, there are more than 200,000 people in the state registered as consumers of marijuana for medicinal purposes.

As for Mr Ammiano's proposal to legalise marijuana in the state, that is still making its way through the California state assembly and it is difficult to say whether it will succeed or not.

What is clear, however, is that whatever the outcome of the legalisation proposal, the medical marijuana law and the multi-million dollar industry it has spawned appear to be here to stay in California.

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