Health: Getting under your skin without getting stuck in

The nightmare of vaccinations could soon be a thing of the past for needlephobes thanks to the jab-free injection. By Lynn Eaton
If watching junkies shooting up in Trainspotting was your worst nightmare or you would rather go to Bognor than have jabs for Borneo, chances are you may have needle phobia - a fear most can understand but few own up to.

"It's all very well being five and terrified, but at 55 you feel a bit stupid," says Jon Fraise, a phobia expert. Needlephobes avoid medical treatment, dental fillings and even, in one case, essential treatment to prevent a cancer spreading. However, a new device could do away with conventional needles - and remove much of the fear for ever.

Called Intraject, it looks like a pen but contains a small gas cylinder where the cartridge would be. The tip is placed against the skin and, when the gas is released, it forces the liquid injection out under such high pressure that it turns solid, shooting into the skin in the same way a needle would.

"It sounds like great news," says Darren Taylor, who nearly passed out when he went to see Trainspotting. "It was a bad choice, that film," says the 26-year-old, who works in Lincolnshire. "I didn't faint, but that was only because I looked away. Anything like that on TV and I can't look. I am really squeamish."

A couple of years ago he went to have a wisdom tooth removed - and fainted at the sight of the needle. "It wasn't that it was particularly painful or anything. It was just the thought of it. I tried to tell myself not to worry, but as the time got closer, I got more and more worked up.

"I had an accident last year and cut my arm quite deeply and needed an injection. On two previous occasions I fainted, but this time I didn't. I was quite proud of myself. But I would rather be knocked on the head with a brick than have an injection. It's just fear of the needle."

Men seem to be more frightened of needles than women. "People who tend to faint are well over six foot and weigh 16 stone," says Sue Taylor, a senior nurse adviser with the Medical Advisory Service for Travellers Abroad (Masta). Picking them off the floor afterwards is no easy task, so many nurses will ask even the slightly queasy to lie on the couch, just in case. Although Masta clinics give vaccinations all day, she says they rarely see people who are terrified of needles. "I think needlephobes just stay away."

Paula, 32, who is too embarrassed to give her full name, admits her fear of needles would prevent her going to any exotic holiday destination. "I can't even take my daughter for an injection. I've always been frightened. I've had a lot of bad experiences with blood tests, especially one when the doctor couldn't find a vein. People don't understand. They say it's nothing. But it is so traumatic. It's not the pain, it's the thought of it."

The Intraject device, designed by Weston Medical Limited, is about to be used in clinical trials with a new drug for hepatitis C being developed by Hoffmann-LaRoche. It is also being considered for use in a flu vaccine. Beyond that, its uses are potentially enormous, says the company's chief executive, Christopher Samler. "We are looking at any drugs that are currently being given by conventional needles and syringes that have to be given to the subcutaneous tissue - and don't require variable doses."

Which means that people with diabetes who inject daily with variable amounts of insulin won't benefit. At the moment Intraject delivers a fixed dose, which would be put into the device by the drug company.

But it could help people with renal failure or cancer who are injecting erythropoietin (a hormone that stimulates red blood cell production) and those using growth hormones or heparin (an anticoagulant used after surgery to thin the blood).

"We are not talking about intravenous drugs," says Mr Samler, which rules out the Trainspotting set. "But it could be used by people who have an allergy to bee stings or peanuts, who could keep the antidote in a bag to use themselves, if they ever needed it."

Encouraging news. But Intraject doesn't come cheap. At around 80p for the device alone (excluding any drug inside) it costs 10 times the traditional needle and syringe. Nor is it totally pain-free. Mr Samler reports that it feels as if someone has flicked your skin sharply. And the whooshing noise as the gas is released may frighten some users.

But the biggest catch is that the device is unlikely to be available until 2001, at the earliest. So, for those who can't wait that long, the remaining option is a course in systematic desensitisation to tackle phobias. These are available both on the NHS and privately. They begin by explaining how your body reacts when you panic, with a racing heart, sweating and dizziness, and gradually introduce you to the thing that you fear. "Explaining the psychological process helps demystify it," says Mr Fraise, who is a clinical psychologist with Wakefield and Pontefract Community Health Trust. "The sufferers stop seeing themselves as loopy."

He then teaches phobics to relax and concentrate on their breathing. Only when they have learnt these skills will he gradually introduce the syringe, perhaps at first having it across the room, then gradually bringing it nearer.

"I will sometimes give a patient a syringe without a needle in it for them to take home and handle. Eventually I may ask their GP or practice nurse to take a small blood sample. I also teach them to challenge negative thoughts, to focus on how brief their distress is going to be and how much they are likely to enjoy their holiday."

Although it doesn't always work, he reckons that most patients will be able to have essential injections afterwards. It may be more practical than waiting for the Intraject, which, after all, will offer only a limited alternative. The manufacturers have yet to come up with a device that will do away with needles for blood tests - the procedure that phobes fear most of all. But they are working on it.

`Living with Fear' (McGraw Hill), by Professor Isaac Marks, of the Institute of Psychiatry, tackles all phobias, including needles; Triumph Over Phobia offers self-help groups run by people who have overcome phobias - for details send an sae to Triumph Over Phobia UK, PO Box 1831, Bath BAZ 4YW; the Institute of Psychiatry runs a computerised course on tackling phobias - call 0171-919 3365