Archive for the ‘Doctors and Drugs’ Category

When Patients Ignore Symptoms

October 24th, 2009

Health Information, Medical Advice, Cardiovascular Disease, Heart Attacks, Ignored

One of the great advantages of HMOs, at least according to advocates, is that they typically offer patient education, a key preventative health measure. But recent evidence indicates that merely providing health information and medical advice doesn’t guarantee that patients will heed it.

A new study just published in the journal Circulation: Cardiovascular Quality and Outcomes, followed 3522 people with an average age of 67, who had a history of heart problems. Half of the subjects received intensive counseling about how to recognize heart attack symptoms and when to seek help. The study found that the patients who received the counseling were not one bit more likely to seek help at the appropriate time than patients who had received no such coaching. During the duration of the study, 565 of the subjects made use of emergency medical services due to cardiovascular symptoms.

The subjects who had received counseling waited 2.2 hours between experiencing symptoms and getting to the hospital, the un-counseled group waited 2.25 hours. Given the fact that patients need to receive treatment within 90 minutes of the onset of symptoms in order to prevent the worst outcomes, and given that the counseled group had been warned about the 90-minute window, the education clearly failed to make a dent. Also, the patients who hadn’t received counseling actually made better use of the emergency medical system, employing it 66.9 percent of the time, versus only 63.6 percent for the "educated" patients. Again, this points to the failure of the counseling, which focused on the urgency of getting to the hospital immediately and using the emergency medical system to expedite delivery of services.

In the case of cardiac problems, not heeding medical advice can mean big trouble — trouble, of course, best avoided by implementing natural health practices that prevent heart disease in the first place. But this blog entry isn’t about people following the advice of natural health practitioners; it’s about people following the advice of their doctors. And, as it turns out, advice issued after medical problems have developed often comes too late and patients don’t listen anyway, as other studies attest. It seems that the impulse to ignore what the doctor says may come with the human psyche. Patients consult doctors, but they don’t always like what they’re told and in the end, do what they please.

One study found, for example, that two-thirds of patients with gum disease ignore advice given by their dentist about how to brush their teeth. And if you think the results of such noncompliance would not equate to the dire consequences of failing to act in the case of cardiac warning signs, you would be wrong. Serious medical conditions associated with periodontal disease include, rheumatoid arthritis, diabetes, and heart disease. As it was, the dentists in the study advised patients to brush for two minutes twice a day. The patients used special toothbrushes that recorded brush time, and the vast majority fell short, though half believed that they had complied.

One of the lead researchers, Professor Peter Heasman of Newcastle University, said: "I think that many dentists and dental hygienists are fully aware that their patients do not always follow their professional advice. Nevertheless, we were surprised to find so many of our patients who were unable to follow instructions accurately, even in the short term."

Dr. Heasman’s comment allows that patients might not understand that non-compliance can really lead to loss of teeth [and death], rather than assuming deliberate non-compliance. But deliberate non-compliance seems to be the reason that college students ignore advice to wash hands regularly as a flu-busting measure, a recent study found. The schools involved in the study placed sanitizer gel dispensers at the entrances to public buildings, with signs urging students to make use of the gel, but only 17 percent of students did so. At New York University, students received flyers and emails urging them to wash hands and stay out of classes if they became ill, but again, most simply paid no attention.

NYU freshman Daniel Lee explains, "I think most people just toss the fliers out without giving them a second thought."

Perhaps of greater concern is the fact that young people also ignore advice about taking pharmaceuticals, according to a 2001 study by the Royal Pharmaceutical Society in Great Britain. The study followed 200 people aged 18-39, and found that only a small minority followed the instructions they were given with their prescription medicine. One-third ignored advice to avoid alcohol when on their pills, many drove when on medication that could make them drowsy, and 50 percent stopped taking their medications before completing the recommended course.

What’s going on here? Are people unable to pay attention long enough to grasp the advice? Are they simply cantankerous, rebellious, pig-headed? Or is ignoring medical advice sometimes actually called for?

In fact, while doctors fret and moan about patients who fail to complete the course of their medications, given the side effects of so many medications, stopping may be "just what the doctor [should have] ordered." For instance, the recommended course for antibiotics keeps shrinking. Whereas a 10-day course of treatment once was standard for upper respiratory infections, doctors in Europe now typically prescribe only five days. Recent research indicates that three days of treatment for non-acute pneumonia works as well as five days. So patients who use their own intuition and stop after a few days may simply be in advance of the medical establishment. When patients stop taking medications that make them feel awful, they may be making the wise choice — or they be helping to breed resistant strains of viruses and bacteria that threaten all of humanity. The problem is that they don’t necessarily know what alternatives are available to them (no thanks to the medical professionals), and doing nothing may be dangerous.

There’s also the fact that a very recent study found that the percentage of patients leaving the hospital against medical advice has increased 40 percent in recent years. Still, only 1.2 percent of all hospital patients self-discharge, and many of those leave for financial reasons; but patients who leave because they fear getting worse in the hospital are on to something real, given the fact that hospital-induced infections are legion, and medical errors account for 98,000 wrongful deaths a year in the US alone.  

In short, it often makes sense to heed advice intended to prevent problems in the first place. If you ignore heart-attack symptoms, you can end up dead within a few hours. If you fail to brush your teeth thoroughly, you can end up toothless, diabetic, or dead from a heart attack. If you drink while on prescription meds, you’re asking for trouble. But sometimes it makes sense to ignore advice that would hurl you into the pill-popping, hospital frequenting medical mainstream, as long as you know what alternatives might work more safely and effectively.

:hc

Doctors Have Problems, Too: Health Blog

October 10th, 2009

Physician Error, Medical Mistakes

In the interest of protecting life, limb, and pocketbook, I’ve sometimes harped on the ugly statistics concerning physician error. For instance, I’ve written about how mistakes made by doctors cause as many as 98,000 deaths each year in the United States alone — more than traffic accidents, breast cancer, or AIDS. I’ve mentioned that medical error ranks as the fifth leading cause of death, trailing right behind death by prescription drugs at 106,000 deaths per year. Protecting patients from becoming victims has been a primary concern for me, but several new studies just published in the Journal of the American Medical Association (JAMA) now turn the lens away from vulnerable patients and allow me to take a sympathetic look at some of the factors that may make doctors too frayed to do a good job. Unfortunately, though, these factors give you even more reasons to be concerned for your own health and safety.

The first study examines how fatigue and mental strain affect physician performance. It doesn’t take a neurosurgeon to figure out that falling asleep on the job may lead to problems. Earlier studies, in fact, have shown a startling correspondence between doctors who work long hours and big errors. In 2006, a study out of Harvard University and Brigham and Women’s Hospital in Boston reviewed monthly reports of 2307 medical residents and found that doctors who worked even one extended, 24-hour shift during the month increased the odds of reporting a “significant medical error” by 300 percent. Those who completed five extended shifts reported 700 percent more significant errors and a 300 percent increase in errors that resulted in patient death.

Similarly, earlier research identifies burnout as a risk factor. Once doctors make a serious mistake, their chances of burning out skyrocket according to a 2006 study out of the Mayo Clinic. And once the doctor burns out, his or her chances of making subsequent mistakes increases exponentially. “In addition to the obvious negative effects of errors on patients, studies have shown that the physicians involved often experience guilt, shame, distress and depression,” said Tait Shanafelt, M.D., the director of that study.

Now this new study builds on previous knowledge by not only looking at the impact of fatigue and burnout, but also evaluating the impact of psychological distress on doctor performance. Distress, according to the study criteria, includes factors such as depression, financial issues, family concerns, and emotional issues. Subjects, who included 430 medical residents, underwent standardized testing to measure their emotional state and level of exhaustion every three months between 2003 and 2009. Big surprise: the results show that the most distressed and tired physicians made the most mistakes (39 percent of the subjects reported making a significant error during the study period). The next time you go to a hospital, you might want to think of Clint Eastwood’s line from Dirty Harry, “Well punk, do you feel lucky?” Interestingly, depression seemed to have more of an impact on performance than even exhaustion did.

“While changes have been made to reduce fatigue and sleepiness during residency training, other changes may be necessary to more specifically address distress and burnout,” said Dr. Shanafelt. “Changes to the process of physician training should address both resident fatigue and distress in an effort to improve resident and patient safety.”

Of course, one man’s vinegar is another man’s wine. What changes are we talking about here? Medical students used to work 120 hour weeks during their residencies. Now, thanks to the changes Dr. Shanafelt refers to, some hospitals are “trying” to enforce an 80 hour per week maximum. But expecting doctors to work even 80 hours a week — and under stressful conditions — is still completely insane and guaranteed to leave hospital physicians exhausted and depressed.

Which brings us to the second study, also published in JAMA. That research involved 70 primary care physicians from Rochester, New York, who attended a continuing education program in “Mindful Communication.” The program specifically aimed to address psychological distress, burnout, and communication skills among doctors. During the year-long program, doctors submitted to regular testing on standardized scales for mindfulness, burnout, empathy, psychosocial orientation, personality, and mood. At follow-up several months after completing the program, the doctors showed improvements in all areas, with a 17 percent reduction in mood disturbance, a nine percent increase in mindfulness and an almost seven percent reduction in burnout. Good for them…and their patients.

The fact is that medical doctors experience burnout and depression at alarming rates. Doctors commit suicide at six times the rate found in the general population, with even modest estimates assuming that 30 percent of doctors suffer from depression. Studies of physicians in private practice have found burnout rates exceeding 60 percent. The reasons for physician distress may include factors such as debt, pressures exerted by the HMO system, easy access to drugs, and the aforementioned lack of sleep and guilt over mistakes made in providing care to patients.

So back to the idea of protecting life, limb, and pocketbook. What all the previous adds up to is the fact that the health care system depends on sleep-deprived, depressed, burned out healers with free actions to an entire world of pharmaceutical drugs. Without doubt, this is a recipe for disaster.

Assuming that at least some of those healers started their careers with good intent, plenty of brains and a fair amount of expertise, it seems that a key component in healthcare reform needs to address how physicians get trained and treated so that they can thrive and perform optimally. Certainly, communication skills need to be taught before doctors have scalpel in hand, rather than long afterwards. And certainly, doctors need as much sleep as auto mechanics and chefs and even patients so that the scalpel doesn’t go haywire as the physician nods off.

Finally, physicians need psychological support to deal with the extraordinary pressures they face. Insurance companies could probably reduce malpractice payouts if they demanded that their covered doctors undergo regular psychological screening. And those doctors also would benefit from access to nutraceuticals and some dietary guidance so they can lift their mood naturally, without resorting to the drugs they can so easily acquire and so often turn to.

:hc

Tamoxifen, Killer “Cure”: Health Blog

September 12th, 2009

Tamoxifen

The breast cancer drug Tamoxifen might well be marketed with the slogan, “If it doesn’t kill you, it will cure you”– except that would be an overstatement. The truth is that it probably won’t cure you of anything, but may very well kill you, as yet one more study makes clear. According to that study, just published in Cancer Research no less, long-term use of tamoxifen ups the risk of getting aggressive cancer in the other breast by 440 percent. In spite of this finding, researchers insist that women should keep taking the drug because, they say, the benefits outweigh the risks. Then again, they’re not the ones at risk.

Tamoxifen has been used for over 25 years both to treat breast cancer, as well as to prevent it. Most breast cancers spread when exposed to estrogen, and since tamoxifen inhibits estrogen receptivity, it has been the standard treatment, although recently aromatase inhibitors, a new class of drugs, have taken precedence. Tamoxifen also has frequently been prescribed to high-risk women who don’t have breast cancer as a prophylactic measure to stave off tumors. And, it’s been used to treat osteoporosis, bipolar disorder, and prostrate cancer.

But problems with tamoxifen have been surfacing for years, and now this study shows the drug causes an even more deadly version of the disease it supposedly cures. The tumors negatively associated with tamoxifen use do not feed on estrogen, no drugs on the market have been effective in treating them, and the prognosis for cancers featuring these tumors is worse than for estrogen-dependent cancers.

The study followed 1100 women aged 40-79 who received treatment for estrogen-receptive breast cancer between 1990 and 2005. Those who took tamoxifen were 60 percent less likely to develop estrogen-dependent breast cancer in the other breast compared to those not taking the drug. But those women who took the drug for more than five years, as already mentioned, had a hugely increased risk of developing estrogen-negative tumors. The study did not include women who took the drug long-term to prevent breast cancer in the first place. If it had included that group, the risk most likely would reflect far higher numbers.

So, you might conclude, since the drug does seem to provide significant short-term protection, you can safely take it for the recommended five years (that’s the standard regimen) and then stop, thus reaping the benefits and avoiding the risks. Doctors point out that in the study, the overall numbers of women developing the aggressive breast cancers remained small (an interesting double standard as we’ll discuss in a moment). The tumors appeared in only 14 of the 358 women treated for longer than five years. But, two troublesome key points make those arguments look lame. First, tamoxifen causes life-threatening problems other than breast cancers. Also, studies have found that while tamoxifen may prevent estrogen-dependent breast tumors, it does very little, if anything, to prolong life expectancy, at least when used as a cancer preventative. Let’s examine these issues in a little more detail.

First, the other health problems associated with tamoxifen include blood clots, strokes, uterine cancer (about double the risk), ovarian cancer, liver cancer, gastrointestinal cancers, and cataracts among them, as well as the usual chemotherapy discomforts — nausea, vomiting, headaches and so on. “Any sort of treatment has risks and benefits, and the benefits for tamoxifen are very clear, particularly with respect to reducing mortality,” says lead researcher Christopher Li, MD, of the Fred Hutchinson Cancer Research Center in Seattle. But are they? A huge study of 13,000 women by the National Cancer Institute back in the 1990’s found that while tamoxifen did indeed cut “the incidence” of breast cancer by 30-50 percent in the high-risk group of women who took it as a preventative, seven years into the follow-up, women in the no-tamoxifen control group had fewer deaths from breast cancer than those in the tamoxifen group — marginally fewer, but fewer none-the-less.

And, as I’ve written before, those statistics touting the huge percentage reductions in new tumors from tamoxifen’s effects do not hold up on closer inspection. About ten years ago, newspapers cited studies proving the efficacy of tamoxifen that consistently read something like “The National Cancer Institute’s Breast Cancer Prevention Trial reported that there was a 49 percent decrease in the incidence of breast cancer in women who took tamoxifen for four to five years.” That’s stunning. If your doctor told you that using tamoxifen cut your chances of getting breast cancer by 49%, would there be any question in your mind on whether or not to use it? But if you look past the statistics, the truth is that according to the study, your odds of getting breast cancer without using tamoxifen were only 1.3%. With tamoxifen it dropped to .68%. And yes, that could be represented as a 49% difference between the two numbers. But the reality is we’re talking about a difference of just 86 women out of 13,388, or just a little over one-half of one-percent (0.64%) in real terms.

If you already have breast cancer, it’s your call whether or not to take on the risks tamoxifen brings. On the other hand, if you’re going the mainstream medical route, you may want to consider the fact that aromatase inhibitors beat tamoxifen in terms of survival rates, plus they have far fewer side effects. The only proviso here is that these drugs work only for post-menopausal women, and they cost more than tamoxifen.

But if you’re taking tamoxifen as a cancer preventative, you might want to think very carefully about the payoff versus the potential cost. And you might want to view the following statement made by Dr. Li regarding his recent study with a skeptical eye: “Certainly none of the data has suggested that we stop using tamoxifen or change the way we apply it.”

Keep in mind that there are natural alternatives available that are at least as effective as tamoxifen — alternatives that not only strengthen your body and reduce your vulnerability to cancer and other deadly diseases but that have the added benefit of not triggering even more vicious diseases than those you seek to fend off. In fact, the self same Dr. Li just released the results of another study a few days ago that found that a simple change in diet can drop your risk of breast cancer by 40%. That makes it virtually as effective as tamoxifen, but with only beneficial side effects.

:hc

Does Medical Imaging Fry Patients?: Health Blog

September 8th, 2009

Medical Imaging Dangerous

For years I’ve been saying that many medical procedures are far less “proven” and far more dangerous than most people think. And now we can add another one to the list — one so commonly used, in fact, that its very commonness may be its biggest problem.   I’m talking about medical imaging procedures, which doctors annually prescribe to about four million people under the age of 65.  The typical patient, having received the work order, rushes over to the hospital to get the images taken, grateful for the sophisticated technology that can diagnose incipient internal problems. But according to a study just published in the New England Journal of Medicine, tests such as CT scans and nuclear imaging may be provoking cancers without providing any real benefits. (You might want to reread that last sentence again.)

The study analyzed medical records of about one million adults under 65, and found that two-thirds of them had undergone at least one imaging test between 2005 and 2007, not including “low-dose” dental X-rays. Eighty percent of the imaging procedures were performed on people who weren’t in hospitals, and 30 to 40 percent were administered to patients under age 50. While 71 percent of the tests were regular X-rays, the remaining tests included high-dose CT and nuclear imaging radiation scans. CT scans emit 50 times the amount of radiation you’d get from a regular X-ray. You get even more radiation from nuclear stress tests, also known as myocardial perfusion imaging, which doctors prescribe to search for cardiovascular problems. 

It may seem obvious to any non-doctor that exposing people to high levels of radiation isn’t good, but study director Dr. Reza Fazel of Emory University School of Medicine seems to think that lots of physicians haven’t figured that out. She says, “We don’t want to scare people and have them refuse necessary procedures, but physicians and patients need to be aware that radiation is not benign. Our study shows that a lot of people are getting high doses of radiation.”

And that radiation, according to experts, leads to at least two percent of new cancers in the US (about 29,000 cases a year). Keep in mind, that two percent applies only to cancers caused by CT scans, without accounting for the cancers related to nuclear imaging and other forms of medical radiation. Also, keep in mind that people don’t typically receive just one scan. They may have multiple images taken at a single time or have repeat sessions of imaging, and the impact of radiation is cumulative over time.

“The risk in individual patients is small, but when you start totaling up millions of people getting these kinds of doses, it adds up, and the population risk starts to become concerning,” says Dr. Fazel. It’s interesting that the data show women get imaging tests at a greater clip than men — 79 percent of women versus 58 percent of men had such tests during the study period. Not surprisingly, then, women also contract radiation-induced cancers at a greater rate.

Experts have noticed it’s possible that the risks outweigh the benefits, at least in some cases. “We are exposing people to significant amounts of radiation and on the other hand we do not have evidence that [the scans lead to] improvement of health,” says Dr. Michael Lauer, a cardiologist with the National Heart Lung and Blood Institute. The fact is that studies haven’t been done to determine if all this scanning actually saves lives, prevents heart attacks, or leads to health improvements. (As I keep saying, medicine is not as scientific as you might think.) And experts particularly worry about exposing children to imaging, since kids are about 10 times more sensitive to radiation than adults are. Elderly people, who were not included in the study, get the most imaging done, but the reports seem to dismiss this fact. Perhaps the thinking is that they’ll die soon anyway, so who cares? But at least the cost of the procedure is covered by Medicare.

In addition to the health concerns, the report cites exorbitant costs associated with imaging. According to the Radiological Association of North America, $17 billion may be paid annually in unnecessary imaging in cases of acute trauma. Doctors get paid for each service they perform, and so they may be ordering tests for which the need is questionable. The Government Accountability Office issued a report saying that Medicare spending on imaging more than doubled to $14 billion between 2000 and 2006, with most of that increase going to the highest-dose, most dangerous tests. (And we wonder why health care costs keep climbing).

Unquestionably, scanning can reveal hidden problems, and sometimes that does indeed lead to remediation and healing. Certainly, the American College of Radiology (ACR) sees the issue differently. In a rebuttal, the ACR calls the NEJM study “ill-advised and misinformed.” The rebuttal claims that, “The patients who experienced the higher doses of radiation (and repeated exams) outlined in the study were almost certainly cancer patients and others with chronic illnesses whose conditions necessitated repeat exams to gauge effectiveness of their treatment and/or help ensure their short term survival.” (It’s useful to remember here that if those patients weren’t cancer patients going into the exam, they probably were down the road as a result of the tests.) Also, the ACR refutes the claim that most imaging turns up nothing because the procedure isn’t called for, saying that, “Negative exams are of value. They preclude further costly and invasive exploratory techniques, rule out disease, provide a baseline to monitor patient health, and provide the patient with peace of mind.”

Really?? Perhaps they missed the studies that demonstrated that mammograms have up to a 90% false positive rate!! That means that 90% of mammograms actually lead to “further costly and invasive exploratory techniques,” give false confirmation of disease, provide a totally erroneous baseline to monitor patient health, and unnecessarily destroy patient peace of mind!

While the medical community slugs it out, it might help you to know that MRI tests and ultrasounds don’t use radiation, nor does thermography. Always opt for the non-radiation test where there’s a choice.

:hc

Short Kids Equal to Peers: Health Blog

August 25th, 2009

Shortness, Children

According to singer Randy Newman, “short people got no reason to live.”  It would seem that some parents believe the lyrics to be true, based on the anxiety with which they try to “fix” the “height problem” of their diminutive youngsters. They worry that their undersized offspring will lag behind peers socially and that other kids will pick on them, but a new study may help those concerned parents chill out.

The study, just published in the journal Pediatrics, followed 712 sixth graders, 28 of whom were considerably under normal height. The researchers found that the short children were just as well-adjusted, happy, and popular as kids of normal height. Although the shorter kids did report more instances of being teased and victimized, they weren’t any more depressed or troubled than the other children.

Study author Dr. Joyce M. Lee of the University of Michigan and C.S. Mott Children’s Hospital, in Ann Arbor, says, “There’s just a lot of stereotypes about short stature and its impact on the well-being of children. What I would stress is, parents should really be reassured by this data, [and] even if they have a child of moderate short stature, it’s not likely to have any impact on their emotional and behavioral well-being….children with short stature do just as well socially and emotionally as their taller peers”

The researchers focused on sixth graders because that’s the age at which kids usually become obsessed with physical characteristics. Pre-adolescents who deviate from the norm in terms of height theoretically would experience more psychological and social stress during these years. Parents, however, seem to experience the stress sooner, sometimes requesting growth hormones for their diminutive kids. In the year 2004, companies that manufacture growth hormones for children raked in well over $1.5 billion in sales. The argument in favor of dispensing the hormones has been that the short kids suffer so much — that taking the hormones should help them socially. But based on the new data, Dr. Lee says, “Seeking specialty evaluation and treatment purely on the basis that a short child will be happier seems unwarranted.”

Does this mean that drug companies will see a huge loss as parents of short children wait it out, hoping their kids will experience a growth spurt? Not likely. While pharmaceutical companies might lose a little money in the sale of growth hormones, they can use the study’s argument to bolster sales of several leading pediatric drugs — including drugs for asthma and for hyperactivity.  These drugs tend to delay growth and so result in short height during childhood; now, the drug companies have a case to convince parents not to worry. As the University of Michigan’s own Health Newsletter says, “The results of the study allow pediatricians and other primary care providers to reassure parents that these temporary decreases in growth [resulting from pediatric drugs], leading to short stature, are unlikely to have a significant impact on their child’s quality of life.”

Then again, it’s unlikely that most of  these “concerned” parents will find the results of this study reassuring enough to quit worrying…and in fact, perhaps that worry isn’t totally unwarranted. While short children seem to fare fine, once they reach adulthood, if they remain short they may run into problems. This especially applies to short men. Several studies have found that short men earn considerably less than taller men (up to 25 percent less). One study found that for every extra inch in height, men earned another $789 in higher wages per year And a University of Pittsburgh study revealed that although, “The average height of a man in the United States is five foot nine…more than half of the CEO’s in the American Fortune 500 are over six feet tall, and only three percent are less than five foot seven.” Other studies have shown that taller men are more likely to get married and that they have, on average, more children than shorter men.

So is Randy Newman right? Do short people have no reason to live? Hardly! They may simply have reason to combat the stereotypes that abound regarding height, and to work on self-esteem so that they assert themselves as powerfully as their taller compatriots. Parents of short children can support this process by not flipping out if Johnny falls below the 50th percentile. (Also, they can remember that short children don’t necessarily grow up short.)

Before resorting to the last-resort option of synthetic hormone treatments, consider the fact that if your kid doesn’t have a growth hormone deficiency but you’re contemplating hormone therapy anyway, those treatments up the risk of diabetes, abnormal bone growth, intracranial pressure, hypertension, hardening of the arteries, overgrowth of cardiac and kidney tissue, and colon cancer. Even if your child does have a growth hormone deficiency, there can be side effects such as nausea, rashes, carpal tunnel syndrome, itching, fatigue, infection, growth of breast tissue in boys and so on. Synthetic  hormones are relatively new to the market and the long-term effects aren’t really known. At best, the hormones can add a few inches to final height and can speed up the process of getting there. Unless your children’s height deficiency is dramatic, you might want to think twice about showing them your worry or taking drastic measures to make them taller, and instead concentrate on making them feel accepted just as they are.

And as a final thought, keep in mind that:

  • Mahatma Gandi was only 5′3″
  • Paul Simon (singer/songwriter) is only 5′2″
  • Buckminster Fuller (inventor of the geodesic dome) was also just 5′2″
  • And Dolly Parton is a cool 5′ even

:hc

Antidepressants Up, Therapy Down: Health Blog

August 13th, 2009

Antidepressants, Depression

Here’s some depressing news: Antidepressant use in the US has nearly doubled since 1996, according to a study out of Columbia University and the University of Pennsylvania. The study found that over 10 percent of the US population aged six and up now takes an antidepressant. Of those on antidepressants, only 20 percent get additional help from psychotherapy of any sort. These figures represent a breathtaking change from 1996, when (a still hefty) 5.84 percent of the population took antidepressants but of those, 31 percent saw a therapist. In the years leading up to 1996, we see an even more dramatic spike, with antidepressant use almost tripling in the six previous years between 1988 and 1994.

While it’s amazing to think that at this point 27 million Americans — one out of every 10 men, women, and children — depend on pharmaceutical drugs to get through the day, it’s even more incredible to consider that the vast majority don’t get any additional help to address the underlying issues causing the depression. They don’t get support handling difficult emotions, they don’t learn how to handle grief, when to leave destructive situations or how to improve them and so on — benefits that psychotherapy conveys. And so, the painful situation or chemical or nutritional imbalance triggering depression remains intact, ensuring continued dependence on drugs in order to cope. It’s the psychological equivalent of taking blood pressure medication without addressing the dietary issues that cause hypertension in the first place.

As of now, antidepressants are the most commonly prescribed drugs in the US, at 118 million prescriptions a year. According to Dr. Kelley Posner of Columbia University Medical School and the New York Psychiatric Institute, 25 percent of all adults have at least one major depressive episode at some point in their lives. The World Health Organization (WHO) predicts that by 2020, depression will be the second leading cause of the global health burden. If they’re right, that means that there’s still room for more prescriptions. In fact, Dr. Posner thinks that lots of people who need the prescriptions don’t get them. “Fifty percent of African-Americans who have depression don’t seek treatment for it,” she said. “Not enough people are getting the treatment they need.”

More drugs! More drugs! Everyone needs more drugs.

Others, however, have a more skeptical view. For instance, Dr. Ronald Dworkin, author of the book Artificial Unhappiness, says, “Doctors are now medicating unhappiness. Too many people take drugs when they really need to be making changes in their lives.” His colleague, Dr. Robert Goodman, a New York internist, agrees. He says that it’s not medical need that’s driving the surge in antidepressant medications, but marketing to both doctors and consumers. “You put those two together and you get a lot of prescriptions for antidepressants,” he said. “It’s hard to believe that number of people are depressed, or that antidepressants are the answer.”

Party pooper! Just when I was convinced that everyone should be on antidepressants.

Then again, studies show that cases of clinical depression have been multiplying by enormous increments, doubling right along with antidepressant medications in the past decade. But are more people actually depressed than in the past, or is some other factor at play, driving up the numbers? Says Dr. Eric Caine, chair of the Department of Psychiatry at the University of Rochester, “People are not so embarrassed [as before]; they are more open to seeking help for depression.” Perhaps that explains it, and also explains the rising number of antidepressant prescriptions.

Or perhaps it works in reverse: the rising number of prescriptions means that doctors need to slap the “depressed” label on ever more patients in order to justify dispensing the meds. And in fact, there seems to be a pattern here. As the old saying goes, “To a hammer, everything looks like a nail.” And so we see ever more members of the medical community saying, “More drugs; more drugs!” Thankfully, though, there are a handful of dissenting voices that say, “Maybe not.”

If people and their doctors believe that antidepressants are the answer, they might do well to look at the facts. According to an article in the New England Journal of Medicine last year, the press on antidepressants hasn’t presented an accurate picture. Of the 74 antidepressant studies submitted to the FDA between 1987 and 2004, only 38 were “positive.” The remaining studies found that antidepressants, in fact, did nothing to relieve depression. Zip. Nada. Ultimately, even the positive studies tended to find that the drugs worked only for the most severely depressed patients.

As I’ve written before, the potential payoff from taking antidepressants certainly seems negligible for most (not all, but most) people, especially considering the risks. Those potential risks range from increased depression and suicide to weight gain, nausea, congenital defects, chest pain, insomnia, stroke, and so on. Thirty percent of those on antidepressants experience sexual dysfunction, and a recent report found the drugs blunt the ability to experience and express love.

Certainly, there are effective and safe alternatives. First, as Dr. Caine points out, “In mild to moderate depression, psychotherapy is as good as or better than medications.” As I reported last year magnets have been found more effective than medication for many depressed patients. I’ve also reported on numerous supplements and herbal approaches that can help. And of course, dietary and lifestyle changes can make an enormous difference in mental outlook — just getting off sugar and starting to exercise can work wonders.

That said, there’s little chance that antidepressant prescriptions will decline anytime soon: quite the reverse. At this point, current sales net $11 billion worldwide, with sales in the US comprising 71 percent of that figure. Think about that for a moment. If taken literally, that means that 71 percent of all the depressed people in the entire world live in the US. And don’t get me started on the “fact” that 80% of all children with ADD and ADHD seem to live here too. Certainly the pharmaceutical industry won’t let such juicy profits slide, and their task is eased by the fact that neither the masses nor the medical establishment want to accept that, by and large, the pills are just expensive placebos. There’s just too much appeal (and too much money) in the magic bullet solution.

:hc

Mammogram Mania: Health Blog

July 28th, 2009

Mammogram, Breast Cancer

If there’s one thing most women agree on, it’s the fact that going for the routine mammogram is about as distasteful as doing the annual tax return — which may be one reason fewer and fewer women show up for it. Back in 2000, 70 percent of women in the US had regular mammograms, but that figure slipped to 66 percent by 2005, and the downward trend continues. Plus, a huge study reviewing Medicare records of 146,669 women nationwide found that far fewer actually had mammograms than claimed they did, dropping the real percentage to more like 61 percent — which leaves almost 40 percent of women without screening. 

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More Bad News about Statins: Health Blog

July 16th, 2009

Statins, Muscle Weakness, Muscle Pain, Lipitor, Crestor

The latest brick in the tomb of statins — those cholesterol-regulating meds — comes from a new study confirming that the drugs cause structural damage to muscles. Even worse, the study, published in the Canadian Medical Association Journal, found that muscle damage can continue to progress even after patients stop taking the drugs. As study author Dr. Annette Draeger of the University of Bern, Switzerland, puts it, "Although in clinical practice, the majority of patients with muscle symptoms improve rapidly after cessation of therapy, our findings support that a subgroup of patients appears to be more susceptible to statin-associated myotoxicity, suffering persistent structural injury."

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Depression Gene Has Mental Breakdown: Health Blog

June 27th, 2009

Depression

Back in 2003, depressed people had something other than bad parenting to blame for their mental malaise. At that time, a well-publicized study announced that a link had been found between a gene called 5-HTTLPR and depressive illness. The research postulated that people with a variant of that gene didn’t carry serotonin to their brain cells effectively. Since serotonin seems to allay depression, the scientists suspected that those with the gene variant would get depressed when life became difficult. And sure enough, the study found that those subjects who had the gene did get more profoundly depressed after traumatic life events than the subjects lacking the gene.

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Ritalin for an Extra Boost?: Health Blog

June 25th, 2009

Ritalin

No matter the side effects and the fact that it’s illegal: an article on the British Medical Journal website advocates the use of Ritalin to help adults think more clearly. Using the "if Johnny can do it, why not me" argument, the author, Dr. John Harris of the University of Manchester, says that Ritalin has been deemed safe enough for hyperactive kids, so it must also be safe enough for adults. Even better, he believes they should have free access to the stuff. In fact, he asserts that it is "unethical" to stop healthy people from taking the drug and that it’s relatively safe. "Safe always means safe enough," he says, "and since no drugs are free of side effects, that always means the consumer has judged the risks of adverse effects worth taking, given the probable benefits."

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