May
24
According to the BBC, epidemiologist Professor Malcolm Law is advocating giving everyone over 55 drugs to lower their blood pressure, even if they are perfectly healthy.
 photo credit: Goldmund100
This isn’t some fringe nutter. He’s at the Wolfson Institute of Preventive Medicine, associated with Barts and the London School of Medicine and Dentistry, which according to their website was recently assessed as “one of the top 5 research institutions in the UK”. His conclusion was published in the British Medical Journal (“medical publication of the year“), backed by “other experts” (the BBC’s phrase), and based on a review of 147 studies, involving 464,000 people.
I can’t match those big guns in terms of credibility, but I still think he’s talking nonsense. So do advocacy groups. The article quotes spokespeople for the Stroke Association, the Blood Pressure Association and the Faculty of Public Health, warning that these medications do have side effects (though Professor Law is advocating low doses for exactly this reason), and that there are other, non-drug interventions which also reliably lower blood pressure (healthy eating, reducing salt and alcohol, and regular exercise). They appear to think, as I do, that throwing pills at everything and everybody is not the best approach.
photo credit: tomsaint11
Of course, I could go for the cheap shot and point you to the Wolfson Institute of Preventive Medicine list of funders, which includes Aventis, Astra-Zeneca, Glaxo Smith Kline, and Pfizer, and then claim that Professor Law is in the pockets of Big Pharma. I think it’s probably more complex than that. Professor Law is operating in a particular mindset which is very common among doctors and medical researchers, and which large pharmaceutical companies are very happy to encourage: the way of thinking that says that medication is the first and best solution for any health problem.
I differ from him in that regard. I don’t think giving 100% of the older population a pill that may lower risk 25-30% of the time for 5-10% of them is a good idea.
What do you think?
Technorati Tags: blood pressure, heart disease, stroke, risk, medication, drugs, drug alternatives, medical research, ageing, pharmaceuticals, Big Pharma
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May
12
Part of what I do with smokers who want to stop is teach them emotional management and stress management techniques, and the reason that I do it is to improve their chances of remaining smokefree. I’ve been basing this on anecdotal evidence – that is, most people who come to me to stop smoking have stopped before, and most of them report that they went back to smoking because of a stressful time in their lives. A recent study provides some further backing for the idea.
It’s a University of California study into nicotine and aggression by Jean Gehricke and colleagues, published in Behavioral and Brain Functions 2009, 5:19 (Nicotine-induced brain metabolism associated with anger provocation, doi:10.1186/1744-9081-5-19). It was a small study (20 participants), but it included brain scan data. This showed that the parts of the brain related to anger and aggression were affected by nicotine patches, but not by a placebo patch, in a within-subjects study on nonsmokers. (“Within-subjects” means that all the participants experienced both conditions – nicotine and placebo – in a random order.)
The researchers’ theory is that at least some smokers are using nicotine to normalize the balance of their brains when it is disturbed by an anger reaction. It’s well-known that people with mental illnesses often use nicotine to self-medicate, and many smokers also claim to smoke to calm themselves down (despite the fact that nicotine arouses the body’s stress response). Irritability is a common complaint among people giving up smoking, and is reduced by nicotine patches.
photo credit: Jan Tik
The researchers found correlations between the behaviour of the participants in a simulated anger/retaliation task and the measured effects of the nicotine on the activation levels of particular brain areas related to emotion. This suggests that they are on the right track with their theory that nicotine contributes to emotional management for at least some smokers. They concluded, “Novel neurotherapeutic and behavioral treatments (e.g., anger management training) that affect the cortical and limbic brain areas may aid smoking cessation efforts in anger provoking situations that increase withdrawal and tobacco cravings.”
“Secondary gains” – what you get out of continuing the behaviour that you want to stop – are always important to look at any time you approach behaviour change. If emotional management is a common secondary gain from smoking – and it seems that it is – then teaching non-chemical emotional management techniques is a useful thing to do for people who want to stop smoking.
(That’s why my free stop-smoking ebook, How to Stop Smoking, recommends my free stress management course, Simple Stress Management Techniques.)
Technorati Tags: anger management, smoking, smoking cessation, nicotine, emotional management, stress management, brain scan, PET
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Feb
26
The ABC (that’s the American, not the Australian, Broadcasting Corporation) were kind enough to draw my attention to an article on their website: College Insomniacs Resort to Sleeping Pills. Usually when people email me and say, “You might be interested in this,” they’re wrong (and if they read and considered my reviews policy, they would know it), but this time, it’s very relevant to something I’ve talked about before here: Getting good sleep.
photo credit: dominiqs81
It’s also relevant to my theme of alternatives to drugs. Not because the students the article profiles were looking for such alternatives, but for exactly the opposite reason. Their first thought when they were having difficulty sleeping was to pop a pill.
According to the article, “use of prescription sleep aids has nearly tripled among 18-to-24-year-olds over the last 10 years”. The three students interviewed cited anxiety and racing thoughts among the reasons they found it hard to sleep, and blamed the stress of dealing with the demands of study, work and an active social life.
Dr. Akram Khan, a sleep medicine expert at Oregon Health & Science University in Portland… said he doesn’t believe that rising stress levels are the only reason for the increase in the use of sleep drugs. “I would say that the biggest factor is the marketing that these drug companies are doing,” he said. “The ads offer an easy fix and people want some kind of a magical fix.”
Although the ads mention that these medications can cause headaches, nausea, dependency and should not be mixed with alcohol, Khan noted, “All this is spoken so fast that, even as a doctor, I find it rather difficult to follow what they’re saying.”
Which is fairly normal behaviour for a big company trying to sell its product, but is obviously ethically questionable.
photo credit: Stéfan
Most sleeping medications haven’t been approved for long-term use beyond six months. “The ideal thing would be to use these drugs as a last resort measure and as a short-term measure to help you streamline your sleep,” Khan said.
But this isn’t what the students are doing. One student interviewed said, “As much as I didn’t think there were other things affecting why I wasn’t sleeping, my doctor opened my eyes to what types of things were really the underlying causes. I think it’s better to fix those before you turn to medicine.” She has stopped using the medication now. But the other two were quite happy to use medication rather than look at their unhealthy lifestyle or the underlying issues of anxiety and worry. This isn’t an uncommon scenario in modern life: They’re stressed, too busy, easily influenced by marketing, and focussed on quick fixes to symptoms rather than good fixes to underlying problems. They’d prefer to alter their body’s balance with drugs than restore it by changing their behaviour to something more sustainable – which would require going against the flow of what everyone around them is doing.
The article ends with some good advice on lifestyle changes to improve sleep, similar to what I offer in 7 Tips for a Better Night’s Sleep.
photo credit: TheMuuj
The piece as a whole is, if I can use the phrase, a wakeup call. If you’re having trouble sleeping, pills should be the last thing you use, not the first. Look at those healthy lifestyle modifications first, and if you’re still having trouble try a relaxation recording like my Good Sleep download. Sleeping pills interfere with the normal sleep mechanism, should only be used short-term, and are a last resort after you’ve tried everything else.
Technorati Tags: sleep, insomnia, non-drug alternatives, sleeping pills, students, stress, anxiety, healthy lifestyle
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