Monthly Archives: August 2009

Dem dry bones

August 29, 2009 2:52 am by Margaret McCartney

You won’t always be able to feel it in your bones. Osteoporosis, a condition in which the bones become thin or brittle, often stays well hidden, until a minor fall results in a major injury. A broken hip, perhaps, or broken wrist. Scans can reveal thinning of the bones, but in the NHS they are mainly reserved for people who have already had a fracture or are thought to be at increased risk of one. Private companies, meanwhile, have made use of small, easily transportable scanners in order to offer bone density tests at community venues such as church halls or shopping malls.

There is no doubt that osteoporosis is a serious health problem. One in three women and one in 12 men over the age of 50 are estimated to suffer a fracture due to osteoporosis at some point. Hip fractures can have grave consequences: half of patients are unable to live independently thereafter; one in five dies within six months.

Prevention, of course, is better than cure. Weight-bearing exercises, such as walking or aerobics, can help. Studies have also suggested that strength and balance training can also be effective. In addition, it is important to maintain a reasonable weight (being underweight is a risk factor), and to have a diet with sufficient calcium.

The remainder of the article can be read here. Please post comments below.

Posted in Complementary medicine, Medical ethics, Research, Testing treatments | Permalink

Gender testing for atheletes

August 27, 2009 11:12 am by Margaret McCartney

The gender testing of the athlete Caster Semenya is attracting a lot of media attention. In case you’ve missed it, she is the 18-year old South African who trounced her rivals in the final of the 800m at the World Athletics Championships earlier this month, only to see her achievement marred by a highly-personal dispute over her gender. It seems incredibly unfair to me that details have been released about what should be a private medical matter. To illustrate just how complex testing and the meaning of the results can be, this resource from the Howard Hughes Medical Institute in Maryland is excellent. And an illuminating history from the Journal of the Royal Society of Medicine.

Posted in Health | Permalink

Young at heart?

August 22, 2009 3:21 am by Margaret McCartney

A lady of pensionable age recently explained to me why she was a convert to handheld computer games. Playing them, she said, was cerebrally invigorating and fun. So much so, in fact, that she felt sure computer games could rewind her mental state to a more youthful age. She also disclosed that “him at home” couldn’t hope to provide a similar level of entertainment. I was about to start preaching about how “real” social interaction, rather than computer games, is known to be a crucial factor in healthy ageing – but no. She now felt five years younger.

The trend for putting ages on our faculties and organs is a curious one. I can see the appeal, but I find it hard to see how complex expressions of health risk can be satisfactorily compressed into a simple number.

Take, for example, working out cardiovascular risk. Using known risk factors such as family history, ethnicity, smoking, blood pressure and cholesterol, charts can plot where one’s future risk lies. However, a lot depends on which chart you choose. Doctors commonly use those from the “Joint British Societies” (British Cardiac and Hypertension Societies, and British Hyperlipidaemia and Diabetic Associations). Other calculators, such as “Assign” in Scotland, have been developed for this specific geographical area, and employ information from postcodes in addition to basic clinical data.

The remainder of Young at heart? can be read here. Please post comments below.

Posted in Public Health, Research | Permalink

Time to ditch the homeopathy?

August 21, 2009 10:46 am by Margaret McCartney

“It won’t hurt, and it might even help.” So goes the philosophy which some people use to justify their use of complementary medicine. Some doctors accept this, thinking that it is good if people can exercise a bit of control in a difficult medical situation. Other more cynical types like me argue that the harm could still be present – wasting time, resources or meaning that effective treatment was missed or delayed.

However another possibility has been raised by a paper in Human Reproduction - Use of complementary and alternative medicines associated with a 30% lower ongoing pregnancy/live birth rate during 12 months of fertility treatment
The study followed a group of women having assisted reproduction over a 12 month period. 30% of women were using complementary/alternative medicine at the start. By the end of the year, 42.2% of these women were pregnant/given birth, versus 61.4% who hadn’t used CAM (complementary and alternative medicine) interventions.

So are alternative treatments harmful? There are at least two problems with the study: it was neither randomised nor double blind, but observational. There may have been a factor or factors associated with people using alternative interventions that made them less likely to concieve, which was not the fault of the alternative medicine itself.

Second, the researchers haven’t given full details of the interventions – CAM is a broad term. But the results are interesting, and the subject merits further investigation. The usual teaching to medical students is to only use in pregnancy what you know to be safe, or when you have carefully weighted up the pros and cons with the woman. This approach should apply to complementary interventions too.

Posted in Complementary medicine, Parenting | Permalink

America on the case of the NHS

August 18, 2009 12:02 pm by Margaret McCartney

I’m following the US/NHS debate with a kind of bewildered fascination: all those politicians wanting to pledge allegiance to the ethos of the NHS with one hand - but continuing political meddling with the other.

What I haven’t heard acknowledged properly is the fact that the US wastes an immense amount of time, energy and money on tests and treatments that don’t actually improve health outcomes. Most of the massive screening industry selling check ups to ‘customers’ is the ultimate outcome of healthcare where sales techniques are allowed to subvert clinical need and ignore evidence based medicine. And then we come to the massive inefficiency created by a system where funding follows tests: and leads to more and more and more tests, many of which would not be done in the UK simply because they are not needed.

And nor does there seem to be much acknowledgement of the political interference with clinical decision making via the GP contract, or waiting list manipulations, or the waste of money on things like Choose and Book – which would facilitate the market based system of delivering healthcare, except that it has been unreliable for doctors and not wanted much by patients.

I apologise for linking to the Jeremy Vine show, but an excellent interview with Professor Allyson Pollock says it all. (It’s only online till 17/8/9 and is about half way through.)

Posted in Media, Politics, Public Health | Permalink

Just forget it

August 15, 2009 2:22 am by Margaret McCartney

The test was going okay, until I got to this: name four creatures whose names start with the letter “S”. It took me several seconds to get spider and seal. It took me three more hours to remember slug, even though one had appeared on the kitchen floor that morning. Scorpion and sea anemone came much later. Overall, I didn’t do terribly well.

This could have been worrying. The seemingly innocuous question was part of the simple test that, if you believe the tabloid press, “can detect Alzheimer’s in five minutes”. It is not difficult – who is the prime minister, when did the first world war start – but, having completed it, I found my memory wanting. And here’s the thing: I’m not very bothered about it.

The test, recently published in the British Medical Journal, was billed by its authors as a fast and easy way to screen for Alzheimer’s disease, enabling treatment to start early. It sounds good, but there are a number of problems.

The remainder of the article can be read here. Please post comments below.

Posted in Medical Screening, Public Health, Research, Testing treatments | Permalink

Four ways to lengthen your life

August 14, 2009 3:56 pm by Financial Times

By Rebecca Knight

What does it mean to lead a healthy life? Sure, we all have our peccadilloes – some of us smoke cigarettes, or eat too much fast food, others spend too much time on the couch, and not enough on the treadmill. (My own indulgences include too much sun, too much chocolate, and far too much red wine.)

But with apologies to John Maynard Keynes, we’re all dead in the long run, right? Do these sins against our own wellbeing make any real difference to our longevity? Some matter more than others, according to a report in the latest issue of Archives of Internal Medicine.

Researchers at the Centers for Disease Control and Prevention in Atlanta have determined that four lifestyle factors – never smoking, maintaining a healthy weight, exercising regularly and following a healthy diet -together appear to be related to as much as an 80 per cent reduction in the risk of developing the most common and deadly chronic diseases, such as cancer and diabetes, that account for most deaths.

Continue reading: “Four ways to lengthen your life”

Posted in Cancer, Effectiveness, Fitness, Healthy eating, Parenting, Public Health | Permalink

Pandemic of press releases fails to answer important swine flu questions

August 12, 2009 11:39 am by Andrew Jack

Vaccine manufacturers have been at pains to point out recently that swine flu is a one-off public health issue more than a bonanza that is likely to make them significant money over the long term: Drug groups to reap swine-flu billions

Some have even donated stocks for free or at substantial discounts to the World Health Organisation and developing countries: Sanofi to donate 100m swine flu vaccines , although others have resisted, arguing that they need to recoup their costs in order to provide supplies sustainably: Novartis rejects call for vaccine donations

But the high-minded debate has not prevented a fierce public relations battle, with Baxter, CSL and other vaccine makers each eager to grab public attention by claiming to be the first to produce the latest pandemic (or even seasonal) doses. In the process, they hope to hype their scientific prowess.

Yet such spin is largely irrelevant. Many of the richest countries have already long made their decisions on which vaccines they will buy. Others are still waiting for answers that the recent pandemic of press releases cannot answer: how much can be produced over what timescale, what the pricing will be, and which vaccines with which chemical adjuvants to boost effectiveness will the data show offer best value for money.

It’s a fair bet there may be a little less triumphalism from some of the loudest corporate shouters when the final evidence – and contracts – come out.

Posted in Effectiveness, Media, Pharmaceuticals, Public Health, Swine flu | Permalink

Testing and tamiflu

August 11, 2009 12:54 pm by Margaret McCartney

Yesterday the British Medical Journal published a systematic review and meta-analysis on flu drugs (where all trials, published and unpublished, are searched for and combined, making for a more powerful and reliable conclusion) about the effects of antiviral medication in seasonal flu in children.

The conclusions are that “Neuraminidase inhibitors provide a small benefit by shortening the duration of illness in children with seasonal influenza and reducing household transmission. They have little effect on asthma exacerbations or the use of antibiotics. Their effects on the incidence of serious complications, and on the current A/H1N1 influenza strain remain to be determined.”

We have to bear in mind that these antivirals are relatively new drugs, and that children can react in different ways to medicines from adults.

Additionally, the side effects of antivirals in children- vomiting, or nightmares – may well outweigh any small reduction in how long the flu symptoms last. The Department of Health has reacted to the trial by saying that they will not be changing prescribing policy because they say they are using a ‘safety first approach’ to swine flu.

This makes no sense to me: there are lots of things doctors have prescribed or done over decades which might have seemed to make sense but actually ended up doing far more harm than good. What this paper says to me is that there is pretty strong support for getting a decently sized and powered randomised controlled trial underway so that we have good evidence on how best to treat children should a further wave of H1N1 appear later this year or next.

Posted in Children, Effectiveness, Pharmaceuticals, Policy, Swine flu | Permalink

Bad news can get better

August 8, 2009 2:23 am by Margaret McCartney

In his illuminating book, Three Letter Plague, South African writer Jonny Steinberg describes the complex reasons why people at high risk of HIV do not take up the offer of testing. Steinberg follows a young man, Sizwe Magadla, who lives in a small, poor village. Magadla is due to get married, and his fiancée is pregnant. He owns a shop, which lends him enormous social standing. But should he test positive, he fears his marriage plans would be cancelled and his shop’s custom ruined. Witchcraft and curses are used to explain illness and medical problems; the cultural fabric wreathed around HIV is made of shame and fear.

When testing comes to the village, rapid test kits are used, which check for antibodies to HIV in a similar way to blood tests. Sexual health clinics often have trouble getting people to return for test results, so doing everything in “one stop” is highly attractive. Many clinics in the developed world find the rapid tests popular, since oral swabs mean no needles.

However, there is a risk of false positives. This occurs when the test confuses the antibodies made in the presence of HIV with other similar antibodies. The test “misreads” them, and reports the presence of HIV when there is none. But the number of false positives depends, at least in part, on the prevalence of the disease.

The remainder of the article can be read here. Please post comments below.

Posted in HIV and Aids, Public Health, Testing treatments | Permalink