Healthcare

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Margaret McCartney

Sibutramine, the weight-loss drug otherwise known as Reductil, has had its licence suspended after a European-level review concluded that it raised the risk of non-fatal heart attacks. The good news for those taking it is that it wasn’t a terribly effective medication in the first place. Despite our massive efforts to find one, a pharmacological solution to obesity remains stubbornly out of reach.

The drug still prescribed for weight loss, orlistat, can also be bought over the counter at a different dosage, as Alli. Both orlistat and Reductil reduce weight; the problem is what happens afterwards. Orlistat cuts an average of 3kg compared to control groups. However, it also has unpleasant gastric side effects – a common reason why patients stop taking it.

Continue reading “The bigger picture”

Margaret McCartney

Old age is often beset by a variety of illnesses and health risks, and we end up taking a large number of pills as a result. But even though the elderly are more likely to need multiple medications, we still do not know enough about the effect these medicines have, since older people are rarely included in trials. As Professor Peter Crome, former president of the British Geriatrics Society, says: “They [the elderly] are less likely than younger people to have clinical trial evidence on which to make decisions about the risk and benefits of drugs and other treatments.” This, he believes, is a form of age discrimination.

One study showed that even though almost 40 per cent of heart attack patients are over 75, only 9 per cent of people taking part in treatment trials for heart attack were in this age group. A new project is trying to correct this distortion. The scheme, PredictEU, is examining the reasons why older people are under-represented in trials across Europe. Using this information, it’s organisers have drawn up a charter for the rights of old people in clinical trials.

Continue reading “The trials of age”

Margaret McCartney

Well-meaning medicines can have devastating effects. Antipsychotic drugs, administered in nursing and care homes to dementia sufferers, are making headlines because of the fatal harm they supposedly cause.

This is not news: knowledge of the drugs’ adverse side effects has been festering for several years. What is new is the official attention now being paid to the problem.

Continue reading “Drugged and confused”

Margaret McCartney

In September this year, a young woman fell ill and died, hours after she was injected with Cervarix, the vaccine intended to prevent cervical cancer.

Several media reports questioned the safety of the vaccine and called for the schools vaccination programme to be scrapped. The batch of vaccine was quarantined until investigations could be completed, but after a postmortem concluded that the schoolgirl had died of a previously unknown tumour, the vaccination programme continued.

I am no great fan of Cervarix, but not for safety reasons. Rather, I am not convinced that doubts about its performance have been adequately addressed by research. The management of this unexpected fatality, however, was faultless. The possible link to the vaccine was instantly spotted and properly reacted to. Deaths in young schoolgirls are uncommon, so the potential danger was easier to identify, and in this case it was relatively easy to rule out.

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

Margaret McCartney

News from the US, I can scarcely believe it: The New York Times reports that the American Cancer Society now accepts that screening for breast and prostate cancer is not only inefficient, but frequently inaccurate and alarmist. It has realised that such programmes – designed to detect cancer early – can do damage too, because they often detect cancers or pseudocancers that were never going to maim or kill.

That is the bit I can believe. After all, these are evidence-based observations, and none is particularly new. A recent paper in the Journal of the American Medical Association (Jama) also highlighted the weaknesses of screening. What I have difficulty with is that paper’s conclusion: “To reduce morbidity and mortality from prostate cancer and breast cancer, new approaches for screening, early detection, and prevention for both diseases should be considered.” The problem with screening and even early detection is that because these two elements sound useful, we have great difficulty in believing it when the evidence tells us they are not.

The Jama paper states that, after 25 years of screening, “conclusions are troubling: Overall cancer rates are higher, many more patients are being treated, and the absolute incidence of aggressive or later-stage disease has not been significantly decreased”. The authors also say that screening comes at significant cost, including overdiagnosis and overtreatment. The complications of therapy are likely to get worse as the population ages. Not only that, but treatments for relatively indolent disease may in themselves do harm.

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

Margaret McCartney

I’m no slouch when it comes to professional lingo, but at a conference last week, I was outjargoned in 30 seconds. I heard: “intervention support worker”, “management advice counsellor”, “duty liaison officer”, and clients as “the service key”; I could be anywhere, I thought – a bank, a beauty counter, or, oh yes, the NHS.

I have a loathing for fancy opacity, especially when it confuses, bewilders or misleads. And so I come to “mindfulness meditation”, an intervention being touted in so many areas of healthcare that it makes my head spin. It involves (depending who you believe) “specific behaviours, experiential manifestations and implicated psychological processes”, not to forget “temporal stability, situational specificity” and a speculation on “the conceptual and operational distinctiveness of mindfulness” (all this from the journal Clinical Psychology: Science and Practice). Basically, it’s about concentrating on your breathing, thinking about the present, and relaxing. The aim is to produce a state of heightened awareness, focused on the moment, without getting caught up in anxiety or stress.

And mindfulness is very big. There are courses on it everywhere, and the potential applications – well! From treating chronic coughs to preventing depression relapse, from coping with cancer, attention deficit disorder, anxiety and bone marrow or organ transplants to insomnia, and from improving white cell counts in HIV sufferers to treating heart-failure patients. It is even recommended for improving “attentiveness, self-awareness, acceptance, wisdom and self-care in dentistry”. It sounds so nice, so free of side effects and so mystical, enabling us to leave mere medical professionalism behind for that precious role of “healer”.

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

Health and science blog




This blog, part of the FT's health series, is a forum for readers interested in the science, policy, management, technology, business and delivery of healthcare.

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Margaret McCartney is a Glasgow-based GP and FT Weekend columnist. She started writing for the Life and Arts section in 2005 and moved to the magazine in 2008. She also has her own blog: www.margaretmccartney.com/blog

Clive Cookson has been a science journalist for the whole of his working life. He joined the FT in 1987. Clive, the FT's science editor, picks out the research that everyone should know about. He also discusses key policy issues, from R&D funding to science education.

Andrew Jack is pharmaceuticals correspondent, covering the industry and public health issues. He has been a journalist with the FT for 19 years, based in London, Paris and Moscow

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