Rachel Danks, PhD – Brain Blogger http://brainblogger.com Health and Science Blog Covering Brain Topics Wed, 30 May 2018 15:00:03 +0000 en-US hourly 1 https://wordpress.org/?v=4.9.6 Too Much Information? http://brainblogger.com/2010/01/22/too-much-information/ http://brainblogger.com/2010/01/22/too-much-information/#comments Fri, 22 Jan 2010 20:16:44 +0000 http://brainblogger.com/?p=3538 How things have changed. Once information was a precious commodity, jealously guarded by the elite who deliberately withheld it from the masses in order to keep them in their place. Now information is everywhere, available to everybody, all of the time. While the democratization of information is undoubtedly a force for good, is there such a thing as too much information? And, who is verifying the information? Does something become true just because it has been written?

No issue has been more affected by the explosion of information than health. A 2009 study reported that 61 percent of all Americans currently look online for health information, a figure up from 25 percent in the year 2000. More and more patients are going to their doctors having already researched their symptoms on the Internet, and already convinced of their own diagnosis. What is more, doctors are also increasingly turning to the Internet, with nearly half of doctors reporting using the notoriously inaccurate Wikipedia as a source of medical information. Interestingly, despite their enthusiasm for Wikipedia as a source of information, around only 10% of the physicians surveyed actually created new posts or editing existing entries, which is surprising when you consider that these are the very people best qualified for the task.

So, just how reliable is all this information? A study from The Annals of Pharmacotherapy compared drug information from Wikipedia with the Medscape Drug Reference (MDR), the largest online drug reference designed for practicing physicians and reviewed by pharmacists. Researchers found that Wikipedia was able to answer less than half the drug information questions answered by MDR (40.0% vs. 82.5%), Wikipedia was rated 0% for information on dosing, compared with 90% for MDR, and answers on Wikipedia were 76.0% complete, compared with 95.5% complete on MDR. Errors of omission were also much higher on Wikipedia (48 in total) than MDR (just 14).

As well as the danger of inaccurate information on Wikipedia, there is some evidence that pharmaceutical companies have intentionally tried to delete or modify Wikipedia entries that have mentioned adverse effects associated with their drugs.

The irony is, that as the amount of information available grows, and people try to find ways to pick the reliable sources from the rest, it is the ‘old fashioned’ media that may ultimately provide the path through this minefield. As people are burnt by unreliable information from unknown, or discredited, sources, they may begin to go back to the names they know and trust. The traditional newspapers and broadcasting networks may yet benefit from the this age of information, particularly in the critical area of healthcare.

References

Clauson, K., Polen, H., Boulos, M., & Dzenowagis, J. (2008). Scope, Completeness, and Accuracy of Drug Information in Wikipedia Annals of Pharmacotherapy, 42 (12), 1814-1821 DOI: 10.1345/aph.1L474

Manhattan Research Study. Taking the Pulse. 2009.

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When the Drugs Don’t Work, or Just Make it Worse http://brainblogger.com/2009/12/30/when-the-drugs-don%e2%80%99t-work-or-just-make-it-worse/ http://brainblogger.com/2009/12/30/when-the-drugs-don%e2%80%99t-work-or-just-make-it-worse/#respond Wed, 30 Dec 2009 18:26:13 +0000 http://brainblogger.com/?p=3472 When we are given a new prescription, most of us happily go away and take our medicine just like the doctor ordered. We may not study the patient information particularly carefully, and we may not follow the given advice to the letter, but we cheerfully assume that, unless we do something particularly stupid, the medication will do us no harm. But… we could be wrong.

Faking it

There is a significant and growing international business in the manufacture and sale of counterfeit medicines. The World Health Organization (WHO) estimates that up to 20% of all medicines in some areas of the world are fake. Customs data from the European Union shows that 34 million counterfeit pills, valued at €89m, were seized between October and December 2008. The European Medicines Agency (EMEA) is warning that criminal gangs are currently busy trying to cash in on the H1N1 flu pandemic by selling fake or low-quality antiviral medicines and vaccines.

Counterfeit medicines, which can be either branded or generic, appear in a variety of guises. Some contain no active ingredients while others, according to industry sources, are laced with sugar, unrelated medicines or even rat poison. While the dangers of taking a medication containing traces of poison are obvious, counterfeit drugs that contain no active ingredients can be equally damaging if they deprive a patient of an essential treatment.

Many of the counterfeit drugs in circulation are purchased online, and patients should always be wary of obtaining medications in this way. However, fake drugs can also reach patients through apparently reputable pharmacies in cases when the supply chain is not 100% secure.

Pharmaceutical companies, regulators, law enforcement authorities, and healthcare professionals have joined forces to try to combat the threat of counterfeit medicines. The Partnership for Safe Medicines is a US-based group of organizations and individuals dedicated to protecting consumers from counterfeit or contraband medicines. The European Alliance for Access to Safe Medicines (EAASM) was founded in 2007 with the objective of fighting against counterfeit medicines and promoting patient safety around Europe.

Technology also has an important part to play in tackling the problem of counterfeit drugs. The US Food and Drug Administration (FDA) is developing an electronic pedigree (ePedigree) system, scheduled for launch in 2011, to track the movement of prescription drugs throughout the entire supply chain. This technology is intended to prevent the diversion or counterfeiting of drugs by allowing wholesalers and pharmacists to determine the identity of individual products. Other technological solutions include the use of radio frequency identification to track and identify pharmaceutical products by through individual serial numbers, while techniques such as Raman spectroscopy and Energy Dispersive X-Ray Diffraction (EDXRD) can be used to uncover counterfeit drugs while still inside their packaging.

It seems that the scale of the problem is starting to be appreciated by patients. In recent research carried out by ICM, on behalf of patient safety communications company, Aegate, 61 per cent of those surveyed in Europe were aware that prescription medicines could be faked and 79 per cent of consumers reported that they feared counterfeit medicine more than any other fake product. However, even with the combined efforts of industry, patients and regulatory authorities, we may have to learn to exercise a little more caution over the medications that we routinely receive.

References

WHO Counterfeit Medicines Factsheet, July 2009. http://www.who.int/medicines/services/counterfeit/CfeitsFactSheetJuly09.pdf

Rankin J. Fake medicines…genuine solutions? Europeanvoice.com, November 2009. http://www.who.int/medicines/services/counterfeit/CfeitsFactSheetJuly09.pdf

Medicines top counterfeit concern list in Europe – consumers call for tougher safety measures. Press release, November 2009. http://www.aegate.com/aegate-news/medicines-top-counterfeit-concern-list-in-europe-consumers-call-for-tougher-safety-measures.html

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The Secret to Good Health – Listen to the Data http://brainblogger.com/2009/11/27/the-secret-to-good-health-listen-to-the-data/ http://brainblogger.com/2009/11/27/the-secret-to-good-health-listen-to-the-data/#comments Fri, 27 Nov 2009 15:17:43 +0000 http://brainblogger.com/?p=3421 A recent study proved what we all already know… that healthy living really does improve long-term health. A lot. The US-based study found that not smoking, maintaining a healthy weight (BMI <30), exercising regularly (3.5 hours/week) and eating a balanced diet (high in fruits, vegetables, and whole grains, low in meat) reduced the risk of developing chronic disease by nearly 80% over the course of the study. 80%! Just imagined if a new drug promised an 80% reduction in chronic diseases — it would be a wonder drug! People would be beating a path to their primary care providers, demanding a prescription. Shareholders in the manufacturers would never have to work again!

But, such a remedy is readily available to everyone. It costs relatively little. It isn’t particularly complicated to follow. And yet, so few of us choose to take it. Certainly, the advice could hardly be described as exciting or (for most of us) fun, but surely it’s not that difficult to follow, is it? So, why are we so reluctant to do what is so obviously good for us?

One train of thought is that while we understand intellectual arguments perfectly well in our heads, our “gut,” which largely drives our behavior, just doesn’t get it. Our gut instinct is great for getting us out of immediate trouble — the fight or flight mechanism. But it is not so good at assessing long-term risk, and modifying behavior accordingly. It is for this reason that we tend to ignore hard data that should clearly direct our behavior in one way, while we react to risks that are intellectually indefensible.

The media is full of stories that terrify us — air crashes, child abductions and knife crime. Yet, the risk of suffering from any of these is, mercifully, actually quite small. If we really examined the data, we would see that, the risk of death from driving 1,150 km (the distance of the average nonstop flight in the US) is about 65 times that from flying the same difference. Still, but we don’t think twice about jumping in the car. On average, 36,000 Americans are killed each year by flu and its related complications. But unless this happens to be “swine flu” or “bird flu,” we don’t take too much notice. And, obesity is thought to be responsible for the deaths of around 100,000 people per year in the States.

Which brings us back to healthy living… The evidence demonstrating the benefit of a health lifestyle is overwhelming. The risk of developing a chronic disease through obesity is much greater than many of the dangers we routinely panic about. We all know what we should do, we know how we should do it, now it is just a matter of persuading our gut to listen to our head.

References

Ford, E., Bergmann, M., Kroger, J., Schienkiewitz, A., Weikert, C., & Boeing, H. (2009). Healthy Living Is the Best Revenge: Findings From the European Prospective Investigation Into Cancer and Nutrition-Potsdam Study Archives of Internal Medicine, 169 (15), 1355-1362 DOI: 10.1001/archinternmed.2009.237

Gardner D. Risk. The science and politics of fear. (London: Virgin Publishing, 2008).

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If Herbal Medicine is Medicine, Shouldn’t it be Treated as Such? http://brainblogger.com/2009/10/16/if-herbal-medicine-is-medicine-shouldnt-it-be-treated-as-such/ http://brainblogger.com/2009/10/16/if-herbal-medicine-is-medicine-shouldnt-it-be-treated-as-such/#comments Fri, 16 Oct 2009 12:00:42 +0000 http://brainblogger.com/?p=3330 Recently, the UK Government announced a consultation on whether practitioners of acupuncture, herbal medicine and traditional Chinese medicine should become subject to statutory regulation. Unsurprisingly, the announcement has sparked some lively debate. Currently, most herbal remedies and dietary supplements are classified by regulatory authorities as “foods,” and therefore subject to far less stringent legal requirements than pharmaceutical products. However, if a herbal remedy offers some pharmacological effect over and above its nutritional value (and many undoubtedly do), then it becomes no longer a food but a medicine.

Medicines, including herbal medicines, make changes at a physiological level. Some of these changes are desirable and some are not. It would be irrational to imagine that any agent would have only positive benefits: if you believe an effect is real enough to do you good, you must also believe it could do you harm. The secret of good medicine is to balance the potential benefits of a drug with its known side effects.

There is a widespread perception that a herbal remedy is somehow more gentle or less ‘alien’ than a prescription drug. In fact, herbal medicines are generally no more than plant extracts containing an assortment chemicals whose actions are largely unknown. Is it really better to swallow a jumble of plant chemicals than a single, purified and identifiable one? With a prescription or over-the-counter drug, at least you know what you are getting; a herbal remedy, by contrast, can vary from one country to another, one manufacturer to another or even one bottle to another. In fact, analyses have revealed that the contents of many herbal products do not always match the ingredients listed on the labels, and some even contain dangerous poisons, including pesticides, lead or mercury. It is ironic that so many people who are so particular about what they consume are prepared to take tablets they so little about.

Despite the advances made in conventional medicines, many people live their lives in constant pain and discomfort, and are willing, or desperate, to give anything a try. It is these people more than most who must be protected from the false hopes and exaggerated claims that some herbal remedies offer.

Of course, many alternative health practitioners care deeply about their patients, and genuinely believe they can offer something that alternative medicine cannot. These practitioners stand to gain from regulation, through the increased credibility and patient reassurance that it brings. Indeed, the European Herbal and Traditional Medicine Practitioners Association (EHTPA) and National Institute of Medical Herbalists (NIMH) have both publicly welcomed government consultation. So, with support from practitioners and encouragement from the government, can it be long before alternative medicine comes under the umbrella with its better researched and more robust cousin, medicine?

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Swine Flu – A Lose-Lose Situation for Public Health Authorities http://brainblogger.com/2009/08/23/swine-flu-a-lose-lose-situation-for-public-health-authorities/ http://brainblogger.com/2009/08/23/swine-flu-a-lose-lose-situation-for-public-health-authorities/#comments Sun, 23 Aug 2009 12:00:12 +0000 http://brainblogger.com/?p=3173 After the great SARS terror of 2002 which was predicted to cause more devastation than AIDS, and the bird flu panic of 2006 when we were warned that a quarter of Britons might die, we now have the great swine flu crisis of 2009. But just as SARS and bird flu failed to deliver on their predicted devastation (together, they were responsible for an estimated 1031 deaths globally), so will the great swine flu disaster also fade away into the annals of health scares that never were?

The truth is, it is simply too early to tell. While the number of swine flu cases greatly exceeded initial predictions and early attempts at containing the virus were soon abandoned, the summer outbreak has already peaked in the US and Mexico and is predicted to peak very soon in the UK. Furthermore, although there have been a number of tragic deaths, the severity of swine flu in most cases has been relatively mild, even milder than ‘normal’ seasonal flu for many people. On the face of it, it looks as though our worst fears have not been realized. The great flu epidemic of 2009 failed to materialize. Once again, a health scare has failed to live up to its hype.

However, this is not over this yet. Flu viruses are notoriously unstable. The H1N1 virus could still mutate at any time and without warning. The antiviral treatments that seem to be having some effect at the moment could be rendered useless against an evolved version of the virus. And, although the summer outbreak in the Northern hemisphere looks to have peaked, the cooler weather of the autumn and winter may bring the virus back with a vengeance; perhaps just as we let down our guard. Furthermore, the shadow of bird flu still threatens; just because we have had swine flu, does not mean we will not have bird flu. This is not an ‘either, or’ situation.

So, real threat or phantom menace? Who knows? Only one thing is certain; nobody responsible for public health is likely to come out of this well. If governments and health authorities underplay the threat, they stand accused of negligent complacency, and if they talk-up the threat, they are accused of scaremongering. They simply cannot win.

Ultimately, if we emerge through this scare relatively unscathed, there will be the predictable backlash against the authorities for causing unnecessary panic and squandering public resources. What we will never know, however, is how much all the preemptive action was responsible for mitigating the effects of the disease. As with the millennium bug scare (and, who knows, with SARS?), those in authority may be condemned by the very success of their actions.

In practice, global health authorities have no option but to plan for the worst case scenario, and advise the public accordingly. However, as they consider ongoing and future precautions, policy-makers must know they are in that familiar territory — damned if they do and damned if they don’t.

References

Editorial (2009). Between a virus and a hard place Nature, 459 (7243), 9-9 DOI: 10.1038/459009a

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The Curse of the Nocebo Effect http://brainblogger.com/2009/07/15/the-curse-of-the-nocebo-effect/ http://brainblogger.com/2009/07/15/the-curse-of-the-nocebo-effect/#comments Wed, 15 Jul 2009 17:52:52 +0000 http://brainblogger.com/?p=3040 The placebo effect is a universally acknowledged phenomenon. In essence, if you think something is going to make you better, it probably will. If you believe that three tablets will do you more good than two, this may prove to be the case; if you believe that capsules are more effective than tablets, this may become your experience; and if you believe that expensive branded medicine must be better than the cheaper generic; this may turn out to be money well spent.

By contrast, the placebo’s darker cousin, the nocebo, is much less well researched and is rarely considered in clinical practice. The term nocebo is taken from Latin for “I will harm”* and was first formalized in the 1960s to mean something that rationally should have no effect but actually causes a deterioration in health. The difficulty in researching the nocebo effect arises because ethics review committees tend to take a dim view of trials in which an intervention is likely to cause actual harm to the subjects.

There are many anecdotal examples of the nocebo effect at work. For example, a nocebo response may explain the phenomenon of the voodoo curse in which a victim dies only because a belief in the power of the witch doctor has been so ingrained that, after he has been hexed, the target simply cannot believe that he will live. Other cases have been reported in which a patient has died after having been given a terminal prognosis; only for a post-mortem to reveal no such fatal disease was present. A few scientific studies have also looked at the phenomenon, including one in which volunteers were told that the researchers were looking for a link between mobile phone usage and the incidence of headaches. Throughout the trial a number of users reported headaches, even when (unbeknown to them), the phone they were using was actually an empty shell.

Patients taking pharmaceutical drugs often report unwanted and nonspecific adverse effects that cannot be attributed to the pharmacological action of the medicine. In a review of studies examining the reported side effects from pharmacological treatments, several factors were found to be associated with an increase in the number of such reports, including the patient’s expectations of adverse effects at the outset of treatment; a patient’s prior experience with certain treatments; and particular psychological characteristics such as anxiety and depression.

Although poorly understood, physiological explanations of the nocebo effect have been proposed. It has been shown, for example, that a patient’s anticipation of worsening pain causes an increase in anxiety which triggers the activation of cholecystokinin that, in turn, facilitates pain transmission. This response generates a vicious circle of anxiety and pain which may be one explanation of the nocebo effect.

The nocebo effect has important implications for clinical practice, and there are several measures that physicians and other practitioners can adopt to limit its damaging effects. Health care professionals should try to identify in advance those patients most at risk of the nocebo effect, they should choose their language carefully in consultations with patients, so as not to generate any self-defeating attitude in the patient, and they should always consider that nonspecific side effects of drug treatments may be due to the nocebo effect, and manage accordingly.

Placebo and nocebo are two sides of the same coin. A strong relationship and effective dialogue between doctor and patient can take advantage of any placebo response while mitigating any response from its darker and opposite number, the nocebo effect.

*The term placebo, meaning “I will please,” dates back to the 18th century.

References

Barsky AJ, Saintfort R, Rogers MP, Borus JF. Nonspecific medication side effects and the nocebo phenomenon. JAMA. 2002;287:622-7. DOI: 10.1001/jama.287.5.622

Colloca L, & Benedetti F (2007). Nocebo hyperalgesia: how anxiety is turned into pain Curr Opin Anaesthesiol, 20, 435-439 DOI: 10.1097/ACO.0b013e3282b972fb

Oftedal G, Straume A, Johnsson A, Stovner LJ. Mobile phone headache: a double blind, sham-controlled provocation study. Cephalalgia. 2007;27:447-55. DOI: 10.1111/j.1468-2982.2007.01336.x

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Natural Good, Chemical Bad – Right? http://brainblogger.com/2009/07/09/natural-good-chemical-bad-right/ http://brainblogger.com/2009/07/09/natural-good-chemical-bad-right/#comments Thu, 09 Jul 2009 14:19:09 +0000 http://brainblogger.com/?p=3005 Opinion CategoryArsenic sandwich anyone? Mercury soup, deadly nightshade surprise? No? Really? Well, I’m baffled! They’re all natural you know. And as we know, natural is good; natural is pure. Best of all, natural is healthy.

Such is the creed that has grown up around natural products. You want to market a new range of face cream –- make sure everyone knows it is natural. You want your expensive new yogurt to sell –- include the word “natural” on the packaging. The word “natural” has become byword for purity, health and goodness.

ChemicalsSo, why are we so obsessed by natural products? It may be that we associate science with all that is bad in the modern world –- pollution, climate change, the nuclear threat. By rejecting science and its associated chemicals, perhaps we believe that we can return to a gentler time in which the honest farmer toiled the land and people’s lives were more in tune with nature. While it is true that we have drifted away from nature, largely to the detriment of the health of the planet, this view is in danger of romanticizing the past into a golden age that never really existed. At the start of the nineteenth century, global average life expectancy was less than 30 years; today it is around 67. The infant mortality rate in Europe in the 1860s was around 230 per 1,000, compared with less than 50 per 1,000 in the 1950s. If you asked parents of the nineteenth century whether they wanted their child to be vaccinated against the ravages of polio, they wouldn’t understand why you even needed to ask.

The current generation living in the Western world is the luckiest in history. We have forgotten what it is like to be surrounded by death, disease and infirmity. It is because we enjoy such comfort and security that we find ourselves in a position to be picky about what we eat, wear and put on our bodies. We demand that things be natural only because science has given us that luxury.

I am not arguing that natural is bad; I am simply saying that just because something is natural, it does not make it good. Even more, I am objecting to the artificial and facile distinction between natural and chemical. If you analyze a banana, you find 39 chemicals, including 2-heptyl acetate, isoamyl acetate. 2-methylbutyl acetate and 2-heptyl acetate. Try putting this list of ingredients on a package label and see how much you sell.

The separation into natural versus chemical may be tempting, it may be convenient, but I don’t believe it’s actually helpful. Some people may find this argument gives them a headache — in which case they may like to chew on the bark of a willow. Personally, I’d rather take a couple of aspirin.

References

Riley JC. Rising Life Expectancy: A Global History. New York, US: Cambridge University Press, 2001.

Bideau A, Desjardins B, Pérez Brignoli H. Infant and Child Mortality in the Past. Oxford, UK: Clarendon Press, 1997.

Pino, JA, Ortega A, Marbot, R, & Aguero, J (2003). Volatile components of banana fruit (musa sapientum L.) “Indio” for Cuba JEOR

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