What Doctors dont tell you 21 sept

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E-news broadcast - 21 September 2006 No.294

 

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News Contents

 

 

· PARENT OF THE WEEK: Father spends own money to prove suicide

link to acne drug

· AMERICAN MEDICINE: The monster that ate itself

· HOW TO KEEP YOUR CUSTOMERS: Give them more nicotine

 

· EAR INFECTION: Doing nothing is as good as antibiotics

 

· STENTS: Back to the drawing board

 

 

 

 

 

PARENT OF THE WEEK: Father spends own money to prove suicide link

to acne drug

 

 

Our Parent of the Week award goes to Liam Grant, who has spent

£340,000 of his own money on research that suggests the acne drug

Roaccutane may be linked to depression and suicide. Mr Grant's own

son, also called Liam, committed suicide while he was taking the

drug.

 

One of the studies, which was published by the American Academy of

Psychiatry, scanned the brains of 15 Roaccutane patients and 15

others who were taking another acne drug. There were changes in the

brains of the Roaccutane group that were associated with depression.

 

Roche, the drug's manufacturer, has already offered to pay Mr Grant

all of his research costs together with a no-liability sum of

£800,000. Mr Grant has refused to settle and is instead pressing

for a public hearing in court.

 

Despite the behind-the-scenes offer, Roche's public stance is to

vigorously deny any link between Roaccutane and depression and

suicide. The drug has been suspected of causing more than 100

suicides or attempted suicides over the years, and Roche has been

forced by drug regulators to include a warning of possible suicidal

tendencies in the drug information sheet.

 

Researchers at Bath University have also recently established a link

to depression in a study involving mice. It's not known if similar

behavioural patterns would be replicated in humans, the researchers

conclude, but we think we know the answer Mr Grant might give.

 

(Source: The Guardian, 19 September 2006).

 

 

 

 

 

 

 

AMERICAN MEDICINE: The monster that ate itself

 

 

 

The main driving force of the American medical model is money rather

than health care. Because money from insurers is in ready supply,

doctors adopt a more interventionist and aggressive approach, which,

in turn, increases the premiums, and so on, round and round.

 

Not surprisingly, perhaps, the wheels are starting to fall off, as a

new survey has discovered. It found that 40 per cent of all

Americans have 'serious problems' paying for health insurance as

premiums continue to rise, while a similar number couldn't make a

quick appointment with a doctor. Even those who jumped those two

obstacles then found they were dealing with a mountain of paperwork

relating to their claim, and with disputes with the insurer.

 

While 40 per cent of those with a household income of less than

$50,000 a year reported a serious problem in paying their health

insurance, a third of those earning up to $75,000 were also having

difficulties.

 

The survey, carried out by the Commonwealth Fund, involved

interviewing a representative sample of 1023 adults. Its working

group is due to report back with recommendations at the end of the

month.

 

As a starter, the vicious circle could be broken at the doctor's

surgery with a more conservative approach to healthcare, perhaps.

 

(Source: The Lancet, 2006; 368: 963).

 

 

 

 

 

 

 

HOW TO KEEP YOUR CUSTOMERS: Give them more nicotine

 

 

 

It's been a tough couple of decades for the tobacco industry, what

with it killing off quite a few of its customers. Not surprisingly,

the remaining healthy ones may be thinking twice about smoking,

which presents an interesting challenge for the industry.

 

Fortunately, it's one that the manufacturers are meeting head on -

by making sure that existing smokers get more of a nicotine fix each

time they puff.

 

Health officials in Massachusetts have found that there's been a 10

per cent increase in the amount of nicotine that's inhaled from

cigarettes over the past seven years.

 

Nicotine yield - which is the amount inhaled rather than the amount

in the cigarette - has increased in 92 of the 116 brands monitored

by officials, and across every type of cigarette, such as 'full

flavour', 'light' and 'ultra-light'.

 

Massachusetts is just one of three states that requires tobacco

companies to submit annual information on the nicotine content of

its cigarettes.

 

The state's health commissioner, Paul Cote, said that smokers could

need " additional help in trying to quit " . Time to crank up that

nicotine content again.

 

(Source: British Medical Journal, 2006; 333: 566).

 

 

 

 

 

 

 

EAR INFECTION: Doing nothing is as good as antibiotics

 

 

 

Around 15 million prescriptions are written every year in the USA

for an antibiotic for children with the ear infection, acute otitis

media.

 

But, as a new study reminds us, the drug merely creates resistance,

and does nothing to cure the problem any faster than doing nothing.

 

In all, 283 children with the ear infection were either given an

antibiotic immediately or were told to 'wait-and-see' for 48 hours

before taking the drug.

 

There was no difference between the two groups in terms of fever or

otalgia, or ear pain - and yet, interestingly within the 'wait-and-

see' sub-group, those who finally took the drug experienced worse

fevers and more ear pain.

 

So there's yet another example that doing nothing first is the best

policy - and it's one that has already been adopted in the UK,

Holland and other northern European countries for cases of ear

infection. Perhaps, now, the USA will follow suit.

 

(Source: Journal of the American Medical Association, 2006; 296:

1235-41).

 

 

 

 

 

 

 

STENTS: Back to the drawing board

 

 

 

Drug-eluting stents were supposed to be the great way forward in

artery health in people with atherosclerosis, the disease where

plaque narrows the artery.

 

Not only did the stents employ the latest technology of releasing

small amounts of a drug, they were also more effective than standard

stents, according to early trials.

 

As a result, six million people have been fitted with this new

generation stent, which includes the Cypher (sirolimus) and the

Taxus (paclitaxel), in the last few years.

 

But a new study has discovered that they can dramatically increase

the risk of death and heart attack through thrombosis.

 

Two Swiss researchers made the discovery after they carried out a

meta-analysis of studies to discover the long-term effects of the

drug-eluting stent.

 

In itself, there's nothing particular clever about the stent; in

fact, it's a form of micro scaffolding inserted into the artery to

keep it propped up. It can be fitted after angioplasty, where the

arteries are unblocked, or it can be inserted into patients for whom

angioplasty is not appropriate

 

But the standard bare metal or uncoated stent hasn't been a great

success. In one study in 2002, 26 per cent of patients who had a

standard stent fitted still suffered re-stenosis, where the arteries

block up again - while not one patient with a drug-eluting stent

suffered re-stenosis.

 

The rest, as they say, is history.

 

(Source: Proceedings of the World Congress of Cardiology,

Barcelona).

 

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