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Consumer and General Health
Written and researched by Bob Murray, PhD
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Antibiotics, The Unspoken Demand
August 22, 2001
Nothing is simple when parents talk, or don't talk, with pediatricians about antibiotics for their children, say researchers who, in effect, listened in during office visits.
The overuse of antibiotics has been linked to the spread of drug-resistant diseases. One factor in unneeded prescriptions has been the pressure doctors feel to give a remedy for viral illnesses like colds, which do not respond to antibiotics. Researchers at U.C.L.A. interviewed about 300 randomly chosen parents at a pediatric office, taped the visit that followed and interviewed the doctor. Reporting in Archives of Pediatrics & Adolescent Medicine, they found a lot of hinting and misunderstanding and a fair amount of dissatisfaction.
Half the parents said they expected their children to be given antibiotics, but only 1 percent of them actually directly asked for them. Another 8 percent expressed an interest indirectly. The pediatricians picked up an expectation of antibiotics in only about a third of the visits.
One tactic that appeared to increase patient satisfaction was discussion of contingency plans: parents who expected to receive antibiotics but did not get them were significantly more pleased with the visit if they were told that the pediatrician had antibiotics in mind if they were needed later. The study's lead author, Dr Rita Mangione-Smith, said she was surprised to find how many parents said nothing about medicine they thought children needed.
Read more in Archives of Pediatrics & Adolescent Medicine online
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Poor Smokers 'Support Smuggling'
July 30, 2001
'Sin taxes' and other price mechanisms on goods such as alcohol and cigarettes have long been a favored method used by most governments both to raise more taxes and to curb the growth of 'socially undesirable' habits. Many economists have said for a long time that such methods don't work, and research is now beginning to prove them right.
Low-income smokers living in socially deprived areas view cigarette and tobacco smuggling as a positive way to keep the cost of smoking down, according to a team of researchers from Edinburgh University. The findings follow the launch of a three-year government campaign to tackle the problem of tobacco smuggling.
The researchers say the strategy may be undermined by smokers who think black market smugglers provide a valuable service. It is estimated that up to a third of cigarettes smoked in the UK are smuggled or contraband -- amounting to 2,500 million in lost revenue during 1999. (A study carried out in Australia recently came up with similar results.)
Only a minority of smokers questioned in the study said the rising cost of legitimately-sold tobacco would encourage them to stop smoking.
Report author Amanda Amos said that while few people were prepared to openly admit to researchers that they bought illegally-smuggled tobacco, most knew where to get hold of it, how much it would cost and the brands available.
Interestingly the contraband cigarettes in the UK were mostly available in pubs or from door-to-door merchants whereas in Australia they were sold by tobacconists.
Read more on BBC News
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Bedbugs Do Bite, And They're Back With A Vengeance
July 30, 2001
All the advertisements proclaiming the wonders of Disneyland in Orlando or the splendor of the Golden Gate Bridge in San Francisco are having an effect. Tourists are flocking in their millions occupying every available room. Sometimes these overseas visitors become permanent residents and sleep many to a bed. The tourists are, in this case, bedbugs.
Called the "new scourge of America" by one expert, this blood-feeding insect has been spotted increasingly in cities that have an influx of international tourists. Infestations have been reported in hotels and motels -- and it's not just the rundown, seedy ones. Unlike the cockroach, which thrives on unkempt environments, the bedbug is not so choosy, invading posh, $1,000-a-night hotels with the same panache as it does flophouses.
Phil Koehler, an urban entomologist with the University of Florida's Institute of Food and Agricultural Sciences, said the bedbug's preferred food source -- a sleeping human -- is available no matter how clean the environment.
According to pest-control experts, increased tourism has contributed to the problem because bedbugs are transported in luggage from overseas. The U.S. Department of Commerce reported the United States had a record 51 million international tourists in 2000 and a goodly percentage of them come with unwanted and undeclared companions.
In Florida -- where pest-control companies reported a 10-fold increase in bedbug service calls from 1999 to the present -- the state had 9 million international visitors in 2000, which accounted for almost 20 percent of the US total.
Koehler said that in addition to increased tourism, a change in pest-control techniques has unintentionally aided the insect's comeback. The bedbug, or Cimex lectularius, has not been a serious problem in the United States since the early 1940s, when the pesticide DDT came into widespread use. After DDT was banned in the early 1970s, pesticides in categories such as organo-phosphates, carbamates and pyretheroids took up the slack.
But Koehler said that in the early 1990s, the pest-control industry began changing its techniques such as spraying floorboards and by 1995 had practically eliminated sprays. At the same time, less toxic insect baits and hormonal insect growth regulators came into widespread use.
"But ironically," Koehler added "the safer, technologically advanced approach to pest-control has aided the bedbug's resurgence."
Mel Whitson, technical manager for Steritech Group Inc., a Charlotte, NC-based environmental safety company, said it's the nature of the business. "When you suppress insects such as cockroaches in a targeted manner with insect baits, it allows for other parts of the insect ecosystem to rise up," Whitson said.
"No simple solution exists," Koehler said. "When an infestation hits, exterminators have to take the room apart, use pesticide spray on everything, and throw out furniture from which eggs cannot be removed." He said education is the best defence. "It's been 50 years since we've had a serious problem with bedbugs, so most hotel workers don't know what to look for," Koehler said.
Some signs of infestations are:
- Small, reddish-brown stains on sheets and mattresses.
- Similar stains at other locations that could be entrances to hiding places.
- A sickening, sweet odor.
- Bedbugs in the pockets of "popcorn" ceilings and other secreted places.
Still, pest-control experts said the bedbugs are back and won't be going away anytime soon. Koehler said the bedbug's nocturnal and secretive behavior makes it difficult to treat. "This bug is tough to eradicate," Koehler said. "Until we develop a new weapon, bedbugs will be with us."
Reported in Uniscience
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Leading Cancer Charity Claims Chemotherapy Doesn't Work
July 2, 2001
In the advertisement, placed in the UK regional press in May, the Cancer Prevention Research Trust (CPRT) said: "Evidence is accumulating that chemotherapy is ineffective in prolonging the life of cancer patients and proof of life extension is sadly lacking."
It also claimed there may never be a "magic cure" for many forms of cancer, and said efforts should instead be concentrated on prevention. Chemotherapy involves treating cancer cells with drugs designed to kill them.
In its response to an attack on the ad by the Advertising Standards Authority (ASA), the CPRT claimed pathologists made mistakes and that many cancer patients with long survival rates possibly never had cancer.
CPRT founder Victor Fallas said: "Studies have been made comparing cancer patients who have been treated by surgery with patients who were left untreated; survival was the same whether the patients were treated or not. No such studies have been carried out with chemotherapy and marginal studies which have been carried out comparing different cytoxic [cancer killing] agents have only shown a life extension of three to four months."
But Dr Victoria Wilson, Cancer Research Campaign (CRC) science information officer, said the trust's views were "completely misleading, negative and not at all helpful to anyone." She added: "It is inaccurate and depressing to say chemotherapy cannot help when people fighting the disease need to remain positive. The whole slant of what they are saying is wrong. If someone was just about to start chemotherapy, or their loved one was, it would be an extremely upsetting thing to read." She said chemotherapy was able to improve the quality and prolong the life of cancer patients.
She added the group was right to suggest there were many causes of cancer, some of which were understood, such as smoking and lung cancer. But she said it was unlikely all its causes would be understood and that cancer would be completely preventable.
Whether a drug works or not probably depends more on the patient's belief in it's efficacy. This has certainly been shown to be true of antidepressants
(see our health news special on depression) and other medications. It has also been shown that upbeat pharmaceutical advertising makes drugs more potent. The CPRT may be right as a matter of fact about chemotherapy but there is a moral dilemma here: do you advertise the truth on the basis that to tell the truth is always right, or do you suppress the truth on the grounds that you are destroying the faith in the treatment which may be the healing ingredient? More research into the efficacy of chemotherapy drugs is obviously needed. BM
Read more in BBC News
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Advertising Can Make Us Well
April 11, 2001
A recent Wall Street Journal article (April 11, 2001) in their opinion section has documented some curious moves by the FDA in America to curb advertising by pharmaceutical companies which might tend to use the well-documented 'placebo effect' to their advantage.
For a long time it has been known that the efficacy of a drug depends on two factors -- the patient's relationship with the prescribing physician and the patient's belief in the drug's powers. It would make sense, then for the big drug companies to improve the cure rate of their products by showing them in the best possible light in their advertising, thus stimulating belief, which leads to the cure.
In drug ads, therefore "everybody looks young for their age, happy and energetic," according to the WSJ, even if the drug being advertised is aimed at HIV sufferers (one of the drugs the FDA is targeting).
The reality is that Madison Avenue is merely catching up to research from the University of Connecticut that was published two years ago and which really made the pills hit the fan. This study concluded that perhaps 75% of the success of popular antidepressants is due to placebo action. Later studies on other kinds of drugs has found something of the same effect with them.
The FDA wants advertising for drugs to be 'educational' and 'informative' so that they don't rely for their success on the placebo effect created by the advertisements themselves.
However, as the article says, a cure is a cure whether its by placebo or drug action. Maybe sugar pills given a medical-sounding name, 'sucrodex' perhaps, should be manufactured and marketed by Merck or Pfizer. This wonder drug could be heavily advertised as the cure for everything. What a bonanza! Of course they would have to install some unpleasant side-effects in 'sucrodex' to really convince people that the drug was doing them some good!
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Can Mosquitos Transmit HIV?
July 2, 2001
A storm of controversy has raged around the possibility that mosquitos may be able to transmit the HIV virus, and many studies have set out to answer the question once and for all. To date there has been no verifiable recorded instance of insect transmission, though a few years ago stories appeared in the press suggesting that mosquitos were the cause of large numbers of AIDs cases in some towns in the American deep south.
According to Laurence Corash, chief medical officer of Cerus Corporation, mosquitoes do not provide HIV with the T cells the virus needs in order to replicate. The AIDS virus on used needles is infectious when injected into a human where the virus can bind to T cells and start to replicate. The human T cell is a very specific host cell for HIV. When a mosquito feeds on a person with HIV in his or her blood, the HIV enters the insect's gut, which does not contain human T cells. The virus thus has no host cell in which to replicate and it is broken down by the mosquito's digestive system. The single-celled parasite that causes malaria, in contrast, can survive and multiply in the mosquito's gut and mature into an infectious form. The resulting sporozoites then migrate to the insect's salivary glands.
Because mosquitoes inject their saliva when they bite, the parasite is passed along to the next human the insect feeds on. In this case the complex interaction between the infectious agent and the mosquito is required for transmission. HIV, however, deteriorates in the gut before the mosquito bites again and therefore is not transmitted to the insect's next victim.
Read more in the Scientific American
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Oral Sex Not Safe
July 10, 2001
The risk of contracting HIV from oral sex may be greater than previously thought. It has long been known that the virus can be transmitted through oral sex -- but the risk was thought to be minimal. However, research in the UK and US among gay men now suggests that oral sex may be responsible for up to 8% of HIV infections.
Other sexually transmitted diseases, such as syphilis and gonorrhoea, are also spread from person to person by oral sex.
Public health experts fear that the public is unaware of the dangers associated with the practice because it remains largely a taboo subject. In addition, anecdotal evidence from other countries like the US suggests that people tend to reject messages advising them always to use condoms for oral sex.
In fact, such messages can, in theory at least, put people off condom use altogether.
A report by the UK Public Health Laboratory Service (PHLS) concludes that it is important for people to be more aware of the dangers and decide for themselves the level of risk they consider acceptable. Dr Barry Evans, an PHLS expert on sexual diseases, said: "The picture that is emerging is that the risk is greater than previously thought. "Instead of a handful of cases a year in the UK of HIV being transmitted through oral sex, we are seeing 30 to 50."
A microbiologist friend of mine told me recently that it is theoretically possible for the HIV virus to spread through kissing, or even by way of tear-drops. BM
Read more on the BBC News
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'Fat Tax' Proposed
'Sin tax' has traditionally been levied on alcohol and cigarettes, often as a way of reducing consumption. Now nutritionists in New Zealand are proposing to add eating fatty foods to the list of grave sins that must be taxed. Pass me a (presently untaxed) cookie while I consider the situation.
Apparently the Kiwis have woken up to the fact that 50% of the population is overweight. And this despite their pride in their country's sporting heritage and outdoor lifestyle. More than 1,000 people die each year from obesity -- that's more than double the annual road death toll.
The report's authors include the Heart Foundation, diabetes experts and the Cancer Society. They are now recommending a special tax on sugary or fatty foods, and they want to see more information on the nutritious content of servings in cafeterias and restaurants.
The group says the current methods -- making people feel bad about what they eat -- are not particularly successful. Not surprisingly, the recommendations have received a lukewarm response, at least on radio phone-ins. Welfare groups say many low-income families rely on fast food because it is the cheapest available. They say a 'fat tax' will only penalize those who can least afford it.
Actually quite a lot of recent research shows that well-meaning education programs fail to achieve their goals. One study (released June 14) showed that gay men given intensive education about the dangers of 'unsafe sex' were more likely to indulge in risky practices than a control group who didn't have the coaching. Sex education programs in schools ditto. The failure of the 'Just Say No' and 'DARE' campaigns are further cases in point. More striking is the fact that the latest figures (released June 15) from Australia show that while, as a result of some particularly graphic and strident education programs, cigarette smoking has lowered by 25% over the last few years, marijuana smoking has increased proportionately. What none of these campaigns takes into account are the underlying biochemical/social/familial/emotional problems at the root of all these problems. These fundamental difficulties can only be treated by programs or therapies that take all these these factors into account, such as the
Uplift Program. BM.
Read more in BBC News
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Hold That Baby While I Check Your Insurance
April 29, 2001
The most effective medication for pain relief during labor is the epidural, an anaesthetic injected into the epidural space surrounding the spinal cord. It eliminates pain, allows the mother to remain awake and has no effect on the newborn. Whether a laboring woman receives an epidural or other pain control, however, depends on her insurance type, a University at Buffalo study has found.
Results of the study show that women who are residents of New York State and covered by Medicaid are less than half as likely to receive an epidural for vaginal delivery than mothers with HMO or private coverage. Further, Medicaid recipients undergoing cesarean section were twice as likely as mothers with HMO or private coverage to receive general anaesthesia, which renders the mother unconscious and increases the risk of adverse effects on the mother and her baby.
Results of the study showed considerable variation among women with vaginal deliveries in the use of either no anaesthesia or epidural anaesthesia, based on the type of insurance. During vaginal delivery, 18 percent of women with HMO coverage and 21 percent with private insurance received an epidural, compared to about 9 percent of Medicaid mothers. Among those receiving no anaesthesia for vaginal delivery, however, Medicaid mothers dominated, with 36 percent compared to 18 percent of women with HMO coverage and 22 percent with private insurance.
The real importance of this study, apart from highlighting the absurd differences in treatments, lies elsewhere. Pain and stress that a mother feels, either during delivery or prenatally, are passed on to the infant in the form of an increase in stress hormones in their systems. This may lead to high levels of anxiety and stress in later life, or even to depression. It could mean that your chances of developing depressive symptoms depend on your mother's choice of, or ability to afford, certain insurance policies. Absurd, isn't it? BM
Reported in Uniscience
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Women's Shoes: The Height of Folly
April 10, 2001
OK, so we know stillettos, with their high, narrow heels are no-nos and increase a specific knee-joint pressure called the varus torque. Increased joint pressures have been linked to the development of arthritis. But now it seems that shoes with high, wide, heels may be even worse.
A study done by Casey Kerrigan and colleagues at Harvard Medical School tested 20 healthy women who were comfortable wearing shoes with seven centimetre-high wide or narrow heels walked 10 metres wearing the shoes, and barefoot. The narrow-based heels were an average of 1.2 centimetres wide, and the wide-based heels 4.5 centimetres.
Wide heels increased the varus torque by 26 per cent, compared with 22 per cent for the stillettos. "We have shown that wide-heeled, women's dress shoes cause the same, if not greater, alterations in knee torques as narrow-heeled shoes," says Kerrigan.
The new findings have particular importance for the development of knee osteoarthritis because "women tend to wear these wide-heeled dress shoes routinely and for longer periods of time," he says. "We recommend wearing low or preferably no heels."
Although barefoot walking imposes the same forces on the knee in women and men, knee osteoarthritis is twice as common in women. Wearing high heels could explain this, says Kerrigan.
Once again we see that the further we get from our hunter-gatherer ways of doing things the more trouble we cause ourselves. BM
Reported in New Scientist
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Obesity Increases Cancer Risk
May 22, 2001
A major review of the causes of cancer led by Professor Julian Peto, and paid for by the Cancer Research Fund, has come up with some surprising results. What is not, now, controversial is their finding that 60% of all cancers are 'caused' by smoking (or perhaps a genetic predisposition is triggered by smoking -- BM). However exposure to cigarette smoke in non-smokers (i.e. from secondary smoking) has no effect at all.
Worldwide, 15% of cancer deaths can be attributed to some sort of infection (in particular hepatitis) -- although the figure is lower in the US and Europe.
Now comes the surprise. Professor Peto said: "In developed countries such as Britain and America obesity and carcinogenic infections are the major avoidable causes of cancer deaths in non-smokers."
Some of the cancer deaths linked to obesity are breast and ovarian cancers -- it is thought that the excess oestrogen produced by obese patients increases their chance of developing hormone-sensitive versions of these cancers.
Professor Peto stressed the importance of preventing people becoming obese in the first place -- as there was no real evidence that an obese person who slimmed down actually reduced their risk of dying from cancer -- although this does reduce the chance of developing heart disease or diabetes.
Read more on BBC News
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About the Author
Dr Bob Murray is a widely published psychologist and expert on emotional health and optimal relationships. Together with his wife and long-term collaborator Alicia Fortinberry, he is founder of the highly successful Uplift Program, and author of Raising an Optimistic Child (McGraw-Hill, 2006) and Creating Optimism (McGraw-Hill, 2004).
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