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Written and researched by Bob Murray, PhD
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Our Over-Drugged Children
Nov 1, 2005
For a long time we have been saying that pharmacology has been replacing adequate parenting as the preferred means of raising kids in the US and other Western countries. A new report adds weight to this argument.
Pediatric polypharmacy, the practice of prescribing two or more medications for psychiatric symptoms in children, is on the rise in the United States, raising concern about unknown side effects, according to a new study appearing in the August issue of the journal Psychiatry 2005.
"This is a critical issue -- it's not uncommon to find a child on an anti-depressant, a mood stabilizer, and a sleep agent all at the same time, but there's no research to see how these drugs interact with each other" says co-author Joseph Penn, MD a child psychiatrist with the Bradley Hasbro Children's Research Center (BHCRC) in Providence, RI and Brown Medical School.
The authors of the study reviewed 10 years of scholarly articles pertaining to polypharmacy in pediatric settings, and found that all the studies comparing these rates across time showed an increase in the practice. However, the authors warn there are almost no studies or published research on which to justify prescribing multiple medications for psychiatric disorders in children. Indeed many of the drugs - such as antidepressants - have been shown to be ineffective in people under 18.
According to the study, the most frequent combination were stimulants such as methylphenidate (Ritalin) or dextroamphetamine (Dexedrine, Adderall) commonly used to treat ADHD, with another psychotropic medication. And this despite the fact that ADHD is the most mis-diagnosed of all pediatric mental disorders and that Ritalin and other drugs have been shown to lead to long-term adult depression (arguably a much worse disorder than ADHD).
Another contributing factor to the increased risks of prescribing multiple drugs is the prevalence of off-label prescriptions -- the practice of prescribing a medication to children when there is not a FDA approved indication for that disorder in children.
"For example, aytpicals like risperidone are sometimes used to symptomatically treat psychosis or aggression in children, but most of these medications don't have FDA approval for use on psychiatric symptoms in the pediatric age group," says co-author Henrietta Leonard, MD, also a child psychiatrist with the Bradley Hasbro Children's Research Center and Brown Medical School. "We just don't have the efficacy or safety data to back up what is common clinical practice."
Because there are limits to the data available on the efficacy of a single medication in the pediatric age group, the authors express deep concern over the rise in polypharmacy because it could multiply the risk of adverse events. "The FDA recently questioned whether there is a link between the use of antidepressants in children and suicidal thoughts -- if there is so much concern over the effects of a single drug, how much riskier is it to prescribe multiple drugs?" Penn says.
The authors cite examples of a child on two medications for ADHD who died suddenly, and additionally describe serotonin syndrome, a serious and potentially fatal illness that can result when a child receives two medications with serotonergic properties.
In addition, the American Academy of Child and Adolescent Psychiatry (AACAP) has issued a policy statement saying, "Little data exist to support advantageous efficacy for drug combinations, used primarily to treat co-morbid conditions." The authors concur. "We need more systematic studies to establish the safety and efficacy of medications in the pediatric age group," says Penn.
Amen to that!
Our next book Raising an Optimistic Child is to be published by McGraw-Hill in February, 2006 - BM
Read more in the Psychiatry 2005
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Frequent Eating Lowers Cholesterol
December 8, 2001
People who eat frequently have lower blood cholesterol levels than those who eat once or twice a day -- even if they eat more in total, a new study has found.
Despite higher intakes of fat, those who ate six or more times a day had cholesterol levels five per cent lower on average and an associated reduction in coronary heart disease of 10 to 21 per cent. The study of 14,000 people aged 45 to 75 years was carried out in Norfolk, England and involved asking participants how many times a day they ate, including meals, snacks and biscuits. Their concentration of blood fats was then measured and the results adjusted for body mass index and cigarette smoking.
The report's authors suggest that, if their findings were applied population-wide, there could be significant reductions in heart disease. "We need to consider not just what we eat but how often we eat," they write in the British Medical Journal.
Kay-Tee Khaw, professor of clinical gerontology at the University of Cambridge, UK, carried out the research after animal studies showed "gorgers" had higher cholesterol levels than "grazers".
"Animals that gorge have a huge insulin peak after eating, which induces hepatic enzymes that produce cholesterol. The evolutionary reason for this may be that this type of animal expects a famine so needs to store energy as cholesterol," explains Khaw. "We wanted to look at a free-living human population to see if our metabolism worked in the same way," she says.
Khaw says that the best advice remains to eat a healthy diet, but she adds: "People at risk could divide up what they usually eat into several smaller meals -- perhaps eating every two hours."
Sara Stanner, a nutritional scientist from the British Nutrition Foundation says: "People perceive snacking as being bad for you, but as this study shows, it needn't be the case, especially if you snack on low-fat foods like fruit."
Our ancestral cousins, the other great apes, are all "grazers" so it would seem natural that our digestive and other systems were geared to this sort of nutritional intake. BM
Read more in the New Scientist online
Read more in the British Medical Journal online
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Frightening Look at a Mini-Epidemic
November 10, 2001
According to just-published research a virulent Beijing tuberculosis bacterial strain, one that was not previously identified on-site and that was brought in by a Liberian refugee in 1993, exploded into a micro epidemic over a 4-year period to become the most common cause of the disease on Spain's Gran Canaria Island.
The researchers report that a single Liberian refugee spawned 75 new cases, which accounted for 27 percent of all strains of TB in 1996 on Gran Canaria. The strain of TB was not present on the island in surveys conducted from 1991 to 1992. Further, this strain could be responsible for much of the worldwide resurgence of tuberculosis, and may itself represent an epidemic within the larger tuberculosis epidemic.
The research appears in the first of two October issues of the American Thoracic Society peer-reviewed American Journal of Respiratory and Critical Care Medicine.
With the burgeoning problem of refugees from wars, poverty and oppression in Africa, the Middle East and Asia the danger of this kind of epidemic is bound to increase. Of course it's not just the lands that these refugees finally arrive at that are in danger, but all of the countries that they pass through. An illegal immigrant into Australia from Afghanistan or Iraq (illegal immigration was one of the main issues in the recent Australian election), for example, may pass through Malaysia, Thailand and Indonesia before being picked up by the Australian Navy and parcelled off to one of the staging posts in Papua-New Guinea, New Zealand, Fiji or Nauru.
Read more in Uniscience online
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Running Marathons Leads to Heart Attacks
October 26, 2001
The research was published in The American Journal of Cardiology. Arthur Siegel, MD, director of Internal Medicine at McLean Hospital, and his collaborators analyzed the blood of marathoners less than 24 hours after finishing a race and found abnormally high levels of inflammatory and clotting factors of the kind that are known to set the stage for heart attack.
"My concern is for people who exercise thinking 'more is better,' and that marathon running will provide ultimate protection against heart disease," said Siegel. "In fact, it can set off a cascade of events that may transiently increase the risk for acute cardiac events."
Few studies have defined the cardiovascular risks imposed by a 26-mile run on a person with a presumably healthy heart. However, it is known that there are diminishing returns from the benefits of exercise as intensity and duration are increased. What's more, other studies indicate that overtraining leads to decreases in immune function and increases your risk of disease.
Also troubling, Siegel and his colleagues found that early stage markers used to detect heart attack in the emergency room (creatine kinase-MB, considered the gold standard) produced positive results on the runners, none of whom displayed any obvious cardiac symptoms.
"The benefits of an active lifestyle are tremendous," said Susan Kalish, executive director of the American Medical Athletic Association. "But Dr Siegel's work shows that marathoning may have its risks. If your goal is to improve your health, go for a run... but perhaps don't train for a marathon."
It is easy to see why overexercising leads to heart problems if we look at the why that humans were designed to move. Men are designed to be hunters. Hunting involves hours of walking, stalking the prey, followed by a burst of speed at the end when the spear is thrown or the ax is wielded. Women, as gatherers, were not designed for running at all. The best exercise for both sexes is walking and most studies have shown that a hour's walk a day is perfect. Our own Repatterning Movement (RPM) exercises are the ideal companion to the walking for all round flexibility and suppleness. BM
Reported in Uniscience
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Doctors 'Fuelling Antibiotic Resistance'
September 21, 2001
US doctors are prescribing antibiotics freely to people with sore throats -- even though for most the treatment is completely inappropriate. The research was published on the same day that the World Health Organization issued a warning that humans are building up dangerous levels of resistance to modern antibiotics that could leave them vulnerable to killer diseases.
The world health body said tuberculosis strains in several countries had become resistant to two of the most effective drugs and some antimalarial medicines had become practically useless as parasites adapted their defenses.
WHO Director Gro Harlem Brundtland said: "Antibiotics were one of the most significant discoveries of the 20th century. Unless we act to protect these medical miracles, we could be heading for a post-antibiotic age in which many medical and surgical advances could be undermined by the risk of incurable infection."
Results from the US National Ambulatory Medical Care Survey, conducted between 1989 and 1999, showed that 73% of patients with sore throats received antibiotic prescriptions. However, antibiotics are only helpful in about 10% of cases, in which sore throats are caused by bacterial "strep" infection. Most sore throats are due to viruses, against which antibiotics have no effect. "
Lead researcher Dr Jeffrey Linder, from Massachusetts General Hospital, said: "If you go and see your doctor for an upper respiratory infection, including a sore throat, nine times out of 10 you should not be given an antibiotic."
The researchers said part of the problem was that doctors were pressurised into prescribing antibiotics by expectant patients (see our health news stories "Patients Demand Powerful Drugs" and
"Antibiotics, the Unspoken Demand"). They warned that as well as helping develop drug resistance, excessive antibiotic use could place patients at risk of allergic reactions.
Many of the prescriptions were for newer, "broad-spectrum" drugs which cost as much as 20 to 40 times more than the two antibiotics recommended for strep throat, penicillin and erythromycin. Researcher Dr Randall Stafford said: "Patients who previously received antibiotics for viral conditions, probably received no benefit from those prescriptions.
"On their next episode of sore throat, they may feel they need a newer antibiotic because of their unsatisfying earlier experience."
Doctors need to be able to prescribe placebos, they work wonders! (See our health news stories on the subtle effectiveness of placebos "Advertising Can Make Us Well" and
"Myths of Depression Challenged", in which we discuss trials of antidepressants versus placebos.) BM
Read more in the Journal of the American Medical Association
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Forgetting What The Doctor Ordered
September 21, 2001
Researchers at Ohio State University have proven what many doctors have learned the hard way: just giving prescriptions to patients is no guarantee that the drugs will actually be taken as directed. They also found that even reminding the patients makes little difference.
The researchers have found that patients who received reminders encouraging them to take their prescriptions did so at about the same rate as others who were not reminded. In both cases, one in five reported not following the doctor's instructions.
The study's conclusions were based on a look at about 4,500 people taking a cholesterol-lowering drug. The results were reported in a recent issue of Clinical Therapeutics.
One group of the patients in the six-month study was given telephone reminders after two and eight weeks and a postcard reminder at four weeks. The other group was not given these reminders, although all participants in the study were sent postcards during the fourth and fifth months. The patients were sent periodic surveys about their compliance, which found little difference between the groups.
The point here is twofold: many people don't want to get well because they get their only sympathy and attention from others through their illness and also many people don't trust drugs and dislike their side-effects. BM
Read more in The New York Times
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Patients Demand Powerful Drugs
September 4, 2001
Women with breast cancer want the reassurance of having chemotherapy -- even if there is little evidence it will help them, says research (see our Health News article "Leading Cancer Charity Claims Chemotherapy Doesn't Work"). Women having powerful drug treatment for early breast cancer following surgery were asked whether they would make the same choice again in hindsight.
Many said they would ask for chemotherapy -- even in a situation where doctors were saying there it was unlikely to benefit them. This came as a surprise to doctors, who would not normally countenance giving any treatment which =ppears unlikely to improve the patient's survival chances.
However, the research team believes that the need of cancer patients to "take control" of their disease prompts this apparently irrational demand.
The research, published in the British Journal of Cancer, involved a survey of 78 women, who were all having regular check-ups. Some were having chemotherapy, others were not.
Although the side-effects of the drugs can be severe, including hair loss, nausea, weight loss and fatigue, in general, even the tiniest increase in their chances was enough to prompt most to choose chemotherapy. And 40% of those already on chemotherapy said they would have been prepared to take it, even if doctors said it would not improve their survival chances.
Dr Anne Stiggelbout, from the Leiden University Medical Centre, where the survey was conducted, said: "With chemotherapy there's always a trade-off between the temporary deterioration in the patient's quality of life and the chance of their cancer not returning. We wanted to know the minimum benefit that a patient would need before she would opt for chemotherapy -- just how low should we go?"
Dr Sylvia Jansen, who performed the research and interviewed the patients, said that the women's response might seem irrational, but could be a reflection of the hidden psychological benefits of chemotherapy. She said: "We think that taking the treatment may help to combat the feeling of helplessness that can come with a cancer diagnosis. As one of our patients remarked: 'At least I've done everything I could.'"
Professor Gordon McVie, director general of the UK Cancer Research Campaign, said: "We have got to remember that a cancer patient's goal is to live at all costs. This suggests that for women with breast cancer, adjuvant chemotherapy not only improves their chances of survival but also gives them a sense of control over their lives."
Not only do placebos act as effectively as the 'real' drugs (see our health news special edition story
"Myths of Depression Challenged" for research about the effectiveness of placebos in anti-depressant trials) but it would seem that the chemo drugs themselves have this placebo effect. With any illness the important thing is belief -- whether that belief is in a protecting god, a physician or a chemical compound. BM
Read more in BBC News
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Home Team: 7, Visitors: Jet Lag
September 4, 2001
Only a few more weeks remain in the baseball season. Which teams will make it to the playoffs? Which team will win the World Series? A team's travel schedule may help you make some predictions! Visiting teams may be fighting jet lag as much as they will the home team. Jet Lag causes fatigue and is caused by changes in body rhythms such as those involved with body temperature and sleep. To examine how jet lag affects the performance of professional athletes, researchers in the Department of Neurology at the University of Massachusetts Medical School examined the win-loss records of 19 East Coast and West Coast baseball teams in the 1991-1993 seasons. Overall, teams won 54% of their games on their home fields. However, home teams won 62.9% of their games if their opponents traveled west to east the day before they played. If a team traveled east to west the day before a game, the home team won only 56.2% of the time. These data show that home teams gain an advantage if their opponents must travel east the day before a game. This travel may disrupt the biological clocks of visiting players and impair players' performances on the field.
So, check the travel schedule of your favorite team. Which way do they have to travel? Do they have time to recover before they play? You may be able to predict how your team will perform.
A friend of my parents, the Australian writer Olaf Rouen, had a theory, which I used to call Rouenism, that nations never lost if they expanded westward but always failed if they marched eastward (Napoleon and Hitler are famous examples of the no-no to the east and the expansion of the United States to the west an example of the reverse psychology). What seems to be true of nations is also true of baseball teams and business travelers. BM
Reported in Science
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Passive Smoking Harms Blood Flow to the Heart
August 8, 2001
A study reported in the British Medical Journal has shown that even transient exposure to cigarette smoke is bad news. The research supports arguments that passive smoke is dangerous and a risk factor for heart disease. The American Lung Association has already estimated that passive smoking is responsible for 35,000 to 50,000 cardiovascular deaths a year.
The new research was carried out by Dr Hiroyuki Watanabe and colleagues from Osaka City University Medical School, Japan. They conducted a study of the effect of exposure to environmental smoke on coronary artery blood flow. They enrolled 30 healthy Japanese men, of whom 15 were non-smokers and 15 were smokers who had no symptoms of heart problems. The mean age of the men was 27 years, and none of them had a history of hypertension, diabetes, or hyperlipidaemia. The non-smokers lived and worked in smoke-free environments.
Blood pressure, heart rate, and coronary flow velocity reserve were measured in all participants before and after a 30 minute exposure to environmental tobacco smoke. The researchers found that, before being exposed to environmental smoke, non-smokers had significantly greater coronary flow velocity reserves than the smokers.
After exposure to tobacco smoke, the coronary flow velocity reserve of non-smokers resembled that of the smokers. They said that this was a sign of the early stages in the development of atherosclerosis and that this change may be one reason why passive smoking is a risk factor for heart disease and death in non-smokers.
Read more in theBritish Medical Journal online
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Dirty Money
August 8, 2001
Most US dollar bills are bacteria farms, cultivating dozens of potentially dangerous pathogens, a study in Ohio has revealed. The finding raises the possibility that paper money could be transporting antibiotic resistant bacteria quickly from one geographic area to another, say the researchers.
Peter Ender, chief of infectious diseases at the US Air Force's Wright-Patterson Medical Center near Dayton, Ohio, and his colleagues collected 68 dollar bills from a grocery store and a gymnasium.
They soaked the notes in a nutrient broth, and left them for 24 hours. Next, they smeared samples of the broth onto plates for analysis.
"There were a fair number of plates that were just clogged with an overgrowth of bacteria," says Theodore Pope, a co-researcher in the study.
In fact, the team identified 93 species of bacteria. Some 94 per cent of the bills harboured pathogens with the potential to cause disease, particularly in people with impaired immune systems. Particularly dangerous bacteria -- such as Klebsiella pneumonia, which causes pneumonia, and Staphylococcus aureus, which can cause food poisoning -- were living happily on seven per cent of the bills.
Read more in New Scientist
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Traffic Pollution May Lead to Heart Attacks
July 10, 2001
It has long been known that there is a link between pollution and heart disease, but that the reaction time between exposure to a particular pollutant and symptoms could be so fast is very surprising.
Almost 800 heart attack victims from the Boston area were interviewed and asked when they first started feeling the symptoms. These times were compared with data collected about levels of air pollution in the city.
The risk of heart attack was higher among those who had experienced a higher level of small pollution particles called PM2.5s in the two hours before the attack. Their risk was doubled compared to a normal member of the public -- although overall, even this doubled risk is not high.
These fine particles are mainly produced by car engines, power plants, refineries and other industries. Professor Douglas Dockery, from the Harvard School of Public Health, believes the PM2.5s are dangerous because they can get into the tissues of the lungs more easily. He said: "They can get past the normal defence mechanisms in the lungs and penetrate deeply into the air exchange regions.
According to Dockery those who have heart problems should avoid outdoor exercise on hot hazy days.
Or doing anything downtown, presumably. BM
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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