No placebo

Placebo effect is real, so keep drinking that snake oil

Breaking news  – German scientists have managed to prove there is a ‘placebo’ effect. While this is hardly surprising, one can almost see all the alternative medicine skeptics rubbing their hands together in glee and unanimously shouting out, ‘I told you so!’

But what does this experiment really prove? Should the sick give up fighting for the only thing they may have left – hope? Or should they just be a little more wary of doling out cash to those claiming fail-proof cure-all treatments?

No doubt, every type of treatment comes with associated risk. Complimentary therapies are no exception. Nothing makes the blood boil more than when parents expose their to risky therapies due to their own  beliefs and then suffer the consequences.

For example, chelation therapy used to treat epilepsy, or homeopathic treatment used for eczema. And what about when the alternative therapy is God? A toddler died due to his parents’ committment to faith healing church.

In all cases, the children died. But the question is, was it the treatment that killed them or perhaps negligence on behalf of their parents?

Complimentary medicine is  just that – complimentary. But what also occurs is that ‘scientific’ tests often prove the therapies to have ‘negligible’ benefits.

However, these tests fail to take into account that ancient medicines such as TCM (Traditional Chinese Medicine) and Ayurveda are designed with each individual person in mind. They are rarely of the western concept of ‘one tablet fits all’.

In addition, they are not meant to be medications taken in isolation of diet and lifestyle. And they rarely ‘fast absorbing’ or ‘quick acting’.

When it is a matter of health, putting faith and money into one alternative basket can be risky. But hope is nothing to be sneered it. Just do the research, keep your doctors in the loop and maybe invest some of that hope in a complimentary basket.

Links:

Latest News: “Supplements for joints don’t work“

Left out in the cold

Certain cold & flu medications could soon require a trip to the GP

When I recently purchased my pseudoephedrine, I was fairly certain that the girl at the counter was giving me more than a cursory glance. She was not one to be easily fooled, despite my snotty nose, puffy red eyes, plegmy cough or my husky 1300-number voice. 

I was asked to produce  my driver’s licence, and even though she was not familiar with a waratah or Wales, much less one that was new and south, I soon had, in my hot little hands, the only relief I could find over-the-counter.  But this could all be about to change.

The medicine is a major component of the drug, ‘ice’ or ‘meth’, and attempts to curb illegal purchase of it by requiring ID and a one packet limit have largely failed. The NSW Drug Squad have estimated that a third of the pseudoephedrine used to make ice is bought or stolen from pharmacies.

NSW Police are keen to have pseudoephedrine-based medicines reclassifed so they could be accessed only through obtaining a prescription from a GP.

By restricting access, an additional burden may be placed on the health system, not to mention the increase in time and money required for legitimate users of the drug to visit the GP.

On the agenda for while, has been a bid to legalise marijuana for medicinal purposes, such as cancer. Naturally this would require a trip to the doctor’s office. However, the restrictions placed on cold & flu medications may make the pain relief from cannabis all but a distant dream for sufferers.

In the increasing ‘war on drugs’, that the ‘good guys’ appear to be losing, there have been numerous bids to legalise drugs entirely to stop drug-related violence.

Prohibition creates violence because it drives the drug market underground. This means buyers and sellers cannot resolve their disputes with lawsuits, arbitration or advertising, so they resort to violence instead.

– Jeffrey A. Miron, Senior Econ. lecturer, Harvard University

The proponents of this war will not give up easily and it seems unlikely that a trip to the GP will bring the drug trade to its knees.

Mindfulness over matter

Mindfulness can improve doctors' quality of care

The constant demands and time pressures force many of us to multi-task and lose focus leading to burn-out. But when our doctors burn out, they are

more likely to depersonalize their patients and treat them as objects rather than as individuals suffering from disease. They are less professional, exhibit less empathy and are more prone to making errors.

Depression and suicide are also then more likely. The Journal of the American Medical Association recently published a study to determine whether an intensive educational program in mindfulness, communication, and self-awareness would improve the doctors’ well-being, their psychological state and also  their quality of care when relating to patients.

Mindfulness meditation differs from the concentration form of meditation. The intention is to be fully aware and awake of what is going on in the present moment but not to be focused. While the breath is still important, no attempt to direct attention is made.

Whatever thoughts, so called distractions, sounds, images, ideas, or feelings arise, nothing is excluded…We simply pay attention to whatever is there… we just sit quietly and observe.

The results of the yearlong study that included mindfulness meditation; writing sessions; discussions; and lectures on topics like managing conflict, setting boundaries and self-care were promising.

The participating doctors became more mindful, less burned out and less emotionally exhausted…And those changes correlated with a significant increase in attributes that contribute to patient-centered care, such as empathy and valuing the psychosocial factors that might affect a patient’s illness experience.

Some of these improvements persisted even after the course ended.

As our health is often in the hands or perhaps more importantly, in the minds of doctors, we can hope that they are mindful about what they are doing.

But the most important person involved in your health and well-being is you. So take a deep breath and try being mindful in your own life.

Exercise, what is it good for?

Exercise good for cancer patients

The end of the week is nearing and it’s time to lift our spirits with more positive health news stories:

The British Medical Journal conducted a study that concluded that exercise reduces fatigue in cancer patients undergoing chemotherapy.  The study assessed 269 patients and the effect of group exercise including cardiovascular and weights training with high and low intensity components.

 The study concluded that exercise,

“reduced fatigue and improved vitality, aerobic capacity, muscular strength, and physical and functional activity, and emotional wellbeing, but not quality of life.^“

The NHS recommends that moderate intensity but  low-impact exercise was just as effective as lowering the risk of heart disease as high-impact exercise. The only downside is that low-impact activities were not effective in maintaining healthy bones to protect against osteoporosis. 

“Low-impact exercise doesn’t put the joints under much stress,…it’s less likely to cause an impact-type injury, such as an ankle sprain or cartilage tear.”

– Robin Gargrave, executive director of YMCAfit

But if your goal is to have those super-slim thighs, then it  isn’t necessarily the answer to a long life. The BJM introduced research conducted by the Research Unit for Dietary Studies, Institute of Preventive Medicine, Copenhagen University Hospital,

A low thigh circumference seems to be associated with an increased risk of developing heart disease or premature death

So the overall news is good – exercise is good for improving fatigue for cancer patients undergoing chemotherapy, low-impact exercise is just as good for reducing cardiovascular disease as is having slightly thicker thighs.

The letter of the law

Medical bureaucracy gets in way of patient care

Bureaucracy and red-tape are words that are never far away when dealing with the health system. When does it go to far?

This week, a British war veteran died from cancer after receiving a lung transplant. Unfortunately, the lungs developed a tumour, that were caused by the donor’s severe smoking habit. According to hospital rules, he was unable to receive another transplant as he was a cancer patient.

Last month, a top US orthopaedic surgeon will be forced to leave the country in a visa bungle. Dr. Trost arrived on a retirement visa, but when a regional hospital in Queensland required his services, his sense of duty had him back at work. He was promised that once his work was completed, his retirement visa would be reinstated. Unfortunately, the new restrictions on foreign-trained doctors over the age of 45 (Dr. Trost is 77), have meant that he will have to return to the US.

“I didn’t come here to get a job,…But when duty called, I felt I had a responsibility to help my fellow man... If I’d not gone back to work, I’d be happily retired and still living the dream. We don’t want to go. This is our home. But we have no choice.”

And earlier this year, another doctor was unable to see patients due to the delay in renewing his provider number.

At some point, surely, reason would have to kick in.  Bureaucracy in other fields may cost time and money, but when it comes to the medical industry, it can mean lives.

Lost in the system

Patients lost in system without case manager

While my previous post (See ‘Doctors, Fatigue, Coffee and Mistakes) discussed the disadvantages of doctors working long hours leading to fatigue and mistakes, the other side of the sword seems that a  reduction of training hours and the reduction of  doctors’ hours is harming patients also.

We now have a clear message from the frontline that patient care is being made significantly less safe through systems that lead to poor continuity of care, the loss of teams and ‘wildcat’ closure of services

– President John Black (Royal College of Surgeons)

So how can we strike a balance so that a patient receives the necessary continuity of care without worrying that their doctor will make a fatal mistake?

In the United States, the speciality of internal medicine trains doctors who provide, long-term, general but comprehensive medical care in treatment rooms and hospitals.

They are trained to diagnose, treat and prevent various conditions and diseases of adults. Typically, they will determine and manage the specialists required to treat the patient.

In Australia, physicians offer similar services. However, despite my  lengthy experience with the public health system, I am yet to come across one. So the questions that need to be asked:

• If one suffers from more than one condition or disease, who takes responsibility for the care?
• Is it the prevailing disease that determines the speciality care?
• Who ensures that the medication provided by one specialist is not contraindicated against another?

Hospitals around the world are renowned for their complex system of medical departments, mostly specialising in a particular part of the body: renal (nephrology) for kidneys, rheumatology for bones / joints, cardiology for heart, etc.

But what happens to the person as a whole? Who is looking after the patient from beginning to end? It is very easy to simply get lost in the system.

While the recent case of a decomposing body found in hospital was found to be human error, it is certainly not alone in a long list of medical errors where there is lack of continuity of care once a patient has been admitted into hospital.

The overhaul the patient record system that would include the prevention of contraindications, the proposed ‘e-Health’ computer system, is still rife with errors and may not solve the problem. But presciptions are not the only problem.

We need a system where the patient is more than a bed number, more than a condition and where someone takes charge. Suggestions welcome.

Added Extras

There is continued debate over whether governments have the right to fortify our foods and drinking water with vitamins and minerals as a public health strategy, in order to address a health problem.

Have we become a ‘nanny’ state, where governments have to make decisions regarding our diet for us, that we apparently no longer able to make for ourselves?

Call to add fluoride to bottled water

Fluoride

Take the case of fluoride added to our drinking water. According to the Victorian Department of Health’s Chief Health Officer,

Water fluoridation helps protect teeth against decay, and is the most effective way of allowing everybody access to the benefits of fluoride. Scientific studies have shown that water fluoridation is a safe and effective way to reduce tooth decay, even though there is widespread use of fluoridated toothpaste.

Earlier this year, there were calls for fluoride to be added to bottled water. Does this remove our right to chose what we put into our bodies?

The debate continues with the use of fortified foods, such Vitamin D, Iodine and folate.

Vitamin D

Studies indicate that Australians suffer from Vitamin D deficiency. While most Vitamin D should be obtained from exposure to the sun, which presumably is readily available in Australia, certain food sources contain significant amounts of vitamin D.

Rich sources are fish, especially fish with a high fat content, such as sardines, salmon, herring and mackerel. Other sources of importance are meat, milk and eggs, and fortified foods such as margarine.

In Australia, there is mandatory Vitamin D fortification of table edible oil spreads (eg, low-fat spreads) and table margarine, and voluntary fortification of modified and skim milks, and powdered milk, yoghurt and table confections (eg, Frûche dairy products) and cheese.

While the United States fortifies a large variety of foods, the fortification levels and range in Europe is very low.

Iodine now mandatory addition to bread

Iodine

And now, Iodine is on the hit list as an added extra in our foods. In fact, it has now become mandatory to fortify the bread in Australia with iodine. While iodine can be an important factor in the development of newborn babies, the AMA concedes that,

Although we haven’t seen any large numbers of babies born who are severely iodine deficient over the years, it’s the subtle changes that are important, … anything that we can do that gives babies the best chance and the best start in life is really worth doing

So is adding things into our food and water for the good of those that are not able to make wise choices for themselves? Some of the commentary on response to the iodine article include:

It has to be pointed out that a healthy, balanced diet will provide sufficient Iodine in most cases. We can’t just keep shoving stuff in bread and water to make up for people’s poor dietary choices.  (Ford: 09 Oct 2009 10:44:34am)

Yet the point of the article was that iodine levels in the average population are deficient, so there goes that statement. So the alternative is let the people get sick, afterall it is their own fault, resulting in more pressure to our already overtaxed health system when those people get sick. Brilliant idea – NOT. (lopati: 09 Oct 2009 11:13:04am)

 That’s not true, particularly in Australia. You could be eating a ‘healthy’ diet of home grown fruit and vegetables in many places (like Tasmania, Canberra, Adelaide Hills to name a few) and not getting sufficient iodine because it is deficient in the soil. If you were also avoiding salt (because it is linked with increased blood pressure) or not using iodised salt it would be easy to become iodine deficient. (luke warm: 09 Oct 2009 12:21:31pm)

Iodised salt can be bought anywhere, however some people are affected by too much iodine…so it is unfair to force this onto the public! If you need iodine, ask your doctor what the side effects of overdosing will be and how it works with any medications! You don’t know all the additives in food that can cause so many problems. (Pat Johnson: 09 Oct 2009 10:59:42am)

According to Australia’s Policy Guideline – Fortification of Food with Vitamins and Minerals, the mandatory addition of vitamins and minerals will only occur if there has been a demonstrated significant health problem and that the additives do not result in detrimental excesses or imbalances in the intake of the general population.

What but does this mean for those who would suffer ‘detrimental’ excesses? According to Deakin University’s Adjunct Professor Joe Lederman,

Australian consumers should have the right to claim for compensation if they are adversely affected by food which has been fortified with additives by Government mandate

Folate

He said while that attempts to encourage pregnant women to increase their folate intake through folic acid supplements and voluntary fortification of certain foods with folic acid, had resulted in a 30 per cent decrease in neural tube defects among non-indigenous infants, there was no change in the rates of these defects in indigenous Australian infants.

He also claimed that the mandatory fortification meant that,

Australians would be exposed to significantly raised levels of synthetic folic acid (that) …might cause serious illness or mask other serious health conditions.

He concluded that this mandatory fortification should be accompanied by a legal right to compensation should it result in ill-health in the future.

Perhaps education  regarding good diet should go hand-in-hand with the availability of fortified and non-fortified foods (and water), giving consumers the ultimate right to chose and the responsibility of what is right for their bodies.