January 16th, 2008 by Dr. Val Jones in News
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We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.
– The US Declaration of Independence, July 4, 1776
When I was in college I spent my summers working with mentally and physically disabled adults in group homes and camps. Many of the patients had IQs<75, which presented a unique communication challenge. Emotional outbursts were not uncommon as the adults used the only form of communication that seemed to draw attention to an immediate need. I spent a lot of my time trying to predict needs before frustrations bloomed, and after getting to know the peculiarities of each individual, I could generally keep the group in a fairly content state.
Most of the adults were on a long list of medications – some were for epilepsy, others were for heart defects, but many were antipsychotics and sedatives. At the time I didn’t realize exactly what each medicine was for, and wondered why these relatively young men and women needed so many pills.
In retrospect I believe that many of the medicines were a misguided attempt to control behavior. It’s analogous to giving someone, with their hand in a bucket of very hot water, a pain medicine instead of removing their hand from the bucket. And now new research in the Lancet suggests that antipsychotic medications (such as haldol or risperdal) do little or nothing to control aggressive behavior in the mentally disabled (though not psychotic) population.
So why have we been giving mentally disabled individuals antipsychotics for decades? Sadly, we thought that these pills would provide a quick and easy way to conform their behavior to our sensibilities, without having to get to know the reasons for their frustrations. And of course, these people weren’t intellectually sophisticated enough to question the utility of this approach or to decline the use of such medications.
I find it terribly sad that it has taken us this long to realize that giving anti-psychotics to mentally impaired people is not in their best interest. Surely more evidence would have been gathered prior to subjecting “normal” adults to such treatments. In this imperfect world, it does seem that those without a voice are less often heard. It is our responsibility as healthcare professionals to look after their interests and not take the easy way out. Mentally disabled individuals have the right to express themselves, and to be free of unproven and unnecessary drug treatments. Life, liberty, and the pursuit of happiness. Our own Declaration of Independence argues as much.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
October 18th, 2007 by Dr. Val Jones in News, Opinion
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You might have seen the recent news about the middle school in Maine – King Middle School, in the Portland school district – that is planning to provide birth control to pre-teens, without requiring explicit parental consent. School officials argue that this will help to prevent pre-teen pregnancies, and estimate that at least 5 out of 135 of their 11- to 13-year-old female students are sexually active already.
While I absolutely sympathize with the desire to avoid pre-teen pregnancies, and I do understand that there is a reality here that some very young children will become sexually active at the tender age of 11, I personally do not support giving pre-pubescent girls hormone-altering tablets. We do not have good studies demonstrating the safety of such therapies in children, and until we do it’s just not medically sound to be offering this treatment. (For example, we don’t know what extra estrogen does to early breast buds, or whether there’s an increased risk for developing breast cancer later on.)
I also think that 11 year olds are not physically and emotionally prepared for sexual intimacy – and the prematurity of this event could be quite harmful for their psyche. We know that 11- and 12-year-old brains are not fully developed to think the way adults do, so there’s really no telling what impact it could have or what long term psychological effects might result.
Apparently sex before the age of 14 is illegal in Maine, so (although there’s no doubt that it may happen prior to that age) it seems that the state’s legal system is not in step with their school system, and that needs to be looked at. It is inconsistent to claim that an activity is illegal for children and then enable it with tax dollars.
I suppose that education about the use of condoms and access to them (without aggressive promotion of them) may be acceptable at this age. After all, condoms can prevent STDs and don’t have medical effects on the body as a whole. But my plea is that parents take the lead here – and educate your children about the risks of STDs, pregnancy, and the emotional damage that premature sex can have on a young person. Advocate for abstinence as a first choice, explain that condoms are non-negotiable, and try to help them turn their focus away from sex and towards more age-appropriate endeavors.
A new Dove advertising campaign asks parents to talk to their kids before the beauty industry does, and I think the same goes for sex and the media. Today’s parent must launch a preemptive strike against the over-sexualization of children, or risk having their 11 year olds taking estrogen patches from a school nurse without their consent.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
September 23rd, 2007 by Dr. Val Jones in Health Tips
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If you’re one of those unlucky souls who is easily nauseated by riding in planes, trains, and automobiles – and forget about boats, they’ll keep you hanging over the rail for hours – then welcome to the motion sickness club. You’ve probably already read about your treatment options, but you may not find any of them completely satisfying.
Motion sickness (like car sickness, sea sickness, etc.) is caused by an uncoupling of input from the eyes, ears, and joint position-sensing nerves throughout your body. In other words, your brain becomes confused by conflicting messages about where your body is in space. If you’re sitting in a chair, your brain expects it to be fixed and not to move – but then if that chair is in a car or on a boat, the movement doesn’t make sense to it, and you become dizzy and nauseated. The details of the science behind motion sickness is quite complex – and there are many different approaches to treating and preventing it.
In terms of medications – antihistamines such as Benadryl (diphenhydramine), Dramamine, Antivert (meclizine), and Phenergan and anticholinergics like Scopolamine may be the most commonly used. They have varying sedative side effects which can be very inconvenient for those who need to be alert and active immediately after they get out of the car, train, boat, etc.
Some people have used Zofran (ondansetron) for motion sickness prevention – and although this drug is only approved for the treatment of nausea side effects caused by cancer chemo and radiation therapy, it has a unique mechanism of action for preventing nausea. It works by blocking serotonin receptors in the brain (and perhaps in the gut) to head off motion sickness. It does not produce drowsiness as a side effect, and is generally well tolerated. Unfortunately, it is very expensive (about $50 per pill – without insurance).
Personally, I try to stay away from medications as much as I can (they always have the potential for unwanted side effects) – but if you’re really struggling with motion sickness and have exhausted all your options, you might want to ask your doctor about Zofran. I must admit that for me (someone who gets ill just looking at amusement park rides), a little bit of Zofran has radically improved my traveling difficulties. In fact, I’m writing this blog post from a seaside vacation spot in sunny California… and I have no worries about the flight home, choppy air or not. Bring on the deep sea fishing, parasailing, and jet skiing – I have no fear, Zofran is here!This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
August 29th, 2007 by Dr. Val Jones in Expert Interviews, News
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We’ve known for quite a while that lowering your cholesterol can reduce your risk of heart disease, heart attack, and stroke. Low fat diets, weight loss, and exercise can help people to control their cholesterol levels – but for those who do not succeed with these methods, a class of medications have been developed (known as “statins”) to reduce cholesterol. These drugs have been so successful at reducing cholesterol that some doctors have joked about putting statins in the water supply. In fact, 36 million Americans take a statin every day, generating annual sales of
$15.5 billion for the manufacturers, and making two statins – Lipitor and
Zocor – the top two best-selling drugs in the USA.
Four new studies were published in the past week about these drugs. I thought I’d summarize the findings for you to keep you up to speed with the very latest statin information.
Statins May Reduce Mortality After Having A Stroke
Spanish researchers followed the progress of 89 stroke patients who were already taking statins. For the first three days after the stroke, 46 patients received no statins, and 43 got their normal dose. After three months, 27 people – 60 % of the “no statins”
group – had either died or were disabled to the point that they needed
help to live a normal life, compared with 16 people from the group
allowed to keep taking statins.
This small study suggests that stroke patients should not stop taking their statins. More research is needed to clarify the role of statins in stroke.
Statins May Reduce The Brain Plaques Associated With Alzheimer’s Disease
Researchers at the University of Washington examined the brain tissue of 110 people who had donated their brains to research upon their death. They found there were
significantly fewer plaques and tangles (the hallmarks of Alzheimer’s disease) in the brains of people who had taken statins compared with those who had not. This is good news, but will require further research to determine whether or not statins could be used (or should be used) specifically for the treatment or prevention of Alzheimer’s Disease.
Statins Don’t Seem To Reduce The Risk of Colon Cancer
A group of Greek researchers conducted a review of the scientific literature to see if there may be a reduction in colon cancer rates among people who take statins. They found no evidence that statins reduce the risk of colon cancer.
Statin Side Effects Appear To Be Ignored By Some Physicians
The journal Drug Safety surveyed 650 patients about their experience with statins. Eighty-seven percent of patients reportedly spoke to their physician
about the possible connection between statin use and a symptom.
Physicians were more
likely to deny than affirm the possibility of a connection. Rejection
of a possible connection was reported to occur even for symptoms with
strong literature support for a drug connection. This report is concerning since it seems to suggest that physicians don’t take patient complaints as seriously as they should.
I asked Dr. Frank Smart what he thought about the side effects of statins and whether or not physicians should be more aware of them.
“The statin side effects exist
but in my opinion are overplayed. In my practice about 5% of people on statins
have some muscle issues. Most improve with dose reduction or change to a more
hydrophyllic compound.
Physicians should be better educated about side effects and the one who
should do the educating is pharma, and websites like Revolution Health. Most docs are as
familiar with statin side effects as they are with other drug classes, so good
but not great. We would all love to raise the bar but it is tough as you
know.”
As many as 30% of patients reportedly experience a side effect from statins (including: headache, nausea,
vomiting, constipation, diarrhea, rash, weakness, and muscle pain) though severe muscle damage is very rare (for example, one article reported 24 cases in 252,460 patients.) Overall, statins have many health benefits and are well tolerated by the majority of patients.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
July 17th, 2007 by Dr. Val Jones in Uncategorized
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Just because a drug is new, doesn’t mean it’s more
effective. A recent
article published in the Annals of Internal Medicine demonstrated that older
diabetes medications may be equally effective as some of the newer, more
expensive drugs.
Now this comes as no surprise to physicians, who know very
well that some of our “old standby” meds work just as well as their newer, more
expensive versions.
For example:
For mild to moderate acne treatment, good old Clearasil may be all you need.
A study
published in the Lancet found that over-the-counter topical treatments (benzoyl
peroxide based) worked just as well as more expensive new oral antibiotics
(including minocycline).
For mild to moderately elevated cholesterol, there doesn’t appear to be much
advantage to taking a newer statin than on older one. The cost difference may be as much as ten
times more, for small gains (if any).
For example, mevacor (lovastatin) is as inexpensive as 0.24 cents/pill
while lipitor (atorvastatin) can run up to $2.54/pill.
Dr.
Charlie Smith, former president of the American Board of Family Practice,
recommends these very cost effective medications to his patients as needed:
Hydrochlorothiazide for hypertension (from 8 cents to 20 cents/pill)
Bactrim (trimethoprim/sulfamethoxisole) for urinary tract infections (15
cents/pill).
Ibuprofen for pain relief/arthritis (about 7 cents/pill).
So consumer beware – those medications that you see in all the TV ads may not actually provide substantial benefits over older, less expensive drugs. Be sure
to ask your doctor if a less expensive medication might be appropriate for you… or
better yet, healthy lifestyle changes can sometimes make the difference between needing
a medication and not needing it at all.
*Drug prices may vary.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
