Monday, 16 January 2017

Acupuncture: what’s the point?

THE UNIVERSITY of York has now become the first university in the UK to appoint a ‘Professor of Acupuncture Research’, after awarding the title to Dr Hugh MacPherson at the start of this month. Dr MacPherson works in the Department of Health Sciences and has a focus on researching acupuncture’s effectiveness for various conditions, explanations for possible mechanisms that might explain its working, as well as its safety and cost-effectiveness in a clinical setting.
Image: Wikimedia commons. A standard acupuncture needle.
Image: Wikimedia commons. A standard acupuncture needle.
Increasingly popular in the UK, acupuncture is a major component of traditional Chinese medicine and involves thin needles being inserted into areas of the body. Techniques and practices vary from country to country, but the procedure is mostly used to treat pain. However in more recent years people have begun to claim that acupuncture has helped them with everything from weight-loss to allergies to quitting smoking.
Research into acupuncture in recent years has taken two approaches, use of “sham” needles (needles that withdraw into themselves so the patient is not receiving acupuncture but still believes that they are, placebo acupuncture) and trials on rats and mice. There have also been several large data reviews, such as that by White et al in 2002 who looked at 22 different studies of the effectiveness of acupuncture on smoking cessation and concluded it did not help smokers trying to quit.
However in 2010 a group from the University of Rochester Medical Centre in New York induced pain in adult mice and then inserted (and rotated, ouch!) needles just below the mouse’s knee every five minutes for half an hour. These mice appeared to show a reduction in discomfort by 60%. Obviously this is somewhat different from the acupuncture that you or I would experience at a clinic, but, combined with some research from Kyung Hee University in Seoul that showed stimulation with needles reducing inflammation in rats with spinal cord injury, there is some data that drives more research into the medical viability of acupuncture.
Meanwhile, in humans, the placebo effect is a powerful thing, and hard to account for. A 2014 Nature Reviews Cancer review article published data showing patients reacting equally well to sham needles as to the real thing There is some debate as to whether “sham acupuncture” can ethically be used on elderly patients seeking treatment for osteoarthritis or if it is deception and thus unethical.
There are few dangers from acupuncture as such, as long as it is performed by a professional using sterilised needles. As such, some may argue that, even if the effect is purely placebo, perhaps for some patients as a pain management approach this would be more effective, safer and certainly cheaper than long-term drug treatment.  Nonetheless until there is sufficient evidence to support the use of acupuncture in the place of conventional medical treatment, it should not be offered in its place.

Published in Nouse 22/10/16

Sunday, 15 January 2017

The fight to resist antibiotic resistance

WHEN SIR Alexander Fleming received the Nobel Prize for Medicine in 1945, for the discovery and isolation of penicillin (jointly, with Ernst Boris Chain and Edward Abraham who discovered how to concentrate the drug and proposed the correct structure), he gave an interview  in which he predicted the situation we now find ourselves in.
“The thoughtless person” he declared, “playing with penicillin treatment is morally responsible for the death of the man who succumbs to infection with the penillin-resistant organism.”
Image: Pintrest
Image: Pintrest
Throughout the Second World War, penicillin was used to treat soldiers with infected wounds as well as bacterial infections such as pneumonia, syphilis, tuberculosis, gangrene, and gonorrhoea. Now most strains of gonorrhoea are resistant to penicillin, as well as other first line antibiotics such as tetracycline, and fluoroquinolones. Some multi-drug resistant strains are even resistant to cefixime, a broad spectrum antibiotic; it’s now no longer recommended to use this family of drugs to treat the STI in case resistance develops in more strains.
Whenever anyone undergoes a surgical procedure they are given antibiotics to reduce the risk of developing bacterial infections that can lead to sepsis. As more and more antibiotic-resistant bacteria develop, the number of people in the UK dying from antibiotic resistant infections will increase. In 2015, 44 000 people in the UK died from sepsis, compared to  35 000 from lung cancer. As more and more antibiotics are rendered ineffective, we risk returning to a world where a simple operation like an appendectomy is a life-threatening risk of infection.
In September, all 193 UN member states agreed to combat the threat of antibiotic resistant bacteria. This was only the fourth time in the history of the UN that they met to discuss a health subject. Margaret Chan, director general for the World Health Organisation (WHO), spoke at the event, calling for medical providers to rely less on antibiotics for disease treatment, and for more innovation in antibiotic development.
Only two classes of antibiotics have reached the market in the last 50 years. There is little profit seen in their discovery. It’s not a sound investment to create a drug, costing in the hundreds of millions, only to have to tell people to refrain from using it in large quantities in case resistance develops. Citizen science programs, such as Swab and Send created by Dr Adam Roberts at UCL, look to harness the energy (and financial backing) of the general public in the hunt for new antibiotic compounds.
There are other uses of antibiotics that we can now curtail. In the US, 80 per cent of all antibiotics sold are used on livestock to promote animal growth. Most of these drugs are often given at a sub-clinical level (i.e. a dose too low to combat a disease) so some bacteria in the animal are killed off but those that are naturally slightly resistant survive to multiply and mutate. This also has the effect of flooding surrounding land with waste run-off still filled with antibiotic compounds. Not only are the animal pathogens becoming more and more antibiotic resistant but the frequency of antibiotic resistance in other bacteria (such as those found in the soil and waste water) increases. The use of antibiotics to promote animal growth was banned by the EU in 2006, though it wasn’t completely phased out until 2011.
Tackling the increase of antibiotic resistance may seem daunting, but the signatories to the UN declaration agreed with the WHO to commit to innovation in antibiotic development, increase public awareness of the threat of antibiotic resistance and to develop regulatory systems for human and animal antibiotic use. As individuals we can play our part by only taking antibiotics when prescribed by a doctor, and always finishing the entire prescription, even if you start to feel better. You should never share an antibiotic prescription with another, or use up a left over prescription; even if you think it is for the same complaint. And remember, antibiotics will do nothing for a viral infection, so are unlikely to help if you have a sore throat or a cold!
Published in Nouse 1/11/16

Saturday, 14 January 2017

The Pill and depression: a correlation we cannot ignore

ON SEPTEMBER 28, a team of Danish scientists published the results of a six and a half year- long study linking hormonal contraception with depression. This is the largest study of its kind; a total of 1,061,997 women aged 15 to 34 participated. The study included women taking both kinds of oral contraceptive (combined and progesterone only), users of a patch (norgestrolmin) and users of users of a levonorgestrel intrauterine system (brand name Mirena® in the UK).
Depression, noted in the study as either a filled prescription for antidepressants or a recorded diagnosis by a medical professional, affects 2.6 in 100 adults in the UK every year, according to Mind, a mental health charity.
From the data gathered in Denmark, it seems that taking the combined pill increased the risk of a woman aged between 20 and 34 being prescribed antidepressants by 23 per cent.  A levonorgestrel intrauterine system appears to increase the likelihood of a depression diagnosis by 40 per cent.  The largest increase for both diagnosis of depression and prescription of contraceptives were seen in users of the hormonal patch, with a 100% increase in recorded depression signs.
Incidents of depression in teenagers (aged 15 to 18) taking the combined contraceptive pill who had no previous experience of mental health issues increased by 80% – from 1% in the general population of younger women to 1.8%.  Why the impact is greater on younger minds is not clear, but the NHS currently pushes longer term contraception to young women and perhaps this many lead to more GPs taking more time to discuss alternative contraception methods with their patients.
For those who have experienced mood-affecting side effects of hormonal contraceptives, this research couldn’t come soon enough. In fact, mood changes are one of the main reasons women stop taking the pill within the first year. Many women have felt that their concerns and experiences with the psychological and emotional problems from the prescription have been too easily dismissed.
However it should be noted that this is only a statistical analysis of the data, and though the research team did control for many variables it cannot yet be said what causes the link; correlation is not causation.
There are some things however that are not up for dispute. Depression is very real, and if you are concerned about yourself or others then please seek out help.

Published Nouse 7/10/16

Friday, 13 January 2017

Blue Monday

THIS YEAR, "Blue Monday" will fall on the 16th of January, three days after Friday the 13th (spooky...?)



What is Blue Monday? As well as a #9 1983 hit by New Order, apparently January 16th will be the bleakest, most depressing day of the year for the Northern Hemisphere. The concept of Blue Monday was thought up in 2005 when Dr Cliff Arnall was persuaded to come up with an equation behind melancholy that looked so science-y and official that the press would be powerless to refuse it. That formula is: 


[W+(D-d)]xTQ/MxNA – where W is weather, D is debt, d monthly salary, T time since Christmas, Q time since failure of attempt to give something up, M low motivational level and NA the need to take action.

Despite being pseudoscience at best and self-contradictory at worst, the concept of Blue Monday has now been picked up by most news outlets, many advertisers and even some mental health campaigners.

But are we generally more blue at certain times of year? On an individual basis,  one in 15 people in the UK may experience seasonal affective disorder during the winter months. 

Seasonal affective disorder (SAD) is a well documented phenomenon. First observed in the 1500s by Goth scholar named Jordanes in the Getica - a history of Visigoths and Ostrogoths - in which he describes the moods of some inhabitants of Scandinavia.

By the 1980s, SAD was named and lack of sunlight was blamed. Treatment with artificial sunlight does appear to be effective along with physical exercise and SSRIs. However on a population-wide scale things look a little different. 

There are many difficulties in measuring the general mood of a population but large scale surveys and suicide rates are the go-to data. During the 1960s and 1970s, a study in the United States revealed that suicides were 47% more common in the spring and summer months. A 1951 review of suicide statistics in the UK from 1912-1948 showed similar results. 

More recently, multiple studies have put to bed the popular belief that suicide are more common during the winter months. In fact, sunshine and high temperatures may cause a peak in suicide numbers, in both northern and southern hemispheres. 

So the Blue Monday myth is just that - a myth created for Sky Travel to increase holiday bookings during what would otherwise be a lull that got picked up by media outlets needing an easy headline. Plus it is a pretty good dance anthem. 

Vaccinations: better late than never

Image: Flickr
Image: Flickr

ALMOST TWO years ago there was a measles outbreak at Disneyland, which started when an unvaccinated Californian woman contracted the disease before travelling through airports and the theme park. Although more than 26 people got sick, many anti-vaccination activists mocked the spread of “Mickey Mouse measles”; the virus is possibly the most contagious human virus in existence. Some were loudly claiming that they remembered measles from their childhood as a mild, if annoying, infection; something harmless that all children should go through, that skipping vaccines wouldn’t harm.
In fact measles kills 367 per day across the world at present, according to the WHO. The total number of deaths last year were recorded at 134 200, down from an astonishing 2.6 million back in 1980. In 2000, the death rate in the US was 3 per 1000 cases (about 0.3 per cent) with another 0.2 per cent suffering permanent brain damage from the disease. For immunocompromised patients, such as those with AIDS or on chemotherapy, death rates are as high as 30 per cent.
Measles is currently one of the leading causes of child death that could be preventable using vaccines. A Vietnamese measles epidemic in 2014 led to over 8000 cases with 114 reported fatalities. In Europe, most cases occur in unvaccinated people, who then can expose those who are either too young to have been vaccinated (under a year old) or immunocompromised (they likely have been vaccinated but their system can no longer combat any disease exposure). In the 2013-14 period, there were 10 000 measles cases in Europe, 90 per cent occurring in Germany, Italy, the Netherlands, Romania, and the UK.
If you have been vaccinated against measles, given as two doses during childhood, you will likely remain immune to the virus for your whole life. However the influenza virus changes rapidly and this is why you will see a new flu jab offered every year. The WHO recommends that everyone gets the flu vaccine annually unless you are allergic or otherwise unable.
Influenza is caused by a family of RNA viruses that are classed into three genera, influenza A, B and C. The influenza A genus contains the virus serotypes H1N1 (swineflu) and H5N1 (birdflu) among others, differentiated by the antibodies on the virus surface. All three genera infect humans and cause disease, although influenza C is less common than the other types and normally only causes symptoms in children.
Influenza infection in adults can be mild to severe depending on the strain and the immune response of the individual. Fever, aches, cough, and fatigue lasting a week are the universal symptoms and you can remain infectious several days after they clear up. While the NHS only offers the free flu vaccine to those most at risk, most pharmacies now have the jab at a low wholesale price, and anyone can be vaccinated for £5.
It is never too late to catch up with childhood vaccinations. If you find that you’ve missed a measles, meningitis or other vaccine, your GP will be happy to help keep you safe and up to date.

Published in Nouse 22/11/16

Dry January – Is it worth it?

MANY PEOPLE, at least on my Facebook timeline, are giving up alcohol for the month. Perhaps the New Year’s hangover was particularly rough, or the work and academic pressures coming up require a clean and sober mind. But how much impact on your health can an alcohol-free month really have?
According to drinkaware.co.uk, the average student consumes 20 units of alcohol a week, the recommended limit being 14 – the equivalent to 6 pints of beer. These figures are reliant on self-reporting and it is likely that many people are consuming more than they are aware.
Image: wikimedia commons
Image: wikimedia commons. One pint of beer (2.3 units) contains the same number of calories in one large slice of pizza.
In 2014 the New Scientist had 10 members of the editorial team give up drinking for a month. The participants all considered themselves “normal” drinkers and were given full medical work ups before and after the dry month.
After 31 days without alcohol, liver fat fell by an average of 15%. This is particularly significant as a fatty liver is one of the first signs of liver damage. The test subjects also saw an improvement in blood glucose levels, a reduced risk of Type II diabetes, as well as a reduction in cholesterol levels, a reduced risk of heart disease. A month off drinking had allowed their bodies were more able to manage both.
Participants also lost an average of 1.5 kilos, without any other change to their diet. Alcohol is calorific, with one glass of red wine (250 kcal) having a similar calorie count to a McDonalds cheeseburger.
Aside from the physical changes, the subjects reported an improvement in sleep quality and ratings of how well they could concentrate rose by 18%. A booze-free month can improve academic work and general mood.
The only downside reported was a reduction in social contact. Unsurprising, as many social occasions in the UK are based around drinking. Quitting alcohol itself maybe easy enough but putting up with friends trying to push “just one beer” on you would likely cause the strongest will to snap and stay home for an evening.
Whether or not a dry January can lead to long term health improvements is not yet clear. Though 31 days can have an impressive impact on your well-being, it doesn’t balance out 334 days of unlimited binging. The benefits of the month off can be quickly undone.
However that doesn’t mean it is not worth it. Even the occasional 10 days off throughout the year can have a positive impact on your health, both physically and mentally. Perhaps a few weeks off is what your body needs to beat the January blues.

Publish in Nouse 10/01/17