Claire was about to start at college when her counsellor recommended that she should not tell anyone that she was being treated for drug dependence. So she spent months leaving class early and making up excuses to sneak to the chemist to collect her methadone prescription: lying to teachers, administrators and her friends. Eventually, the pressure of the constant evasions became too much and she dropped out of the course, rather than reveal her secret.
Claire’s story is far from unusual. As her treatment counsellor had recognised, suspicion, fear and distrust of people struggling with drug problems are widespread. The result is that people with drug dependence, and their families, are suffering in silence, missing opportunities for treatment, and prolonging the process of recovery.
Research by the
UK Drug Policy Commission(UKDPC found these attitudes to be widespread, affecting those with drug problems throughout their lives. We encountered people who felt trapped in their homes because of the hostility they faced from neighbours. Being stuck indoors, without social contacts or the opportunity to find work, may be one of the hardest settings imaginable in which to fight drug dependence.
Everyday prejudice creates a host of obstacles for recovering drug users. Offers of work or housing are commonly withdrawn when it becomes known that the recipient has had a serious drug problem, even if they have stopped using. Yet employment and stable accommodation are two of the most important factors for helping people overcome dependence and stay off drugs. Anything that makes these harder to access will worsen drug problems.
Public hostility can even make it harder for people with dependence problems to get the treatment they need to help rebuild their lives. The fear of being exposed as someone with a drug problem can deter them from going to a pharmacy to collect prescriptions for methadone, for example, which could provide the stability they need to stop using street drugs.
These attitudes are not just those of an uneducated general public. Our
researchfound that many people with drug problems experience similar barriers in their dealings with the professionals who should be helping them. Some find it impossible to convince doctors or nurses that they need help, even when they are in agonising pain or suffering from long-term conditions like Hepatitis C. The suspicion of the medics is often that their patient is just looking for drugs to relieve their cravings.
Others are made to wait at pharmacies for as long as it takes to serve every other customer in the store, including those who arrive after them. For recovering drug users, treatment can mean daily visits to pharmacies. Such long waits can make it impossible for them to be reliable in keeping other appointments, such as work obligations or job interviews.
Disapproval
Such problems are not just faced by those still using drugs. Even after they have managed to overcome drug dependence, former drug users can face similar hostility and distrust. The negative attitudes they face go beyond simple disapproval. Disapproval is usually linked to a person’s behaviour, and so disappears when that behaviour changes. Social disapproval of drug use even has a useful role in dissuading some from engaging in potentially risky behaviour.
But perceptions of people with drug problems go far beyond this. They are seen as bearing a stigma, an enduring mark that defines them and which cannot be removed by their stopping using street drugs. For many people with serious drug problems, suffering not only from a debilitating health condition, but also from social exclusion, the prospect of never being able to move past the label of drug user or addict can be one more barrier to overcoming their dependence.
The families of those with drug problems are also affected by this stigma. Such is the fear of being associated with the shame of addiction, that family members may avoid situations that could lead to their being identified as the relative of a drug user, even at risk to their own well-being.
In our research, we met Patricia, a mother who avoids contact with her old friends because she is afraid they will mention her son’s drug dependence. We also spoke to Tom, the brother of someone with a drug problem, who will not seek the support he needs himself because he is worried others will find out and would think less of him and his family.
Public opinion on dependence and recovery suggests that this worry is not misplaced. In one survey of public attitudes that UKDPC carried out, we found that, while people want top-quality help to be made available to those recovering from dependence, they are nevertheless suspicious and afraid of those who have had drug problems.
More than four in five agreed that people recovering from drug dependence should be part of the normal community. But the public still wants to keep its distance, with 43 per cent of those asked saying they would not want to live next door to someone who had been dependent on drugs. More than a third felt it would be foolish to get into a serious relationship with someone who had suffered from drug dependence, even if they appeared to be fully recovered.
Beating stigma
To a certain extent, these attitudes reflect how dependence is portrayed in the media. People with drug addictions tend to labelled as “junkies” not as people with a health problem that can be addressed. The term “addict” has itself become pejorative and frames the issue in a particularly negative way.
If a media story about a drug user is not about a celebrity, it is most likely to be about a criminal, who, for example, has mugged someone or broken into a house in order to pay for drugs. And if an article features someone who used to be dependent on drugs but is now drug free or on medication, their previous addiction is invariably mentioned, even when it has no relevance to the story. The implication is that no one can truly move on from dependence.
But if television and newspapers can perpetuate attitudes that make recovery more difficult, changes in how they report such stories could be similarly effective in making recovery more achievable. A forthcoming guide for journalists and editors, produced by the Society of Editors and UKDPC, will suggest ways to reframe news stories to avoid the assumption that drug dependence is a life sentence.
But media coverage cannot stray too far from where the public is. The stigma of drug dependence will only be overcome if it is acknowledged and confronted directly.
There is a parallel with attitudes to mental health. Public perceptions of those suffering with mental illness have shifted over recent years. Nonetheless, it is still less than a decade since the
Sun
newspaper
ran a front-page storyabout boxer Frank Bruno being taken to a psychiatric hospital under the headline “Bonkers Bruno locked up”. The editor belatedly realised this was out of step with British attitudes and later editions carried the headline “Sad Bruno in mental home”. Even today, the
Time to Change campaign “Get Talking”, which aims to encourage debate about mental health, demonstrates that shifting these views takes a lot of work over a long period.
Attitudes to those who suffer from drug dependence may lag behind perceptions of other stigmatised groups. But the process has begun. Earlier this year, the Duchess of Cambridge became a patron of the charity
Action on Addiction and said specifically that she wanted to
break the stigma associated with addiction, as Princess Diana had done with Aids.
UKDPC, along with other organisations, is working on a project to determine practical measures, such as the media guide, that can make recovery and inclusion achievable for everyone.
* Names have been changed
EARLY diagnosis has become one of the most fundamental precepts of modern medicine. It goes something like this: The best way to keep people healthy is to find out if they have (pick one heart disease, autism, glaucoma, diabetes, vascular problems, osteoporosis or, of course, cancer — early. And the way to find these conditions early is through screening.
It is a precept that resonates with the intuition of the general public: obviously it’s better to catch and deal with problems as soon as possible. A study published with much fanfare in The New England Journal of Medicine last week contained what researchers called the best evidence yet that colonoscopies reduce deaths from colon cancer.
Recently, however, there have been rumblings within the medical profession that suggest that the enthusiasm for early diagnosis may be waning. Most prominent are recommendations against prostate cancer screening for healthy men and for reducing the frequency of breast and cervical cancer screening. Some experts even cautioned against the recent colonoscopy results, pointing out that the study participants were probably much healthier than the general population, which would make them less likely to die of colon cancer. In addition there is a concern about too much detection and treatment of early diabetes, a growing appreciation that autism has been too broadly defined and skepticism toward new guidelines for universal cholesterol screening of children.
The basic strategy behind early diagnosis is to encourage the well to get examined — to determine if they are not, in fact, sick. But is looking hard for things to be wrong a good way to promote health? The truth is, the fastest way to get heart disease, autism, glaucoma, diabetes, vascular problems, osteoporosis or cancer ... is to be screened for it. In other words, the problem is overdiagnosis and overtreatment.
Screening the apparently healthy potentially saves a few lives (although the National Cancer Institute couldn’t find any evidence for this in its recent large studies of prostate and ovarian cancer screening . But it definitely drags many others into the system needlessly — into needless appointments, needless tests, needless drugs and needless operations (not to mention all the accompanying needless insurance forms .
This process doesn’t promote health; it promotes disease. People suffer from more anxiety about their health, from drug side effects, from complications of surgery. A few die. And remember: these people felt fine when they entered the health care system.
It wasn’t always like this. In the past, doctors made diagnoses and initiated therapy only in patients who were experiencing problems. Of course, we still do that today. But increasingly we also operate under the early diagnosis precept: seeking diagnosis and initiating therapy in people who are not experiencing problems. That’s a huge change in approach, from one that focused on the sick to one that focuses on the well.
Think about it this way: in the past, you went to the doctor because you had a problem and you wanted to learn what to do about it. Now you go to the doctor because you want to stay well and you learn instead that you have a problem.
How did we get here? Or perhaps, more to the point: Who is to blame? One answer is the health care industry: By turning people into patients, screening makes a lot of money for pharmaceutical companies, hospitals and doctors. The chief medical officer of the American Cancer Society once pointed out that his hospital could make around $5,000 from each free prostate cancer screening, thanks to the ensuing biopsies, treatments and follow-up care.
A more glib response to the question of blame is: Richard Nixon. It was Nixon who said, “we need to work out a system that includes a greater emphasis on preventive care.” Preventive care was central to his administration’s promotion of health maintenance organizations and the war on cancer. But because the promotion of genuine health — largely dependent upon a healthy diet, exercise and not smoking — did not fit well in the biomedical culture, preventive care was transformed into a high-tech search for early disease.
Some doctors have long recognized that the approach is a distraction for the medical community. It’s easier to transform people into new patients than it is to treat the truly sick. It’s easier to develop new ways of testing than it is to develop better treatments. And it’s a lot easier to measure how many healthy people get tested than it is to determine how well doctors manage the chronically ill.
But the precept of early diagnosis was too intuitive, too appealing, too hard to challenge and too easy to support. The rumblings show that that’s beginning to change.
Let me be clear: early diagnosis is not always wrong. Doctors would rather see patients early in the course of their heart attack than wait until they develop low blood pressure and an irregular heartbeat. And we’d rather see women with small breast lumps than wait until they develop large breast masses. The question is how often and how far we should get ahead of symptoms.
For years now, people have been encouraged to look to medical care as the way to make them healthy. But that’s your job — you can’t contract that out. Doctors might be able to help, but so might an author of a good cookbook, a personal trainer, a cleric or a good friend. We would all be better off if the medical system got a little closer to its original mission of helping sick patients, and let the healthy be.
H. Gilbert Welch, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice, is an author of “Overdiagnosed: Making People Sick in the Pursuit of Health.”
“It could be possible to reverse the muscle damage seen in children with a form of motor neurone disease,” according to BBC News. The condition in question – spinal muscular atrophy (SMA – causes deterioration of specific nerves and muscles in the body, and is sometimes known as ‘floppy baby syndrome’ due to the weakness it creates in the limbs. The condition reportedly affects 1 in 6,000 babies, with around half of children with the most severe form of this disease dying before the age of two.
Research has already established that the condition affects the nerves, and it has previously been thought that the muscles waste mainly as a result of this nerve damage. However, this news is based on an experiment in mice that suggests the muscles start to undergo changes even before the nerves deteriorate. Crucially, some of these changes could be reversed using a drug called SAHA, which has also been found to increase lifespan in SMA mice in a previous study.
The drug SAHA is already approved by the US Food and Drug Administration for use in a very specific form of cancer. The fact that this drug has already been tried in humans for another condition may make it easier to test in people with SMA. Trials will still need to be carried out before we can say whether this drug is effective and safe in humans. Drug treatments for this condition would be valuable, as there is currently no cure.
Where did the story come from?
BBC News’ coverage referred to two related papers from the same group of researchers based primarily at the University of Edinburgh. One of these research papers looked at the effect of using drugs called HDAC inhibitors on a mouse model of SMA, while the other paper focused only on the biology of a mouse model of SMA, but did not assess the effects of any treatments. This Behind the Headlines appraisal focuses on the former of these papers as online news reports tended to focus on the possibility of developing new treatments.
This HDAC inhibitor study was carried out by researchers from the University of Edinburgh, and other research centres in the UK and Germany. It was funded by SMA Trust, BDF Newlife, the Anatomical Society and Germany’s DFG research fund.
The study was published in the peer-reviewed medical journal Human Molecular Genetics.
The report from BBC News gives a very brief summary of the two studies, and provides more information about the condition SMA itself. It does report the fact that the treatment study was in mice.
What kind of research was this?
Spinal muscular atrophy (SMA is a form of motor neurone disease that is caused by mutations in the SMN1 gene, leading to degeneration of a type of nerve cell found in the spinal cord. These nerve cells, called motor neurones, normally carry messages from the brain to the muscles. In SMA, motor neurone degeneration causes progressive weakness of the limbs and trunk, followed by muscle wasting. About 1 in 6,000 to 1 in 10,000 babies are thought to be affected. Some forms of SMA typically lead to death in the first few years of life, and the condition is reportedly among the most common genetic causes of infant death. Other forms become apparent later in life and are less severe.
SMA is an ‘autosomal recessive’ disease, meaning that it only becomes apparent if an individual has two copies of a faulty gene, one inherited from each parent. People with only one faulty copy of the gene will not have the condition but are known as carriers, and can have a child with the condition if their partner is also a carrier. People with the condition have low levels of a protein called SMN.
This was animal research that looked at the changes that occur in the muscles of a mouse model of spinal muscular atrophy (SMA . It also looked at whether the changes could be reversed by a specific type of drug called a histone deacetylase (HDAC inhibitor.
The researchers say that, thus far, most research has looked at how this disease affects the nerves that send messages to the muscles, rather than the muscles themselves. They wanted to look at the effect of the disease on the muscle in mouse models of SMA.
Animal models are very useful for studying aspects of the biology of human diseases that would be hard to study in humans. They are also essential for the initial testing of drugs that might be useful for treating human conditions, to make sure they are safe and effective enough to test in humans. These animal tests should be seen as only the first of many stages, as drugs that show promise in these tests are not always effective or safe in humans, due to differences between the species.
What did the research involve?
In their first set of experiments the researchers used a mouse model of SMA that causes a severe form of the condition.
In SMA the nerves that send signals to the muscles break down, and this then leads to loss of muscle fibres. The researchers looked specifically at one muscle that does not lose its nerve signals early in the disease, so they could see whether any changes in the muscle happen independently of the problems with the nerves.
The researchers looked at what changes happened to the proteins in this muscle before the mice developed any symptoms. They found that the proteins that were affected related to cell death, so they then looked at whether there were signs that more cells were dying in muscles of SMA mice than in muscles of normal mice. They also looked at whether some of the protein changes seen in mice were also seen in samples of muscle taken from human SMA patients.
Previous research has suggested that chemicals called HDAC inhibitors can increase levels of the SMN protein in mouse models of SMA, and reduce muscle loss. Based on this the researchers decided to test whether HDAC inhibitors directly affected the muscle. These experiments used a different mouse model that causes a less severe form of the condition. They say that this model is better for testing the effects of potential treatments for the disease because the mice live slightly longer.
The mice were given an HDAC inhibitor called suberoylanilide hydroxamic acid (SAHA orally from birth. Control mice were given no SAHA. The researchers looked at the effect of this treatment on the levels of the different proteins in the muscles that are affected by SMA. SAHA (Vorinostat is approved by the US Food and Drug Administration for use as a treatment for a specific type of cancer in humans.
What were the basic results?
The researchers found that the muscle from pre-symptomatic SMA mice showed differences in the levels of a number of proteins compared with normal mice. This was despite the fact that the nerves sending messages to the muscle were not yet affected. This finding suggests that the condition starts to affect the muscle even before any deterioration occurs as a result of changes in the nerves.
Many of the proteins affected by the condition were found to be involved in muscle function or cell death. The researchers found that there were also other signs of increased cell death in the muscle of SMA mice compared with normal mice.
The researchers then examined human SMA muscle to look at two proteins found at abnormal levels in SMA mouse tissue: one protein called Vdac2 that was found at higher levels in the SMA mouse muscle and one protein called parvalbumin that was found at lower levels in the SMA mouse muscle. They found that levels of these two proteins were similarly affected in human SMA muscle tissue.
Treating SMA mice with the HDAC inhibitor drug SAHA from birth increased levels of SMN protein in their muscle. SAHA treatment also reversed the changes seen in the levels of the proteins Vdac2 and parvalbumin, although the levels of parvalbumin were still not quite as high as in normal muscle. SAHA treatment also reduced the levels of a protein called H2AX, which is involved in cell death and which was significantly raised in SMA mice.
How did the researchers interpret the results?
The researchers concluded that the molecular effects of SMA on muscle in mice were improved by the existing FDA-approved drug SAHA. They say that their study showed that abnormalities in skeletal muscle tissue proteins are an important and potentially reversible part of SMA.
Conclusion
This study has shown that in mouse models of spinal muscular atrophy (SMA , before problems develop in the nerves that send messages to the muscles, the muscles themselves have abnormal levels of certain proteins. Human SMA muscle tissue was also found to have some of these abnormalities. Notably, the researchers also showed that, in mice, some of these abnormalities could be reversed using a drug called SAHA, which belongs to a group of drugs called the HDAC inhibitors.
Previous studies have suggested that SAHA treatment increased the lifespan of mice with SMA. The current study did not look at the effect of this drug on symptoms or lifespan in these mice, just at its effect on particular proteins within the muscle.
The drug SAHA is already approved by the US Food and Drug Administration for use in a very specific form of cancer (cutaneous manifestations of cutaneous T-cell lymphoma . The drug does not appear to have been approved for use in Europe for this type of cancer or for other conditions. The fact that this drug has already been tried in humans for another condition may make it easier to test this drug in people with SMA. Such trials will need to be carried out before we can say whether this drug is effective and safe for the treatment of SMA. New treatments for this condition would be valuable, as there is currently no cure.
Analysis by Bazian
Links To The Headlines
Child motor neurone disease treatment clue. BBC News, February 27 2012
Links To Science
Mutsaers CA, Wishart TM, Lamont DJ et al. Reversible molecular pathology of skeletal muscle in spinal muscular atrophy. Human Molecular Genetics (2011 20 (22 : 4334-4344
Jefferson City, MO (KSDK - The state's Medicaid program will receive more than $289,000 to settle allegations that a St. Louis-based pharmaceutical company lied to customers by saying two drugs were approved for coverage under state and federal health care programs.
Under the agreement, KV Pharmaceutical Company, parent company of now-defunct Ethex Corporation, will pay approximately $17 million to the federal government and participating states to compensate for Ethex's conduct.
According to the suit, Ethex misrepresented the regulatory status of Nitroglycerin Extended Release Capsules (Nitroglycerin ER and Hyoscyamine Sulfate Extended Release Capsules (Hyoscyamine ER .
Despite not being covered by federal and state health care programs, the two drugs do not pose a risk to patients. At present, neither drug is on the market.
Koster said citizens should report suspected Medicaid provider fraud or abuse and neglect to his Medicaid Fraud Hotline toll free at 800-286-3932, e-mail the complaint to
attorney.general@ago.mo.gov or complete a complaint form at the
Attorney General's Medicaid Fraud Website.
the PPRS report also shows that not a single drug company has taken advantage of new rules championed by Sir Andrew and introduced three years ago allowing price increases if new medicines prove more effective than initially believed. That implies disappointing levels of innovation.
On collective sales of drugs totalling ?7.7bn in 2009, the PPRS report showed 34 companies reported costs of ?7.9bn, representing a return on sales of -1.8 per cent. That was down on profits of ?123m in 2008 and of ?149m in 2007. The figures include a rise in research and development costs of ?1.3bn in 2009, up from ?1bn in the previous year.
The final figures accepted by the Department of Health, recalculated from company returns to exclude profits from “transfer pricing” on medicines they purchased from their foreign subsidiaries, show profits of ?1.4bn for 2009, representing a return on sales of 18.3 per cent.
James Howson, first mixed-race actor to play Heathcliff, awaits sentencing for abusing mother of his child after they split up
The young star of the
latest film version of Wuthering Heights, who is awaiting sentence for racially abusing a former girlfriend, has been sectioned under the Mental Health Act.
Proceedings were adjourned at Leeds magistrates court after James Howson's solicitor explained that the 24-year-old was being treated at a hospital in Newcastle.
Sectioning is used in cases where doctors are convinced that psychiatric treatment is essential, compelling the patient to accept medical help for 28 days, renewable for further periods, with the right of appeal by the patient or friends and relatives.
Howson's solicitor Anthony Sugare said outside the court: "The position is that on arriving at court this morning, I was told that the court itself had heard from the hospital that he had been taken in there under the Mental Health Act for a period of 28 days for observation."
The actor, who made his much-publicised debut as the first mixed-race actor to play Heathcliff in November, admitted the racially aggravated harassment of Shakira Ramdihal at a hearing in Leeds last month. Magistrates were told that
he shouted abuse and threats at the 23-year-old after rows over her pregnancy and the end of their three-year relationship.
The abuse went on for about four months and he had been so aggressive that he was banned from the maternity unit after their baby daughter was born. The offences coincided with the launch of Wuthering Heights which saw Howson combine unsuccessful hunting for more film work on a ?34-a-week jobseeker's allowance with engagements at the Venice film festival and other such gatherings.
He landed the part after hearing from a centre for the unemployed in Leeds that the film's director, Andrea Arnold, was looking for a young actor matching Emily Bronte's original description of Heathcliff as a
"dark-skinned gipsy in aspect and a little lascar" (an old term for Indian sailors . He beat hundreds of other applicants to the role at auditions organised by the casting director Gail Stevens, who previously chose the local children used in the 2008 Oscar-winning film Slumdog Millionaire.
Howson's background from a broken home, expelled from school at 14 and serving jail terms for theft and drug offences, mirrored that of the young Heathcliff. Paid ?7,800 for his work, which won critical approval, he was upset to discover on seeing the film that his voice had been dubbed.
The sentence hearing was adjourned until 26 March.
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Illegal internet pharmacies are selling illicit drugs and prescription medicines online and are increasingly targeting young people, a UN drug agency warns.
 | Advanced Weight Loss-Potent Formula with African Mango, Acai, Resveratrol, Apple Cider Vinegar & Grapefruit! Raspberry Ketone is a natural phenolic compound that is responsible for the heavenly aroma of red raspberries. And according to certain studies, its also a potent fat burner. It was discovered that raspberry ketone increased both the expression and secretion of adiponectin. This is important because adiponectin is a protein hormone which modulates a number of metabolic processes, including glucose regulation and fatty acid catabolism. Past research into adiponectin has shown that your levels of adiponectin are inversely correlated with your body fat percentage: Higher adiponectin - lower levels of body fat. During this latest study, this theory was re-affirmed as the formerly fat lab mice melted off a ton of body-fat. And if weight loss isnt enough, higher levels of adiponection have been shown to control theme tabolic derangements that may result in type 2 diabetes, obesity, atherosclerosis, non-alcoholic fatty liver disease and metabolic syndrome. As a result of all of this, the researchers concluded that Raspberry Ketone holds great promise as a fat-burning, health-improving herbal medicine. African Mango: A weight loss supplement derived from the seeds of a rare Mango from Africa, it has many health benefits. It helps to speed up the bodys metabolism. Acai & Resveratrol: Super strong Antioxidants! Apple Cider Vinegar: Powerful Weight Loss Aid & other health benefits! Other ingredients are Kelp, Grapefruit& Caffeine, all formulated to help you loose weight! Our price: $8.75 |
New research suggests that stable heart patients with stents are no better off then patients less costly drug regimens.
MASSDEVICE ON CALL — Patients rushed to the hospital for a heart attack are no better off with a stent than they would be with less-costly drug therapy, according to a new study.
Implanting a stent to prop open blocked arteries represents a more costly alternative that failed to improve patient outcomes, according to researchers from the Stony Brook University Medical Center in New York.
News Well,
Capitol Hill,
Cardiac Assist Devices,
Healthcare Reform,
Regulatory/Compliance,
Research & Development,
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U-Systems wins a date with an FDA advisory panel to move forward on a pre-market application for the somo.v, the first ultrasound device to target breast cancer screening.
U-Systems won a date with the FDA to review its pre-market application for the first ultrasound device indicated for breast cancer screening.
The somo.v Abus device, which is set to undergo agency review on April 11, 2012, is already FDA-cleared for diagnostic use as an adjunct to a mammogram.
510(k ,
Breast Cancer,
Food & Drug Administration (FDA ,
Imaging,
Pre-Market Approval (PMA ,
Ultrasound
Category: Health News
Created: 2/26/2012 8:05:00 PM
Last Editorial Review: 2/27/2012
A developing human egg.
What’s the News: Since the 1950s, it’s been generally accepted that women are born with all the eggs they will ever have. One gets doled out with each menstrual cycle, and when they run out, you get menopause. But a smattering of papers over the last decade or so have indicated that that dogma might be incorrect: scientists found cells in the ovarian tissue of female mice that appear capable of producing new eggs. Now, working with donated tissue,
researchers have found similar cells in human ovaries.
Headlines hyping the find have been spreading across the web, and we feel compelled to point out that this paper doesn’t mean that
we will be able to grow fresh new eggs in Petri dishes, and it doesn’t prove that in
real, live women these cells actually mature into eggs that can develop into offspring. It does, however, provide an interesting chance to see whether egg production by these cells can be jump-started using drugs.
Everything You Need to Know About Eggs:
stem cells—cellular blank slates that can develop into more specialized cells—that will become eggs stop being produced ...
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