Tuesday, November 14, 2006


This summer, the influential European Medicines Agency (EMEA) officially advocated the prescription of the antidepressant Prozac within the EU for children from the age of eight upwards, reinforcing a similar recommendation made last year by the UK's Nice (the National Institute for Health and Clinical Excellence), despite the known dangerous side effects of the drug on children and adolescents.

The nub of the medical authorities' argument is that there are mental conditions that only Prozac or Prozac-type drugs can reach. Prozac (or fluoxetine) came off patent five years ago, prompting the manufacture of a number of generic drugs of essentially the same chemical compound. As for the side effects, which include the risk of suicide, everything depends, the medical authorities advise, on the circumstances and care with which the Prozac-type drug is prescribed and monitored.

The EMEA and Nice have insisted that treatment with fluoxetine should be preceded and attended by psychotherapy. But Sane, the mental-health charity, and YoungMinds, the childhood mental-illness watchdog, are concerned about the lack of adequate resources in the National Health Service for the provision of psychotherapy for children.

Nor is there legislation in place that prevents doctors from prescribing fluoxetine to children without the recommended safeguards. There is ample evidence that some doctors have been prescribing the drug "off licence" to toddlers - in other words, they are doling them out outside of recommended usage, as an antidote to infant "agitation". A study made by a pharmacology unit at Southampton University recently surveyed a small sample of 100 general practices in the UK, and found that 19 children - whose ages range from 1 to 12 - were on fluoxetine.

Against the background of the huge increase in the use of the amphetamine-like drug Ritalin for attention-deficit hyperactive disorder (ADHD), especially for middle-class children, there are fears, says Professor David Healey of the University of North Wales, that Prozac could follow a similar pattern of rapidly expanding usage as a quick fix for children deemed to be "low" or depressed. "Companies have been enabled to medicalise childhood distress, and as the rapidly changing culture surrounding the management of such problems indicates, companies have the power to change cultures and to do so in astonishingly short periods of time." According to Department of Health (DoH) figures, the past 10 years have seen a tenfold increase in prescriptions for Ritalin in Britain to combat a range of perceived childhood and adolescent problems - from restlessness to lack of concentration in class.

According to the DoH, an estimated 30,000-40,000 children and teenagers are already being prescribed antidepressants in Britain (off licence in the case of pre-puberty children), and about half of those are treated with fluoxetine or Prozac. In total, the UK Prescription Pricing Authority reports a rise in courses of Prozac-type drugs from 3.7m in 2000 to 4.4m last year. No figures are as yet available for 2006 following the recommendation of Nice, and the authority offers no breakdown for prescriptions for children anyway. But prescriptions for children are clearly set to rise despite serious doubts about fluoxetine that have persisted ever since the drug first reached our pharmacies in the mid-1980s.

The debate over all antidepressants and children has been especially fierce in the US, where a federal panel of drug experts last year found a proven link between antidepressants and suicide in children and teenagers. The risk, according to the US Food and Drug Administration (FDA), is high when the course of treatment starts, or when there is a change of dosage, or sudden withdrawal. Last year an American teenager, Jeff Weise, shot dead nine men, women and children before committing suicide at Red Lake high school, Minnesota. His aunt Tammy Lussier told journalists that he first attempted suicide after he went on Prozac. After that, he was taking increased dosages, she said: "I can't help but think it was too much, that it must have set him off."

Fluoxetine is a compound designed to combat low activity of a natural brain chemical called serotonin - a condition associated with depression and obsessive-compulsive disorders, such as nonstop hand-washing. Problems begin, say neuropharmacologists, when serotonin is absorbed too speedily into the billions of minuscule "receptor sites" at the synapses - the contact points between brain cells. Fluoxetine latches onto the receptors like a key in a lock, to switch off serotonin absorption, or "serotonin reuptake", thus increasing the presence and action of this vital natural chemical in the brain. Hence, Prozac is known as an SSRI -a selective serotonin reuptake inhibitor - which, scientists claim, elevates the mood of the depressed and increases "impulse control".

Questions have been raised, however, as to whether an individual, with paranoid fantasies that have been rendered inactive in the depths of depression, gains impetus as a result of fluoxetine to fulfil a murderous fantasy rather than control the impulse. This was the explanation proposed in a civil action in America following 47-year-old Joe Wesbecker's shooting spree in 1989. He shot 20 of his co-workers at the Louisville Courier-Journal printing plant, killing eight of them, before killing himself. He had been on Prozac for one month.

The SSRI strategy is based on the belief that there is a direct link between the state of our brain molecules and our moods. The co-inventor of Prozac, the late Dr Ray Fuller, once told me during the Wesbecker trial that the SSRI proceeds from the principle that "behind every crooked thought there lies a crooked molecule".

Three years ago, the UK Medicines and Healthcare products Regulatory Agency (MHRA) issued warnings about most antidepressants for children, specifically including SSRIs, on the grounds of risk of suicide. The view was based on a review by a group of medical experts studying all available evidence of clinical trials on both sides of the Atlantic.

The MHRA asserted that the benefits of treating under-18s with any SSRI, except one, Prozac, were outweighed by the risks of side effects. The drugs mentioned were paroxetine (Seroxat), sertraline (Lustral), citalopram (Cipramil) and fluvoxamine (Faverin).

Fluoxetine alone was judged on statistical evidence, and in strict specific circumstances (of which more later), to have a positive balance of risks versus benefits in the treatment of the most severe forms of depression in the under-18s. In other words, when risk of suicide, for example, is so great and persistent that it outweighs the worst-case-possible side effects of the drug.

But the gap between an 18-year-old and an eight-year-old is huge in brain-developmental terms. And Prozac itself has been associated with suicidal patients of all ages, as well as side effects such as stunted growth and deleterious effects on the sexual organs of children. SSRIs have been associated with atrophy of gonadal tissue in boys, indicating future problems with puberty and sexual activity later in life.

It is still not known whether there could be a deleterious effect on a girl's ovaries. Two years ago, researchers at Columbia University in New York found that young mice exposed to fluoxetine and other SSRIs were prone to abnormal brain development; the drugs appeared to be inhibiting normal neural growth factors. Animal studies have claimed that SSRIs weaken bone growth. There are also addiction issues, as yet unexplored in children owing to lack of longitudinal studies.....

Philosophy and sentiment apart, the neurophysiological unknowns are substantial. The American professors of psychology Alison Gopnik and Andrew Meltzoff claim in their book How Babies Think that typically by the age of three "the number of synapses reaches its peak when there are about 15,000 synapses for each brain cell, which is actually many more than in an adult brain". They argue that children have brains that are "literally more active, more connected, and much more flexible than adult brains". So under what conditions could a child, still subject to rapid neurobiological development, show signs of clinical depression comparable to an adult, or even an adolescent, so as to be a suitable case for treatment with powerful mind-altering drugs?

More here

Australian Feds on the evils of fizzy drinks

No mention that milk is even more calorific

Health Minister Tony Abbott has flagged a government campaign to make Australians aware of the dangers of soft drink. "I think that soft drinks, other than as an occasional treat, can be very, very harmful," Mr Abbott said. But he stopped short of promising tighter regulation around the sale and advertising of soft drink. "I'm not saying it should be banned, but I do think that it should be something which people buy for the occasional treat, not as a regular part of their kid's diet," Mr Abbott said. "What the government ought to do is help get the message out there."

Speaking at a global forum on diabetes in indigenous people, Mr Abbott said consuming soft drink as part of a regular diet was dangerous and could lead to obesity in children. "It's distressing that soft drinks are overwhelmingly the biggest single sellers in our supermarkets right around Australia." Mr Abbott said that unless children matched their soft drink consumption with regular exercise, they were at risk of childhood obesity.

"The problem with soft drink is that it's basically water spoilt," he said. "A small can of Coke contains something like 160 calories, it's a good half hour's walking to burn up that kind of energy. "So, as a matter of course, kids that have a couple of cans of Coke a day, obviously they've got to get that much more exercise if they're going to avoid the problem of childhood obesity."

International Diabetes Federation president-elect Professor Martin Silink said governments globally needed to take a stronger stand on soft drinks. "While they provide calories, they provide very little nutritional value," he said. "There was recently a study, for instance, in NSW that indicated infants are being given soft drinks and biscuits - these are not infant foods." But Mr Silink said it was too simplistic to lay the blame on parents, adding there was a broader societal responsibility to ensure diabetes is screened for, particularly in indigenous people.

Diabetes Australia national president Peter Little said having a labelling system for soft drinks displaying calorie content would be effective. "It's probably reasonable to educate people to link that energy value to how much exercise you have to do," he said. "In my view those energy labels would become de facto warning labels. "That sort of labelling system would be really simple and I think that's an excellent idea."



Just some problems with the "Obesity" war:

1). It tries to impose behavior change on everybody -- when most of those targeted are not obese and hence have no reason to change their behaviour. It is a form of punishing the innocent and the guilty alike. (It is also typical of Leftist thinking: Scorning the individual and capable of dealing with large groups only).

2). The longevity research all leads to the conclusion that it is people of MIDDLING weight who live longest -- not slim people. So the "epidemic" of obesity is in fact largely an "epidemic" of living longer.

3). It is total calorie intake that makes you fat -- not where you get your calories. Policies that attack only the source of the calories (e.g. "junk food") without addressing total calorie intake are hence pissing into the wind. People involuntarily deprived of their preferred calorie intake from one source are highly likely to seek and find their calories elsewhere.

4). So-called junk food is perfectly nutritious. A big Mac meal comprises meat, bread, salad and potatoes -- which is a mainstream Western diet. If that is bad then we are all in big trouble.

5). Food warriors demonize salt and fat. But we need a daily salt intake to counter salt-loss through perspiration and the research shows that people on salt-restricted diets die SOONER. And Eskimos eat huge amounts of fat with no apparent ill-effects. And the average home-cooked roast dinner has LOTS of fat. Will we ban roast dinners?

6). The foods restricted are often no more calorific than those permitted -- such as milk and fruit-juice drinks.

7). Tendency to weight is mostly genetic and is therefore not readily susceptible to voluntary behaviour change.

8). And when are we going to ban cheese? Cheese is a concentrated calorie bomb and has lots of that wicked animal fat in it too. Wouldn't we all be better off without it? And what about butter? It is just about pure fat. Surely it should be treated as contraband in kids' lunchboxes! [/sarcasm].

9). For a summary of the weak science behind the "trans-fat" hysteria, see here. Trans fats have only a temporary effect on blood chemistry and no lasting harm from them has ever been shown.


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