Monday, August 20, 2007

Drugs for sadness?

Doctors were too often mistaking common blue moods in their patients for clinical depression and prescribing drugs for normal emotions, a leading Sydney psychiatrist has said. Professor Gordon Parker, the executive director of the Black Dog Institute, wrote in the British medical journal BMJ that the threshold for diagnosing clinical depression had become too low and the definition too broad.

"It's normal for human beings to be depressed," Professor Parker told the Herald yesterday. "Normal depression to my mind means you certainly feel depressed and you feel deflated and you're pessimistic and your self-esteem drops but it's a transient state. After a few minutes, hours, a couple of days, you bounce back."

He said that over the past 20 years diagnostic models had taken "an extreme position" and ran the risk of treating normal emotional states as an illness. "There's been a blurring of clinical depression into normal depression and the consequence of that has been to strain credibility and for many people to have been delivered a bouncing cheque [when drugs do not work]," he said. "There's often an automatic reaching for the prescription pad. People are not looking at the cause." He said the prevalence of depression had increased mostly due to "the incredible broadening of its definition". It was also due to destigmatisation and, to a lesser extent, an actual increase in disorders, he said.

At the opposite end of the debate, published in BMJ yesterday, Professor Ian Hickie, the executive director of the University of Sydney's Brain and Mind Research Institute, said that it was wrong to say depression was being overdiagnosed. Professor Hickie said there was also no evidence of overprescribing. He also said that a study conducted in 27 countries 2003, published in BMJ, showed an increase in the use of antidepressants had led to a decline in suicides. "The answer is do the body count ." he said "In order to save lives you have to treat the mild and moderate cases." He said "the continual demonising of the medicines just plays into the stigma" of mental illness.

"I think it's time the specialists got over it and we got on with the public health issue of identifying those who are likely to benefit and make the wide range of treatments, medication and psychological treatments available," he said. "We're still providing so little treatment to those whose lives are at risk that we hardly need to concern ourselves with overtreatment." Treatment for depression has become more widespread since the early 1990s with the advent of drugs such as Prozac.

The Australian Institute of Health and Welfare says one in five Australians will experience a mental illness. It estimates that there were 10.2 million general practitioner encounters involving mental health-related problems in 2003-04, more than a third of which were about depression.


'Phone-in' heart treatment helps

Getting it implemented beyond the pilot trial will be the difficulty

MOBILE-PHONE technology being used to help treat heart-attack victims and dramatically cut death rates at two Sydney hospitals, is receiving international recognition. The program allows information about a patient's condition to be instantly transmitted from an ambulance on the way to Royal North Shore and Westmead hospitals, giving doctors a head start on treatment.

Research on the program has been published in the European Heart Journal. Greg Nelson, the head of the Interventional Cardiology Group at RNS, said it saved an average of 100minutes, which is critical in reducing the size of the heart attack and the likelihood of death.

Using the method, cardiac mortality rates at RNS dropped from 8per cent to 2per cent. As part of the emergency triage acute myocardial infarction (ETAMI) program, the results of an electro-cardiogram on patients with a suspected heart attack are transmitted by ambulance officers at the scene, using the same technology as making a mobile-phone call, to the emergency department where it is examined by doctors. If it shows the patient is having a heart attack, a surgical team is assembled ready for the patient's arrival.

"It's getting that artery opened sooner that's going to make a big difference," Dr Nelson said. "From symptom onset to opening the artery using the old strategy the average time is 246 minutes. "What we've shown with this method of diagnosis is that time is reduced, on average, to 150 minutes. "We have confirmed that the level of muscle damage is less in people treated this way than people treated in the conventional way."



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 and margarine? They are just about pure fat. Surely they should be treated as contraband in kids' lunchboxes! [/sarcasm].

Trans fats:

For one summary of the weak science behind the "trans-fat" hysteria, see here. Trans fats have only a temporary effect on blood chemistry and the evidence of lasting harm from them is dubious. By taking extreme groups in trans fats intake, some weak association with coronary heart disease has at times been shown in some sub-populations but extreme group studies are inherently at risk of confounding with other factors and are intrinsically of little interest to the average person.


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