Friday, November 23, 2007

Smoking and mental illness

Smoking correlates with ALL indices of social disadvantage. You mostly have to be dumb, poor or mad to smoke these days

Virtually everyone knows about the connection between smoking and health. Smoking causes 440,000 deaths a year in the United States (50,000 of which are from exposure to secondhand smoke) and 5 million worldwide. It shortens smokers' lives by 10 to 15 years, and those last few years can be a miserable combination of breathlessness and pain.

But few are aware that smoking is concentrated among people with mental illness, often compounded by substance-abuse disorders such as alcoholism. Go to most Alcoholics Anonymous meetings, and the room will be so full of smoke that you can cut it with a knife. Ask the members, and they will tell you that it was much easier to stop drinking than to stop smoking. Indeed, nicotine, the addictive component of tobacco smoke, is as habituating as cocaine or heroin, and it has a similar effect on chemical receptors in the brain.

The facts about smoking and mental illness are stark. Almost half of all cigarettes sold in the United States (44 percent) are consumed by people with mental illness. This is because so many people who have mental illnesses smoke (50 to 80 percent, compared with less than 20 percent of the general population) and because they smoke so many cigarettes a day - often three packs. Furthermore, smokers with mental illness are much more likely to smoke their cigarettes right down to the filters.

Yet for years, mental health professionals ignored smoking. Why did patients, their families and clinicians do nothing to help smokers quit? One reason is well-intended but uninformed compassion. The reasoning goes something like: "Poor Joe is suffering so much from his illness and gets such pleasure from his cigarettes that I don't want to take them away from him."

Another reason lies in the extent to which smoking is integrated into mental health treatment. In psychiatric hospitals the denial of the opportunity to take a smoke break is used as a disciplinary tool, and cigarettes have become part of the culture - often being traded for goods or sexual favors as a form of currency.

Another factor is that many clinicians who work with people with mental illness have themselves recovered from psychiatric conditions, including substance abuse, but have not been able to stop smoking. They feel hypocritical about trying to help patients quit when they are unable to do so themselves.

After years of tolerating, and even encouraging, smoking among people with mental illness, mental health professionals are beginning to recognize the hazards of smoking. Two things have been especially powerful: the spread of facts about secondhand smoke dangers and a recent analysis showing that people with chronic mental illness die 25 years earlier than the rest of the population, with many of those lost years attributable to smoking.

So, what can be done to help people with mental illness stop smoking? Despite strong addictions or concerns about patients' quality of life, this isn't a futile effort. Like the general population, most smokers with mental health conditions would like to quit. Although their odds of actually quitting are not as high - about half that of smokers who don't have mental health conditions - there are many success stories.

Opportunities exist in both hospital and community settings. There is a growing trend to make mental health hospitals smoke-free, both indoors and on their campuses. For the first time ever, more than half of these institutions in the United States are now smoke-free, and those numbers are increasing. Predicted complications of increased violence and the need for disciplinary actions in the wake of going smoke-free have proved false. In fact, removing smoking as a cause of staff-patient friction has meant fewer violent incidents and more opportunity for staff to interact therapeutically with clients. Tools to help smokers quit - including counseling and drugs such as nicotine replacement, buproprion and varenicline - are available but are still greatly underused.

It will not be easy to reverse the long alliance of smoking and mental illness. But the fact that mental health clinicians and patient and family advocacy groups have recognized the problem and are willing to address it is an essential first step toward wellness.


Researchers strike gold in meningococcal disease fight

Meningococcal disease can strike with frightening speed. Its victims can present with symptoms in the morning and be dead by nightfall. But now, a breakthrough by researchers might go some way to reducing meningococcal fatalities by making it significantly easier to detect the bacteria. It involves the use of nanotechnology, and more specifically, the use of small gold particles being injected into suspected sufferers.

Larraine Pocock knows more about meningococcal disease than most. But it hasn't always been that way. It wasn't until her 21-year-old son Troy travelled to England for a working holiday that she began learning all about the deadly disease. "We got a call from Chelsea Hospital - he'd been admitted and he was critical," she told AM. "We were to ring back in an hour, and I asked them what they thought it was and they thought it was meningitis, and I just realised how serious that was, so I rang back in an hour and he was actually on life support. "So, we rushed to Sydney to try and get to London, but he was to pass away that night."

Ms Pocock now runs a meningococcal foundation named in honour of her son, the Troy Pocock Foundation, based on the New South Wales south coast. She has welcomed the news that new technology might be able to detect the disease within 15 minutes, a far cry from the current testing procedure, which can take up to 48 hours. "Meningococcal disease attacks very quickly and you can be well at breakfast, and you can be actually dead by dinnertime," she said.

Meningococcal disease affects 700 people in Australia each year and 10 per cent of those who contract meningococcal will die from the disease. About 20 per cent of those who contract it will have permanent disabilities.

A prototype device has been developed for the new technology, which involves molecular-sized flecks of gold being covered with antibodies that will attract the protein present in meningococcal bacteria. Jeanette Pritchard is involved in the development of the new technology, which has been designed by Melbourne's RMIT University. She says it has already proven highly successful in tests, and could pave the way for a significant reduction in deaths from meningococcal. "The test result will show either a yes that bacteria are present in the sample, or no the bacteria aren't present," she said. "So, it will basically given an indication that yes, treatment needs to be administered." She says the technology is still in development, but could be in clinics within three years.

Ms Pocock says that while the development of the new technology is welcome, it's far from being a panacea. "We've still got to like raise the awareness for the parent or the teacher or the carer to, you know, take the child to the doctor or the hospital first," she said.



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].

9). And how odd it is that we never hear of the huge American study which showed that women who eat lots of veggies have an INCREASED risk of stomach cancer? So the official recommendation to eat five lots of veggies every day might just be creating lots of cancer for the future! It's as plausible (i.e. not very) as all the other dietary "wisdom" we read about fat etc.

10). And will "this generation of Western children be the first in history to lead shorter lives than their parents did"? This is another anti-fat scare that emanates from a much-cited editorial in a prominent medical journal that said so. Yet this editorial offered no statistical basis for its opinion -- an opinion that flies directly in the face of the available evidence.

Even statistical correlations far stronger than anything found in medical research may disappear if more data is used. A remarkable example from Sociology:
"The modern literature on hate crimes began with a remarkable 1933 book by Arthur Raper titled The Tragedy of Lynching. Raper assembled data on the number of lynchings each year in the South and on the price of an acre's yield of cotton. He calculated the correla-tion coefficient between the two series at -0.532. In other words, when the economy was doing well, the number of lynchings was lower.... In 2001, Donald Green, Laurence McFalls, and Jennifer Smith published a paper that demolished the alleged connection between economic condi-tions and lynchings in Raper's data. Raper had the misfortune of stopping his anal-ysis in 1929. After the Great Depression hit, the price of cotton plummeted and economic condi-tions deteriorated, yet lynchings continued to fall. The correlation disappeared altogether when more years of data were added."
So we must be sure to base our conclusions on ALL the data. But in medical research, data selectivity and the "overlooking" of discordant research findings is epidemic.


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