Saturday, March 12, 2011

Life-saving drugs 'are less effective when it's sunny'

The usual leaping to conclusions. For a start, the very extreme variation in Swedish summers and winters may have effects not seen elsewhere.

Secondly, depression and other ailments (including heavy consumption of alcohol) may be common in the Swedish winters and that may be the cause of the effects observed.

Thirdly, it seems reasonable that immunosuppressive drugs might be in a class of their own. It is only theory that says the effect will generalize widely.

Fourthly, in the very sunny part of Australia where I grew up, the same standards for drug prescription are used that are used elsewhere in Australia and I have never heard any rumblings about drugs being less effective there.

Fifthly, what is true of organ transplant patients might not be true of healthier patients

Potentially life saving drugs become less effective when it is sunny, a new study has found. Swedish scientists have shown that the extra vitamin D produced by the body in the summer months, speeds up the body's ability to break down medicines. [They did NOT show that. The cause is speculation]

The findings - based on a study of 6,000 people - suggest that doctors should reduce doses of some medications in the dark winter months, and increase them in prolonged periods of hot sunny weather.

The researchers say the findings could have implications for half of all prescribed medicines - but warned patients not to alter their doses without consulting a doctor.

The study looked at 70,000 blood samples from organ transplant patients taking one of three immune system suppressing drugs in Stockholm, Sweden over 10 years. Samples taken in the winter - when Stockholm gets only a few hours of daylight and almost no sunshine - were compared with samples taken on long summer days.

The concentrations of the drugs varied throughout the year in a way that closely reflected changes in the levels of vitamin D - a nutrient produced by the body in response to sunlight, the researchers report in the journal Drug Metabolism and Disposition.

The highest levels of vitamin D were reached during the summer months at a time when levels of two of the immuno-suppressant drugs were seven per cent and 17 per cent lower.

The researchers believe vitamin D increases the amount of a chemical released by the liver involved in breaking down medications.

Dr Erik Eliasson, who carried out the study at the Karolinska Institute, said the chemical - an enzyme known as CYP3A4 - was involved in the metabolism of around half of all medications.

'The drugs we were studying were being very closely monitored in the patients anyway - but for other drugs which aren't monitored as closely there could also be an effect,' he said.

Stockholm is as far north as the Shetlands where winter days are very short, and summer days long. The effect on daylight on drug metabolism will be less pronounced further south.


Back to Prohibition?

Professor David Nutt – the former government advisor on drug policy – argued in the Guardian yesterday that there is no such thing as a safe level of alcohol consumption. I’m not convinced – as one commenter points out, he uses some anecdotal evidence and an extremely strict definition of ‘safety’ – but for the sake of argument, let’s say that Nutt’s right and alcohol really IS a lot more harmful than we currently think. What would the policy implications be?

For a start, you might want the government to inform people so that they make an informed decision about their drinking. People tend to be distrustful of government information but I suppose it’s worth a shot. It might also encourage rebellious teenagers to drink more, but teenagers like drinking plenty already. Some would want to tax alcohol more highly to discourage drinking. If people are sufficiently informed about the dangers it seems too paternalistic to try to make them act as we’d like them to, but it’s a popular position.

There are plenty of other regulations that people would have across the board, but almost nobody would propose to prohibit alcohol consumption altogether, even if it was shown to be rather more harmful than Nutt is saying. Most people understand that outlawing something altogether makes it more dangerous. As during Prohibition in the US (PDF), a black market would grow (funding organized crime), alcohol would become more dangerous (brewed in people’s bathtubs and cut with things we’d rather not drink), and people would be put into prison for doing things in the privacy of their own home that didn’t really affect anybody but themselves.

On that last point, I hate to think of the social consequences of jailing thousands of people for victimless crimes. Prohibition didn’t work the last time round, and it wouldn’t be any more effective if we suddenly learned that alcohol was a physical evil rather than a moral evil. Most people know these things and accept that even if they hated alcohol’s effect on others, it would be foolish to try to outlaw it.

So why do we have precisely the opposite view of recreational drugs? A social and individual harm reduction policy against a dangerous alcohol would fall far short of outright prohibition. Applying the policy to alcohol has and would be a failure, irrespective of alcohol’s harmfulness. What reason is there to think that cannabis, ecstasy, mephadrone – and even heroin and crack, for that matter – are any different?


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