Rise in mortality in England and Wales in first seven weeks of 2018 | The BMJ

Health chiefs are failing to investigate a clear pattern of worsening health outcomes

Within the first seven weeks of 2018, some 93 990 people died in England and Wales.1 Over the same weeks in the previous five years, an average of 83 615 people died.1 This rise of 12.4%, or 10 375 additional deaths, was not due to the ageing of the population. Ageing is a slow process and leads to slow, not sudden, rises in mortality.2 An additional person died every seven minutes during the first 49 days of 2018 compared with what had been usual in the previous five years. Why?

Not the weather or flu
The weather was unusually mild during the initial weeks of this year—very cold weather did not arrive until late February. The mean temperature was 4.1°C across the UK in January 2018, almost half a degree above the average for this time of year.

full text – BMJ

“worse than Hitler” “pharma-whore”

A government adviser on the use of antidepressants has resigned after being called “worse than Hitler” and a “pharma-whore” in a campaign of harassment that he has accused colleagues of fomenting.

David Baldwin claimed that a fellow adviser helped to fan the flames of online abuse in a row over the effects of the drugs. The controversy began when he wrote to The Times in February to downplay the side-effects of coming off the drugs, saying: “In the vast majority of patients, any unpleasant symptoms experienced on discontinuing antidepressants have resolved within two weeks of stopping treatment.”

https://www.thetimes.co.uk/edition/news/drugs-adviser-david-baldwin-quits-after-being-branded-worse-than-hitler-in-online-abuse-row-srtqltmfs

Valium: What is it used for and why are people buying it on the street?

Harriet Williamson Wednesday 19 Sep 2018 8:12 am Last November, Christina Craig died after taking a fake Valium pill. The tablets were known as ‘Blue Plague’. She was the fourth in a group of six friends in Glasgow to lose her life to what she believed to be Valium.

Scottish police estimate that there could be millions of fake Valium pills on the streets. Why is there a thriving market for the drug? Why aren’t users getting it on prescription?

Valium, also known as Diazepam, is part of a group of drugs called benzodiazepines. It’s a sedative recommended for short-term treatment only because it can quickly become addictive.

Valium isn’t usually prescribed for longer than two to four weeks at a time, and some GPs are uncomfortable prescribing it at all. The NHS lists the side effects of benzodiazepines as including drowsiness, difficulty concentrating, vertigo, low sex drive, headaches and the development of a tremor.

After four weeks of use, benzodiazepines may start to lose their efficiency, meaning that you need a higher dose to get the same effect. The way Valium loses potency and the potential for addiction are two reasons why GPs don’t regularly prescribe the drug for long-term conditions like anxiety, as they did when it was first released. Valium was created by Leo Sternbach and released in 1963. It became one of the most frequently prescribed medications in the world, and between 1968 and 1982, it was the highest selling medication in the US. More than two billion tablets were sold in 1978 alone.

Anxiety and insomnia had previously been treated with barbiturates, which caused extreme withdrawal symptoms, were highly addictive and easy to overdose with. Benzodiazepines like Valium seemed like the safer and more effective option, and they became the prescription solution for every problem.

The drug was particularly associated with women, and in 1966, the Rolling Stones even wrote a song about it, entitled ‘Mother’s Little Helper’. It took a long time for the addictive nature and negative side-effects of benzodiazepines to be recognised, despite research in the 1980s linking the long-term use of this drug group to brain damage and calling the drug ‘more difficult to withdraw people from than heroin’.

The NHS is now supposed to prescribe benzodiazepines for a maximum of four weeks to curb the potential for addiction. However, some doctors are failing to stick to guidelines published more than 20 years ago.

Full Metro article

Patients who are becoming addicted to prescription drugs – ITV

VIDEO

They are powerful painkillers bringing relief to millions of people – but there is growing concern over the use of opioids.

There’s evidence that some patients are becoming hooked on them and many experts argue they are ineffective when it comes to reducing long term chronic pain.

Benzodiazepines

What are benzo's & their side effects?
What are benzo’s & their side effects?

What are benzodiazepines, and how do they work?

Benzodiazepines are a class of drugs primarily used for treating anxiety, but they also are effective in treating several other conditions. The exact mechanism of action of benzodiazepines is not known, but they appear to work by affecting neurotransmitters in the brain, chemicals that nerves release in order to communicate with other nearby nerves. One of these neurotransmitters is gamma-aminobutyric acid (GABA), a neurotransmitter that suppresses the activity of nerves. Scientists believe that excessive activity of nerves may be the cause of anxiety and other psychological disorders, and benzodiazepines reduce the activity of nerves in the brain and spinal cord by enhancing the effects of GABA.

For what conditions are benzodiazepines used?

Benzodiazepines are used for treating:

anxiety and panic
seizures (convulsions), and
insomnia or trouble sleeping.

They also are used for:

general anesthesia,
sedation prior to surgery or diagnostic procedures,
muscle relaxation,
alcohol withdrawal and drug associated agitation,
nausea and vomiting,
depression, and
panic attacks.

Alprazolam (Xanax), chlordiazepoxide (Librium), chlorazepate (Tranxene), diazepam (Valium), lorazepam (Ativan), and midazolam are used for anxiety disorders.

Clonazepam (Klonopin), clorazepate (Tranxene), lorazepam (Ativan), clobazam (Onfi), and diazepam (Valium) are used for seizure disorders.

Estazolam (Prosom), flurazepam (Dalmane), quazepam (Doral), temazepam (Restoril), and triazolam (Halcion) are used for insomnia or trouble sleeping.

Midazolam (Versed), lorazepam (Ativan), and diazepam (Valium) are used in anesthesia.
Diazepam (Valium) also is used for muscle relaxation.

Chlordiazepoxide (Librium) is used for alcohol withdrawal.

Side Effects

Most common:

drowsiness
light-headedness
confusion
unsteadiness (especially in older people, who may have falls and injure themselves as a result)
dizziness
slurred speech
muscle weakness
memory problems
constipation
nausea (feeling sick)
dry mouth
blurred vision

Less common:

headaches
low blood pressure
increased saliva production
digestive disturbances
rashes
sight problems (such as double vision)
tremors (shaking)
changes in sexual desire
incontinence (loss of bladder control)
difficulty urinating

Also reported:

blood disorders
jaundice (yellow skin)
breast development in men

Words can hurt those on benzodiazepines

There exists a large, mostly-underground, growing community consisting of those iatrogenically harmed by benzodiazepines. Guilty only of following doctors orders, these patients are marginalized and misunderstood. This has been enabled, at least in part, by poor terminology………

……….
Physical dependence and addiction are not synonymous (see: patient education materials that accompany some benzodiazepine prescriptions). Yes, physical dependence can manifest from both abuse and compliant use. But physical dependence can stand alone. Signs of its development — tolerance, interdose withdrawal, and/or withdrawal symptoms with dose reduction — are not an accurate indicator that addiction is co-occurring. So then why are terms like “addictive,” “addicted,” and “hooked” utilized by many experts and media outlets to describe what is actually prescribed physical dependence? I believe the answer is two-fold: (1) confusion (lingering from a history of bastardized language) or a lack of education; and (2) the media’s desire for a sensational headline. The latter alienates the as-prescribed population and comes at the expense of accurate reporting.
When examined objectively, it is obvious that this terminology approach is illogical.

It also has considerable cost in the following ways:

1. By providing a false sense of security to the prescribed physically-dependent population. Drug abusers know they are at risk of harm. Patients compliantly taking benzodiazepines, long-term (>2-4 weeks), often do not. Stories encountered about “benzodiazepine addiction” are dismissed as irrelevant and fall on deaf ears. Instead of an informed warning, patients and their prescribers are left incorrectly reassured that any problems with benzodiazepines lie solely with the user’s behavior as opposed to being inherent to the drug class itself.

2. It results in misdiagnosis and dangerous mistreatment. Physically dependent patients who do accurately identify symptoms as originating from their benzodiazepine may seek out or be referred to addiction-based “treatments,” like rehab or “detox,” if they are left under the impression that they are “addicted.” At such facilities, the “law of the instrument” often manifests when all patients are universally “treated” under the “addiction model,” consisting of abrupt discontinuation of any drug deemed “addictive,” irrespective of abuse history. This practice defies all respected benzodiazepine withdrawal guidelines (calling for slow, patient-guided tapers). The result is often disastrous, increasing the risk of severe symptoms (seizures, psychosis, suicidality, akathisia, etc.) and protracted neurological insult.

Similarly, in the outpatient setting, physically dependent patients mistaken for “addicts” are sometimes “fired” or have their prescription “cut off” by misinformed prescribers. For best outcomes, patients require understanding, patience, and withdrawal guidance that facilitates slow tapering, usually over many months and years.

3. It causes displaced blame. Compliant patients are too often on the receiving end of misdirected blame when they are mistakenly believed to be “addicted” to benzodiazepines. This literally adds insult to injury. Worse, it enables the problem to persist because fault is directed away from actual causes like prescribing practices which ignore well-documented long-term risks and harms, inadequate pharmacovigilance, lack of truly informed consent, etc. Since fault is assigned solely to patients, there is no impetus for change.

To tackle this terminology hurdle effectively, clinicians, educators, the media, etc. need to present benzodiazepine issues in a way that makes clear there are four distinct problems: (A) adverse effects; (B) iatrogenic physical dependence (including tolerance and interdose withdrawal) and subsequent withdrawal reactions; (C) post-withdrawal (protracted) neurological insult; and (D) addiction/misuse.

Collectively, these encompass all potential complications but each has individual problems deserving of their own platforms. Prescribed harm advocates are attempting to spotlight the first three (A-C), those being the most common yet most unrecognized and overlooked. Doing so proves difficult, however, because there is a lack of meaningful discussion as a consequence of the language of condition D eclipsing everything. The dominant narrative is that everything falls under the addiction umbrella, regardless of whether that narrative applies. Case in point: cardiologist Dr. Christy Huff recently told her story of prescribed physical dependence to Xanax on “NBC Nightly News with Lester Holt” (the news story referenced in the above tweets). Her story is a cut-and-dry case of elements A (adverse effects appearing after only a few weeks) and B (physical dependence that developed, as could be pharmacologically expected, shortly after being prescribed Xanax for insomnia), with no trace of D. Much to the chagrin of everyone championing for accurate benzodiazepine safety information, the newscast was riddled with addiction terminology. The narrator misrepresented Dr. Huff’s story, proclaiming she was “hooked” on the longer-acting Valium she’s using to taper. Meanwhile, the following caption trailed beneath her on-screen image: “Doctors warn of addiction risk from anti-anxiety drugs.” More inaccurate information. More false security. More misplaced blame.

Unfortunately, public commentary beneath the news segment on social media consisted largely of finger-pointing at the “addicts” for “ruining it for everyone else who takes them appropriately!” Another missed opportunity to warn the public with the message that Dr. Huff set out to convey — that anyone who takes benzodiazepines, even exactly as prescribed, is at risk for potentially severe adverse outcomes (physical dependence, painful and/or lengthy withdrawal, protracted neurological insult, etc.)

A popular children’s rhyme concludes, “… words will never hurt me.” But this isn’t just a case of hurt feelings over a botched news story or labeling people addicts when they aren’t. It’s much more serious than that. In this case, misapplied words do grave harm. Many people’s lives and health hang in the balance. By taking great care with the terms we use to discuss benzodiazepines, we can alleviate unnecessary suffering, provide the information needed for consent to be truly informed, and save as many patient lives as possible.

Nicole Lamberson is a physician assistant and serves on the medical advisory board, Benzodiazepine Information Coalition.

full document

Chronic stress – identified in the brain

“….identified a new process in the brain that is responsible for the delayed stress response and the long-term effects of stress…”

“…The potential for a threat from outside might also be protracted, thus requiring the body to adopt not only an immediate but also a prolonged state of alertness…”

“…..Within fractions of a second, a direct neural connection is made to the prefrontal cortex and this determines our behaviour…”

(Vienna, 13 September 2018)
In an international collaboration between MedUni Vienna, Semmelweis University in Budapest, the Karolinska Institute in Stockholm and Yale University in the USA, researchers have identified a new process in the brain that is responsible for the delayed stress response and the long-term effects of stress: with a delay of 10 minutes after the “danger”, the area of the brain that reacts to stress and responsible for further action is activated via the cerebral fluid. The findings could open up new perspectives for understanding the neuronal processes at play in post-traumatic stress disorder, chronic stress and burnout.

“Hitherto we were aware of two main stress mechanisms in the brain”, explains Tibor Harkany from the Division of Molecular Neurosciences at MedUni Vienna’s Center for Brain Research: “A group of neurons located in the hypothalamus is responsible for triggering both mechanisms. The one process is a hormonal pathway, which leads to hormones being released from the adrenal glands into the bloodstream within a few seconds of the stress event. The other process is the nerve pathway, which is even quicker. Within fractions of a second, a direct neural connection is made to the prefrontal cortex and this determines our behaviour.”

Third stress mechanism identified in brain
In the recent investigations led by Alán Alpár (Semmelweis University), Tamás Horváth (Yale), Tomas Hökfelt (Karolinska Institute) and Tibor Harkany (MedUni Vienna), it has now been discovered that these same neurons are also capable of triggering a stress response in a third way, the effect of which occurs slightly later and is sustained.

The completely new mechanism that has now been described proceeds via the cerebrospinal fluid. This also involves a molecule that is important for the development and maintenance of the nervous system, the so-called ciliary neurotrophic factor (CNTF), reaches the stress centre by travelling in the cerebrospinal fluid.

Since this is a mechanism that spreads with the cerebrospinal fluid, it is much slower than the process that occurs via the bloodstream. The substance is diluted more slowly and can therefore have a longer-lasting effect. Conversely, CNTF molecules in the cerebrospinal fluid constantly bombard the neurons of the stress centre, keeping the prefrontal cortex on permanent alert. This means that the nervous system remains in a heightened state of alert with greater reactivity.
According to lead author Alán Alpár from Semmelweis University in Budapest, it is very probable that all three known mechanisms are deployed in the event of severe stress. This third type of process identified by the researchers plays a major role in producing the delayed, and hence lasting effect.
“We know from the work of the world-famous Hungarian-born stress researcher, János Selye, which areas of the brain are responsible for responses to external stressors. He also described what happens in a stress situation, how the hypothalamus activates the pituitary gland, and this in turn activates the adrenal glands,” explains Tomas Hökfelt from the Karolinska Institute in Stockholm. However, stress is a longer-lasting process. The potential for a threat from outside might also be protracted, thus requiring the body to adopt not only an immediate but also a prolonged state of alertness.

Better understanding of neuronal processes

According to the research team, the discovery of the new process can also open up new perspectives for understanding the development of post-traumatic stress disorder. The fact that acute stress can metamorphose into chronic stress, manifesting itself in burnout, for example, represents a serious challenge to today’s society. “Understanding the neural processes that lead to it can open up new options for treating this neuropsychiatric condition, particularly since we identified several molecular steps that might become targets for pharmacological development in the future” emphasises Tibor Harkany.

full article

J.J.’s story

4 years is nothing. 4 years is a black spot on a clean canvas that you can only really see if you step over those red rope barriers in museums that stop you from getting too close. But 4 years of depression and anxiety left my life paralyzed from the early teens onwards. It came in waves, waves of not being able to leave my bed, wishing I was dead, crying until my eyes were burning and my brain felt like it was under a hydraulic press.

Being 15 – noting that I’m 16 now – my mother was desperate. She was frustrated, blaming herself, my father, mostly just me, though. I couldn’t face going to school, so I missed most of the high school experience, I couldn’t even leave my room most days.

We tried aromatherapy. I had candles and drank herbal mixtures and dropped two drops of flower water onto my tongue a day. I had mouth sprays and scent sticks and special herbal chewing gum. That didn’t work so well.

We tried tapping, sort of like massage therapy. I’d tap areas of my body and tell it I will go to school tomorrow. I didn’t.

We tried therapy. My mother took me to a counsellor named Mindy who made me cinnamon tea. Later, I saw an Anne who let me play with the fidget toys she had in a box in the corner. Then I got to the top of the CAMHS waiting list and I saw a Sandra who brought in aromatic play-dough to make me feel more relaxed. Then I got to an Adrienne, who had a fun accent. After her came Linda, who said ‘breasts’ too much.

Then I got Dr Tom.
I’d done CBT – it hadn’t helped. I was missing my GCSEs due to anxiety – I was thrown deeper into depression. My relationship with my mother was angry yells and her being disappointed in me every time she saw me (or, that’s what it felt like to a 15-year-old).

I couldn’t live like this anymore.
Dr Tom explained, in much detail, that medication – Fluoxetine, 20mg – was a last-ditch effort to try to keep my 4 years of misery from becoming 5.

I’d had friends who’d benefitted from taking medication, so when I wasn’t opposed to the idea, my mother agreed. Desperate times and all that.

Dr Tom had explained the side effects to me, and how if they surpassed the two-week mark, I was to call his office immediately. Dizziness, nausea, suicidal thoughts. I was willing.

The first few days, I was dizzy. My head felt heavy and I felt like I was floating. No nausea, no suicidal thoughts.

A week later, I did get a dark cloud over my head. It didn’t last long, but it was there.

A week later, I’d tidied my room. The first time in months.

A month later, I looked up courses in local colleges. I didn’t cry about missing my GCSEs.

6 months later, I set up a board of aspirations and was slowly ticking them off.

A year later, I bought a pet budgie, whom I look after. That’s a lot of responsibility for someone who couldn’t look after themselves last year.

When the time came to come off of my meds, I had no side effects. I was living. I was alive. I had plans, I didn’t look around and hate where I was in life. I was something. Not nothing. 4 years of dark at the end of the tunnel, and suddenly there was light. And it wasn’t a train coming right at me this time, I’d actually found the end of the tunnel!
I’ve been off Prozac for a few months by now. I dyed my hair the other day and laughed when it didn’t come out the way I wanted it to.

When I was 13, if my hair wasn’t right, my anxiety would have me missing days of school to cry on my bedroom floor. My bird, Archie, is my best bud, and likes to sit on my shoulder. I volunteer at an animal rescue and walk the dogs. I used to cross the street when one was coming towards me. I want to learn sign language. I’m going to a concert next year. I go to a drama club. I take the train. I read books. I spend time with my friends. I smile at strangers. I’m not angry anymore.

Prescription drugs can be awful. It can turn something bad into something worse and make someone scared into someone scary.
But I’d been scared for so long.
And I’m not anymore. I’m unsure that I ever will be again.
Whatever prescription drugs are to you, I wish you luck, and remind you there is hope.
cool. peace.

Common painkiller prescribed to MILLIONS increases risk of a stroke

  • Taking the drug diclofenac also raises the risk of gastrointestinal bleeding

  • Diclofenac was banned over-the-counter in the UK due to heart concerns

  • It can still be bought from pharmacies in its gel form, such as Voltaren

A common painkiller that is prescribed to millions in the UK may increase a person’s risk of suffering a heart attack or stroke by 50 per cent, research suggests.

A study of more than 6.3 million adults found that diclofenac, which is prescribed under the brand names Motifene and Diclomax among others, also puts patients at a higher risk of gastrointestinal bleeding compared to other painkillers.

Diclofenac is a non-steroidal anti-inflammatory drug (NSAID) that is approved for the relief of gout, severe allergic conjunctivitis, pain post surgery and arthritis in the UK.

Heart concerns caused British regulators to ban tablet forms of the drug from being sold over-the-counter in 2015. It can still be bought from pharmacies in its gel form, such as Voltaren, to relieve pain and inflammation.

On the back of the study’s findings, published in the British Medical Journal, the Danish researchers are calling from the drug’s UK ban to be expanded worldwide.

The scientists, from Aarhus University Hospital, said: ‘It is time to acknowledge the potential health risk of diclofenac and reduce its use.

‘Dicofenac should not be available over the counter and when prescribed should be accompanied by an appropriate front package warning about its potential risks.’

The scientists analysed national registry data for millions of Danish adults.

Full story

https://www.dailymail.co.uk/health/article-6133497/Common-painkiller-prescribed-MILLIONS-UK-increases-persons-risk-having-stroke.html

(Cough) One in seven patients experiencing negative side effects, study finds

Coughs cost the UK economy nearly £1bn a year in lost productivity and sick days, with a further £100m bill for the NHS in seeing patients who will get better on their own.

There is no evidence that medicines for persistent coughs have any benefit, and one in seven patients actually experience negative side effects, a study has found.

Swiss researchers comparing the medications against a placebo found no examples where they significantly sped up recovery or improved patient wellbeing in any of the other areas tested.

https://www.independent.co.uk/news/health/cough-medicine-work-help-persistent-symptoms-weeks-asthma-a8531286.html