Taking back control of opioid prescription drugs

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Addiction is, by its very nature, about loss of control. The more I’ve been in this job and the longer I’ve lived, the more substances seem to be added to the addictive list. 

In the past few weeks, my early morning news on the radio has featured addiction to alcohol, to food, to gambling, to smart phones, to illegal psychoactive substances, and, the inspiration for this blog, to opioid prescription painkillers. Sadly yet more deaths and lives destroyed. 

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Cancer, burnt toast and roast potatoes

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I should think the entire western world is now afraid to eat their roast potatoes.  This comes after the international media coverage  of the UK Food Standards Agency’s new campaign “"Go for Gold” , [@CABI_Health 23rd Jan ], which hopes to encourage us (UK) to reduce acrylamide in our diet by cooking starchy foods to a pale golden colour and no further.

Speaking as someone who spent nearly 20 years in labs handling acrylamide on a daily basis (for analysing proteins), I can’t say I am too worried about the acrylamide content of my Sunday lunch roast potatoes  and burning my toast.

But what about the general public? Should they be nervous…so what is behind the UK Food Standards Agency (FSA) campaign?

It’s their recently published Total diet study of inorganic contaminants, acrylamide & mycotoxins (TDS-2014), covering years 2014 and 2015 for the UK, and how the results fit with European Food Safety Agency (EFSA) recommendations.

A total diet study differs from other food surveys in that foods are firstly prepared and cooked for consumption. The aim of TDS-2014 was to estimate dietary exposure to contaminants for population age groups: it assessed 138 food categories, and for each category pooled food items collected from 24 UK towns.

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Air pollution, can we reduce the impact of cars on urban air quality?

Air pollution in Delhi

Air pollution in Delhi

In January 2016, Delhi, India, improved air quality on its streets when it conducted a 2-week air pollution reduction experiment, with private cars allowed on the streets only on alternate days, depending on license plate numbers.   The idea is not new and has been tried elsewhere (Paris and Rome) but I guess its novelty (“who’d have thought” brigade) to the USA explained why it made The New York Times!

Last year, it was all headlines about Bejing [China] and the air quality citizens had to deal with. However it would seem that actually Beijing’s levels of PM10 (particulate matter up to 10 micrometres in size), a measure of air quality, decreased by 40% from 2000 to 2013, whereas Delhi's PM10 levels have increased 47% from 2000 to 2011.

Delhi's PM10 levels are nearly twice as much as in Beijing, and it has the worst PM 2.5 levels of 1600 cities in the world. Thus the need for the license plate experiment. In a BBC article, you can read more about the reasons “Why Delhi is losing its clean air war” and discover the varied & innovative measures China has taken to ameliorate motor car use.

No doubt spurred on by Delhi’s experiment, a health journalist in Bangladesh alerted the HIFA forum to the equally bad situation in India’s neighbour, Bangladesh.

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Accurate and timely communication is key to stopping transmission of Ebola

Ebola on TDB
Ebolavirus: coverpage for CABI's print journal Tropical Diseases Bulletin

Ebola brings out the worst and the best in mankind.

Global coverage of the Ebola outbreak in West Africa began with (the best) courageous foreign health care workers (HCWs) being flown home by their governments in a desperate attempt to save their lives, and rapidly moved on to the sheer panic amongst the local populations experiencing the outbreak: riots, health care workers and government officials abandoning their posts (the worst). Somewhere imbetween mention was made, usually by the foreign HCWS, of their local colleagues left behind who struggled on without resources and personal protection (the best).

Medicin Sans Frontiers highlighted the slow response of the international community.

Misinformation, public panic and stigma

Ebola haemorrhagic fever (caused by different ebola virus strains) has been around since 1976, with regular self-limiting outbreaks, usually in remote areas of one country. Index cases always involve some contact with animal reservoirs (bushmeat (wild animal meat), bats, rodents, monkeys), and its then spread by person-to-person transmission through contact with bodily secretions or with objects contaminated with secretions. It’s infamous for its high case-fatality rate and the ease with which it spreads among contacts of the diseased.

What makes this time different is the Zaire strain has now reached West Africa: there  it has spread from remote regions into highly populated urban areas, and it has crossed borders so that there are escalating outbreaks in 3 adjacent countries (Guinea, Sierra Leone and Liberia), with no end in sight. The epidemic (for that is what it is now), has resulted from sustained person-to-person transmission.

Cases have also been reported in Nigeria and Senegal but these countries seem to have contained the transmission of the virus. DR Congo  has an outbreak.   An up-to-date Ebola Healthmap can be found here.

Ignorance and fear, drivers of disease

Misinformation among health workers and the public fuelled panic and contributed to the spread of Ebola-zaire over the last 6 months.  HCWs abandoned their posts or were the source of rumours that created riots, government officials got out whilst they could. [The index case for Nigeria, was an official who left Liberia, who knowingly had had contact with an Ebola victim].

Fear has not just caused civil breakdown.  It is masking the magnitude of the outbreak, especially in Liberia and Sierra Leone. Families fear stigma so hide sick relatives or consider the hospitals as death sentences (breaking relatives out!) or indeed consider them the cause of the illness in the first place. Cases being cared for outside hospitals do not enter the statistics.   

Unlike the “Black Death” in medieval Europe, it’s not lack of real clinical knowledge that’s the problem but:

  1. Weak health systems, lacking skilled HCWs and resources
  2. Lack of knowledge amongst the general public
  3. Lack of community involvement & mistrust of government
  4. Misinformation among health workers, ministries of health and the public
  5. Lack of effective drugs and vaccines…supportive therapy only is current medical response.

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Alcohol and sport: “drinking culture” affects youth health

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Building the beer tower at Lord's during England vs Sri Lanka.
Photo: Wendie Norris

We went to Lord’s cricket ground to see England play Sri Lanka recently [14/6/14]. In our Lower Compton stand, the cricket was incidental to the main sport of drinking & talking. When did cricket at Lord’s get like this? Apparently at least since 2011 according to The Guardian’s Barney Ronay:  Sozzled – how English cricket got lost in drink

Our enjoyment was marred by the constant hubbub and noise: you could not hear bat on ball.

A group of young men in front of us, with one prime instigator (who somehow never got caught), in great good humour started a “feed the snake”… plastic beer cups were collected into one stack or beer tower and passed through the stand to be added to, while particpants shouted “feed the snake”. Great cheers would start up from the crowded stand – nothing to do with what was happening on the pitch – but because of these precarious beer towers.  For me, it was amusing only the once: repetitions were distracting and required constant security intervention.

What hit me from the beer towers was how many beers our stand had clearly been through between 11am and 2pm. Aided no doubt by the cardboard drinks holders enabling people to carry at least four pints in one hand. And not just beer… 4 lads behind us went through 3 bottles of champagne in the afternoon’s play.

Who was in the stand? All ages, but our stand was particularly full of young people (mostly lads) in their mid-twenties, good humouredly drinking themselves silly but not aggressive. Just silly enough to lose a sense of proportion and consideration for others in the stand.

Most of the drink on the day was bought at the venue, and there was plenty of advertising sponsorship linked to alcohol. The UK government’s minimum pricing for different drinks (April 6, 2014) to stop extreme discounting of alcohol in England and Wales, wouldn’t have helped at Lords.

Back at work I decided to investigate the health facts behind the “drinking culture” amongst young people and in particular young sports fans.

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Angry and sad at Xmas: victims of adolescent bullying

FACES_Tiny_with_creditThere have been far too many stories recently of desperate teenagers committing suicide, and an unknown number of families today will be reeling from the discovery that their teenager is seriously self-harming because of bullying. Mobile phones and social networking sites have exacerbated an age-old problem so that there is nowhere to hide. 

Poison-pen letter writers are no longer adults in detective stories. They have been brought right up-to-date, and are alive and well reincarnated in teenagers. Incapable of empathy with their victim, remote bullying via texts, phones, videoclips and the internet makes it so easy & so much more devastating, reaching  beyond a school, covering entire towns & counties,  and as its not face-to-face, even less likely for the teenage bully to empathise.

There also seems to be more serious consequences to bullying these days:  beyond loss of confidence, our society is experiencing a rise in self-harming and suicide amongst teenagers. Is it because teenagers these days are so interested in relationships & celebrity, following soaps avidly, that they are posting the minutiae of their lives online for all to see as if they were part of a soap opera?

What is the research evidence available to understand what’s going on?

I took a look and discovered to my horror that being bullied in primary schools can set you up to self-harm when you are a teenager in your next school.  Being Bullied During Childhood and the Prospective Pathways to Self-Harm in Late Adolescence ,  was co-authored at Warwick University, UK. Their press release reveals that 16.5% of 16-17 year olds had self-harmed in the previous year, and 26.9% of these did so because they felt as though they ‘wanted to die’. Those who were subjected to chronic bullying over a number of years at primary school were nearly five times more likely to self-harm six to seven years later in adolescence.[see press

Furthermore, other research shows being both the bully and the bully-victim is linked to an increased risk of suicide or mental illness. I also discovered that self-harming is a very difficult habit to break.

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August babies lack self-esteem

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This week we heard that being born in August in England leads to lack of self-esteem and a lifelong tendency to underachieve (Does when you are born matter?, from Institute of Fiscal Studies (IFS)). This appears to be a follow-up study to one focussed on primary school children in 2007, and it certainly got covered well: BBC, Guardian and Telegraph to name just a few.

Speaking as an August baby, the only reason why I grew up lacking confidence and my brother, also an August baby, lacked self-esteem (note the difference between us) was that we had a father who was, frankly, a bully. For us, school was an escape; weekends could be very hard.

So you can imagine what I first thought when I heard about the study on BBC Radio4 Tuesday morning (1/11/2011). My second more rational thought was about this link to underachievement, with 20% less of us going to Russell Group universities. Is it linked to our school year starting in September, is it therefore confined to the UK? Is it linked to day length? Is there a difference between decades reflecting changes in society?

The answer to my questions would lie in studies of August-born children in northern France, or southern parts of Scandinavia, or closer to home, Eire.  Or looking at other countries which have cut-off dates for school entry. Very close to home, it’s February cut-off in Scotland.

I went looking on CABI's public health database, Global Health, for studies on health or educational attainment or adult socioeconomic status, which others may have also linked to birth month (see Further Reading for some examples).

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