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Medic’s warning: prescribed medication caused a 50% increase in emergency admissions & nearly 100,000 hospitalisations a year in England

10 Feb

 

An article by Dr Mark Porter (December 2018) opens, “The first thing I do when faced with a poorly patient is to look at their medication to see if it could be responsible. You would be surprised how often it is”. Polypharmacy is rife: 1 in 18 of the population is taking ten medicines or more and potent pharmaceuticals carry risks as well as benefits. Millions of people are taking medication such as blood pressure pills and statins to prevent problems they may never have.

The really important message that reducing your risk of heart disease is best done by an improved diet and lifestyle is getting ‘crowded out’

Repeated campaigns have advocated mass medication – for example the February 2014 drive by the National Institute for Health and Care Excellence (the ‘health watchdog’) saying that the vast majority of men aged over 50 and most women over the age of 60 should take the drugs to guard against strokes and heart disease – though studies have suggested that up to one in five patients taking statins suffers some kind of ill-effect, including muscle aches, memory disturbance, cataracts and diabetes.

The Times reported on February 1st that a study published in the Lancet says all men over 60 and women over 75 are at high enough risk of cardiovascular problems to be eligible for the drugs. Professor Colin Baigent from Oxford University, a ‘co-investigator’, says “The risk of heart attacks and strokes increases markedly with age, and yet statins are not utilised as widely in older people as they should be”.

Dr Porter writes: “it is not illegal drug use in older people that concerns me most. I am embarrassed to report that prescribed medication exacts a far bigger toll on the nation’s health. Since 2008 there has been a 50% increase in the number of emergency admissions to hospitals for adverse drug events caused by medicines. In England alone such reactions are responsible for nearly 100,000 hospitalisations a year”.

He explains that anti-inflammatories such as ibuprofen and naproxen can work wonders for aches and pains from arthritic joints, but they have worrying side-effects and don’t mix well with many drugs commonly prescribed to treat high blood pressure (BP). They can damage the lining of the stomach, causing life-threatening bleeds (responsible for thousands of admissions every year) and can lead to kidney failure (on their own and when taken with BP drugs).

More subtle reactions impairing the quality of life are far more common and much easier to miss. Dr Porter gives a few examples from an ‘endless list’:

  • Blood pressure and heart pills that cause coughs (e.g. ramipril) and erectile dysfunction.
  • The prostate drug tamsulosin that can make you light-headed and increase the risk of falling.
  • Statins that cause aches and pains and reduce mobility.
  • Sleeping tablets that lead to addiction.
  • Cramp pills (quinine) that can cause heart problems.

He gave a striking case history:

“An elderly man with “early dementia” and diabetes was admitted to a residential home on our patch, where the staff reported that their new resident just sat in the corner all day looking vacant. His drug chart revealed he was taking an old-fashioned treatment for diabetes (gliclazide) that was pushing his blood sugars too low. It was stopped and two weeks later he was a new man and back in his own home. It is a lesson I have never forgotten”.

In October, an analysis in the British Medical Journal cautioned against any expansion in prescribing. One of its authors, Dr John D Abramson, clinical lecturer in primary care, from Harvard Medical School, last night said: “I think we have become victims of the drug companies. All the research is funded by them, and the really important message – that reducing your risk of heart disease is best done by an improved diet and lifestyle – is getting crowded out.”

 

 

 

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Following today’s news about emergency admissions & hospitalisations a year in England due to medical error, we turn to iatrogenic disease and death

10 Feb

Up-to-date figures for iatrogenic disease and deaths (inadvertently caused by a surgeon or physician or by a medical or surgical treatment or a diagnostic procedure) are not readily available in UK or USA. the US Department of Health and Human Services Office of the Inspector General examining the health records of hospital inpatients in 2008, reported 180 000 deaths due to medical error a year among Medicare beneficiaries alone.

Paul Wearn from the Office for National Statistics – 9 June 2011 – finally answered a FOI request for information about the number of iatrogenic deaths each year: “ONS do not have a National Statistics definition for iatrogenic The causes most closely fitting this concept are ‘complications of medical and surgical care’, ICD 10 codes Y40-Y84. Table 5.19, from the annual ‘Mortality Statistics’ publication shows that there were 236 male deaths and 226 female deaths where the underlying cause was a complication of medical and surgical care, in England and Wales, for 2009”.

In the British Medical Journal (2016, sometinmes requires reader to login) Professor Martin A Makary, department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA explains that a major limitation of the death certificate is that it relies on assigning an International Classification of Disease (ICD) code to the cause of death so causes of death not associated with an ICD code, such as human and system factors, are not captured. can directly result in patient harm and death.

  • communication breakdowns,
  • diagnostic errors,
  • poor judgment,
  • and inadequate skill

Currently, deaths caused by errors are unmeasured and discussions about prevention occur in limited and confidential forums

Hospital committees undertake internal root cause analysis and departments hold morbidity and mortality conferences but these review only a fraction of detected adverse events and the lessons learnt are not disseminated beyond the institution or department.

Strategies to reduce death from medical error should include:

  • making errors more visible when they occur so their effects can be intercepted;
  • having remedies at hand to rescue patients
  • and making errors less frequent by following principles that take human limitations into account
  • death certificates could contain an extra field asking whether a preventable complication stemming from the patient’s medical care contributed to the death.
  • hospitals could carry out a rapid and efficient independent investigation into deaths to determine the potential contribution of error.
  • Standardized data collection and reporting processes are needed to build up an accurate national picture of the problem. 

World Health Organisation statistics show that strategies to reduce the rate of adverse events in the European Union alone would lead to the prevention – on average – of more than 750 000 harm-inflicting medical errors per year, leading in turn to over 3.2 million fewer days of hospitalization, 260 000 fewer incidents of permanent disability, and 95 000 fewer deaths per year.

 

 

 

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Over 159 American cities oppose section 9101 of the Federal Farm Bill blocking local pesticide controls

15 Dec

More than 150 U.S. cities and counties have created “organic-first” policies and in some cases banned the use of specific chemicals that may harm people or the environment.

PR Newswire refers to a letter sent by local officials to Congresswoman Nancy Pelosi    noting that research has increasingly connected some pesticides with Parkinson’s disease and honey bee die-offs, A rapidly growing body of evidence links pesticides to a wide range of diseases and conditions including Parkinson’s disease, diabetes, leukemia, lymphoma, lupus, rheumatoid arthritis, dementia, reproductive dysfunction, Alzheimer’s disease, and variety of cancers including breast, colon, prostate and lung cancer.

Recognizing these risks, many communities have passed progressive policies to restrict the use of pesticides and protect our residents before any harm comes to them.

Some local officials in Irvine have opted to go further than federal or state laws and have restricted pesticide use on public land such as parks, sports fields and landscaped central road reservations. The city now uses organic products with ingredients such as corn gluten meal and oil from soybeans, lemongrass or rosemary.

Detailed information and photograph (above) may be seen in https://ocweekly.com/how-irvine-became-socals-first-non-toxic-city-7317638/

However, though the bill has attracted attention by legalizing hemp, bolstering farmers markets and rejecting stricter limits on food stamps pushed by House Republicans, California’s Orange County Register reports that a four-page provision (Section 9101) tucked away in the 748 page 2018 federal farm bill could block local governments in the United States from making their own rules about pesticides, ‘effectively neutering’ local control over pesticides, blocking cities, counties and school districts from restricting the use of on playgrounds and parks.

Felicity Arbuthnot draws attention to a report by the Environmental Working Group, commenting: “It truly says it all when government attempts to force people to eat cancer causing poison and feed it to their families and friends”. The EWG report records that:

  • the National League of Cities and
  • the League of California Cities, sent letters of opposition to congressional leaders.
  • The National Association of Counties – representing all 3,069 U.S. counties – and
  • a diverse coalition of over 170 organizations dedicated to public health urged Congress to reject the rider.
  • The National Audubon Society and
  • the American Academy of Pediatrics also sent letters.
  • A lettersigned by over 60 local officials in 39 communities from 15 different states, urged the conference committee to reach an agreement on a final 2018 farm bill that does not include this rider.

Despite all these representations, on 12th December, the U.S. House of Representatives passed the 2018 Farm Bill by a vote of 369 to 47. The next step to permanent legalization is the President’s signature.

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Will any British city follow Irvine’s lead? 

In 2017 Horticulture Week reported Edinburgh City Council’s decision to pursue an herbicide-reduction policy at the end of 2016 followed a year-long trial of alternatives to chemicals run by the council’s parks department. An online search revealed that similar moves have been proposed and discussed by councils in Dundee, Bristol and Belfast.

Today, the Times reported that Dublin city council is to use alternatives as part of a move towards a “herbicide and pesticide-free city” in the spring.  In 2015 Kaethe Burt-O’Dea (above) started a campaign to stop Dublin City Council from using a weedkiller. She is seen above near the community garden started up more than 10 years ago as a place for the street’s residents to compost their organic waste.

 

 

 

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Lincoln County Community Rights versus the politically supported pesticides industry

27 Oct

Felicity Arbuthnot draws attention to the achievements of Lincoln County Community Rights whose core members include the owner of a small business that installs solar panels, a semi-retired Spanish translator, an organic farmer who raises llamas, and a self-described caretaker and Navajo-trained weaver.

Although some of the world’s biggest companies poured money into a stealth campaign to stop the ordinance, and the Lincoln activists had no experience running political campaigns, these part-time, volunteer, novice activists managed to stop the spraying of pesticides that had been released from airplanes and helicopters in this rural county for decades.

The Lincoln County aerial spray ban, which passed in May 2017, is just one of 155 local measures that restrict pesticides. Communities around the country have instituted protections that go beyond the basic limits set by federal law. Some are aimed at specific pesticides, such as glyphosate, others list a few; while still others ban the chemicals altogether.

The upturn in local legislation is a testament to public concerns about the chemicals used in gardening, farming, and timber production, and reflect a growing frustration with federal inaction. In recent years, scientific research on pesticides has shown credible links between pesticides and cancerendocrine disruptionrespiratory illnesses and miscarriage, and children’s health problems, including neurobehavioral and motor deficits. As scientists have been documenting these chemicals’ harms, juries have also increasingly been recognizing them.

CropLife America, the industry group, which reported more than $16 million in revenue in 2015, represents and collects dues from the major pesticide manufacturers, including Monsanto, Syngenta, Dow AgroSciences LLC, and DuPont Crop Protection

It ranked state and local issues as the top of its list of “tier 1 concerns” for both 2017 and 2018, according to internal documents obtained by The Intercept that pinpointed Oregon as ground zero for the fight. While it paid for all this, its name never appeared on the materials or was referenced in the local fight, which was instead framed as being led by local farmers.

Like the ordinance in Lincoln County, a similar proposal in neighboring Lane County didn’t just specify that aerial spraying would be outlawed, it asserted people’s “inherent and inalienable right of local community self-government.” Both measures were inspired by the Community Environmental Legal Defense Fund, which views the aerial spraying of pesticides as violations of citizens’ basic rights to clean air, water, and soil.

However, federal regulation has lagged behind both the research and public outrage

The Environmental Protection Agency has allowed glyphosate, the active ingredient in RoundUp, to remain in use despite considerable evidence linking it to cancer. Under Donald Trump, the EPA also reversed a planned ban of chlorpyrifos, a pesticide linked to neurodevelopmental problems in children.

Frustrated by the lack of federal action, many people have turned to their towns and counties, only to find that they have been hamstrung by state laws forbidding local limits on pesticides. In 43 states, laws prevent cities, towns, and counties from passing restrictions on pesticide use on private land that go beyond federal law.

A provision in the Farm Bill now before Congress would extend that restriction to the entire country and could potentially roll back existing local laws. The House version of the bill that passed in June and is now being reconciled with the Senate version included a section that prevents “a political subdivision of a State” from regulating pesticides.And an appeal has been lodged against the Lincoln County aerial spray ban.

Read more about the tactics used and the money and individuals involved here: https://theintercept.com/2018/09/15/oregon-pesticides-aerial-spray-ban/

 

 

 

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How many more will fall ill or die because of exposure to pesticides and herbicides?

25 Aug

First published on India’s CHS-Sachetan website

 

Last year Richard Bruce, who has suffered severely for many years following exposure to pesticides in the course of his work, sent news of research into links between diabetes and exposure to organophosphate, the most frequently and largely applied insecticide in the world, undertaken by a team from Madurai Kamaraj University, published in Genome Biology. It is accessible to all readers and may be accessed here.

He now draws attention to the Hindu’s report of a food poisoning incident in Navi Mumbai which led to the death of three children and 40 people falling ill (200 according to the Hindustan Times).

Dr. Ajit Gawli, Raigad district civil surgeon, said “The serum test reports of two patients indicated presence of organophosphate compound in the food. The cholinesterase enzyme level was found to be around 800, which ideally should be around 1,200. It does confirm the presence of organophosphate compound found in insecticides and pesticides. After the reports of the serum of the deceased come in, we can confirm the saturation of the compound and what exactly the chemical was.” The food samples have been sent to a forensic science laboratory at Kalina and the Food and Drug Administration (FDA) for further analysis.”

An American campaign

Richard earlier sent news of a press release issued from Portland, Oregon, by the Center for Biological Diversity, a national, non-profit conservation organization with more than 990,000 members and online activists dedicated to the protection of endangered species and wild places.

It reported that group of farmworkers, child-safety and environmental advocates sent a letter to the government’s Environmental Protection Agency urging it to ban seven organophosphate pesticides, currently under review, that are used on crops such as corn, cotton, watermelon and wheat. It was submitted in response to the EPA’s request for public comments on new releases of human-health and ecological risk assessments for organophosphate insecticides.

“Every spring season, children around the U.S. are facing low-dose exposure to this dangerous chemical,” says a Minnesota mother who was sickened, along with her infant son, by chlorpyrifos. “It is in the air they breathe, the water they drink, and the food they eat,” she adds. “By leaving this chemical on the market, we are gambling with the lives of children. It is stealing their futures from them and increasing the amount of health care dollars they will need for treatment.”

Chemical & Engineering News reported that no ban was imposed; there was ‘pushback’ from Dow Sciences and others in the chemical industry.

Leonardo Trasande, an internationally renowned authority on children’s environmental health, in a study published in 2017 writes:

“A regulatory ban was proposed, but actions to end the use of one such pesticide, chlorpyrifos, in agriculture were recently stopped by the Environmental Protection Agency under false scientific pretenses”.

“Strong evidence now supports the notion that organophosphate pesticides damage the fetal brain and produce cognitive and behavioral dysfunction through multiple mechanisms, including thyroid disruption.

 

 

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Biomedical research: the gender dimension

1 Aug

Dr Elizabeth Pollitzer, Director of Portia, recently wrote to the Financial Times.

Portia was established by a group of female scientists working at Imperial College, to respond to government concerns about under-representation of women in Science, Engineering and Technology.

Portia’s mission is to help women and men have the same opportunities for engagement and advancement in science, across all science disciplines, and to further the understanding and appreciation of the gender dimension in science knowledge making.

Dr Pollitzer responded to Anjana Ahuja’s article: “Britain must stop inflating the biomedical bubble” (July 17, probable paywall) which highlighted the issue of the failure of biomedical industry to translate the huge investment in research into improvements in the quality of medicine.

She pointed out that in 2014, following problems in replicating early pre-clinical studies and differences in efficacy and adverse effects of drugs in women and men, the US National Institutes of Health called for gender to be taken into account in study design and data analysis.

Between 1997 and 2000, ten prescription drugs were withdrawn from the market in the US; eight were judged to be more dangerous for women than for men.

Dr Pollitzer continued:

“Gene expression, immune response and how drugs are metabolised have been shown to differ between women and men. Taking into account these basic biological differences would improve the rigour, transparency and generalisability of pre-clinical research findings.

“Biomedical research has historically relied on experiments that used significantly more males than females as subjects (cells, tissues, animals, people) creating bias in fundamental knowledge of disease processes”.

She ends by saying that this research bias has an impact on how disease outcomes and responses to treatment are determined, resulting potentially in poorer quality of results for women.

Elizabeth Pollitzer has 20 years’ experience teaching and researching in the Department of Computing at Imperial College, University of London. Her original training was in Biophysics. She now applies this scientific background to promoting effective strategies for gender equality in Science, Engineering and Technology.

 

 

 

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Weigh the value of new ‘tools’; apply the precautionary principle

3 Jun

There is mounting evidence of unintended harmful consequences in many sectors – including medicine, pharmacology, agriculture, energy generation, finance, engineering and transport. The most widely read post on this site in May reported the Lancet’s publication of the World Health Organisation’s finding that glyphosate, a widely used ingredient in weedkiller, is probably carcinogenic.

Michael J. Coren‘s article in Quartz magazine summarised the findings of Jameson Wetmore, an engineer turned social researcher at the Arizona State University’s School for the Future of Innovation in Society. Wetmore opened:

“The motto of the 1933 World Fair in Chicago was “Science Finds, Industry Applies, Man Conforms. Governments and companies were saying that technology can lead us out of this. It may not always be comfortable, but we have to ride it out. Household technologies were all the rage. When you hit the 1960s and 1970s, there is this shift.

“I think the hallmarks of that shift are the dropping of the atomic bomb, and then of course you have Ralph Nader’s Unsafe at Any Speed, and you also have Rachel Carson’s Silent Spring”.

“Whereas much of the contemporary world sees technological progress as inevitable, even a moral imperative, Wetmore finds that the Amish watch their neighbours and carefully consider how each one will change their culture before embracing it: They . . . watch what happens when we adopt new technology, and then they decide whether that’s something they want to adopt themselves.”

We don’t think about the impact technology might have on our lives beyond the initial big idea.

“The automobile was sold to us with this idea of a freedom we never had before. With that freedom came a heavy toll of injury and death. So can we anticipate unintended consequences way the Amish do, or are these systems just too complex to go much beyond first-order effects?

A more rigorous application of the EU’s Article 191 (left) would help to do this.

“Less than a mile from where I’m standing [in Phoenix, Arizona], Elaine Herzberg was killed by an autonomous Uber vehicle. I fully recognize the only way we’re going to automated vehicles is running in this world is to test them on city streets. Now, if we were to sit back and think about the values of the society here, we might say that testing those vehicles at 10 PM at night outside of a concert hall where a huge amount of alcohol had been served was not the best place to be testing. Perhaps testing in a school zone when children are present is not the best place to test an autonomous vehicle. But those are decisions that local people did not have the chance to make.”

The idea that technology is an unmitigated good is beginning to be questioned

Wetmore thinks that today Americans have a much more nuanced view of things. The number of people who think technology is an unmitigated good is continuing to shrink, but most haven’t abandoned the idea that there are a lot of problems and technology will play a role in solving them.

The precautionary principle detailed in Article 191 of the Treaty on the Functioning of the European Union aims at ensuring a higher level of environmental protection through preventative decision-taking in the case of risk. It also covers consumer policy, European Union (EU) legislation concerning food, human, animal and plant health. It has been recognised by various international agreements, notably in the Sanitary and Phytosanitary Agreement (SPS) concluded in the framework of the World Trade Organisation (WTO).  

Jeremy Corbyn led the proposal (right) to retain Article 191’s environmental principles after exit day, narrowly defeated by 16 votes.

 

Time for change?

 

 

 

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