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Mass-medication 3: is compulsory fortification of all flour with folic acid imminent?

17 Oct

The Guardian reports that senior government sources say compulsory fortification of all flour with folic acid will be introduced within weeks.  

Theresa May, who was opposed to the measure, has been persuaded to back a plan to add folate supplement to food after a campaign to reduce the number of babies born in the UK with the neural tube defect (NTD). The Independent adds that the Department of Health and Social Care said the proposal is still being considered.

Two years ago, when the second reading of the above bill was debated, Lord Prior quoted from a report by the UK government’s Scientific Advisory Committee on Nutrition (SACN):

“The fortification of white bread flour with folic acid should be introduced only if it is accompanied by a number of preconditions: for example, action to reduce folic acid intakes from voluntary fortified foods, to ensure that individuals do not substantially exceed their safe maximum daily intake of folic acid . . . It also told us that there is inconclusive evidence on several possible adverse health effects of the mandatory fortification of flour with folic acid. For example, for people aged 65 and over, folate fortification of flour may result in cases of vitamin B12 deficiency not being diagnosed and treated”.

Clinical Education reports that Dr Edward Reynolds from King’s College, London has researched this matter, reviewing the literature from the 1940’s. He maintains that the recommended current upper limit of folate -1 mg – is too high.

In the 2016 debate, however, Lord Prior said the dangers of over-medication are small: “The issue is one of balancing the scientific and medical arguments with issues around choice and whether or not it is right to medicate the entire population for the benefit of a fairly small part of it”.

All women are recommended by the NHS to take a daily supplement of 400 micrograms of folic acid while they’re trying to get pregnant and during the first 12 weeks of pregnancy, when the baby’s spine is developing. The BDA asserts that very few women take this advice and according to research published in a 2015 paper in the British Medical Journal, the prevalence of NTD pregnancies was 1.28 per 1000 total births.

A reader comments on the Independent article: “70 million people to be mass-medicated for the sake of 1000 women… well that makes sense doesn’t it?”

 

 

 

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Mass-medication 2: the prevention element – a potential revenue stream?

23 Sep

As Andrew Miles, senior UK vice-president of GlaxoSmithKline observed cryptically in the Financial Times recently, “As much as people might think that the prevention element may not be a revenue stream for the company, it provides phenomenal insights.”

In July, the journal Science Translational Medicine published a report of the trial at Novartis Institutes for Biomedical Research in Massachusetts into a treatment, administered as two daily pills. A Times article noted that it was found to cut the number of infections in older people. Stephen Evans, the professor of pharmacoepidemiology at the London School of Hygiene and Tropical Medicine, said that the study was only an incremental improvement on the treatments already available and there are unanswered questions about the possible side-effects of the drugs.

Mass medication is an iatrogenic catastrophe

In June, this view was expressed in a BMJ article by James Le Fanu, retired GP and journalist. He wrote that ‘profligate’ prescribing has brought a hidden epidemic of side effects and no benefit to most individuals. There is no drug or procedure with its “chance of good” that may not harm some. The more doctors do, the greater that risk. Over the past 20 years there has been:

  • a dizzying fourfold rise in prescriptions for diabetes treatments,
  • sevenfold for antihypertensives,
  • and 20-fold for the cholesterol lowering statins.
  • Meanwhile the number of people taking five or more different drugs has quadrupled to include almost half of those aged 65 or over.

He continues: “The consequences of this massive upswing in prescribing? A hidden epidemic of immiserating symptoms such as fatigue, muscular aches and pains, insomnia, and general decrepitude, a 75% rise in emergency admissions to hospital for adverse drug reactions (an additional 30 000 a year) …

Proposals have been made in the past for mass or even universal medication by aspirin and statins

The NHS now concludes that the risk of side effects (particularly the risk of bleeding) outweighs the benefit of preventing blood clots. It has long been known that the pills carry a risk of gastro-intestinal bleeding. But a new University of Oxford study, published in The Lancet, suggests that the danger increases far more sharply with age than was thought, according to Professor Peter Rothwell, lead author. A Telegraph artlcle reports on his 2017 findings, adding that taking a daily aspirin is more dangerous than was thought, causing more than 3,000 deaths a year.

Britain is already the “statins capital” of Europe

The UK has the second highest prescribing levels in the Western world, with aggressive prescribing of the medication by GPs, whose pay is linked to take-up of the pills.

In 2014 it was reported that twelve million people (one in four adults) would be told to take statins under controversial new NHS guidelines. Draft proposals from health watchdogs were that the vast majority of men aged over 50 and most women over the age of 60 are likely to be advised to take the drugs to guard against strokes and heart disease. The National Institute for Health and Care Excellence (Nice) had cut the “risk threshold” for such drugs in half and experts said that the number of patients advised to take the drugs is likely to rise from seven million to 12 million.

And current medical guidance says that anyone with a 20% risk of developing cardiovascular disease within 10 years should be offered statins.

Almost all men over 60 and all women over 75 in England qualify for statin prescriptions under guidelines adopted by the National Institute for Health and Care Excellence in 2014, a 2017analysis shows – see BMJ.

However, some health experts have questioned the industry forces behind these studies. The first recommendation was put out in 2013 by the American College of Cardiology (ACC) and the American Heart Association (AHA).  CNN reports that a number of experts who worked on the ACC/AHA guidelines had financial links to drug companies, which they disclosed publicly. No conflicts of interests were reported by the authors of the United States Preventive Services Task Force guidelines, but nearly all of the trials they included in their analysis were sponsored by industry, according to Dr Rita Redberg, who stressed this point in a January 2017 editorial in the journal she oversees. “The ACC did not follow its own conflict of interest guidelines“..

Fluoridation – or any practice that uses the public water supply as a vehicle to deliver medicine – violates medical ethics in several important ways:

  • It deprives the individual of his or her right to informed consent to medication.
  • It is approved and delivered by people without medical qualifications.
  • It is delivered to everyone regardless of age, health or nutritional status, without individual oversight by a doctor and without control of dose.
  • The safety of fluoridated water has never been demonstrated by randomized controlled trials–the gold standard study now generally required before a drug can enter the market.

Fluoridating water is a form of mass medication and most western European nations have rejected the practice — because, in their view, the public water supply is not an appropriate place to be adding drugs.

Who profits from all these instances of largescale medication?

 

 

 

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An informative comment on the situation in Ireland

1 Mar

chemStats show immediate world-wide interest in water fluoridation (left) and Chris Price has commented:

“In Ireland, water supplied by local government is required by law to be fluoridated.

“However, water supplied by local community “group schemes”, or from private wells, is nearly always non-fluoridated.

“As a result, less urbanised regions of Ireland have a patchwork of fluoridated and non-fluoridated water supplies serving communities in close proximity”.

We hear about communities developing their own renewable energy schemes, taking over village shops, libraries and pubs  and this is news of another welcome initiative.

A search revealed the existence of the National Federation of Group Water Schemes, the representative and negotiating organisation for community-owned rural water services in Ireland.

 

 

 

 

 

Rising antibiotic resistance in E.coli on UK supermarket meat

9 Sep

tracy-and-pigLast December this site reported that Tracy Worcester is drawing attention to the subject of antibiotic resistance, which is growing – developing not in humans, but in bacteria that can then infect humans. Surgical and cancer chemotherapy patients rely on antibiotics to protect them from potentially life-threatening illnesses and declining efficacy could turn routine procedures into life-threatening ones.

The Organic Research Centre now reports that a new study carried out by scientists at Cambridge University, looked at 189 UK-origin pig and poultry meat samples from the seven largest supermarkets in the UK (ASDA, Aldi, Coop, Morrisons, Sainsbury’s, Tesco and Waitrose). It tested for the presence of E. coli which are resistant to the key antibiotics for treating E. coli urinary-tract and blood-poisoning infections in people. The highly resistant ESBL E. coli was found on meat from all of the supermarkets.

orc-header

The research found rising levels of resistance in chicken meat, with 24% of samples testing positive for ESBL E. coli, a type of E. coli resistant to the ‘critically important’ modern cephalosporin antibiotics. This is four times higher than was found during a similar study in 2015, in which just 6% of chicken tested positive for ESBL E. coli. Modern cephalosporins are widely used for treating life-threatening E.coli blood poisoning in humans.

51% of the E. coli from pork and poultry samples were resistant to the antibiotic trimethoprim, which is used to treat over half of lower urinary-tract infections. In addition, 19% of the E. coli were resistant to gentamicin, a very important human antibiotic used to treat more serious upper urinary-tract infections.

The findings provide further evidence that the overuse of antibiotics used to mass medicate livestock on British farms is likely to be undermining the treatment of E. coli urinary-tract and blood-poisoning infections in humans. Some of the antibiotics tested are used in far greater quantities in livestock farming than in human medicine.

Dr Mark Holmes, from Cambridge University, who led the study said: “I’m concerned that insufficient resources are being put into the surveillance of antibiotic resistance in farm animals and retail meat. We don’t know if these levels are rising or falling in the absence of an effective monitoring system. These results highlight the need for improvements in antibiotic stewardship in veterinary medicine. While some progress has been made we must not be complacent as it may take many years before we see significant reductions in the numbers of antibiotic-resistant bacteria found in farms.”

E-coli is by far the most common cause of urinary-tract infections and of dangerous blood poisoning, and can also cause meningitis. These infections must be treated with antibiotics. Dr Ron Daniels BEM, CEO of the UK Sepsis Trust said: “This study highlights a worrying trend towards rising resistance in E.coli on UK retail meat. E.coli in people is the greatest cause of deaths from sepsis, and poor antimicrobial stewardship in intensive farming is undoubtedly contributing to this trend. It’s of paramount importance that we act decisively to reduce this immediate threat to human life.”

Two recommendations:

 Other proposals:

Tracy points out that we have the choice to buy meat with the high welfare labels RSPCA Assured, Outdoor Bred, Free Range or Organic – eat less meat as Anna advocates – or go meat-free. See the World Health Organisation on the health issues here.

Buy organic/local?

Organic farming is perceived as providing a better quality of life for farmed animals and an earlier article reports that a new financial report on organic farming in England and Wales for 2014/15, undertaken by the Organic Research Centre for the Welsh Government, shows organic farm profits increasing, with organic dairy farming outperforming conventional dairy farming in England and Wales. In particular, the organic dairy industry is now generating higher profits than conventional farms despite producing lower yields.

Animal welfare has been a key motivator to consumers who are increasingly choosing organic products with quality assurance standards, because they want to know the origins of their food, and are willing to pay more for products which are ‘friendly’ to wildlife and the environment.

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Professor Nic Lampkin from the Organic Research Centre in Newbury, was one of the co-authors of the report and the Cambridge study was commissioned by the Alliance to Save our Antibiotics, of which the Organic Research Centre is a member.

 

 

 

Why aren’t people in London and the South receiving compulsory medication?

6 Jun

The Nuffield Council on Bioethics, funded jointly by the  Wellcome Trust and the Medical Research Council, advises policy makers and stimulates debate in bioethics.

nuffield fluoridation logoIts 21 page chapter on the fluoridation of water has drawn on expert assessments, in particular the fifteen year old York review, the most recent major review in this area. It points out that water fluoridation is an example of an intervention that directly affects whole populations, noting that the case of fluoridation raises issues about ‘the nature and strength of evidence required in arguments about the acceptability of an intervention, and about ways in which evidence is, and should be, communicated’.

BFS, BDA & NAEDH: overstated potential benefits, understated potential harms

Soon after the York Review’s publication in 2000, its authors drew attention to their view that the report had been “widely misinterpreted” and sought to correct the record, expressing concern over statements by groups including the British Fluoridation Society, British Dental Association and the National Alliance for Equity in Dental Health which “mislead the public about the review’s findings”. The reported problems included overstating the potential benefits of fluoridation, understating the potential harms, and the inaccurate claim that the review concluded water fluoridation to be “safe”.

A rose by any other name? BFS: fluoride is not a waste product – it is a industrial byproduct or a co-product

nuffield fluoridation coverThe Nuffield report points out that in its ‘Technical Aspects of Fluoridation’, the British Fluoridation Society, confirms that the source of fluoride used in the UK: hexafluorosilicic acid or its sodium salt, disodium hexafluorosilicate, are chemicals are produced from co-products of the manufacture of phosphate fertilisers:

“The chemicals are important co-products of the manufacture of phosphate fertilisers.  Part of the manufacturing process involves `capturing’ gases using product recovery units.  These units are technically similar to pollution scrubbers.  However the important difference is that, in the process of the manufacture of fluoride chemicals, the end result is a valuable and useful resource, not a waste product.”

Reducing inequalities: quality of evidence, low

The York Review of 2000 found that “The research evidence is of insufficient quality to allow confident statements about … whether there is an impact on social inequalities”. It concluded that “[although] the available evidence… appears to suggest a benefit in reducing the differences in the severity of tooth decay, … the quality of evidence is low and based on a small number of studies”. For now, we note that based on the best available evidence it is not straightforward to conclude that water fluoridation reduces dental health inequalities as measured by outcomes. Of the 30 studies assessed, twelve had not detected a statistically significant difference between the populations receiving fluoridated and non-fluoridated water . . .

‘Inconclusive’ association with bone problems, cancers, Alzheimer’s disease, malformations and mental retardation

Alarms voiced in reports in the Mail (Dec. 2015) and the Telegraph (Feb 2015, thyroid problems) were not echoed by the York review study group which concluded that on the basis of the best available evidence no clear association could be established between either bone problems or cancers and fluoridation and studies on other health risks, including Alzheimer’s disease, malformations and mental retardation, were inconclusive.

bedford council fluoridation hearing

The Nuffield Report concludes that the most appropriate way of deciding whether fluoride should be added to water supplies is to rely on democratic decision-making procedures (above Bedford’s Overview and Scrutiny Committee which unanimously recommended (April 2016) that fluoride should NOT be added to Bedford’s water, following a protracted two-year debate).

Conclusion: there should be comprehensive, well-funded and designed research into the impact of fluoridation of the public water supply on human health

Authors of the York Review, McDonagh M, Whiting P, Bradley M et al. (2000) in A Systematic Review of Public Water Fluoridation (York: NHS Centre for Reviews and Dissemination) declare that:

fluoride UK map“Given the level of interest surrounding the issue of public water fluoridation, it is surprising to find that little high quality research has been undertaken”. This is particularly surprising as fluoridation has been implemented as an intervention in some areas of the country, and has been considered as a policy option in others, over several decades”.

The Nuffield Council Report adds (7.42):

“We noted that the evidence base for fluoridation is not strong, and that as such ongoing monitoring and further research, particularly on risks, are recommended. Policy makers and the public need to have access to clear and accurate information, and uncertainties and the strength or weakness of the evidence should be explicitly recognised. Therefore, the UK health departments should monitor the effects of water fluoridation, including the incidence and severity of fluorosis and other possible harms.

“Water fluoridation policy should be objectively reviewed by the UK health departments on a regular basis in light of the findings of ongoing monitoring and further research studies. Furthermore, the conclusions and their basis should routinely be published”.

 

 

Water fluoridation: Bedford councillors accept the Precautionary Principle

16 May

In April, Bedford’s Overview and Scrutiny Committee unanimously recommended that fluoride should NOT be added to Bedford’s water.

This followed a protracted two-year debate. Bedford Council will now have to consult Bedfordshire County Council and the Secretary of State will eventually be involved in their decision. The issue could then go out to consultation and the public will be asked to respond within 3 months.

bedford cllrs fluoridationA video made by Fluoride Free Bedford includes footage of the council reflecting on this important decision.

Councillor Anthony Forth (below) issued the following statement:

bedford cllr quoted“I would like to propose that following the review process, this committee recommends a termination of the existing water fluoridation scheme, subject to the necessary consultations that are outlined on pages 26 to 28.

“I think that the evidence in favour of water fluoridation does seem extremely dated… On the other hand, a number of the pieces of evidence of dis-benefits are not as scientifically rigorous as we might like.

I think that as a group we’re happy to accept the Precautionary Principle that there isn’t strong evidence for re-introducing fluoride, so therefore we should not go ahead.”

Professor K.K. Cheng (professor of epidemiology, University of Birmingham) and his colleagues Iain Chalmers, editor, and Trevor A Sheldon,  professor and pro-vice chancellor. co-authored Adding fluoride to water supplies: US National Library of Medicine: National Institutes of Health

They reflected, in similar vein, that public and professional bodies need to balance benefits and risks, individual rights, and social values in an even handed manner. Those opposing fluoridation often claim that it does not reduce caries and sometimes overstate the evidence on harm. On the other hand, the Department of Health’s objectivity is questionable—it funded the British Fluoridation Society and, along with many other supporters of fluoridation, it used the York review’s findings selectively to give an overoptimistic assessment of the evidence in favour of fluoridation: Wilson PM, Sheldon TA. Muddy waters: evidence-based policy making, uncertainty and the “York review” on water fluoridation. Evidence Policy 2006: 2:321-31.

In response to the Medical Research Council recommendations, the department commissioned research on the bioavailability of fluoride from naturally and artificially fluoridated drinking water. The study had only 20 participants and was too small to give reliable results. Despite this it formed the basis of a series of claims by government for the safety of fluoridation.

The Cheng study ends: “Against this backdrop of one sided handling of the evidence, the public distrust in the information it receives is understandable. We hope this article helps provide professionals and the public with a framework for engaging constructively in public consultations”.

 

 

 

 

Westminster Hall Adjournment Debate on organophosphate sheepdip poisoning

3 Jun
There is to be a Westminster Hall Adjournment debate on OP/sheep dip health problems next Wednesday 10th June from 4 – 4.30pm.
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It is being proposed by MP Jessica Morden [Newport East] on behalf of her constituent Stephen Forward (who was on Radio Wales last week here at 4:45).
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For readers new to the subject a paragraph from the BBC website is added:
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Sheep dip poisoning – leading organophosphate poisoning campaigners have welcomed recent calls for a “hillsborough style” inquiry into whether farmers were misled over the use of the dangerous chemical. There’s cross party support from MPs for a parliamentary debate for full disclosure of the facts. Twice yearly sheep dipping was compulsory back in the 1970s, eighties and nineties to prevent sheep scab but finally stopped being mandatory in 1992. But farmers across the UK were left with debilitating health problems that they put down to sheep dipping.
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Notice sent by Tom (01942 671020) http://www.sheepdipsufferers.uk/