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Archive for the ‘health’ Category

Non- drug ADHD treatment that can also help beat insomnia

Posted in from the consulting room, health, psychology on November 14, 2007| 3 Comments »

Research recently showed that ADHD drugs don’t sustain their short term benefits in the longer term and demonstrated the case for more complex interventions such as parenting classes, psychological and social training and support for the children, and so on.

One interesting element in the whole ADHD story is the environment. Here’s an interesting approach. Scientists at John Carroll University have developed devices for screening out blue light. What this does is to stimulate the production of melatonin which is an important element in setting an individual’s circadian rhythms. They’ve found that if someone puts on the blue filter glasses, or sits in a room with blue-screened lightbulbs, for a couple of hours before bedtime, that the melatonin kicks in earlier than usual (usually it’s induced by darkness). This seems to result in improvements in ADHD symptoms and also helps those who have trouble getting off to sleep.

I wonder if these are benefits which are sustained over time?

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ADHD – Taking a longer view

Posted in from the consulting room, health on November 13, 2007| 2 Comments »

A three year study into ADHD treatments has shown that while drugs like Ritalin reduce ADHD childrens’ “difficult” behaviour in the short term (in fact even up to a year), looking at them over three years shows that not only are the children still on these drugs not showing sustained improvements in their behaviour but some are showing significantly adverse effects such as stunted growth.

There’s a real emphasis in the dominant medical model on quick fixes. Arthur Frank, in his excellent The Wounded Healer, calls this approach the “restitution” one – the patient’s narrative is one of “I’m broken, please fix me and I’ll be on my way”. He says this is like the Fast Oil Change approach to medicine, but it’s very, very common, and it’s nurtured by both the medical profession (as fixers) and by the health industries (not least Big Pharma with its pill-for-every-ill approach to suffering). It is supported by a short-termist managerialism which insists on measurable targets or “outcomes” in clearly defined groups of patients. So we end up with people being classified according to diagnoses and then given treatments intended to produce changes in a set of variables defined by experts.

In ADHD (Attention Defecit Hyperactivity Disorder) the thrust has been to classify it, turn it into a defined entity and then “treat” the symptoms. The pharmacological approach is not curative but in the short term it takes the edge of the more extreme behaviours and so makes the child’s behaviour more acceptable. To be fair, this can also produce real benefits for the child who can then progress socially and educationally. What this study shows, however, is that in the longer term these benefits are often not sustained. And worse than that, in the longer term, the disadvantages of a drug approach become more apparent – stunted growth being one of the main findings.

What’s a better way? Well we don’t know yet but a complex approach involving the parents, the child, and the school seems to bring sustained benefits. And what about the roles of diet and the lived environment?

The trouble is those kinds of approaches are not as easy to deliver as a drug and the outcomes are not necessarily so measurable. But we have to bite that bullet if we want to move away from drug-focussed containment, to genuine improvement in terms of coping, resilience and growth.

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Whole food rather than nutrients

Posted in from the consulting room, health on November 8, 2007| 4 Comments »

A recent article in the Journal of Nutrition Reviews raises the issue of how focusing on single ingredients or nutrients within food in relation to health both misleads us and at times even results in harm.

The authors propose the concept of “food synergy” by which they mean “a perspective that more information can be obtained by looking at foods than at single food components”. They point out for example that measuring the amounts of a single nutrient – for example a vitamin, or a mineral, or an energy supply like fat or carbohydrate – frequently (I think they may even mean usually) significantly underestimates the levels that have biological effects on human beings which are available from actual food, due to synergistic effects of a variety of components within a foodstuff.

They take an example of the dietary connections with heart disease and cite several pieces of research which show that considering only the fat content in a diet to lower cholesterol levels in blood and so reduce the chances of heart disease is actually pretty inadequate. In fact, they even cite studies which show that certain other food factors in the diet may be even more important than lipids. For example, diets rich in unrefined plant foods such as whole grains, dark green and yellow or orange fleshed fruits and vegetables, legumes, nuts and seeds etc can lower blood cholesterol “comparably to statins”. Wow! What does that mean?

Well, before I draw any conclusions let me say one further thing from this paper – they show that what is most important is not the levels of single nutrients or components of food, but that the way components interact within a food is more significant. But more than that, they show that food patterns within a diet are also very important.

So here’s the conclusion. You can’t consider the impact of diet on food by measuring components and classifying some as good, some as bad, and defining optimal levels of them. No. What you have to do is consider the diet as a whole. And that’s much harder for scientists – because scientists have become dependant on “randomised controlled trials” and they can do those with single components of single foods but its much much more difficult to do that with the complexity of whole diets.

But, just cos its difficult for scientists to use their traditional componential methods, doesn’t mean we can’t develop emergent ones instead!

Look at the example of the relation between diet and heart disease again. There are two standout features there. Unrefined foods. And colourful foods. The more your diet contains refined foods, the worse it is. The more your diet contains brown or beige foods, the worse it is. (And, hey, no cheating – no artificial colourants allowed!!)

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The old nature vs nurture debate – turns out both matter!

Posted in from the consulting room, health on November 6, 2007| 3 Comments »

I know, you might be a bit underwhelmed by this news, but scientists have found that

found that the baby’s intellectual development is influenced by both genes and environment or, more specifically, by the interaction of its genes with its environment.

Apparently, nine out of ten children have a particular gene. When this gene is present breastfeeding increases their intelligence. When it’s not present (one child in ten, the breastfeeding doesn’t make a difference)

The thing that really grabbed my attention however was in the conclusion –

“We’re more interested in proving to the psychiatric community that genes usually have a physiological effect,” Moffitt said. “When looking at depression or intelligence, the key bit that’s often left out here is the environmental effects.”

Surely this is where the future discoveries will lie – in understanding the way in which genes and the environment (and I include nutrition here) interact to affect mental functioning.

Here’s to more joined up thinking!

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One size doesn’t fit all when it comes to exercise either

Posted in from the consulting room, health on November 6, 2007| 1 Comment »

One of the main themes of this blog is that we are all different and when it comes to health a one-size-fits-all approach fails to address that reality.

This is certainly true of diet where the old adage “one man’s meat is another man’s poison” is so right. But here’s an interesting piece of research into the role of exercise in weight loss.

“This study is the first evidence-based study that shows despite people doing the same amount of supervised exercise people lose different amounts of weight.”

Turns out peoples’ bodies respond differently to the same amount and type of exercise. It really is the case that you need to find what works best for YOU.

You can become the expert in your own body by observing carefully and becoming aware of how different foods and different activities affect you.

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Symptoms don’t mean disease

Posted in from the consulting room, health on November 5, 2007| 4 Comments »

I know, this is going to sound odd, but did you know that just because you have a symptom doesn’t mean that you have anything wrong? It’s odd because most of us only go to see a doctor because we have symptoms – pain, or dizziness, or lack of energy, or whatever. Kurt Kroenke and others have done a lot of interesting work on this phenomenon, showing that if you take the top 10 symptoms patients complain of to their doctors, over 80% of them never turn out to be related to any pathology or disease.

Charlie Vivian, an Occupational Health Consultant in Gloucester, wrote an excellent letter to the BMJ about this. Here’s a quote –

Western medicine is based on the biomedical model. This model is reductionist—all symptoms can be explained by underlying pathology—and dualist—if there is no pathology, it’s all in your head. This model was drilled into us at medical school and is the principal model for the National Health Service. Society largely accepts the model too.

But it’s wrong. For up to 90% of people presenting to their general practitioner with genuine physical symptoms, the symptoms are not explained by pathology. It is also not appropriate to label most of these patients as anxious or depressed. I now explain this to patients, and tell them that the problem lies with the model, not with them. It is normal to have genuine physical symptoms that cannot be explained through radiographs or blood tests.

You know, a lot of doctors don’t know this! There’s a general assumption two ways – that if someone has symptoms they have a disease, and that if a disease is treated then the symptoms will get less. Neither is actually true. For many people their symptoms are only indirectly related to their diseases. He also nicely summarises some of the psychological impediments to recovery from disease –

catastrophising (fearing the worst), low mood, avoidance behaviour, and having an external locus of control (for example, make me better doctor)

I like that latter summary. It gives us things to work with.

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Set a beacon and spread some light

Posted in from the consulting room, health, life on November 3, 2007| 7 Comments »

I’m a Lord of the Rings fan – both the book and the movies. One of my favourite scenes is this one –

I find this inspiring. I think this is what we can do. If you have passion for life, you light a beacon. That beacon spreads light that changes lives. If I had to write down one tip for a better life it would be this – be passionate. Passion is flow. The Chinese have a concept of Chi – a kind of energy. Csikszentmihalyi espoused the concept of “flow“. In modern, Western terms, we are able to be very aware of energy. I often ask medical students to take a score from 1 to 10 where 1 is the worst possible energy they can imagine and 10 is the best possible and to tell me what figure they’d apply right now to describe their own energy state. They can all easily state a number. Then I ask them to do the same thing for their mental energy and they find that equally easy. Then I ask them how they came up with the numbers they picked. What did they assess, and how did they do that? What criteria did they use? Which parameters did they pick? They don’t know. We assess our own energy levels holistically and intuitively. We don’t have to break it down into components, and the strange thing is that the energy we are measuring is not measurable by either instruments or others. Only we are capable of assessing and experiencing our own energy levels.

I think this “energy” idea is related to flow. Flow can be thought of as the Western equivalent of Chi. When the flow is strong, and we are “in the flow” then we feel well, our energy feels good and we alive and healthy. When our flow is weak, we’re unwell. Passion is both a product and a cause of this flow. When we are passionate about life, our energies flow, our creative abilities surge, our resilience is strong and we touch, and are touched by, others. Passion is contagious.

Pass it on.

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Too much competition is bad for you

Posted in from the consulting room, health, life on November 3, 2007| 2 Comments »

Research by Danny Dorling at Sheffield University has shown clear links between inequality and death rates.

Sure, there’s a kind of intuitive logic to the fact that poorer people suffer poorer health, but a slightly less intuitive finding is that the amount of social inequality (as indicated by the differences in income between the poorest and the richest) impacts on death rates in all countries, rich or poor. So, within any one country, when social inequality gets greater, mortality rates rise. Danny Dorling’s research has shown that this is an age dependent factor – he’s shown that the larger the inequalities in a society, the greater the mortality in people from 15 – 65 ie. people of working age.

there is an age related mechanism that results in higher mortality being experienced in societies where there is greater social competition, all else being equal. Higher rates of income inequality tend to reflect more competitive rather than more cooperative societies. Whatever the mechanism that results in harm from competition (or protection from cooperation), it has its strongest effects in early to middle adulthood.

One of his conclusions particularly struck me –

social inequalities as reflected through unequal incomes are damaging to health for those living in both rich and poor nations, and the direct mechanisms for such damage are likely to vary by area. Psychosocial stress is unlikely to be the only route by which income inequality damages health. However, the underlying mechanism may be similar—that, because humans are social animals, human health is best protected when people cooperate.

It’s that last phrase that really interests me. “…..because humans are social animals, human health is best protected when people cooperate”

It’s always been the case that the big impacts on the health of populations doesn’t come from the skills of doctors, or the power of drugs, but from the changes in the contexts of peoples’ lives. Education, housing, sanitation, food and water, and income are still the most powerful levers of power in the creation of health.

Yes, of course, there’s lots we can do as individuals. We can make choices about our own lives. And when we are sick individual treatments can make a difference, but if we want more people to have more health, if we want to reduce suffering from cancer, heart disease, mental illness and a host of other diseases, the big gains come from changes in these areas. How we behave towards others, whether or not we value competition or cooperation more highly, impacts on the prevalence of disease and on death rates in people under the age of 65.

One of the things I love about the net, is how it gives us a chance to build our links, to share ideas and thoughts, to encourage and inform each other. In short, to cooperate. And, well, who would have thought it, turns out that’s good for you!

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Money as a motivator in healthcare?

Posted in from the consulting room, health, life on November 3, 2007| Leave a Comment »

I’ve a lot of respect for a London GP, Iona Heath, who frequently writes in the BMJ, . Last week she wrote an opinion piece about what she sees as the corrupting influence of money on healthcare. I know that healthcare is a big debate in the US, what with Rudy Giuliani throwing around mis-information about cancer treatment to bash what he calls “socialised medicine”. Well, I guess if he reads Iona Heath’s views he’ll confirm his current view that the UK has it all wrong. The system of payment for GPs in the UK has changed with the government paying them for carrying out certain procedures (actually mainly paying them for recording certain pieces of information, like whether or not a patient smokes, BP readings and so on). This has resulted in massive income rises for GPs and the advocates of the system say this shows that money motivates doctors to work according to best practice. Here’s what Dr Heath says –

But if money is thought to be the only motivation, hugely important human aspirations are systematically marginalised and our conception of what it is to be human and a member of society is diminished.

And, this –

In The Burial at Thebes, his translation of the story of Sophocles’ Antigone, Seamus Heaney gives King Creon these words: “Money has a long and sinister reach. It slips into the system, changes hands and starts to eat away at the foundations of everything we stand for. Money brings down leaders, warps minds, and generally corrupts people and institutions.” It seems an extraordinarily accurate description of the state of the NHS. Money is everywhere the driver of change but it is warping minds and corrupting both individuals and institutions. There seems no place left for the altruism of public service to flourish and this is taking a huge toll of the morale of those working in the frontline of health care, whose motivation has always gone beyond the simple question of money. The neglect of altruism seems likely to prove both destructive of social solidarity and ultimately extremely costly for individual citizens.

Let me put my cards on the table. I completely agree.

From the age of three I wanted to be a doctor. Don’t know where that idea came from because there were no family connections with doctors but I pursued that dream and became a doctor back in 1978. Graduation Day was one of the most thrilling days of my life. But it’s only after graduation that doctoring starts and my training jobs were tough, demanding and challenging. In 1982 I became a GP. From the start I’ve always loved working with patients and I always brought my constant curiosity and desire to improve and change things with me. I always made what others would consider stupid decisions about money, not least deciding to leave one practice and join another in 1986 resulting in a drop in income of 70% overnight. Money didn’t motivate my medical decisions. But the government always thinks otherwise and the trend to motivate doctors to carry out government-determined tasks by paying more for what the authorities wanted the doctors to do started to take off in the early 1990s. It drove me out of general practice. It just didn’t sit right with me that I might get paid more if I persuaded a patient to choose one particular course of action over another. I wanted to help every single patient to choose the action they preferred, not to choose the one that paid me more. And I realised that when patients became aware of the payment system they started to question whether I was recommending a treatment because it was good for them or good for me. That was it. I couldn’t do that.

So I stopped.

In fact that was my crisis point. I resigned as a GP and didn’t have another job to go to. For the next 8 months, I got by on one day of clinics at Glasgow Homeopathic Hospital, a weekly radio show (Phone Dr Bob!) and I wrote a textbook of homeopathy for GPs. Financially, it wasn’t clever! Then I got the job I still do – a full-time job at Glasgow Homeopathic Hospital with half the week seeing patients and half the week focussing on teaching. It’s a great job. I love every day of it. There is no greater thrill and sense of reward than I get from the privilege of meeting new patients, getting to know people over time and helping them to find relief from suffering and to experience better health. Financially, I’d be way, way, better off if I’d stayed as a GP (or if went back into general practice now) but in terms of satisfaction and fulfilling a life’s purpose? Well, this current job ticks those boxes for me.

That’s my personal story, but I don’t think my motivations are unusual. I don’t think most doctors become doctors for the money and I totally agree with Iona Heath that creating the health care system around money as a motivator is destroying the environment in which altruism and the desire to care can thrive.

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Nutrition and mental health

Posted in from the consulting room, health on November 2, 2007| 7 Comments »

(by special request of damewiggy….) What are the links between food and mental health? The short answer is definite but complex. There is growing evidence of links between food and mental health and the Mental Health Foundation in the UK launched a campaign with Sustain last year to raise awareness of this. Their website is a great place to start and they have a lot of really useful studies and information there. MIND also has a very balanced summary of the issue. What these reports and articles are saying is that there seems to be growing evidence of the part played by food in mental health. From first principles this makes a lot of sense – after all the brain is an organ of the body and it’s function is dependent on it’s nutritional supplies amongst other things. Also, we are increasingly getting a clearer picture about the mind and understanding it’s not all about the brain. Both the concepts of the embodied mind and the extended mind force us to consider that the mind is a more complex phenomenon than just the product of brain function. This has enormous implications for us in terms of considering the health of the body, and of the contexts within which the individual lives. Part of this is about nutrition – and here I’m thinking of nutrition as not only about the biology and chemistry of food but of the effects of eating patterns, the social impacts of what’s eaten when and with whom, the memories, associations and expectations that we tie to particular foods, the connections between eating and the health of relationships, and so on.

It’s a complex issue.

But it doesn’t stop there, in my opinion. Because everybody is different. And not only do we not have individual and different food preferences but the same food will have different effects on different people. It’s a good idea to become more self-aware about this – what effects do different foods have on you?  Are there some things which seem to drain your energy, make you irritable, to make you happy and give you an energy burst? Are there certain foods you crave? Others which disgust you, and yet others which upset you in some way? Your answers to those questions won’t be the same as other people’s answers but they are the important answers for you. Self-observation, raising your awareness around your own relationship to food is way more useful than any expensive, and probably dubious tests.

Let me finish with a personal story. I’m an optimistic, energetic and pretty cheerful character. I went on the Atkins Diet once. I did it for four weeks. I felt exhausted. My legs were so heavy I could hardly climb the four flights of stairs to my flat. And worst of all I felt depressed. Utterly. It was if someone had put a pleasure filter between me and the world and is was sucking all the joy out of life before life got to me. Within hours of stopping the diet I was my good old cheery energetic self again. Now, I know a lot of people who have an utterly different experience on the exact same diet. But that was my experience and it taught me what kind of diet is definitely not good for me.

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