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Health Controversies

Over the years there have been numerous health controversies which have been reported in the news. This article looks at a few of these controversies.

Statins

Statins which lower the levels of harmful cholesterol (low-density lipoprotein, or LDL) associated with heart disease and stroke, work by disrupting the production of cholesterol in the liver, are one of the most commonly prescribed medicines in the UK and the US with approximately 6 million and over 13 million people taking them respectively. Offered to patients who have had a heart attack or stroke to reduce the likelihood of a further incident, there has been a great deal of controversy over their use. The value of statins is being questioned as to whether they are being overprescribed and inappropriately used.

The UK’s National Institute for Health and Care Excellence (NICE) recommended that “preventative treatment for cardiovascular disease (CVD) should be halved from a 20 per cent risk of developing the disease over 10 years to a 10 per cent risk.” This recommendation raised some controversy in that although statins have proven to be beneficial in high-risk patients with established heart disease a concern was raised that in low risk patients who were “healthy”, the risk of side-effects outweighs the potential benefit.

Professor Mark Baker, Director of the Centre for Clinical Practice, NICE, said: “To make progress in the battle against heart disease and stroke, we must encourage exercise, improve our diets still further, stop smoking, and where appropriate offer statins to people at risk. Doctors have been giving statins to ‘well people’ since NICE first produced guidance on this in 2006. We are now recommending the threshold is reduced further. The overwhelming body of evidence supports their use, even in people at low risk of cardiovascular disease. The effectiveness of these medicines is now well proven and their cost has fallen. The weight of evidence clearly shows statins are safe and clinically and cost effective for use in people with a 10 per cent risk of CVD over 10 years. We’re not saying that everyone with a 10 per cent or greater risk of CVD within 10 years needs to take a statin. The guideline recognises the importance of choice in preventing CVD and that this should be guided by information on the trade-off between benefits and risks.”

The US Preventive Services Screening Task Force agrees with this stance although recommendations are slightly more restrictive than those proposed by NICE. They have issued guidelines which state there is some evidence that statins can benefit healthy people aged between 40 and 75 years, with ≥10-year cardiovascular disease (CVD) event risk and at least one CVD risk factor (including dyslipidaemia, defined as low-density lipoprotein [LDL] cholesterol >130mg/dL or high-density lipoprotein [HDL] cholesterol <40mg/dL, diabetes, hypertension or smoking).

However despite the recommendations from the UK and US the European Society of Cardiology (ESC) have retained a threshold of a 5% 10 year risk of fatal cardiovascular disease. The ESC’s task force believe that high-risk patients who do not have high cholesterol should not be prescribed statins, instead they think around 80% of CVD instances could be prevented by behavioural changes.

Taking the argument further and showing the level of controversy and disagreement the editors of the BMJ and The Lancet, two of the world’s most well-known medical journals have been waging a “statin war” over the last three years, regarding the use of statins. Some physicians disagree that statins are appropriate for low-risk patients, others that the benefits far outweigh any issues, preventing around 80,000 heart attacks and strokes every year. “Controversy over the safety and efficacy of statins has harmed the health of potentially thousands of people in the UK,” adds Dr Richard Horton, editor-in-chief of The Lancet.

Others argue that side-effects include an increase in Type 2 diabetes, myopathy (muscle weakness; this can, rarely, lead to severe complications), haemorrhagic strokes (strokes resulting from an internal bleed) and memory loss should result in a restriction in the use of statins.

Electro-convulsive Therapy (ECT)

Electro-convulsive therapy was first developed in the 1930s and widely during the 1950s and 1960s, before effective medication was available. ECT involves anaesthetising the patient and passing an electric current through the brain to induce a fit or seizure. Doctors noticed that some people who suffered from depression or schizophrenia and who also had epilepsy felt better after having a fit.

Effects of ECT may be due to the electricity passing through the brain resulting in a change to the patterns of the blood flow through the brain and a change to the metabolism of areas of the brain which may be affected by depression. Or it may be due to the fit rather than the electrical current. Other recent research has also suggested that ECT can help the growth of new cells and nerve pathways in certain areas of the brain.

It’s mostly used as a treatment for severe depression, resistant mania or catatonia. ECT is sometimes also considered for the rapid treatment of severe depression that is life-threatening, or when other treatments have failed. There is research to suggest that ECT may also help some patients with Parkinson’s disease or with the side-effects of some psychiatric medications.

A recent article in The Guardian reports that electro-convulsive therapy is on the rise in England and shows that more than 22,600 individual ECT treatments were carried out in 2015-16, a rise of 11% from 2012-13, when about 20,400 were carried out.

As no-one is certain how ECT works, how effective it is or what the side effects are the treatment continues to be controversial.

Obesity

Obesity is a worldwide problem and is generally caused by eating too much and moving too little. In simple terms obesity stems from the consumption of more calories than you burn off through physical activity.

Is obesity a disease?

In some circumstances there are underlying health conditions that can contribute to weight gain, such as an underactive thyroid gland (hypothyroidism), although this doesn’t usually cause weight problems if controlled with medication. There is also research to show that genetics plays a role in obesity.

A study carried out by researchers from 25 different international institutions, led by Newcastle University in the UK, and funded by the Alfred Deakin postdoctoral research fellowship and the UK Medical Research Council included 9,563 people from eight separate studies of weight loss programmes involving various combinations of diet, exercise, medication and behaviour change treatment.

Researchers looked at how people with the variant of the FTO gene performed either in a treatment or a control group, compared to those without the gene variant. They also looked to see whether people with the gene variant responded better to different types of weight loss treatment. The conclusion of the study was that while the FTO variant genes make it more likely that people will be overweight, it doesn’t affect their ability to lose weight through diet, or exercise and no one treatment or intervention worked better for them than any other.

Vaccinations

Controversy around vaccinations has been around a long time. Despite scientific evidence and agreement that vaccines are safe and effective, there have been numerous unsubstantiated scares regarding their safety.

A classic and very well-known point in case was the controversy around the mumps, measles and rubella (MMR) vaccine.

In 1998 a paper published in The Lancet by Wakefield et al called “Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children” the researchers investigated a consecutive series of children with chronic enterocolitis and regressive developmental disorder and appeared to link the combined measles, mumps, and rubella (MMR) vaccine to colitis and autism spectrum disorders.

The text of the paper triggered a global health crisis. The main cause of the alarm was the claims that two thirds of the parents of the 12 children examined in the study blamed the MMR vaccination for the sudden onset of what was described as a combination of both an inflammatory bowel disease and “regressive autism”, in which language and basic skills were said to have been lost where the first behavioural symptoms were reported to have appeared within only 14 days of the shot.

These “revelations” led to a sharp drop in vaccination rates in the UK and Ireland and increases in the incidence of measles and mumps, resulting in deaths and severe and permanent injuries.

The fraudulent claims came to light when Brian Deer carried out an investigation for The Sunday Times, Channel 4 and the British Medical Journal and found that “Wakefield had been secretly payrolled to create evidence against the shot and, while planning extraordinary business schemes meant to profit from the scare, he had concealed, misreported and changed information about the children to rig the results published in the journal”. Follow-up studies were undertaken and reviews of the evidence by the Centers for Disease Control and Prevention, the American Academy of Pediatrics, the Institute of Medicine of the US National Academy of Sciences, the UK National Health Service, and the Cochrane Library all found no link between the MMR vaccine and Autism.

There are other theories regarding the cause of Autism from poorly understood genetic predisposition,  toxins, (as well as medications) to environmental or unknown factors leading to the increasing incidence of Autism.  All of these factors share a link to silent inflammation, and whatever the cause, it will be beneficial to counter the common factor which is free radical damage.

Balanced Diet

What we eat can have a big impact on how we feel, mentally as well as physically. In many cases of disease diet can play a vital role in alleviating or removing symptoms.

In the case of heart disease a healthy diet, exercising regularly, stopping smoking and reducing drinking can prevent cardiovascular disease. Further compelling evidence and is also available that shows that a diet rich in fruits and vegetables can lower the risk of heart disease and stroke.

In the case of depression eating the right foods, fruit and vegetables can help to replace certain vitamins, minerals, amino and fatty acids which are deficient and which may directly relate to our mental and physical health and well-being.

In the case of obesity there is no quick fix for losing weight. Once weight is gained it’s a matter of reducing and limiting the consumption of fatty and sugary foods and drinks; increasing the intake of fruit and vegetables, along with legumes, whole grains and nuts and taking regular exercise.

A balanced diet which includes fruits and vegetables which contain fibre, vitamins, minerals and antioxidants (which neutralize free radicals) can help protect against heart disease as well as have an impact on depression, obesity and potentially Autism.

I have long recommended to my patients that a diet rich in fruit and vegetables can provide major health benefits. To find out more sign up for my ebook.

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