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When Does a Behavior Become a Disease?

February 26, 2015

binge eatingThere are plenty of behaviors which are bad for one’s health. Smoking and not getting enough exercise are two things which quickly come to mind. Binge eating. But are these disorders, or is it that their consequences can lead to disorders?

Is it that we create diseases to fit the profitable (and dangerous) cures? If binging is a disease, then so is anything done to excess. Recently binge eating, officially recognized as its own disorder in 2013 by the American Psychiatric Association, has received attention for a media campaign promoting the amphetamine Vyvanse to treat it. Retired tennis player Monica Seles has been hired by pharmaceutical company Shire as a paid spokesperson, appearing on talk shows from “Good Morning America” to “The Dr. Oz Show” to share her personal struggle with binge eating. And to plug Vyvanse.

One prominent eating-disorder specialist said that although Vyvanse showed promise, other treatments, like talk therapy, had more research behind them. And the use of Vyvanse is worrisome, with its classification by the federal government as having a high potential for abuse. In fact for decades, amphetamines, which suppress the appetite, were widely abused as a treatment for obesity.

“Once a pharmaceutical company gets permission to advertise for it, it can often become quite widely prescribed, and even tend to be overprescribed, and that’s a worry,” said Dr. B. Timothy Walsh, professor of psychiatry at the New York State Psychiatric Institute at Columbia University.

A Remarkable Man Confronts His Coming Death

February 20, 2015

By Brian Grant

Oliver sachsI awoke to this op-ed piece in today’s New York Times by Oliver Sachs. Tears formed. Sachs is a man who has contributed to medicine, literature, and entertainment through his writing and clinical care. And he is dying as his article describes. He is 81 and continues to contribute to the world. And when he departs, his legacy will continue with his passing. I will let his article speak for itself. Readers might enjoy clicking on the comments and seeing how other readers value and cherish his many gifts.

60,000 Additional Deaths a Year Attributed to Smoking

February 19, 2015

Risks_form_smoking-smoking_can_damage_every_part_of_the_bodystudy entitled “Smoking and Mortality – Beyond Established Causes” appeared in the New England Journal of Medicine last week. The study followed almost a million people over the course of ten years. Researchers found that compared with people who had never smoked:

  • Approximately 17% of the excess mortality among current smokers was due to associations with causes that are not currently established as attributable to smoking.

  • Smokers were about twice as likely to die from infections, kidney disease, respiratory ailments not previously linked to tobacco, and hypertensive heart disease, in which high blood pressure leads to heart failure.
  • Smokers were also six times more likely to die from a rare illness caused by insufficient blood flow to the intestines.

The study also found small increases in the risks of breast and prostate cancer among smokers. Dr. Brian Carter, an epidemiologist with the American Cancer Society, notes that those findings were not as strong as the others, adding that additional research could help determine whether there were biological mechanisms that would support a connection.

According to the Centers for Disease Control and Prevention, about 42 million Americans smoke — 15 percent of women and 21 percent of men.

 

Chronic Fatigue Syndrome Becomes Systemic Exertion Intolerance Disease

February 13, 2015
Dr. Ellen Wright Clayton, left, chair of the Committee on Diagnostic Criteria for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome speaks during an open meeting at the Institute of Medicine in Washington, Tuesday, Feb. 10, 2015. Chronic fatigue syndrome is a real and serious disease that needs a new name to reflect that _ and a straightforward way to diagnose the illness, a government advisory group declares. The new name, Systemic Exertion Intolerance Disease, better reflects the hallmark symptoms of this mysterious illness, namely, that patients can be wiped out by exertion. Committee member Peter Rowe, center, and Lucinda Bateman, right, listen. SUSAN WALSH — AP Photo

Dr. Ellen Wright Clayton, left, chair of the Committee on Diagnostic Criteria for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome speaks during an open meeting at the Institute of Medicine in Washington, Tuesday, Feb. 10, 2015.  Committee member Peter Rowe, center, and Lucinda Bateman, right, listen. SUSAN WALSH — AP Photo

We have now seen another example of the medicalization of distress and the emergence of a new “disease” (as opposed to a group of symptoms) according to the linked article.

While we have not yet read the report and reserve full conclusions, the release suggests nothing new in terms of science, etiologic agents, or new findings that lend meaningful clarity and a path to recovery from the symptoms of Chronic Fatigue Syndrome (CFS). Rather, the deciding panel appears to have largely achieved a political goal of validating a syndrome of various symptoms that do not lean to any conclusions as to cause or cure. That those who claim to have CFS or whatever new name may be ascribed to it are suffering is not in question. What remains unknown is why, and whether this syndrome is caused by a lesion of some sort, a viral or bacterial pathogen. What is going on with this action?

Likely a number of things. One is that it addresses the anxiety and perceived stigma that often applies to experiences that are ill-defined and may be considered to have an emotional component, implying lack of validity for the sufferers. Noteworthy is that the panel is seeking responsive treatment and diagnostic codes. By validating a syndrome as a disease, the conversation changes to one of obligations and rights for the sufferers that they believe they lacked before.

And it implies and may create duties by others in the industry of treating diseases, including insurance carriers, employers, courts and the culture to increase the level of payment, support, acceptance and accommodation to those claiming the disease. And let’s not forget members of the medical profession, drug companies, hospitals and other parties who have a strong vested interest in adding to the list of issues for which they may/will receive payment.

The list of syndromes, new diagnoses or disorders with expanding numbers and those claiming them are many. In no particular order they include: Post-concussive syndrome, “Low-T,” erectile dysfunction (with a recent ad featuring a beautiful woman claiming that over 50% of men over 40 suffer from some form of it), Epstein Barr Virus, Autism, Post-traumatic stress disorder, Fibromyalgia, ADHD (attention deficit hyperactivity disorder), Lyme Disease, and others. Common to many are claims of financial, educational, occupational or legal entitlement, partial exculpation from responsibility, expensive and proprietary medications, strong advocacy groups and heated arguments in the media and professions.

In short, recent “clarification” on Chronic Fatigue Syndrome likely fits more into the realm of politics than science.

The Top 8 Jobs with the Highest Injury Rates

February 10, 2015
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Four of the top eight are medical workers: orderlies, nursing assistants, personal care aids, and registered nurses.

According to the Bureau of Labor Statistics, more than 35,000 nursing employees are injured each year severely enough that they miss work.

Some hospitals have report that they have reduced lifting injuries among nursing staff by up to 80 percent — using an approach often called “safe patient handling.” They use special machinery to lift patients, similar to motorized hoists that factory workers use to move heavy parts. The hospitals also conduct intensive training among the staff.

Yet the majority of the nation’s hospitals have not taken similar action. The injuries are often so severe that they’re career-ending, a problem compounded by the fact that many of those injured are relatively young. To help address the problem, on Jan. 1, 2012, the Hospital Patient and Health Care Worker Injury Protection Act went into effect in California. This NPR article follows several injured medical workers and their stories.

 rates of injury

 

 

Eating Sawdust Will Not Make You Smarter

February 6, 2015

supplementEating sawdust will not make you smarter. Nor, likely, will eating powdered houseplants or a mixture of dried rice, mustard, wheat and radish, no matter how the product is labeled. And yet millions of Americans apparently are eating just that: As it turns out, testing announced by the state of New York this week found that the Ginkgo biloba sold by Walmart, for example, contained no Ginkgo biloba DNA — it was a mixture of rice, mustard, wheat and radish.

“Supplements” are not considered by the Food and Drug Administration to be drugs or food and therefore are not subjected to rigorous testing and related laws regarding product labeling. The results of multiple tests have shown that many supplements don’t contain much, if any, of what they’re labeled as being (though to be clear, nothing has been found so far that does contain sawdust). Ginkbo biloba may or may not be good for your health, but you might never find out – because the product you’ve bought might not actually contain any.

One in four dollars in the supplement market passes though Utah, the home stage of Senator Orrin Hatch, whose son is a longtime lobbyist for the supplement industry and who was the chief author of a federal law enacted 17 years ago that allows companies to make general health claims about their products, but exempts them from federal reviews of their safety or effectiveness before they go to market.

“There’s a lot of wrong information out there,” warns the American Cancer Society, in its tutorial on these products. “Even for those who are usually well informed, it can be hard to find reliable information about the safe use and potential risks of dietary supplements.”

Read more…

American Addiction Centers Goes Public

February 4, 2015
"Greenhouse," the AAC Facility in Dallas, TX

“Greenhouse,” the AAC Facility in Dallas, TX

In October American Addition Centers, which runs 8 facilities in 6 states, went public. Currently valued at about $588 million, the company’s stock price has almost doubled since its IPO, from $15 to $28. In 2013 its revenue was $116 million, up from $28 million in 2011.

AAC’s IPO underwriters estimate there are 8,100 substance-abuse treatment enterprises across America, operating 16,700 clinics and centers. The market is estimated to be worth $35 billion.

This month’s Bloomberg Business has an in-depth story on AAC, “Addiction Treatment Goes Public: AAC’s Recovery-Center Empire” and its founder Michael Cartwright  as well as a look into the history of treatment centers in the U.S.

New federal and state laws are improving addicts’ treatment options. In 2008, Congress passed the Mental Health Parity and Addiction Equity Act, which requires health plans to provide the same dollar limits for mental-health benefits as for medical and surgical benefits. This is a step in the right direction, as are the additional beds AAC and others have added: while almost 23 million Americans suffer from addiction, only about 4.1 million receive treatment each year, according to 2013 data from the U.S. Substance Abuse and Mental Health Services Administration. Read more…

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