Friday, July 30, 2010

Inventing Disease

With the huge amount of research that surfaces each day, it is not surprising that the quality varies considerably. Sometimes, you actually have to wonder whether the researchers are having a joke at our expense. Dubious research coupled with the tendency to disease mongering and the creation of new conditions can lead to hilarious outcomes.

If this story had appeared on April first, it could easily be dismissed as an April fool joke. However, as it appeared at the end of June, it seems these researchers take themselves seriously. With straight faces, they warned that Australian teenagers are becoming text addicts and in turn, risk a “range of serious mental and physical disorders from depression to repetitive thumb syndrome”.

To help legitimize this nonsense, new terms have been created. “Textaphrenia” is defined as hearing texts arrive when they haven’t and constantly checking to see if a message has arrived. “Textity “is the anxiety felt when they haven’t received a text or are unable to send texts. Post traumatic text disorder are injuries that occur when texting such as walking into things and feeling depressed when people don’t contact them. Binge texting is sending lots of texts. One can only wonder who pays for this sort of research.

This sort of research can be easily dismissed as absolute nonsense. Clearly, texting, which is a relatively new phenomenon by human existence standards, can, like anything, can be taken to extremes by some individuals if they chose to do so. There is no disease entity involved in this. Unfortunately, creating terms like the ones above, allow people to make excuses for their behavior. One wonders if somebody crashes their car while texting will be able to claim that they were suffering from one of these text related conditions and offer that as an excuse.

Furthermore, it continues the trend to medicalise human behavior. Texting is a form of communication. In exactly the same way some people talk more than others, some people will send more texts than others. Some people have brown eyes and some have blue. None of these represent abnormalities or disease processes. Some people will over do activities be it texting, eating, drinking or any other form of human past time.

The solution to this is not to create fancy new medical terms and pseudo diseases. The answer will certainly not be in developing medications to control these non-existent diseases. The continued medicalisation of life is an invitation to people to not be responsible for their actions. The solution is in fact for people to take ownership of their behavior. If they send too many texts, then the simple solution is to send less. If you walk into walls while texting, then the solution is to look where you are going if you are not able to multitask.

Life can be actually fairly simple when researchers are not involved.

Sunday, July 11, 2010

Spending On Disease Does Not have to Keep Rising

You would need to be living under a rock not to know that health (disease) care spending is continuing to increase. The total spending in the OECD is increasing faster than economic growth and inflation in the OECD.

The USA spends the most at around 16% of GDP nearly double the OECD average of 8.3%. This average has gone up from 7.3% in the 1990s . Governments are generally responsible for half or more of this spending. Virtually all the focus at a government level is on how are we going to pay for more disease care in the future.

A different question would be how can we keep healthy so as not to have to spend so much. There are two aspects to this. The first and (dare I say obvious) one is people actually being healthier. With three quarters of spending on “health” being spent on preventable lifestyle related conditions there is plenty of scope . For example 80% of cases of stroke come about in people who are overweight or eat poor diets, smoke or do not exercise. Strokes are extremely costly both in dollar and human terms

There is another aspect as well. One of the big costs in the system is pharmaceuticals particularly those which are “lifelong” treatments. You would think that there would be a interest in making sure that the money was well spent and that there was value, once again, both in dollar and human terms.

Statin drugs, which are used to lower cholesterol, generate billions of dollars in sales on the basis of reducing heart disease. Yet there has never actually been any evidence, which shows that cholesterol in the bloodstream is the problem.

Furthermore there has been a trend to place more and more people on these drugs as a form of “prevention”. Yet a major analysis has shown that for people without heart disease there is no decrease in mortality in those with risk factors who take a statin. Fully three quarters of the people taking these tablets are in this group.

Basically millions of people are taking an expensive drug, which is not actually doing them any good. Questions have also emerged about a study in 2008, which showed benefit from one statin in reducing heart disease given that nine other trials found no such benefit. These focus on the independence of the researchers.

Meanwhile an expensive diabetes drug (Avandia) is under question due to evidence that those taking it had higher rates of heart attacks and strokes than those not taking it. These two conditions are more common in diabetics and one of the aims of managing diabetes is to reduce these conditions. Again you would think that this would raise alarm bells in medical and government circles.

There are more and more examples of this emerging with long term drug use. Medications are trialed over short time periods and then used over long periods. Problems not apparent after two years might become apparent after ten years.

Our reliance on pills is costing us in both dollar and human terms. Every person taking a tablet they do not need is risking side effects for no benefit not to mention enduring cost to their hip pocket. Every time a use for a pharmaceutical is widened to capture more people being in a “risk” group the more this cost increases.

It is time we rejected unnecessary use of pharmaceuticals and were far more questioning of the cost benefit equation in the ones we do use.

Friday, July 2, 2010

Facebook and Bikinis

Facebook is an interesting beast. Over the last year or so I have grown to over 1000 friends some of whom I actually know, most of whom I do not know personally and some of whom I have actually got to know which has been great.

The other interesting thing as the number of friends grows is the invitations to events, causes, groups and pages. The range of these is incredibly diverse. In turn it got me thinking, what does publicly joining a group, cause or page say about the person. It may say a lot more than what is contained in the bio or even what appears on the wall.

Exactly how we get these invitations is not absolutely clear to me. The diversity of what I get invited to though is enormous. Recently I have been invited to like wrestling girls as well as peace in the Middle East. Both have their supporters and although they are poles apart obviously different people felt both might be of interest to me.

Sometimes I click through to have a look at the page in question before forming a view. Other times I “judge the book by its cover” in deciding whether to join, like or ignore. In some respects it is a click of the mouse. In another, it is a public announcement about my likes, interests and even beliefs.

This came home the other week when I “liked” a draw Mohamed page and drew the ire of someone. Now I am happy for people to follow the religion of their choice and absolutely respect their right to do so. However there is no reason why other people cannot have a laugh, be it about religion or anything else.

The interesting thing about offense is that it can actually only be taken not given. Whether or not a person takes offense is a choice they make. It is not a function of what is said or done as nothing causes equal “offense” to all people. Those who choose to take offence will generally blame the other party rather than accept ownership of their own feelings.

The other interesting phenomenon is that after the mouse is clicked that may be the last I see of the group or page. Whilst I can search and find groups I have joined unless I can remember what I am looking for it will be difficult to find.

So what am I do with the invitation, which got me thinking about this whole issue? It is an invitation to like the page “I love sexy bikinis”. It was sent by a friend and promotes a retail website selling, well, bikinis. To be honest they look pretty OK. If the page was “I love pretty landscapes” or “I love stunning architecture” would that be different?

All three are about something, which is visually appealing. If I like the architecture or landscapes no one would bat an eyelid. If I like the bikinis will there be a range of comments from the nudge nudge variety to the morally outraged?

In liking such a page what am I saying publicly? The answer of course is that I like the look of women in bikinis. This puts me in the company with 90% or so of the male population and a high percentage of women too. Serious swimmers do not wear bikinis. They are, of course, worn for appearance not functionality.

So do I publicly declare my like of bikinis or not? You will have to check my Facebook status to find out.