Knowledge saves lives after natural disasters
Published Guardian online, Carl Heneghan, 26/09/2011
Comment: Dr Carl Heneghan, director of the Centre for Evidence-Based Medicine and a clinical reader in the Department of Primary Health Care Sciences at the University of Oxford, writes: ‘Where were you when the tsunami hit in December 2004? ... Have you ever considered how rescue workers and medics on the ground make the right decisions under such extreme circumstances? To improve their decision-making, the Centre for Evidence-Based Medicine at the University of Oxford organised the first conference on Evidence Aid, held in Oxford on Monday ... Evidence Aid was born after the 2004 tsunami. Its aim is to provide summaries of Cochrane reviews of health research in one place and in a timely fashion for those involved in disaster management ... Yet the evidence to support informed choices in disasters is scarce. Evidence is lacking not only for many health decisions, but also for simple interventions such as what are the best shelters, what is the best way to ensure security, and how best to support displaced people, and many more.’
The power of belief to reduce pain and alter arteries
In a recent study involving 30 patients having a procedure to evaluate chest pain, researchers found that those who were told they were being given a pain-relieving drug reported a decrease in pain. They also showed a small narrowing of their heart vessels.
Participants were randomized to receive either a verbal suggestion about the potency of an injection or not. Both groups received a saline injection. The verbal suggestion was developed on hypnotherapeutic principles. They were told:
“Mrs./Mr. XYZ, we are now injecting a drug through the catheter which will widen your coronary vessels. This procedure will improve the blood flow in your heart. This drug is very effective and starts its action immediately. It is possible that you might feel some agreeable warmness or formication after only a few seconds.”
Placebos, including verbal suggestions, are often acknowledged to have ‘psychological’ effects that can be measured using ‘subjective’ outcomes such as pain. However, their benefits for ‘objective’ outcomes, including change in the artery diameter, have often been questioned. More generally, the study explodes the myth that there is a strict mind/body division. If placebos can affect the mind, then they affect the body, and vice versa - our minds and bodies are hopelessly intertwined. If our bodies are ill and we are bedridden we are unlikely to feel good. Conversely, our ‘body language’ often reveals our moods. Emotions can affect physical activity, and vice versa. To name just a few examples, reduced serotonin activity can cause depression, dopamine affects motivation (among other things), and noradrenaline affects arousal (in a general sense).
Caregivers might use the results of this and other related studies to boost the effects of the therapies they prescribe.
To be sure, the study was too small to be conclusive. At the same time it was sufficiently well conducted (randomized and double blind) to be very suggestive …
Bachmann and HPV: the danger of speculation over evidence
This week brought back fears from a decade ago. Michele Bachmann, a US Republican presidential candidate, claimed that the HPV vaccine was a "very dangerous drug" that could lead to "mental retardation".
HPV or human papillomavirus is a virus that is associated with the development of genital warts and cervical cancer. Just this week, the Lancet reported that the global cervical cancer rates have increased over the past 30 years to 454,000 cases in 2010.
Clearly cervical cancer is an issue that cannot be ignored. Vaccines against HPV are life-saving.
Bachmann’s claims drew a sharp response from the American Academy of Pediatrics who stated that her comments have “absolutely no scientific validity.” To date over 35 million doses have been administered in the US with an excellent safety record.
Why did she bother to meddle with science? The answer is deadly simple: politics. Republican rival Rick Perry issued an executive order requiring girls in Texas to get the HPV vaccine in 2007. In a heated debate, Bachmann suggested that the decision was made in return for political donations from Merck, the manufacturers of Gardasil (the HPV vaccine used in the US).
Conflicts of interest are a separate issue; the focus here is on science.
The concern amongst health care professionals is the damaging impact false claims have on vaccination rates. The perceptions of vaccines changed forever after a now retracted article was published in the Lancet in 1998. In this small study of 12 children the now-disgraced British doctor Wakefield linked the Measles Mumps and Rubella (MMR) vaccine to autism. The media coverage and speculation that followed led to UK vaccination rates dropping to 80% in 2003-4.
Vaccine fears have fueled the recent outbreaks of measles. Before the MMR vaccine, measles was thought to be “as inevitable as death and taxes”, mumps infection could lead to sterility in post-pubescent boys and pregnant women that contracted rubella had children with serious congenital defects. The MMR vaccine was a public health success before Wakefield.
Politicians can throw mud at each other all they like but when they enter the ring of public health, they jeopardise putting all our health at risk. Society cannot let another vaccine crisis strike.
A US bioethicist has stepped forward and offered $10,000 to Bachmann’s charity of choice if she can prove a claim that the HPV vaccine caused mental retardation. Will she take on the challenge? For the sake of public health, hopefully not.