A new medicine may not be better
Medicine is a forwardlooking enterprise driven by the search for ever-better treatment. Still, progress can be a mixed blessing when it subsequently transpires that some enthusiastically endorsed practice proves to be no better, or indeed worse, than that which it has replaced.
This turns out to be surprisingly common, with the recent identification of no less than 146 such “contradicted” medical practices in the past decade. They include inserting stents to improve the blood flow in those with stable heart disease – at one time a multi-billion-dollar-a-year industry in the United States – that turns out to confer no advantage over routine medical management. Then, the much-hyped technique of genetic pre-implantation screening with IVF in older women at greater risk of having a baby with Down’s syndrome or other chromosomal abnormalities lost favour when it was shown to drastically reduce the likelihood of a successful pregnancy.
The vogue for “intensive” therapies in anticipation of an improved outcome has also fallen by the wayside both for lowering the blood sugar for those with type-2 diabetes (increased mortality rate) and high-dose chemotherapy with stem-cell transplants for advanced breast cancer (no improvement in survival).
To these can be added arthroscopic surgery for knee arthritis, “vertebroplasty” for osteoporotic fractures, impermeable bed covers for house mite-induced asthma, and antiviral drugs to counter the dizziness caused by vestibular neuritis (an ear infection that disturbs the balance). “The costs are immense,” observes Vinay Prasad of the National Institute of Health, “when medical practices are instituted on the basis of premature, inadequate, biased or conflicted evidence.”
Heart-stopping
The query from a reader as to why she should be woken in the early morning with a pounding heart has prompted an intriguing medley of possible explanations. “In my case, they are triggered by violent nightmares,” writes one gentleman, which were attributed by his family doctor to his “over-vivid” imagination, though are strongly suggestive of a condition, Rapid Eye Movement Sleep Behaviour Disorder.
Cardiologist Dr Mark Hargreaves comments that foods with a high tyrosine count (cheese, soya beans, beef, nuts and grains) may, for those who are sensitive, induce a “hyperadrenergic state” of flushing and palpitations that may only become apparent several hours after ingestion.
On a related theme, a reader describes, from personal experience, how having a bloated stomach at night can induce palpitations through stimulation of the vagus nerve, which another claims can be terminated by sucking ice cubes kept in a Thermos beside the bed.
Two further culprits could be sleep apnoea and an over-active thyroid. And finally there is always the possibility this could be a disturbance of a heart rhythm that may not have been identified by the usual investigations. “I would advise buying a Kardia mobile home ECG monitor,” writes a lady from Bristol, after it showed she had paroxysmal atrial fibrillation.
Pick up some Viagra
That wonder drug of our age, Viagra, has proved to be so safe and free of side effects that negotiations are underway for allowing it to be purchased without prescription from a pharmacy. As noted previously, Viagra has turned out to have several interesting properties, other than that for which it is usually prescribed, including doping greyhounds to run faster and when added to a vase of drooping flowers keeping them upright.
It is also of value in improving the blood flow to the placenta, thus improving the growth of the foetus and to the lungs in those with pulmonary hypertension. More recently, a reader with personal experience commends it as a panacea combating the effects of ageing: “dispelling lethargy, improving lower-bowel function, promoting better urine flow and boosting memory.” He has found a third of a 100mg tablet a day to be sufficient.
Viagra has several interesting properties, other than that for which it is usually prescribed