More people die from taking painkillers than from taking heroin.
This does not mean that heroin is safe. It means that painkillers are dangerous and a lot more people take them than take heroin.
There is a problem - as Gordon Brown found out when looking at re-classifying the level of danger from using Cannabis - with talking about the dangers of drugs.
In terms of risk of death, the three most dangerous 'drugs' in our society are all legal.
In the UK, nicotine kills three hundred people a day, sugar kills two hundred people a day and alcohol kills one hundred people a day.
All the illegal drugs together kill fewer than fifty people a day. This does not mean that they are safe. It means that fewer people take them.
If all the people who drink or smoke were to use heroin, there would be considerably more deaths from heroin.
That would not make it a more dangerous drug in terms of mortality risk. The level of risk would be the same for a greater number of people.
Pharmacologically, heroin is a relatively safe drug. It is nothing like as poisonous to the body as alcohol. Its risks often come from overdose or from the use of contaminated needles.
This gives rise to the concept of 'harm reduction', by which 'safe' use and clean needles are seen as sensible approaches to the problem of addiction.
I believe nothing of the kind. The most effective form of harm reduction is total abstinence from all mood-altering drugs, including alcohol (look what happened to Amy Winehouse) and regular attendance at Narcotics Anonymous.
Methadone is prescribed as an alternative to heroin. It is given as a liquid so that it is swallowed rather than injected. This reduces the risk of transferring HIV via dirty needles.
There is also a risk of Hepatitis B and Hepatitis C and other illnesses being caught in the type of environment in which heroin is commonly used.
The overall risks are therefore not simply those of a drug itself but also of the way that it is taken and the environment in which it is taken.
Methadone is a dangerous drug because it often kills in overdose. The Department of Health likes it because it reduces the risk of HIV and crime.
Except that it doesn't do so to any significant extent. It is estimated that fifty percent of people taking Methadone also take daily - daily - heroin and many of the rest also use it occasionally.
There is a black market in Methadone. Some addicts prefer it to heroin.
There is even a black market in 'spit' Methadone, when the liquid is kept in the mouth after being given under supervision and then spat out into a bottle.
Medicinal treatment for diseases of the human spirit - addictions and compulsions and depression - are fraught with physical and psychological dangers.
Medicinal treatment should be the last, rather than the first, resort.
As for painkillers, they are vastly over-prescribed and also bought excessively over-the-counter in pharmacies. It is high time that this danger should be highlighted.
Today I had surgical injections into the facet joints of my lower spine. I know about persistent pain. I've had it for eighteen months and I don't like it.
But, throughout that whole time, except right at the beginning after the acute collapse of a vertebral body, I have not taken pain-killers. They're dangerous. Years ago I took them for one day when I had gallstones and for two days when I had kidney stones.
But mostly I think it is safer to live with some level of pain rather than to take drugs of any kind.
Drugs - all mood-altering drugs, even those that come from a sympathetic doctor rather than from a dealer - are dangerous.
2011年9月19日星期一
We all need help to navigate rough waters
How do you do it?" is a question put to many a working parent. My husband and I have been working parents for the past 24 years and still wonder how we can handle life's expected and unexpected challenges.
It reminds me of riding the rapids. We had quite a ride this last month.
Summer is a time of playing catch up to doctor and dentist check ups for the kids. When you have multiple kids, you can have one or two appointments each week.
Here was my list for the month: wisdom teeth out, eye doctor for contacts, physical exam, dentist check up, and orthodontist. My husband and I had to dig in our paddles to get through the doctor visit "rapids" with our busy work schedules.
In the middle of this month, my husband had a bout with kidney stones while driving home from work. He pulled over and called 911. An ambulance and two fire trucks responded. He was taken to the emergency room.
From then on I compare the experience to being caught in a white water hydraulic. Once you are pulled in, you really struggle.
An older daughter got to the hospital first. A friend helped us pick up the car he abandoned on the highway. My travel scheduled had to be cancelled. The kids at home had to fend for themselves.
When it got to be around midnight and I was beat, who did I call? My night owl college age daughter, who came and stayed with her dad. I thought to myself, how fitting, she normally starts her evenings out at midnight anyway.
In the end, he had to go through two separate procedures to get the kidney stones out. Poor guy!
As working parents know, time does not stand still at the office while the river of life takes its twists and turns. I had my laptop, Blackberry and brief case and carried on business in the waiting rooms and halls of doctors, dentists and even throughout the time warp of the emergency room.
It reminds me of riding the rapids. We had quite a ride this last month.
Summer is a time of playing catch up to doctor and dentist check ups for the kids. When you have multiple kids, you can have one or two appointments each week.
Here was my list for the month: wisdom teeth out, eye doctor for contacts, physical exam, dentist check up, and orthodontist. My husband and I had to dig in our paddles to get through the doctor visit "rapids" with our busy work schedules.
In the middle of this month, my husband had a bout with kidney stones while driving home from work. He pulled over and called 911. An ambulance and two fire trucks responded. He was taken to the emergency room.
From then on I compare the experience to being caught in a white water hydraulic. Once you are pulled in, you really struggle.
An older daughter got to the hospital first. A friend helped us pick up the car he abandoned on the highway. My travel scheduled had to be cancelled. The kids at home had to fend for themselves.
When it got to be around midnight and I was beat, who did I call? My night owl college age daughter, who came and stayed with her dad. I thought to myself, how fitting, she normally starts her evenings out at midnight anyway.
In the end, he had to go through two separate procedures to get the kidney stones out. Poor guy!
As working parents know, time does not stand still at the office while the river of life takes its twists and turns. I had my laptop, Blackberry and brief case and carried on business in the waiting rooms and halls of doctors, dentists and even throughout the time warp of the emergency room.
2011年4月12日星期二
WHAT'S UP DOC? Learning about bladder cancer
Q: My father was diagnosed with bladder cancer. What is his prognosis?
A: Bladder cancer is the most common cancer of the urinary system, affecting over 70,000 Americans a year. In countries where the urinary form of schistosomiasis (a parasitic disease) is prevalent, the most common type of bladder cancer is squamous cell carcinoma, accounting for 75 percent of cases. However, more than 90 percent of bladder cancers in the U.S. are transitional cell cancers, and over 80 percent of these are associated with environmental exposures, most commonly tobacco use but also exposure to certain chemicals.
The classic symptom of bladder cancer is painless hematuria (blood in the urine), typically throughout the entire urine stream and often intermittent (clearing and recurring).
Hematuria can cause irritation, so some patients have urgency, frequency and/or discomfort as well. However, less than 20 percent of people with gross hematuria have bladder cancer; most have no abnormality identified (60 percent), and many others are diagnosed with urine infections, interstitial cystitis, prostatitis, kidney stones or other kidney diseases.
The prognosis and recommended treatment for bladder cancer depend on whether it invades the muscles of the bladder and/or extends beyond the bladder or has distant metastases, and this is evaluated during staging of the extent of the disease.
The first step in staging is a cystourethroscopy, where a long tube-like instrument is inserted through the urethra to directly visualize the bladder (and ureters) and to remove any tumors (called transurethral resection of bladder tumors or TURBT). Microscopic evaluation of the tumor specimens, as well as the urine, is also done.
Examination of the regional lymph nodes (N0 is no nodes, N1 is only one diseased node within the pelvis, multiple diseased nodes within the pelvis is N2 and nodes outside the pelvis N3) and evaluation for more distant metastases (such as lung, liver and bone) are also part of disease staging. However, the main factor is whether the tumor is confined to just the bladder so TURBT may be curative, or if it has progressed outside the bladder.
Although 70 percent of new transitional cell bladder cancer cases are initially classified as Ta, Tis or T1, up to 40 percent of these are later reclassified. Over half of these will recur if managed only with TURBT, and up to a quarter of these will progress through to the muscular layer or beyond to adjacent tissue or even more distant metastases, hence adjuvant therapy with treatments directly into the bladder (intravesicular) is often recommended (depending on the details of the cell type and other specifics).
The intravesicular treatments may be chemotherapy or more commonly BCG (the same bacteria as in the tuberculosis vaccine) which is used to stimulate an immune reaction to help fight the cancer.
More invasive stages may be treated with complete removal of the bladder and any adjacent affected organs, as well as chemotherapy. Radiation therapy may also be considered, sometimes to shrink the tumor before resection or sometimes in addition to chemotherapy after resection. When the bladder is removed another method to evacuate the urine is needed, sometimes a tube to a bag outside the body, or sometimes construction of a "new" bladder using a piece of intestine.
Up to 80 percent of bladder cancer patients have at least one recurrence, even though the 5-year survival rate of Ta, TIS and T1 disease is over 80 percent. The 5-year survival drops as the extent of disease increases, with a 60 percent to 80 percent 5-year survival for T2 disease, a 20 percent to 70 percent (wide variability with other factors key to a specific patient's prognosis) for T3 disease, and a less than 20 percent survival for those with T4 disease.
Even though most hematuria patients do not have bladder cancer, since early diagnosis of bladder cancer can improve outcomes, all patients with hematuria should see their health care provider to be evaluated.
A: Bladder cancer is the most common cancer of the urinary system, affecting over 70,000 Americans a year. In countries where the urinary form of schistosomiasis (a parasitic disease) is prevalent, the most common type of bladder cancer is squamous cell carcinoma, accounting for 75 percent of cases. However, more than 90 percent of bladder cancers in the U.S. are transitional cell cancers, and over 80 percent of these are associated with environmental exposures, most commonly tobacco use but also exposure to certain chemicals.
The classic symptom of bladder cancer is painless hematuria (blood in the urine), typically throughout the entire urine stream and often intermittent (clearing and recurring).
Hematuria can cause irritation, so some patients have urgency, frequency and/or discomfort as well. However, less than 20 percent of people with gross hematuria have bladder cancer; most have no abnormality identified (60 percent), and many others are diagnosed with urine infections, interstitial cystitis, prostatitis, kidney stones or other kidney diseases.
The prognosis and recommended treatment for bladder cancer depend on whether it invades the muscles of the bladder and/or extends beyond the bladder or has distant metastases, and this is evaluated during staging of the extent of the disease.
The first step in staging is a cystourethroscopy, where a long tube-like instrument is inserted through the urethra to directly visualize the bladder (and ureters) and to remove any tumors (called transurethral resection of bladder tumors or TURBT). Microscopic evaluation of the tumor specimens, as well as the urine, is also done.
Examination of the regional lymph nodes (N0 is no nodes, N1 is only one diseased node within the pelvis, multiple diseased nodes within the pelvis is N2 and nodes outside the pelvis N3) and evaluation for more distant metastases (such as lung, liver and bone) are also part of disease staging. However, the main factor is whether the tumor is confined to just the bladder so TURBT may be curative, or if it has progressed outside the bladder.
Although 70 percent of new transitional cell bladder cancer cases are initially classified as Ta, Tis or T1, up to 40 percent of these are later reclassified. Over half of these will recur if managed only with TURBT, and up to a quarter of these will progress through to the muscular layer or beyond to adjacent tissue or even more distant metastases, hence adjuvant therapy with treatments directly into the bladder (intravesicular) is often recommended (depending on the details of the cell type and other specifics).
The intravesicular treatments may be chemotherapy or more commonly BCG (the same bacteria as in the tuberculosis vaccine) which is used to stimulate an immune reaction to help fight the cancer.
More invasive stages may be treated with complete removal of the bladder and any adjacent affected organs, as well as chemotherapy. Radiation therapy may also be considered, sometimes to shrink the tumor before resection or sometimes in addition to chemotherapy after resection. When the bladder is removed another method to evacuate the urine is needed, sometimes a tube to a bag outside the body, or sometimes construction of a "new" bladder using a piece of intestine.
Up to 80 percent of bladder cancer patients have at least one recurrence, even though the 5-year survival rate of Ta, TIS and T1 disease is over 80 percent. The 5-year survival drops as the extent of disease increases, with a 60 percent to 80 percent 5-year survival for T2 disease, a 20 percent to 70 percent (wide variability with other factors key to a specific patient's prognosis) for T3 disease, and a less than 20 percent survival for those with T4 disease.
Even though most hematuria patients do not have bladder cancer, since early diagnosis of bladder cancer can improve outcomes, all patients with hematuria should see their health care provider to be evaluated.
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