star wars

In the Star Wars films there is a seesawing battle between the empire and the “rebels”. Through the initial three-film trilogy each side is in the ascendency at differing times. Whilst not a perfect analogy, it is interesting to apply this concept to battles in medicine.

Over the last few months I have written about battles in ADHD and the use of cholesterol lowering medications.

Lets apply the Star Wars approach to these.

Last week was certainly a case of The Empire Strikes Back when it comes to statin medications for cholesterol. There was jubilation in the empire about the Catalyst programs, which had questioned the widespread use of statins, were taken off the net. The reason this was done is important to understand.

It was not because any claim made in the programs had been shown to be false. It was because the program was not “balanced”. This is not in my opinion a fair criticism. When you set out to question conventional thinking the aim is to do just that. To be questioning. The two-part program did exactly that.

It interviewed doctors and professors who did not sprout the party line about cholesterol and statins. The “official” line gets lots of airtime. The number of people who are taking these tables at a massive cost to both the health system and themselves is evidence of this.

So you would think that to question this is a good idea. Indeed to have a discussion about policies and beliefs which affect so many people is vital. To have a discussion you need opposing points of view. It won’t happen when everyone speaking says the same thing.

The Catalyst program gave voice to those who don’t generally have one in the media. Clearly those who have been able to express their opinion without question didn’t like it. We saw this in the hysteria, which followed the program being on TV, and they have not let up.

The Empire was also jubilant when one part of a review of statin medications was withdrawn. The claim had been made that 18-20% of people on these medications would get side effects. The paper was found to have overstated this figure.

Note that all the side effects mentioned do occur, just not as frequently. More importantly though, the substantive issue which was that, many people taking the tablets did NOT get any benefit was NOT challenged or withdrawn.

With their media dominance, the empire got this story out far and wide. And of course the one part that was withdrawn was the story. The fact that the tablets don’t help many of the people who take them was not promoted.

Presumably this is fair and balanced.

But it is not all bad news. Professor Allen Francis’ view that we may be approaching a tipping point in ADHD came a step closer this week. The New York Times reports that some 10,000 children aged under three have been diagnosed and treated for ADHD.

Seriously there are doctors out there who feel that a two year olds concentration can be accurately measured and assessed against some “normal level”. And they are prepared to prescribe amphetamine like drugs to these children. These doctors need to be held to account. Parents who push for diagnosis and treatment are also culpable here.

To quote Anita Zervigon-Hakes a children’s mental health consultant at the Carter Centre “It’s absolutely shocking and it shouldn’t be happening”.

I agree.

On the plus side stories like this can get people to question the whole basis of diagnosis and treatment beyond this age group. The “tipping point” will come when the craziness of the diagnostic criteria and overuse of medications has a bright light shone on it.

On another positive note it has been shown that for those who would like to improve their concentration and attention span there is a simple drug free option – mindfulness. Simple mind focusing exercises have been shown to improve focus and attention.

And whereas the “effectiveness” of drugs wanes by the third year at the latest, mindfulness training has a long lasting effect as it teaches you to deal with the issue. Medications just mask the symptoms.

The battles in these (and other) areas are not over yet. But the assorted empires are looking shaky.