January 18th, 2010 by admin

There is a wonderful idiom, several times used as the title to a movie and offering the comparative warning, “It shouldn’t happen to a dog.” It refers to some proposed act or omission that is so unpleasant to humans, it should not even be wished on a dog (being a mere animal, it might be expected to bear most things, but not this). Human culture has grown up with animals a part of our lives. Whether as pets, living as one of the family in our own homes, or as working beasts, we value them for “who” they are and what they can do for us. This means treating them in much the same way as humans. If they get sick, we give them our medications. Sometimes, they retaliate by acting as incubators to encourage viruses to mutate and, as with “swine” or “bird” flu, return the favor by passing us infections to which we have no resistance. But, in general, we worry about them. Even the animals we propose to eat are stuffed full of antibiotics to keep them fit and healthy. So, keeping this real, there are many protections we have put in place for our animals. The most carefully monitored rules affect horses. These powerful animals have become a key part of the gambling industry, running in races for our excitement and jumping fences for our admiration.

As with most sports, the fear is that horses dosed with stimulants and other drugs might run faster and/or jump higher. Think Barry Bonds and the debate about the use of steroids in Major League Baseball for an understanding of the passion in the world of racing and equestrian sports. At the top of the sport, the International Equestrian Federation (FEI) carried out detailed research in the early part of this century and concluded it was unsafe to allow horses to compete if they were relying on painkillers. In 2004, the Federation moved toward a zero-tolerance policy. This was approved by the Veterinary Committee and representatives of the different national bodies. The risk of seriously injuring the horses was too great and this protective care was strongly endorsed by horse-lovers around the world. Horses should only be used when they are completely fit. It’s therefore somewhat surprising to see the FEI change the policy to allow the use of a range of painkillers. Indeed, the decision has provoked outrage. Read the rest of this entry »

January 18th, 2010 by admin

Once formed, habits are difficult to break. It always just seems easier to go on as you have before. This can become a serious problem when science gets in the way of the habits. If you look at the world of adverts in print and the media, you will see opioids recommended as the sure-fire drugs to use as painkillers, no matter what the pain. It carries on in the venerable tradition of the slogan, “Beecham’s Pills cure all ills”. The idea of a panacea – one pill to rule them all, as The Dark Lord of Mordor might have said – has been around since the beginning of time. This is fair game for the marketers to use when talking to the public, but the same thinking has entered the training manuals for the medical profession. Sit in lectures for student doctors and you will hear the same story that opioids are the first line of defense when it comes to moderate to severe pain. Once you have the source of the prescriptions in on the group think, the habit is almost impossible to break.

The monitoring and review process put in place after a drug is released into the market is designed to catch any unexpected side effects. If evidence of problems emerges, the FDA can require the manufacturer to change the warnings on the label or, in the worst cases, withdraw the drug from the market. But this monitoring process is not designed to catch the drugs that are ineffective. If no-one has an adverse reaction when taking it, no report is filed with the FDA. It’s safe so who cares whether it works. All this brings us to the Cochrane Collaboration. This is a non-profit group where researchers sift through and analyze existing published medical research to see whether there are any consistent patterns – what might not be apparent in one clinical trial involving two hundred participants might be identified when you compile the results from fifteen different trials, each involving two hundred participants. Two recently published Cochrane Reports have concluded that opioids should not be routinely prescribed to patients even with severe pain from hip and knee osteoarthritis. Read the rest of this entry »