Posts Tagged ‘drugs’

In The Emperor’s New Drugs Irving Kirsch argues that antidepressant do not work. Well, sort of. What he argues is that the majority of the benefits of antidepressants are also found in placebo and that the additional drug benefit of antidepressants is explained by the enhanced placebo effect generated by the significant side-effects of the drugs.

He begins by talking about the meta analysis he did showing that almost all of the benefits from antidepressants come from the placebo effect. When he published this, the response of the medical community was “yeah, well we know that already”.

The problem with working out if antidepressants work is because it is really difficult to control for. You can add a placebo group, but because placebos cause less side effects it is easy to break blind. Indeed, 80% of patients on the drugs in one study were correctable able to guess they were in the test group. Also, the increased side effects could produce an enhanced placebo effect rather than a drug benefit.

Comparator trials, trials in which you compare with other antidepressants, are also problematic because everyone knows they are on an active drug, and therefore everyone can benefit from a strong placebo effect.

If his claims were true, you could surely use any drug as an antidepressant as it just has to cause side effects to work though? As it turns out, that is basically what we have. SSRIs, NDRIs, beta-blockers, stimulants, depressants, they all produce the same success rate in treating depression.

But surely NICE, the National Institute of Clinical Excellence, are here to protect us? In theory yes, but Kirsch claims they have trouble getting all the data they need. Drug companies publish studies multiple times, publish summaries across different studies and combine them in different ways to make it incredibly difficult for NICE to work out whether they have duplicate data in their own meta analysis.

He also attacks the idea that depression is caused by a chemical imbalance. If it is, we should be able to cause healthy people to become depressed by lowering their levels of serotonin and other monoamines. But we can’t.

Also, we should be able to effectively treat the imbalance. But again, we can’t, people just respond consistently no matter what treatment we give them. For example 60% respond to SSRIs and 59% respond to NDRIs. If we assume that is is a chemical imbalance, there is no way those numbers should be able to add up to more than 100%.

In summary, Kirsch argues that antidepressants to not out-perform active placebo and therefore subjecting patients to the significant side effects is unjustifiable.

I would like to read some rebuttals before I come down on one side or the other, but it is certainly a thought-provoking book.

A note for antidepressant users

In this blog post I have tried to set forward the views expressed in The Emperor’s New Drugs. I honestly do not know what to believe. However in April, I wrote a blog post in favour of antidepressants. I have thought about whether I should reference the two, and I think it is probably best that I add this disclaimer.

This book does not claim that antidepressants do not work. They clearly do. The question is whether their entire effect is due to the placebo effect, or whether they have a drug benefit on top. This is not that relevant for a user of antidepressants though. If you are using them, and they help, keep using them, because the placebo effect is a real, clinically proven, measurable health benefit.

And of course, discuss any medication chances or concerns with your doctor.

After careful consideration, I have decided that heroin is not for me.

I had pretty much decided this already, but Irvine Welsh’s graphic depiction of life on skag in Edinburgh confirmed this view. Maybe it is amazing. Maybe you can kick the habit. But having carefully considered it, I have decided that it probably is not worth the risk of ending up lying on a floor, covered in my own sick, injecting junk into your cock because it is the only vein I can find on my body.

The content is horrible. I have read quite a few of the famous war novels, and none of them match up to this. Perhaps it is because life in the trenches is more of an abstract concept whereas having a drug habit, while not being something I have ever done, is far closer to reality.

Plus, it makes for a really good novel.

It was hard going at first as it is written in Scottish English. However it gets easier as you go along.

Jason Vale’s book “Kick the Drink… Easily!” suggests that it is easy for someone to stop drinking because there is no such thing as an alcoholic. Alcohol completely leaves your system within 10 days so the idea that it is a lifelong problem is “brainwashing”. Once you remove it, you can just stop drinking.

It was an interesting read, though I do not agree with all of it.

He makes a lot of astute points. Alcohol gets a special treatment among recreational drugs. When you say you don’t drink, people ask you why. Nobody has ever asked me why I don’t take crack. Alcohol is a drug and it messes up the human body.

It also tastes like piss. We all know it. We all had that first drink, it was horrible. But we kept at it because it was the socially acceptable thing to do and gradually built up a tolerance to the horrible taste. But at the end of the day it is still a poison that our body does not like.

It goes on. Does it make you more sociable? Probably not when you think about it. People slur their words, withdraw themselves from conversation and become violent. 75% of stabbings involve intoxication. It’s expensive. It’s had for our health. It makes us feel horrible the next day. Why then do we do it?

I don’t agree with all his points. For example, it could offer a pleasurable effect. Being “numb to the world” as it he puts it, could be thought of as pleasurable if you are not happy with your live.

It also does grease the wheels of social interaction. While I do not think being intoxicated actually does make it any easier for me to talk to new people at parties, or make me a more interesting or lively person, it does help many of us get together with long-term partners.

As for his tenet that there is no such thing as alcoholism, that is less clear. Mainly because nobody can really agree on what alcoholism is.

Overall, I think it makes a good case against alcohol. It is more a large collection of anecdotes than a well cited review of the evidence. However, we all know that this evidence is out there. The book is designed to convince people to stop drinking, and people often respond better to anecdotes than hard evidence.

Although, that does appear to be a quote from the Daily Mail on there.

For my second speech at Leeds City Toastmasters, the “Organize Your Speech” project, I spoke about drug decriminalisation.

It is something I have blogged about several times before because there really is no case for arguing that our current drug legislation is either helpful or sensible. I was a bit worried the talk wasn’t really coming together while preparing it, but I must have done something right as I ended up winning best speech of the meeting.

Edit: Five days after I had given this talk, the IDPC published their new report, “The War on Drugs and HIV/AIDS: How the Criminalization of Drug Use Fuels the Global Pandemic”, so if the topic interests you, you may want to have a read. There is also a good blog post about it by Richard Branson.

Recently, I gave a speech on drug legislation, pointing out that tobacco is a far more dangerous drug than ecstasy is. Which is true. To add a bit of colour to my speech, I included in it the use of a bottle of alcohol and a pack of cigarettes as props.

Obviously, being a non-smoker I didn’t have any cigarettes and Ryan having disappeared for the day, I had to resort to going out and buying some. This wasn’t a big deal, they were only £3.95, but it then put forward an interesting question – what to do with the pack of cigarettes after I had used them.

My first instinct would just be to give them to a friend who smoked, so they wouldn’t go to waste. But then, maybe they should go to waste. I had just given a talk on how dangerous cigarettes were after all, and so it seemed that the best thing to do would just be to throw the pack of cigarettes away so that nobody could smoke them.

This seems to undermine freedom of choice though. I don’t want to restrict what people can and cannot do. As both a libertarian and a rationalist, the ideal world for me is one where everything is allowed but people make sensible decisions – so doing heroin would be legal, but nobody would do it because everyone makes rational decisions.

But then, by throwing them away, I wouldn’t be preventing people from smoking. I just wouldn’t be supporting it, which is all I can really do.

In the end, though, I decided to give them to a friend. The decision came down to this – the cigarette company already has my £3.95 from the sale. Now if I throw them anyway, my friends are unlikely to smoke any less, so they’ll just go out and buy some as normal and the cigarette company has got £7.90 out of us. But by giving them away, it avoids the need for them to buy cigarettes and so effectively the tobacco industry hasn’t got any money out of me. This seemed the most satisfying solution.

We’re now ten years on from Portugal legalising drugs and all the evidence says it works. Drug use levels have plunged.

This has interesting implications for drug legislation in the United Kingdom because it shows that a more progressive attitude to drugs is clearly the way forward.

It’s not that Portugal have removed all drug laws – it is still illegal to be a drug dealer. But what they have done is switched from an attitude of punishing drug users, to an attitude of helping them overcome their addiction and giving them the support they need.

We should do the same.

Now of course, the first thing most people will say is “that’s a crazy idea, you can’t legalise doing drugs because doing drugs is wrong.” These people often drink alcohol and coffee as well as often smoking cigarettes as well. But those don’t count, even though it has been shown that alcohol is more dangerous than ecstasy.

But, you don’t even have to agree that it is the right thing to do to legalise drugs. The bar is far lower than that. All you have to agree is that the current method of dealing with drugs has failed. And it has. Drug use is ubiquitous with modern society. Everyone who has gone through the university system in the past few decades has at least tried drugs, don’t kid yourself that that isn’t the case.

What is the result of such widespread drug use? Massive amounts of crime! As DrugScore point out, an addict needs £15,000-30,000 a year to feed their habit and as a result estimate the value of goods stolen each year could be over £2,000,000,000. That is more zeros than there are people in the UK. Do the maths – that is £30 a year each of us are paying. The story is the same in the US – 17% of prisoners are in there because of of drug related crime^[1].

Much of this could be solved by relaxing drug laws. Best of all, it’s been proven to work in Portugal. Of course, chances are that anyone reading my blog already knows this.

We headed over to Oakwood McDonald’s for dinner this evening.

As I pulled in I found a BMW parked across the pedestrian crossing which then started to reverse and almost went straight into me. I presumed he was just picking someone up and was about to leave so I thought nothing of it.

However as we walked back round we saw the guy in the car talking to some youths and hand them a small bag of something.

We headed inside and having been asked what I wanted I replied, “you know, there is someone selling drugs outside.” The shift manager then disappears off and doesn’t return for 10 minutes. I went out to see if something bad had actually happened – no sign of the shift manager but the car was still sat there and greeted me with a

what the fuck you looking at?

Luckily, having gone back inside the shift manager re-appeared 5 minutes later so I don’t really know what happened there. Maybe he actually did get killed and replaced with some kind of evil clone. Who knows. The important thing is I didn’t get stabbed, which I think is a line I’m going to end most of my stories on from now on ;).

How many of you have seen American Graffiti? If not, well, you should. It’s a defining moment in the young George Lucas’s film career and will explain a lot of Simpsons jokes to you. But never the less I shall fill you in. It’s a movie about the 50’s rock and roll cruising culture in the States before it made way for the crime and the drugs.

That’s exactly what The D used to be like. We’d get out from a close at 3am and cruise down to Tesco, grab ourselves a sandwhich and eat, chat and generally wind down.

Those days are gone. Less closers, people heading straight off claiming they are tired despite being doped up on caffeine, taurine and increasingly these days even alcohol as well. The drink and the drugs is pushing out the friendly sandwhich culture which made the old days so great.

Still, having gone through the usual Sunday night ritual of pub quiz then drive thru for some late night food we found ourselves for one night re-capturing the spirit those days, if only for one night. What made last night different from any other night? Maybe it was because we had all been drinking more the normal. And maybe, just maybe, alcohol really is the cause, and solution to all of lives problems.

So Wednesday was graduation. I want to talk a little more about the general concept later but for now I thought I would offer a run down of what happened as it’s certainly an experience even if it is one that you can happily live without.

Heading out from home we took no less than 4 cars down there and somehow managed to stay together as a convoy which is quite an achievement in Leeds given there is so much traffic, lights and junctions. We even made it out too despite them locking the car park barrier and forcing myself and Kieran to drive over the grassy embankment designed to keep cars out which was rather wet and muddy. Go Astra.

The experience of picking up our gown was an experience in itself, not only do they provide you with one but they also having a robing room where they dress you in it.

The ceremony itself was your standard pompous and boring event. The vice chancellor opened procedings with a speech and then the degrees were presented and we filed up to the stage one by one to collect them.

Later in the day our head of school, Roger Boyle was to say to Kieran

You know, someone told the Vice Chancellor they were going to do drugs

Or at least something to that affect. He also added, “I hope it wasn’t one of our lot.”

Wishful thinking Roger. I mean seriously, who do you think it was? Just, and this is a purely off the cuff suggestion, the same kind of person that would put a lolcat in their FYP ;).

Ok, let me explain a bit more. I arrived on stage and shook the Vice Chancellor’s hand. He then asked me “so, what’s next in your life?” I could have explained to him my plans for my start up, my extensive vision of conquering the business world, finding love and founding the Chris Worfolk Foundation to solve the world’s problems, or even the fact that I’ve already moved on to the next stage and am now happily working in a job.

But he didn’t have time to hear all that. And right now all I could think about was the amount of caffeine and alcohol I was planning to consume when I finally get some time to celebrate (or in my case, commiserate) my graduation. So I gave him the short snappy answer he was looking for – drugs.

Anyway, afterwards we stopped by the school for some of Kieran and Norm’s hard brewed GLPale which went down an absolute storm and then headed off to Loch Fyne in town for a celebratory dinner. Taking no less than 29 people I was rather pleased with the amount of people I managed to get down there, though Graham is also owed just as much credit.

I was less than impressed with the food to be honest and it didn’t help that I felt rather ill during the meal but everyone else fully enjoyed the meal and once I got round and talking to people I felt much better. We also met Rachael, the new Ms Wharton who seems very friendly and outgoing – but I’m sure they make a good match none the less :P.

Finally we finished up with a few drinks in The Terrace and then headed home. I can’t say I particuarly enjoyed it but I’m glad my parents did, mainly because I made them pay for most of it and having spent most of the day with Kieran I could see he enjoyed it which I was glad of (even if I could physically feel the smug radiating off him and burning my skin) as it really was well earned on everyone’s part.

I recently watched the Horizon episode on research done by some of Britain’s top drug experts published last year in The Lancet, a medical journal, which offers an alternative system to the current ABC classification for drugs which is far more based on science and evidence.

The new system would rate the harm each drug causes based on a number of factors, most notably – physical harm (what it does to the user when they take it including the route of administration and long term effects), how much dependence the drug induces (and what dependent behaviour it leads to) and social harm in terms damaging family and social life as well as the social costs of medical treatement and policing a drug.

The study ranked 20 commonly abused substances and had some suprising results…

1. Heroin
2. Cocaine
3. Barbiturates
4. Street methadone
5. Alcohol
6. Ketamine
7. Benzodiazepines
8. Amphetamines
9. Tobacco
10. Buprenorphine
11. Cannabis
12. Solvents
13. 4-MTA
14. LSD
15. Methylphenidate
16. Anabolic steroids
17. GHB
18. Ecstasy
19. Alkyl Nitrates
20. Khat

So, anyone fancying dropping a few E next weekend? ;).

If you want more information the text is available online (you need to register but it’s free).