A new study published in the Annals of Internal Medicine brings good news to people with chronic neck pain. The large scale investigation by researchers at the University of York found that the use of Alexander Technique or acupuncture can significantly relieve this debilitating type of pain.
Chronic neck pain is extremely difficult to treat, and previous research has shown that very few interventions provide genuine long term benefits. However, it now seems that the Alexander Technique or acupuncture can reduce pain and associated disability over a twelve month period compared with normal care.
The research was conducted at the Department of Health Sciences at York and recruited 517 patients from a variety of GP practices in Leeds, Manchester, Sheffield and York. The patients were randomised to three groups. One was offered Alexander Technique lessons along with usual care, another received up to twelve sessions of acupuncture lasting 50 minutes as well as usual care, and the third had usual care alone. In all three groups usual care included prescribed medication, GP visits, physiotherapy and visits to other healthcare professionals.
After twelve months, pain was reduced by 32% for those having acupuncture and 31% for those learning the Alexander Technique. The reductions were found to be statistically significant and better still, patients were more able to cope or reduce their pain levels without resorting to medication.
Dr Hugh MacPherson, a Senior Research Fellow in the Department of Health Sciences at York, said: “Our key finding is that there are significant reductions in neck pain associated with Alexander Technique lessons and acupuncture at 12 months. For the first time we now have clear evidence that these two interventions provide longer-term benefits for chronic neck pain.”
Thomas Jefferson famously said “If people let the government decide what foods they eat and what medicines they take their bodies will soon be in as sorry a state as are the souls who live under tyranny”. It’s a good quote to start a book with and one which rings true in Dr Malcolm Kendrick’s new book, Doctoring Data. I thought The Great Cholesterol Con was a cracker but this time has taken his scalpel to the world of medical research and properly dissected it for our inspection.
Kendrick is by his own admission a sceptic on all things medical but sceptics can be a force for good in guiding us through the mire of health messages we are bombarded with on a daily basis.
Take just a few he mentions – Will sausages give you cancer? What should you avoid eating? Sugar, fat, salt or all three? Should you have a smear test? A mammogram? What about statins? The sheer volume of information and statistics is enough to bamboozle the more mathematically challenged among us.
Kendrick has ruthlessly dissected the statistics for us and shows how drug trials are hyped and data manipulated to make minute risk seem enormous. He explains succinctly the difference between absolute and relative risk. He sheds light on the difference between “observational” studies and randomised controlled trials where statistics actually mean something. He illustrates the importance of language when describing the results of clinical trials.
For example, loud warning bells should sound when a study claims that treatment X would save 50,000 lives a year. “In medical research we have to be a little more scientific” he explains. “A more pertinent question would be “How much longer does this intervention allow people to live?”
He debunks long held and deep rooted notions about subjects like screening which is seen as “a good thing” by asking what do we really know about the risks and benefits?
For example did you know that there has never been a randomized controlled study on the benefits of cervical cancer screening done anywhere-ever? So why does nobody challenge it? Kendrick does and argues that the public needs well balanced information rather than propaganda to make informed choices.
Of course in the world of medical research, those in positions of power do not take kindly to anyone who dares to question the established order. That does not stop Kendrick criticizing the pharmaceutical companies who have vested interests in ensuring their drug gets to market.
By the time you finish this book you could feel hard pressed to know who to trust. A good start has got to be sceptics like Kendrick who refuse to simply accept current dogma and go digging for the truth.
Why do people who have strokes feel fatigue? Well on Friday I went back to Queen Square for more tests to try and discover exactly that. I was met at the door of No 33 by the lovely Anna who took me to the special room where the testing takes place. First off she asked me how tired I felt on a scale of 1-10 at that precise moment. I felt slightly ashamed to say I was totally knackered. I had had no lunch and had traipsed round the shops for over an hour. Not only that but I had been fighting off a virus which had been trying to take hold for more than two weeks. So I guess I should not have been surprised I didn’t feel 100%. Anna explained what I was going to do and that it required a lot of concentration. The idea was to measure strength and whether I could tell how much energy I needed to perform a task. In typical high tech fashion that I am getting used to at these sessions, I had to hold my forefinger against a slightly Heath Robinson contraption involving a piece of metal and a pencil. The metal was linked up to Ann’s computer to record measurements. Anna would then press the end of the pencil twice against my finger and record on the computer how hard she had pressed and how accurately I guessed the pressure of the pencil was on my finger. Next she pressed the pencil and handed the pencil to me to press at at exactly the same pressure (I told you the test was high tech!) I could see why you needed concentration as it’s vital to remember exactly how it felt when she pressed the pencil into my forefinger so as to try and match the pressure as accurately as possible. The whole test took around an hour. As ever we had a good laugh about the strange set up and the fact that of course I couldn’t be told whether I had got the answers right or not! All that data will now be put into the study which hopefully will help answer the question why so many stroke survivors suffer fatigue.
Yesterday the news broke that the Japanese prime minister Shinzo Abe is considering watering down the 1995 apology over Japan’s wartime past.
My father was a Japanese Prisoner of War in Java with all the horrors that entailed. He, along with thousands of others, was subjected to the most horrific torture. Torture which included being staked out in the midday sun with a glass of water just out of reach, to routine beatings and operations without anaesthetic. Some prisoners told stories of being forced to drink pints of water, being tied to the ground and then having gleeful guards jump on their stomachs.
My father spoke of the terror when the Kempetei (the Japanese equivalent of the Gestapo) would arrive at the camp and order ten men outside to dig their own graves. Nobody knew who would be called next-all they could do was listen to the shots being fired and the thud as the men fell.
Prisoners were starved and the camps were rife with cholera and dysentery. My father spoke of eating anything he could find including frogs, spiders and snakes. When the Americans finally liberated Java, they were faced with a vision from hell, as they were greeted by thousands of skeletal men with sunken eyes and broken bodies. Many could not cope with “normal” life on return to the UK and simply dropped dead. Many others, like my father, who survived, often never recovered psychologically.
My father’s experiences damaged him for his whole life. He lost his Catholic faith and indeed his faith in the whole of mankind. He was prone to long bouts of deep depression and terrifying nightmares which had a tremendous impact on our family and particularly my mother. For her part my father was not the husband she had fallen in love with four years earlier. She often spoke of her fear he would wake from one of his nightmares and strangle her.
It took years and years to get the Japanese to even recognise that they played a part in the ill treatment and torture of prisoners of war (they were not subject to the Geneva Convention as Germany were). Although many of the more brutal guards were brought to trial and hanged, an apology seemed never to be on Japan’s radar. When it did come it was too late for my father-he died fifteen years ago. However, there are still survivors of those hell camps for whom it would be a terrible insult to hear Japan reneging on its statement.
It took a very long time for Japan to come to terms with the part it played in World War II and manage to say sorry. Even now some Japanese, just like Holocaust deniers, still believe that accounts of Japan’s wartime atrocities were lies or gross exaggerations. They believe it is time for Japan to become proud of itself once more.
On the other side liberal defenders of Japan’s Constitution say the country should never forget how it invaded Southeast Asia and the disaster that arrived in its wake. I am pretty sure that if my father was alive he would be quite certain on which side of the fence he would sit.
This year is the 70th anniversary of the liberation of all those prisoners in the Far East. I feel strongly we should not forget the horrendous experiences they went through and that the Japanese should face up to their responsibilities for their past actions.
With all political eyes now on the NHS, the relentless rise in patients using A&E as a first port of call has even more significance. Recent research shows that one of the main reasons people head straight for A&E rather than any of the other NHS urgent services is that they simply do not understand how they work.
Research done by Resonant-a London based agency specialising in behaviour change and social marketing recently worked across three major South London hospitals to try and find a solution. What they found was that parents in particular do not know the difference between urgent care, walk in services and minor injury units. More importantly they found that this patient group do not know why and when to use them. In fact the only services universally understood were GPs and A&E.
Resonant devised an intervention called Get It Right which tackled this problem head on and delivered an 18% drop in demand on A&E services in this area of London. After much collaboration with local people and a variety of community groups Resonant came up with a simple and engaging guide to local services which gave local families across southwest London the confidence and capability to use other parts of the urgent and primary care network to access the care they needed.
John Isitt, Director of Resonant says: “Local NHS organisations have not learned that it is not enough to tell people not to go to A&E. Instead it is vital to address people’s underlying motivations, anxieties by making the system simpler for them. Managing demand is not the answer to the whole problem but it is an effective, evidenced and good return on investment”.
In today’s society we are expected to fit more and more into our lives. Yet this work-life balance struggle is causing many of us to trade in precious sleeping time to ensure we complete all the jobs expected of us. Sadly this is a ticking timebomb for our health.
Scientists now believe that if we sleep less than six hours a night and have disturbed sleep we stand a 48% greater chance of dying from heart disease and a 15 per cent greater chance of developing or dying from a stroke. So our ‘work hard, play hard’ society encourages us to sacrifice sleep to the detriment of our health.
More than 3.5million of us suffer from excessive sleepiness usually caused by poor sleep. Everyone has experienced the occasional night without sleep. It makes us feel tired and irritable the next day but won’t harm our health. After several sleepless nights however, the mental effects become more serious.
Brain fog, difficulty concentrating and inability to make decisions follow. Some people drop off during the day causing injuries at home, work and on the road. Long term lack of sleep affects our overall health. A recent Sleep Alliance Report showed how excessive sleepiness is damaging the health and economy of the nation. Sleep disorders are a major contributing factor to fatal road accidents, heart disease, strokes, lost productivity and the breakdown of marriages.
A recent Dutch study in the European Journal of Preventative Cardiology showed that good quality sleep can reduce 57% of heart related deaths each year. It looked at the risk of chronic disease in 14,000 people over a 12 year period and showed that poor sleep is as important a risk factor for Cardiovascular Disease as other lifestyle factors such as being overweight or smoking.
Over 3.5 million people in the UK suffer from excessive sleepiness but what’s the answer. If you have trouble sleeping your first port of call should be your GP who will be able to advise you about what you can do at home to help you sleep. This is known as good sleep hygiene and includes:
- establishing fixed times for going to bed and waking up (try to avoid sleeping in after a poor night’s sleep)
- trying to relax before going to bed
- maintaining a comfortable sleeping environment (not too hot, cold, noisy or bright)
- avoiding napping during the day
- avoiding caffeine, nicotine and alcohol late at night
- avoiding exercise within four hours of bedtime (although exercise in the middle of the day is beneficial)
- avoiding eating a heavy meal late at night
- avoiding watching or checking the clock throughout the night
- only using the bedroom for sleeping and sex
Disturbed sleep may be caused by snoring with more than 3.5 million of us being regular snorers. Snoring occurs because of the vibration generated as air rushes past the tissues of the mouth, nose and throat. When most people think of snorers they picture an overweight, beer drinking bloke. Yet snoring is not confined to men. Older women and children also snore. In fact after the menopause women catch up with their male counterparts.
Snoring can be caused by a number of factors. Being overweight often means you have extra fat around the throat which can stop air flowing smoothly. Sleeping on the back causes the tongue to fall back into the throat narrowing the airway. Colds and allergies can also trigger snoring as sufferers end up breathing through the mouth. Drinking too much alcohol or taking sleeping tablets at night can cause the throat muscles to relax.
‘People with respiratory disorders such as asthma or Chronic Obstructive Pulmonary Disorder (COPD) are also more prone to snoring’ says Dr Matthew Hind who runs the Sleep Clinic at the Royal Brompton Hospital, London. Lifestyle changes such as losing weight can sometimes improve the problem. There are also a range of anti-snoring devices such as mouth guards and nasal strips which can help prevent snoring.
The health consequences of snoring can be serious. Around 6-7 per cent of men and 3-4 per cent of women have obstructive sleep apnoea (OSA) where they repeatedly, stop breathing at night (see above). As well as daytime sleepiness and concentration problems, the condition is linked to a raised risk of high blood pressure, heart disease and type 2 diabetes.
‘We have to stop treating snoring as a bit of a joke. Snoring can affect all aspects of life if left untreated. It can cause excessive tiredness, poor concentration and relationship problems’ explains Dr Hind.