DrugsOne of the great tragedies of our age is man’s insistence on blundering into avoidable fiascos. There was no need to over-prescribe antibiotics, still less to pump them into livestock to feed peoples’ desire for cheap animal products, yet if a World Health Organisation study is at all reliable, these practices have led us into catastrophe. Antibiotic resistant bacteria have been observed across the world and treatments have not been prepared to deal with them. Knowledge of their spread, meanwhile, has been limited by inadequate surveillance. “Without urgent, coordinated action by many stakeholders,” says Dr Keiji Fukuda, the World Health Organisation’s Assistant Director-General for Health Security, “The world is headed for a post-antibiotic era, in which common infections and minor injuries which have been treatable for decades can once again kill.” What will our offspring think if there is any accuracy to this? “I hope that the sore throat got better, Mum.” ”I hope that you enjoyed your sausages, Granddad.” Comfort can blind one to the potential for crises.

On the same day that the WHO report was published, Kevin Mullin of the California State Assembly withdrew proposed legislation that would have banned the sale of meat from animals that had been fattened with antibiotics. “This is the second such antibiotic bill to be shut down in California,” reports the San Francisco Chronicle, “Where there are strong poultry and beef lobbies.” Enjoy your meals, folks.

AntibioticsWe hear a lot about drugs: from kids peddling heroin in London’s inner cities to students huffing nitrous oxide in their bedrooms. Legal drug use, however, sometimes escapes our attention, and this is regrettable as its effects can be more significant. I have written before on the overuse of antibiotics, both when they are prescribed to men, women and children and when they are pumped into animals, and there have been intriguing developments on this front.

The US Centers for Disease Control has claimed that the development of antibiotic resistant bacteria sends 23,000 Americans to their deaths each year. Richard Schiffman observes that most of the antibiotics consumed in the US are administered to livestock, because, in part, it fattens the poor creatures up before their deaths. This is dangerous, and disgusting, but it is far from being the single factor. Men, women and children, who can spread bacteria amongst themselves in a more direct manner, are prescribed antibiotics in millions of cases where they are quite unnecessary. Modern populations have become addicted to drugs, as a means of defending themselves from the slightest illness, and in one of the grim ironies of existence it appears to be threatening them with grave sickness.

This is not a national problem, though. It has been globalised. Developing countries have embraced antibiotics as a cheap, convenient way of satisfying patients, and a cheap, convenient way to further the growth of meat production. The Indian government have admitted that between a fifth and a half of antibiotic prescription in the country is unnecessary, while in China the average person consumes many more times the amount of antibiotics than  the hardly abstemious Americans. These rates have, it’s claimed, been falling as officials grow wary of the pharmaceutical feasting they have overseen, but the expansion of hog, poultry and cow farming seems to be shifting the consumption elsewhere.

The effects of these trends can already be observed. A Chinese study founddiverse, abundant, and potentially mobile [antibiotic resistant genes] in farm samples”, while patients in hospitals have also teemed with them. Scientists are claiming that illnesses such as tuberculosis and Shigella infections are becoming harder to cure. A Swedish tourist who was treated in New Delhi, meanwhile, was found to have picked up a strain of bacteria that was extraordinarily powerful in resisting drugs. This proves to us that this is a concern for everyone. Professor Matthew Cooper of the Australian Infectious Diseases Research Centre has observed that, “Animals get transported between countries, as do people. Infectious disease is no longer a national issue, it’s a global issue.”

The scientific and technological knowledge of civilisations need not advance in lockstep with their sagacity and moral conviction. So, the modern world has been so enamoured of the convenience and profitability of this most wondrous example of medical progress that it has exploited it regardless of potential hazards. As for ethics, well, the gross distending of animals in the vast new meat production industries of developing nations shows, as was already proved on Western factory farms, that modernisation can only expand the scale on which cruelty is practiced. China, for example, where horses and dogs are dined upon and bears are slaughtered for their bile, is home to even less concern for animals than Europe or America, and countless pigs, chickens and cows on its ever enlarging farms are doomed to lives of pain. It is when we are sensitive to the effects of our behaviour on all creatures that we might succeed in making it less destructive.

AntibioticsDame Sally Davies, Chief Medical Officer for England, has been beating the drum over the threat of antibiotic resistance. It is, she claims, a “ticking time-bomb not only for the UK but also for the world”. Indeed, doctors in Canada, academics in Australia and politicians in America have been wringing their hands over this phenomenon. One problem, it seems, is that the development of new antibiotics has been slow. Correspondents of the British Medical Journal, however, offer what they call “an important and alarming caveat”…

…new antibiotics alone are not enough to eliminate the threat of drug-resistant bacteria. Indeed, given their rapid turnover and high mutation rate, it is inevitable that bacteria will develop resistance to any newly developed drug regardless of the pharmacological mechanism of action. Thus interventions to tackle antibiotic resistance must focus on targeting misuse and over-prescription.

Antibiotics are often prescribed for such complaints as sore throats, middle ear infections and coughs that they do little to ease and that do not justify their use. Doctors, though, presented with distressed patients or the demanding parents of ailing children, are liable to offer them.

In Britain, doctors have said that there is “clear scope for reductions in antibiotic prescribing”. In America, millions of cases of antibiotic prescription have been found to be unnecessary and over a hundred thousand people, most of them young children, have been admitted to hospital after suffering adverse effects from their treatment. The most frightening case, though, is China, where powerful monetary incentives for prescribing has led to the extraordinary rates that Qiang Sun and his colleagues described in Health Affairs

 In Henan, China’s most populous province with nearly 100 million residents, antibiotics constituted fully 70 percent of prescriptions in village clinics and township health centers. Another study found that 98 percent of outpatients with a common cold were prescribed antibiotics. One study has estimated that approximately half of antibiotic prescriptions in China were medically unnecessary and implicated in more than one million children’s becoming deaf or suffering neurological disorders.

The Chinese government began to fight back against overprescription last year, after it was estimated that its citizens use an average of 138 grams of antibiotics per year – ten times that of Americans. If you consuming far more of a product than the average American, and it isn’t green and vegetably, that is more often that not a cause for concern.

The other problem, as I have discussed before, is the use of antibiotics in the raising of animals for their flesh, milk and eggs. In the EU, drugs are at least banned as a means of growth promotion but they are still used in vast quantities, largely in factory farms, where crowding, stress and aggressive, unsuitable diets seem likely to provoke illness.

In America, where almost four times as many antibiotics are sold for meat and poultry production as to treat ailing people, they are still used like steroids to bulk up miserable creatures. So it seems to have been in China, where a recent study into contaminants in swine farms found…

Diverse, abundant, and potentially mobile [antibiotic resistant genes] in farm samples [that] suggest that unmonitored use of antibiotics and metals is causing the emergence and release of ARGs to the environment.

Education programs that discourage seeking antibiotics to treat minor and unsuitable illnesses have proved successful in the past, and education programs, formal or otherwise, on the distressing conditions of factory farms may help to curb appetites for their products. I am sure drug regulations could be tightened for such places but a more effective solution would be to end the demand for the goods that inspire these practices. (This is, of course, one of many reasons for not encouraging the abuse of animals.)

As Professor Matthew Cooper of the Australian Infectious Diseases Research Centre says, though: “Animals get transported between countries, as do people. Infectious disease is no longer a national issue, it’s a global issue.” The idle distribution of antibiotics across China and also India and South-East Asia has contributed to the formation of such dangerous conditions that experts are warning that tourists are shuttling infections back with them. There should be a concerted international effort to address this problem, as it would be a tragedy of vomitous proportions if our aversion to discomfort and appetite for cheap sausages was a cause of devastation.

DrugsA few weeks ago I reported on the fact that tens of thousands of elderly Britons are being prescribed antipsychotics despite the fact that a governmental report has concluded that most patient derive no benefit from this and one in a hundred will die as a result of taking them. Others are liable to endure weight gain, diabetes, hyperlipidemia and cardiac dysfunction, as well as life amid the torpor of a chemical cosh.

Things seem to be even worse in the United States. According to Becky A. Briesacher and her colleagues from the University of Massachusetts, more than one in five of its nursing home residents have been prescribed them. It is known that many of them do not profit from and, indeed, are harmed by their drugs. One study on patients admitted to nursing homes after hip fractures found that their use of antipsychotics was associated only with adverse outcomes. One wonders if the doctors had been told “first, do no harm” and somehow failed to internalise the penultimate word.

Antipsychotic use is also extremely high among American children and adolescents. More young people than ever are taking such drugs, and most of them are being prescribed in response to conditions they have not been approved to treat, such as ADHD or post-traumatic stress. An investigative report into their use in juvenile prisons and residential programs found that they were being doled out to treat everything from anxiety to sleeplessness.

There has been some evidence that some antipsychotics reduce aggression and conduct problems in children diagnosed with disruptive behaviour disorders but recent studies have described it as “limited” and “incomplete”, and judged that off-label prescriptions are a “cause for concern”. This is because, as well as having questionable virtues, they are known to carry serious risks for children and adolescents, and have been linked to metabolic dysfunction, cardiovascular adverse events and abnormal involuntary movements. It is also eerily true that their long-term effects remain mysterious, and studies have suggested that prolonged use may worsen brain tissue loss.

There are significant interests behind the growth of the market in antipsychotics, of course. It nets fourteen billion dollars per year for Big Pharma, and full 58% of which comes from Americans. As in the cases of other drugs, manufacturers have been sly in promoting their goods. In Florida prisons the investigative report exposed, for example, doctors who had been prescribing drugs were also accepting “huge speaker fees and other gifts from makers of antipsychotic pills”. This does not mean they need have been less objective than other doctors but it was a conflict of interest that it was significant enough that they could have been. Shahram Ahari, a one-time Big Pharma sales-rep who went rogue, revealed that drug companies rank physicians according to the rate at which they prescribe their products, and then offer gifts accordingly.

The behaviour of drug companies has been exposed in numerous lawsuits. Omnicore, which supplies drugs to nursing homes, paid out ninety-eight billion dollars after it was alleged that they had accepted kickbacks from the drug company Johnson & Johnson in exchange for recommending that elderly patients be prescribed one of their brands of antipsychotic. Johnson & Johnson later agreed to pay billions after being charged with marketing the same drug for unapproved uses. Pfizer, meanwhile, was fined after “maintain[ing] on its payroll an army of more than 250 child psychiatrists” to help promote an antipsychotic drug that had not been approved for children. This corruption is enough to give one a headache, though I would not recommend buying painkillers to deal with it.

I will not market myself as an expert on psychiatry or pharmaceuticals. It seems to generally accepted that antipsychotics are efficacious in treating certain conditions, and I can empathise with at least some of the people who recommend them to disorderly youths. This is not to say that it is the right thing to do but that I have been around kids with a great deal of energy and a great absence of respect and understand why people feel pacification is required.

Yet it seems bizarre that drugs with benefits that remain so unclear; long-term effects that are so mysterious and adverse consequences that are so evident and so obnoxious are used in such quantities. The forces behind them make the phenomenon seem more comprehensible yet also more sinister. It is tragic that old people are drugged into states of lethargy until their unassuming deaths but it is also frightening to think of the futures of the kids whose youths will bear the marks of psychological restraints, and whose growing brains may have been choked by their confinement. It seems so much more civilised than straitjackets, yet at least the old camisoles left inmates with their own minds, and at least we could be sure that their wounds would fade.

The irony is that there is another sedative that gives comfort to some of its users but has been linked to deleterious long-term results – though not, it must be said, adverse short-term effects or death among the aged. This drug has inspired Americans to spend billions of dollars, lock up thousands of their prisoners and keep their neighbouring nation mired in brutal violence. These drugs, though, it seems, are no big deal.

Child assassinsThe success of last year’s Kony 2012 video demonstratred how averse we are to the notion of child soldiers: of corrupting a boy or girl’s innocence by thrusting them into combat. Less infamous is the phenomenon of child assassins. In Guatemala, two unidentified girls, aged 13 and 15, have been arrested after killing a man while a 10-year-old boy is suspected of approaching a cab driver and shooting him. Criminal organizations are hiring and training children, a minister claims, because they are exempt from prosecution.

Organised criminals have long been exploiting the benefits of school-age assassins. Minors kill hundreds in Columbia every year – hired by gangsters because their innocent appearance does not raise the suspicions of their victims as they approach, and because they demand lower salaries than men. And, besides, they bring their naive enthusiasm even to such an appalling task. As one mob boss put it of a young killer who was profiled in the New York Times: “if we ask Tiny to do something, he’ll do it right away”.

Unsurprisingly, the Mexican gangs have learned from previous battlegrounds. Thousands of minors, it has been alleged, work for the cartels. Even U.S. citizens, disaffected in border towns and cities, have been lured into their grasp. Rosalie Rita was a 13-year-old boy when he was initiated into the Mexican Gulf Cartel. “I thought I was Superman,” he said of his first killing.

Western audiences have enjoyed Battle Royale and The Hunger Games: stories in which children are extracted from social institutions and thrust into a world of violence that reduces them to a state of primal viciousness. One need not resort to fantasies to conceive of such conditions, though. Alonzo Salazar, a Columbian journalist and one of few people to explore the phenomenon, wrote, a year after Pablo Escobar’s death, that kids had been raised in streets where murder was almost quotidian; authorities were only glimpsed suppressing or enacting violence and fathers were lost inside a daze of substance abuse or, in many cases, simply lost having abandoned their bewildered children.

Young boys, with no one to guide them along a safe path and no inspiration to seek it for themselves, found meaning and support within some of the few remaining social structures. This also reflects realities of life in much of Mexico and, indeed, inner-cities in America and even Europe.

While I am dubious about consequences of drug liberalisation, nothing highlights the appalling futility of the “War on Drugs” so much as the fact that a policy justified on such grounds as protecting children from being seduced by narcotics has ensured that kids are being attracted to that deadliest of intoxicants: murder. They are caught between forces of prohibitionism that have abetted the expansion of underground crime and forces of modernity that have allowed their families to drift away from them and leave no one to hold them up lest they fall in.

Drugs On Friday I wrote of a study by researchers from Queen’s University Belfast, who have revealed that while 1% of elderly people living alone or with relatives in Northern Ireland are on antipsychotics, 20% of elderly people in its care homes take them. It is predictable that residents of care homes are more likely to endure psychiatric conditions than old people elsewhere but the second figure seems awfully high nonetheless, especially given the concerns that the benefits of the drugs are overstated and their dangers overlooked. Like the idle blogger that I am, I called for more research. This research exists, in fact. What is needed is more action.

The researchers claim that these rate of prescription can be observed across the U.K.. I can find little data to suggest that the difference is as stark as that but this is in large part because more people living alone or with family seem to be on antipsychotics than they suggest. At least until recently, figures in care homes were similar. Last decade studies in Leeds and Bristol reported figures equal to and higher than it. The researchers in Yorkshire observed that few of the elderly people were given the chance to have their condition reviewed while the researchers in the South West bluntly concluded that they had “confirmed suggestions of inappropriate drug use”. These studies prompted the government to commission a report by Professor Sube Banerjee, who concluded that at least 80% of people who were given antipsychotics derived no benefit from them.

That troubled people are drugged into stupors needlessly is a grim enough fact. Yet antipsychotics can also be damaging to one’s health, and have been associated with weight gain, diabetes, hyperlipidemia and cardiac dysfunction, among other unpleasant conditions. Banerjee claimed that for 1% of Britons taking antipsychotics, who number 1,800 people a year, they will cause their deaths. Dr. Tom Smith of St. Mary’s Hospital has described this as a “highly conservative underestimate”.

Measures have been taken to address this phenomenon. Last year the Alzheimer’s Society established a training programme that, acknowledging the ignorance and impatience that can lead carers to medicate rather than engage with patients, aimed toincrease understanding and awareness of dementia and provide tools, ideas and resources to enable staff to provide good quality person-centred care”. Such interventions have been found to lead to dramatic reductions in antipsychotic use. One, by Fossey et al, also observed that there had been no corresponding rise in agitated or disruptive behaviour.

The Department of Health invested £100,000 in the programme. This is good, of course, and there have been signs of improvement, though further studies have suggested that these are exaggerated. I cannot help feeling that the work lacks urgency. The bottom line is that thousands of people are being given drugs that they will not benefit from but that are liable to increase their suffering and, in many cases, kill them, despite a potent alternative being available.

The victims, though, tend to be old people and the sad fact is that once they have disappeared from our society has little interest in them. This is the only explanation for the indifference towards the levels of abuse they face. I have, of course, no wish to demean the carers who do marvellous and regrettably unheralded work across the country but it remains true that tens of thousands of disabled and elderly people are claimed to have endured physical and psychological abuse and neglect. Just last week a home was closed after investigators found that its conditions were so dreadful that one resident had not had her hair washed since September and another had bedsores that were in danger of spreading into life-threatening infections. This, in fact, was one of the less hideous revelations. At least they weren’t beaten up.

Both of these phenomena demand concerted governmental action. The elderly cannot be expected to protect themselves from abuse and nor can they be expected to so much as grasp that they might need protection from drugs. The costs of rising numbers of people in social care, and people suffering from dementia, are extremely serious. There is, though, to draw attention to a neglected interest of mine, far more work that could be done into the science of longevity, which is illuminating means of remaining healthy in old age. One’s diet and lifestyle, for example, affects one’s chances of avoiding cognitive decline. Even if this was untrue, however, it would be grotesque to tolerate the needless suffering of vulnerable people – people, mind you, on whose labours our comfort has been founded – because we think them burdensome. It should make us agitated and disruptive, in a manner than no drugs can fix.

CigaretteI’m giving up smoking.

This is not the commendable admission that it would have been from someone who had spent years smoking packs a day because I’ve never smoked a lot nor been terribly addicted. Until tonight, indeed, I hadn’t touched the things for a month. It was a part of my daily routine, though, and I thought I would scribble a few notes to make this choice official for myself.

As one who was not firmly grasped by Lady Nicotine I can inform you that smoking can, in fact, be fun – or, at least, life-enhancing. It is not merely the warm sensation that spreads through one’s chest upon inhaling, it is the sense of devoting oneself to an idle moment; of sealing a time and an environment in one’s memory. There are doubtless other means of engineering this sensation but it remains effective. I still think of post-performance cigars behind the school theatre; cigarettes atop the cark park on summer nights; smokes in fields on New Year’s Eve.

Ultimately, though, it is liable to kill you – and not “you” as such but a weak, wizened, wheezing little parody of whoever you are today. It is true that one should not succumb to the puritanism that defines some orthorexic, abstaining exercisers. While most people care too little about their own health rather than too much there are some who have made their freedom from bad habits such a fundamental part of their ego that they spend all their time not doing things and have rather empty lives. No one has laid on their death bed and wished for a few more days of reading the health pages in lifestyle magazines.

Yet it is depressing that abstaining from intoxicants can be so easily equated with joylessness. I have been enjoying a boxset of The Twilight Zone, the creator of which, Rod Serling, said in an interview at the age of fifty “Jesus, would I love to give it up” and then died a few months later. Wouldn’t it be cool to have some more Rod Serling films? Or some more Bill Hicks routines? More Lon Chaney performances; Dick York appearances; Ian Fleming books or Graham Chapman sketches? I have never lost a friend or relative to this unassuming leaf but I imagine millions dream of years they could have spent with loved ones; of moments that they could have shared in times and places unexplored. Cigarettes and alcohol can be accessories to fun, fulfilling lives but they are rarely fundamental to their value. It is the places seen, the ideas thought, the things made and the people loved that offer chances of fulfillment and God forbid that one’s opportunity be jeopardised because of things consumed.

This does not have the stridency of my piece on drunkenness, because, perhaps, we live in a culture that celebrates drinking but has shunted smokers to its  margins. The exclusion from the public sphere has doubtless put a lot of Brits off cigarettes but it gave some of us a rather feeble sense of comradeship. “Filthy smoker” is not a self-deprecating term but a badge of heretical pride. There will always be a certain thrill in being an outsider but I think it is more worthwhile as the product of a good idea promoted; a lost value upheld or an artistic treasure unearthed.

Smokers can take their habit to be a mark of their freedom. It was, after all, the accoutrement of great lone rangers of our culture: the cowboys, the private eyes, the rock stars, the beat poets. This, surely, is a con trick others have played on us and we have played upon ourselves. What is liberating about a compulsion, and an enfeebling one at that? I want the freedom to wake up in the mornings and fill my days as I see fit, with as much energy as I can muster. And, having been confined to hospital beds on one occasion, I want the freedom to never return to them.

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