medi-culling: 4 may 2015

Dr Arjun Rajagopalan

Medi-culling Curations: current, curious, controversial

4 May 2015


Being thin puts you at greater risk of dementia 1

Hold off on “cortisone” injections into painful joints 2

Livestock rearing and antibiotic resistance 3

Giving kids sips of alcohol promotes substance abuse 4

Paracetamol: no relief for back, hip & knee pain 5

Too much Facebook time may make you depressed 6

EndNotes 7

I know that being overweight has many health risks. Is there such a thing as being too thin?

How being thin puts you at greater risk of dementia …

and obesity protects

How new is this?

Is it for the better?

Will it work in real life?

Can I use it now?

1 2 3 4 5

Low High

Dr Arjun RajagopalanMedi-culling: 4 May 2015

High BMI (> 30) is a well known risk factor for a variety of common illnesses: hypertension, heart disease and diabetes. Up till now, there has been no proven association between dementia — one of the most important problems that go with ageing — and BMI.

Body mass index (BMI)Weight (kg)/ (Height)2 (M)

Surprise!A study of 45,507 patients in the UK with dementia showed:• Those who were underweight (BMI < 20) were 34% more

likely to develop dementia.• Above a BMI of 25, dementia risk decreased. This trend

continued up to a BMI of 35. Individuals with high BMI had a 30% less risk of dementia.

WHO Class BMIUnderweight < 19Normal 19 - 24.9Overweight 25 - 29.9Obesity - 1 30 - 34.9Obesity - 2 35 - 39.9Obesity - 3 > 40

We hear quite often of recommendations for injecting “cortisone” into painful joints. Is it

necessary?

Hold off on “cortisone” injections into painful

joints

How new is this?



Can I use it now?

1 2 3 4 5

Low High


100 patients with proven osteoarthritis of the knee joint were randomly given either a steroid (“cortisone”) injection into the knee joint or a placebo. Two weeks after, all participants underwent a 12-week, exercise programme. Pain was assessed using an objective scoring system.

No difference!A robust, objective scoring system was used to assess baseline pain and the changes that followed both arms of the study. No significant (statistical) benefit resulted from the injection of steroids into the joint concerned (scores shown in the chart above).

Pain score

2 4 6 8 10 12 14 16

14.8

13.6

CortisonePlacebo

Global demand for animal protein is rising steeply. Antibiotic usage is universal in farms and

is an important factor in promoting bacterial resistance. How do we balance this conundrum?

Livestock and antibiotic resistance

How new is this?



Can I use it now?

1 2 3 4 5

Low High


Antimicrobials are used routinely in livestock rearing for disease prevention and as growth promoters. Links between the use of antimicrobials and antibiotic-resistant bacteria originating from livestock are well established.

Rising demand for antibioticsWorldwide antimicrobial consumption is expected to rise by 67% percent between 2010 and 2030.• Five countries — Brazil, Russia, India, China and South

Africa — will experience a growth of 99% in antibiotic consumption, compared with an expected 13% growth in their human populations.

• Two thirds (66%) of the global increase (67%) in antimicrobial consumption is due to the growing number of animals raised for food production.

Is consuming a sip of alcohol at a young age a predictor of future substance use, even if the sip

is provided by adult family members?

How giving kids sips of alcohol promotes substance abuse

How new is this?



Can I use it now?

1 2 3 4 5

Low High


Initiation of alcohol use typically occurs well before the legal age of drinking. In some societies, the first exposure to alcohol occurs before the sixth grade of school (11 years) in as much as 20 - 25% of children. We need to know whether consumption of minor amounts of alcohol at a young age is a marker of risk behaviors in later adolescence.

Yes, it is harmfulIn this long-term study of 561 students:• The first sip took place at their own home, and the primary

source of alcohol was an adult, usually a parent. • Youth who sipped alcohol by sixth grade had significantly

greater odds of • consuming a full drink, • getting drunk, and • drinking heavily by ninth grade than nonsippers

What should I take as an over-the-counter medication for back pain, hip and knee arthritis?

Is paracetamol the drug of choice?

Paracetamol is not effective for pain relief in back pain, hip and knee

arthritis

How new is this?



Can I use it now?

1 2 3 4 5

Low High


Guidelines consistently recommend the prescription of paracetamol (acetaminophen) as the first line analgesic for back and neck pain, and arthritic pain from the knee and hip joints.

Paracetamol (acetaminophen) is not effectiveAn extensive, meticulous, systematic review was carried out of all trials that evaluated paracetamol for the relief of these conditions. The study showed:• Paracetamol is ineffective in reducing pain and disability or

improving quality of life in patients with low back pain.• Paracetamol offers a small but not clinically important benefit

for pain and disability reduction in patients with hip or knee osteoarthritis.

• Patients taking paracetamol are more likely to have abnormal results on liver function tests. The relevance of this is unclear.

Can too much time on Facebook get you down?

Too much time on Facebook may make you

depressed

How new is this?



Can I use it now?

1 2 3 4 5

Low High


Facebook is the way most of us keep in touch today with our extended social circles.

Many more fences to peek over“Facebook gives us information about our friends that we are not normally privy to: more opportunities to socially compare.

Most of our Facebook friends tend to post about the good things that occur in their lives, while leaving out the bad. If we’re comparing ourselves to our friends’ ‘highlight reels,’ this may lead us to think their lives are better than they actually are and conversely, make us feel worse about our own lives.

This kind of social comparison paired with the amount of time spent on Facebook may be linked to depressive symptoms.”

Low BMI and dementia: Habits like alcohol use and smoking increase the risk of dementia. Adjusting for such confounding factors made little difference to the result. BMI associations held true. The reasons for this inverse association are unclear at present.

These results open up an intriguing new avenue in the search for protective factors for dementia. Future research might show why people with a high BMI have a reduced risk of dementia. Researchers might be able to use these insights to develop new treatments for dementia.

Injecting steroids into painful joints: Injections into the knee joint are sometimes recommended for patients with severe arthritis. Evidence in support of this practice is dubious. Injections given under conditions of poor sterility can introduce infections into the knee: a complication with devastating consequences. This study confirms that there is no valid reason to recommend the practice.


EndNotes

Medi-culling: 4 May 2015

Livestock farming and antibiotic resistance: To complicate the situation further, for about a billion poor people, livestock are essential to survival. They usually raise their livestock in small, backyard systems and do not use antibiotics as growth promoters or in disease prevention. In this subsistence rearing, any resistant infection that develops is economically devastating.


EndNotes


Over the last 30 years, there has been a steady drop in introduction of new anibtiotics (see chart). This trend is largely due to the lack of interest on the part of Big Pharma. Antibiotics are less lucrative than other drugs.

Harm to children from sips of alcohol: Sipping alcohol in the family context is advocated to be protective against future problem drinking. This report clearly points to the opposite effect. Although it is possible that offering a sip might be a marker for some other family factor that would predispose children to subsequent substance use, this study did a good job of controlling for temperamental, behavioural, and environmental factors that could contribute to proneness for problem behavior. In short, don’t give them alcohol.

Facebook blues: “People afflicted with emotional difficulties may be particularly susceptible to depressive symptoms due to Facebook social comparison after spending more time on the medium. For already distressed individuals, this distorted view of their friends’ lives may make them feel alone in their internal struggles, which may compound their feelings of loneliness and isolation. Any benefit gained from making social comparisons is temporary and engaging in frequent social comparison of any kind may be linked to lower well-being.”


EndNotes


medi-culling: 4 may 2015

Documents

high bmi

dementia risk

underweight bmi

greater risk of dementia

class bmi

antibiotic resistance

cortisone injections

antibiotic consumption