Going herbal? Switch with caution

Do you use herbal remedies rather than traditional medicines? If you belong to the former group, you may find yourself part of a growing number of individuals who may be increasingly opting for the herbal medicine route in favour of the traditional medicine route.

What makes people resort to traditional medicine? There are many reasons. One may be that they have been on a particular type of medication for a long period of time, and have seen no improvement, and are keen to try something that might bring about change. For example, if you have been suffering from migraines for quite a long time, and the medication does not appear to alleviate the severity of the frequency of the headaches, then would you not be tempted into trying something else that might work? After all, you might think that if you do not try, you might miss out of the potential benefits. Hence, the search for a better treatment might be a motivating reason for going herbal.

But seeking products that might work better because they are more naturally occurring and possibly more readily adopted by the body may only be one reason for switching to or trying herbal remedies. Traditional medicine also carries risks of adaptation and addiction, which is why some individuals consider switching.

Take for example pain relief medicines such as ibuprofen. If taken consistently for a long period of time, the body adapts to this increased level and the benefit of ibuprofen is gradually neutralised and minimised. It does not bring pain relief if taken on a prolonged basis because the body has adapted. But because the body has acclimatised or become accustomed to this, it now depends on this level of ibuprofen. The medicine has now bred dependency, and an individual is now addicted to it. It is possible that something more potent in terms of pain relief may be prescribed by doctors but again with prolonged use there is the danger of adaptation and addiction, but this time to a higher dose.

Medicines also produce side effects if used for long term. We have already examined for example the effect of aspirin in the elderly – it can cause bleeding and other complications.

Hence it is unsurprising that individuals look to the herbal medicine route as a means of avoiding greater dependency on drugs, to avoid tampering with the body’s natural ability to heal itself, and in the hope that herbal remedies could provide a quick alternative resolution to medical issues that they have had long term treatment for.

The herbal medicine world is not as regulated as the traditional medicine world although there is increasingly a tightening on the controls, especially on the advertising and promotion of products to make sure that products cannot make claims to curing certain illnesses.

While some may protest into the regulation of the herbal medicine market as the clamping down on civic liberties by an over protectionist nanny state, there are actually valid medical reasons for these interventions.

Herbal remedies may interact with traditional medicines and cause conflicts. They may either neutralise the potency of the traditional drug, or enhance it to dangerous levels above recommended limits.

The most often reported drugs that can come into conflict with traditional drugs include the blood-thinning drug warfarin, cholesterol-lowering statins, anti-cancer drugs, antidepressants, immunosuppressant drugs for organ transplants and antiretroviral drugs for people with HIV. The most common result of a drug herb interference was that of cardiovascular disease, involving medicine such as statins and warfarin. Other unwanted spheres of influence include cancer, kidney transplants, depression, schizophrenia, anxiety disorders and seizures.

The most commonly used herbal remedies included ginkgo biloba, St John’s wort, ginseng, sage, flaxseed, cranberry, goji juice, green tea, chamomile and turmeric, while those most likely to cause interactions with drugs appear to be sage, flaxseed, St John’s wort, cranberry, goji juice, green tea and chamomile.

In some cases herbal remedies can lead to death or secondary death. One man died after a herbal remedy prevented his anti-seizure medication from working properly, resulting in him drowning.

These facts highlight the need for patients to inform their doctors if they are taking other forms of herbal medication apart from the medication that the doctors are prescribing, so that the doctors can examine if there might be interference in the interactions. This need is particularly important if among the drugs are those that have been identified as being likely to be affected by herbal remedies.

But what stops people from mentioning they are trying herbal remedies? One main reason is embarrassment. Alternative remedies still have a reputation for being outside the periphery of the mainstream and carry with them the stigma of being unconventional, flaky and based on superstitious beliefs. Some might question their unscientific basis as a whole load of quackery, akin to snake oil or elephant powder. Subscribing to herbal remedies in some circles in seen as being illogical. And no one wants to be perceived as a nutter.

There is also the perception of owning up to being a failure for whom traditional medicine has not worked for.

The crossover group is the one most at risk as they are most likely to continue taking the doctor’s medication while trying herbal remedies at their prescribed doseages. In other words, they are most likely to take double of what is recommended in a bid to get the best of both worlds.

Herbal remedies may prove their worth in time. But in the meantime, while we move towards a scientific study, regulation and understanding of non-pharmaceutical medicines, it is best to be cautious of interference and their crossover effect.

The higher cost of body embarrassment

If you were a bloke, would you avoid going to the doctor’s if it meant you had to strip off for the doctor to examine an area of your body you had concern about? Chances are men who have found a lump in their testicles might put off going to the doctor’s for a couple of days, drinking lots of water in the hope that it would go down, and if the lump remained, then work up the courage to make an appointment to see a doctor about it. Why put it off for a few days? It is probably down to the fact that it is slightly awkward and embarrassing to strip off to your private areas in front of someone else, despite the fact that doctors are professional and the health concerns are pressing. Despite the risk that the lumps may need to be operated on, some leave it late – and even a bit too late – because of the embarrassment.

But the embarrassment is not just down to men. Women put off going for tests and checkups because of the awkwardness around their perceived bodies. The BBC News website reported that women were avoiding smear tests to detect cervical cancer, with some either delaying making an appointment, or skipping screening altogether.

Cervical cancer accounts for an average of more than two deaths a day. Over 900 women die annually from it. Each day an average of nine women a day are diagnosed with it. All women aged 25 to 49 are invited for a screening test every three years. From the ages of fifty to sixty-four, this is reduced to once every five years.

Among those aged 25 to 29, more than one in three skip the cervical screening, a statistic that is worrying as the women more likely to get such cancer is the age group most likely to avoid the screening tests meant to catch it.

For what reasons do women avoid such tests?

One survey of around 2000 women found that their embarrssment about body shape was the most largely quoted reason for not attending. In other words, women were not comfortable with their own bodies in front of others. Other women also thought that they were healthy, being regulars of exercise or the gym, and thought that they were of a lower risk than others. A third did not believe that cervical screening reduces the risk of cancer at all. The results of the survey suggest that more importance needs to be placed on educating women of the benefits of screening.

The test only takes five minutes but perhaps one of the biggest barriers facing women was the awkardness if a male doctor or nurse was the one conducting the cervical screening. But women do have the option of asking in advance for a female to carry out the test, and many already do.

Jo’s Cervical Cancer Turst, the only charity in the UK dedicated to women suffers of this form of cancer, is working to improve detection rates and hence reduce the emotional impact of cancer on women and their families. The current screening is the greatest form of protection against such cancer, and helps save the NHS money by preventing the need for later surgery. The treatment of early stage cancer iis estimated by the charity to cost less than a tenth of later stage cancer.

It is not clear from the survery whether the women were representative of different regions, beliefs, or socio-economic groups. Women from certain cultures may find it more socially unacceptable to be naked in front of other individuals, let alone male doctors, and hence not attend screening for such reasons and are likely not to.

Appearance of the body shape and the vulva accounted for 84% or cervical smear absentees. Of these, 38% were also concerned that they might not smell normal, while 31% would not have gone had they not shaved or waxed their bikini area.

A senior nurse mentioned that nurses are aware of the awkwardness of showing an intimate part of the body to someone else but are sensitive to make the procedure less embarrassing so that women continue to have acceptable experiences that do not put them off screening for cancer. A chaperone is always offered and if women prefer to take a friend or partner with them that is fine too. It would be a great shame if women were put off seeking medical advice because of their embarrassment – it would be too great a price to pay for a small period of minimal inconvenience. The same goes for men and visits to their doctors too.

Why health articles in newspapers should be retired

What is it that people look forward to? Most want time to pursue their interests and doing things they love. Some people have managed to combine all this by the traditional interest-led approach, doing things they love, starting up a blog, gaining readership, and then selling advertising space on their blog, or affiliate marketing and other things associated with making money from a website. For others, this lure for things they like is compromised by the need of having to make a living, and hence this is shelved while having to earn a living and put off until retirement.

For most people, retirement would be when they would be able to have the time and money to indulge in things they put off earlier. Some people have combined the starting of a blog and retirement, and made a living by blogging (and gaining a readership) about how they have or intend to retire early.

Retirement. Out of the rat race. All the time in the world. For most people, retirement is the time to look forward to.

A recent study however suggests that retirement is not all that wonderful. Despite it being seen as the time of the life where financial freedom has been achieved and time is flexible, it has been suggested that the onset of mental decline starts with retirement.

The Daily Telegraph reported that retirement caused brain function to rapidly decline, and this information had been provided by scientists. It further cautions that those workers who anticipate leisurely post-work years may need to consider their options again because of this decline. Would you choose to stop work, if this meant your mental faculties would suffer and you would have all the free time in the world but not the mental acuity?

Retired civil servants were found to have a decline in their verbal memory function, the ability to recall spoken information such as words and names. It was found that verbal memory function deteriorated 38% faster after an individual had retired than before. Nevertheless, other areas of cognitive function such as the ability to think and formulate patterns were unaffected.

Even though the decline of verbal memory function had some meaningful relevance, it must be made clear that the study does not suggest anything about dementia or the likelihood of that happening. There were no links drawn with dementia. Just because someone retires does not mean they are more likely to develop dementia.

The study involved over 3000 adults, and they were asked to recall from a list of twenty words after two minutes, and the percentages were drawn from there. The small sample size, not of the adults, but of the word list, meant the percentage decline of post-retirement adults may have been exaggerated.

Look at this mathematically. From a list of twenty words, a non-retiree may recall ten. A retiree may recall six. That difference of four words is a percentage decline of 40%.

Ask yourself – if you were given a list of twenty words, how many would you remember?

It is not unsurprising if retirees exhibit lower abilities at verbal memory recall because the need for these is not really exercised post-retirement. What you don’t use, you lose. We should not be worried about the decline, because it is not a permanent mental state, but it is reversible; in any case the figure is bloated by the nature of the test. If a non-retiree remembers ten words, and a retiree makes one-mistake and remembers it, that would be promoted as a 10% reduction in mental ability already.

Furthermore, decline is not necessarily due to the lack of work. There are many contributing factors as well, such as diet, alcohol and lifestyle. Retirement is not necessarily the impetus behind mental decline. Other factors may confound the analyses.

The research did not involve people who had retired early. For example, hedge fund managers might have retired in their forties. But you would struggle to think that someone in their forties would lose 38% of verbal memory recall.

Would a loss of 38% of verbal memory have an impact on quality of life? It is hard to tell if there is the evidence to support this. But the results point to a simple fact. If you want to get better at verbal memory, then practice your verbal memory skills. If you want to get better at anything, then practice doing it.

Was this piece of news yet another attempt by mainstream media to clog paper space with information – arguably useless? You decide.

One cigarette a day can cost a lot

According to the newspaper headlines of late, teenagers should be kept away from cigarette exposure because of this worrying statistic.

A survey of over 216,000 adults found that over 60% of them had been offered and tried a cigarette at some point, and of these, nearly 70% went on to become regular smokers. The conclusion drawn was that there are strong links between trying a cigarette ones to be sociable and going on to develop it as a habit.

This of course ended up in the newspapers with headlines such as “One cigarette is enough to get you hooked”. The Mail Online, Britain’s go-to newspaper for your important health news (and I’m being ironic here) went a step further, saying one puff from a cigarette was enough to get you hooked for life. Never mind if you had one draw of a cigarette, felt the nicotine reach your lungs, then coughed in revulsion at the bitter aftertaste and swore that you would never again try a cigarette again. The Mail Online bets you would return to the lure of the dark side, seduced by its nicotine offers.

I digress.

While we all know that any event, repeated many times becomes a habit, the statistics in this case are a little dubious.

The study was conducted by Queen Mary University (nothing dubious in itself) but among the various concerns were what you might call the high conversion rate. Nearly 70% of those who tried a cigarette once went on to smoke regularly as a habit.

I’m not sure why the 70% is worrying. In fact, I wonder why it is not 100%! Surely, if you asked a habitual smoker, “Have you smoked a cigarette before?”, the answer would be a resounding “Yes”!

Unless you have caught someone in the act of sneakily smoking his virgin cigarette. But he wouldn’t yet be a habitual smoker.

Let’s establish the facts of the matter again.

216,000 adults were surveyed.

130,000 of them (60% of the adults) had tried a cigarette before.

86,000 (40%) have never smoked before.

Of the 130,000 who had tried a cigarette before, 81,000 (70%) went on to become regular smokers.

49,000 (30%) of those who tried a cigarette before either did not go on to smoke at all or did not smoke regularly.

Another way of looking at the data would be as follows:

216,000 adults surveyed.

135,000 adults do not smoke regularly or at all. Some did try once in the past.

81,000 adults smoke regularly and these people have obviously tried a cigarette before.

Suddenly the data doesn’t look sexy anymore.

The data was an umbrella studywhich means data was pooled rather than created from scratch through surveys. As previously examined, the final outcome is also dependent on the integrity of the original source.

Bias can also creep in because the data has not been directly obtained and inferences have been drawn.

For example, the influence of e-cigarettes and vaping on the results have not been scrutinised, because some of the data may have existed before then.

Before we leave it at this, here is another example of data bias:
216,000 adults were surveyed.

130,000 of them (60% of the adults) had tried a cigarette before.

86,000 (40%) have never smoked before.

We can conclude that 100% of the 86,000 who have never smoked a cigarette in the past have never smoked a cigarette.

You can see the absurdity more when it’s spelt out more in words than in numbers.

If research is costly and expensive, in terms of money and time, then why is it wasted on these?

One reason is that it keeps academics and researchers in their jobs, if they produce findings that are financially low-cost but can stave off the question of what they actually do, and their purpose.

This kind of research is the academic version of the newspaper filler article, one that columnists generate based on the littlest of information, in order to fill the papers with “news”, that actually mask the fact that they are there to sell advertising space. And in this, columnists and researchers are at times colluding for the same purpose. Vultures who tear at the carcass of a small rodent and then serve up the bits as a trussed up main meal.

Unethical? Who cares, it seems. Just mask the flawed process and don’t make it too obvious.

Your daily sausage roll may exact its revenge on you in good time

Ever wonder why people go on a vegetarian or a vegan diet? There are many reasons I can think of.

The most common one is that people are very much against animal cruelty. People who avoid eating animal-based products are against the farming of animals, because they are convinced that animals are treated inhumanely. For example, battery hens are kept in small cages in large densities. Imagine if you and your fellow co-workers were put together in a small room, without any desks, and told to make the most of it. You’d all be up in arms about the way you were treated. The only difference between you and hens is that hens can’t protest about it.

The transition to a vegan diet is not just about not eating animals, although this can be a factor too. Vegans are against the eating of animal meat because of the way farm animals are killed. Cows, pigs and chickens, the main farm animals that are killed to provide the common English foods such as the English breakfast comprising sausages, bacon and eggs, are – in the opinion of vegans – inhumanely killed, despite the best of measures.

Do you know how a chicken is killed before it ends up deep fried in bread crumbs and served with your chips and bottle of cola? There are two main ways. The first is by electric methods. First of all, the birds are shackled to a conveyor belt by their legs, upside down. Needless to say, they don’t willingly walk to the machine and pick their positions. There is a lot of fluttering about, human exasperation, and rough handling of the birds which may result in broken bones – who cares, right? After all, the bird is going to be dead soon – before the conveyor belt brings the birds upside down into a water bath primed with an electric circuit. The moment the bird’s head touches the water, it is electrocuted to death.

The second method involves gassing to death. Birds are transported in their crates and exposed to suffocation. This method is arguably more humane, supporters say, because the birds are not manhandled. But don’t be fooled into thinking the bird’s welfare is under consideration. It is a faster, less human-intensive way of killing the birds. Sling them in the box and gas them to death. No messing around trying to catch the flapping things. Avoiding the need to shackle them also saves time.

There is a third reason often quoted for going further in being a vegan. Cows produce vast amounts of methane and if everyone stopped eating beef, it would be better for the enviroment. In this instance, it is not so much for the animal’s welfare, but more for the sake of avoiding the environmental pollution by the animal.

There may soon be another fourth reason for avoiding meat. Processed meats – which have been preserved using methods such as salting, curing, smoking or adding preservatives – have been linked with cancer.

A study involving 262,195 UK women showed links of breast cancer and processed meat. Postmenopausal women who ate processed meat had a 9% higher chance of getting breast cancer than women who ate no processed meat. Those who consumed more than 9g of processed meat had a 21% chance of getting cancer in comparison to those who avoided it altogether.

The study is significant because the sample size is large – not just 100 women, or a small negligible figure whose results may bias findings, but over 250,000 women; more than enough to be taken seriously.

The women were all between the ages of 40-69 and free of cancer when they were recruited for the study before 2010. They were followed for a period of seven years and the results examined.

Process meats are thought to possibly cause cancer because the methods involved in processing the meat may lead to the formation of cancer-causing compounds called carcinogens.

What is not so clear is whether it was the eating of processed meats in isolation that caused the development of cancer. There are other factors that should be taken into account, of course, such as alcohol, exercise, work stress, lifestyle factors and body mass index. Certain ethnicities may also be prone to developing cancer because of other dietary factors such as cooking with oil, ghee or lard.

The results also did not suggest that the findings would be equally applicable to men.

Nevertheless, it would be a good idea, if you were an older woman, to avoid eating processed meat every day. Instead the consumption could be limited to once every other day, or eating it as an occasional treat. Or cut out the meat completely – a switch to a vegetarian or a vegan diet would not only be good for your health. You would be considering the environment too.

The bigger issues that come with preventing hearing loss

Is there cause for optimism when it comes to preventing hearing loss? Certainly the latest research into this suggests that if positive effects experienced by mice could be transferred to humans and maintained for the long term, then hereditary hearing loss could be a thing of the past.

It has always been assumed that hearing loss is always down to old age. The commonly held view is that as people grow older, their muscles and body functions deteriorate with time to the point that muscle function is impaired and eventually lost. But hearing loss is not necessarily down to age, although there are cases where constant exposure to loud noise, over time, causes reduced sensitivity to aural stimuli. Over half of hearing loss cases are actually due to inheriting faulty genetic mutations from parents.

How do we hear? The hair cells of the inner ear called the cochlea respond to vibrations and these signals are sent to the brain to interpret. The brain processes these signals in terms of frequency, duration and timbre in order to translate them into signals we know.

For example, if we hear a high frequency sound of short duration that is shrill, our brain interprets these characteristics and then runs through a database of audio sounds, an audio library in the brain, and may come up with the suggestion that it has come from a whistle and may signify a call for attention.

What happens when you have a genetic hearing loss gene? The hairs on the inner ear do not grow back and consequently sound vibration from external stimuli do not get passed on to the brain.

With progressive hearing loss too, the characteristics of sound also get distorted. We may hear sounds differently to how they are produced, thereby misinterpreting their meaning. Sounds of higher and lower frequency may be less audible too.

How does that cause a problem? Imagine an alarm. It is set on a high frequency so that it attracts attention. If your ability to hear high frequencies is gradually dulled then you may not be able to detect the sound of an alarm going off.

As hearing gradually deteriorates, the timbre of a sound changes. Sharper sounds become duller, and in the case of the alarm, you may hear it, but it may sound more muted and the brain may not be able to recognise that it is an alarm being heard.

Another problem with hearing loss is the loss of perception of volume. You may be crossing the road and a car might sound its horn if you suddenly encroach into its path. But if you cannot hear that the volume is loud, you may perceive it to be from a car far away and may not realise you are in danger.

The loss of the hairs in the inner ear is a cause of deafness in humans, particularly those for whom hearing loss is genetic. Humans suffering from hereditary hearing loss lose the hairs of the inner ear, which result in the difficulties mentioned above. But there is hope. In a research experiment, scientists successfully delayed the loss of the hairs in the inner ear for mice using a technique that edited away the genetic mutation that causes the loss of the hairs in the cochlea.

Mice were bred with the faulty gene that caused hearing loss. But using a technology known as Crispr, the faulty gene was replaced with a healthy normal one. After about eight weeks, the hairs in the inner ears of mice with genetic predisposition to hearing loss flourished, compared to similar mice which had not been treated. The genetic editing technique had removed the faulty gene which caused hearing loss. The treated mice were assessed for responsiveness to stimuli and showed positive gains.

We could be optimistic about the results but it is important to stress the need to be cautious.

Firstly, the research was conducted on mice and not humans. It is important to state that certain experiments that have been successful in animals have not necessarily had similar success when tried on humans.

Secondly, while the benefits in mice were seen in eight weeks, it may take longer in humans, if at all successful.

Thirdly, we should remember that the experiment worked for the mice which had the genetic mutation that would eventually cause deafness. In other words, they had their hearing at birth but were susceptible to losing it. The technique prevented degeneration in hearing in mice but would not help mice that were deaf at birth from gaining hearing they never had.

Every research carries ethical issues and this one was no different. Firstly, one ethical issue is the recurring one of whether animals should ever be used for research. Should mice be bred for the purposes of research? Are all the mice used? Are they accounted for? Is there someone from Health and Safety going around with a clipboard accounting for the mice? And what happens to the mice when the research has ceased? Are they put down, or released into the ecosystem? “Don’t be silly,” I hear you say, “it’s only mice.” That’s the problem. The devaluation of life, despite the fact that it belongs to another, is what eventually leads to a disregard for other life and human life in general. Would research scientists, in the quest for answers, eventually take to conducting research on beggars, those who sleep rough, or criminals? Would they experiment on orphans or unwanted babies?

The second, when it comes to genetics, is whether genetic experimentation furthers good or promotes misuse. The answer, I suppose, is that the knowledge empowers, but one cannot govern its control. The knowledge that genetic mutation can be edited is good news, perhaps, because it means we can genetically alter, perhaps, disabilities or life-threatening diseases from the onset by removing them. But this, on the other hand, may promote the rise of designer babies, where mothers genetically select features such as blue eyes for their unborn child to enhance their features from birth, and this would promote misuse in the medical community.

Would the use of what is probably best termed genetic surgery be more prominent in the future? One can only suppose so. Once procedures have become more widespread it is certain to conclude that more of such surgeons will become available, to cater for the rich and famous. It may be possible to delay the aging process by genetic surgery, perhaps by removing the gene that causes skin to age, instead of using botox and other external surgical procedures.

Would such genetic surgery ever be available on the NHS? For example, if the cancer gene were identified and could be genetically snipped off, would patients request this instead of medical tablets and other external surgical processes? One way of looking at it is that the NHS is so cash-strapped that under QALY rules, where the cost of a procedure is weighed against the number of quality life years it adds, the cost of genetic surgery would only be limited to more serious illnesses, and certainly not for those down the rung. But perhaps for younger individuals suffering from serious illnesses, such as depression, the cost of a surgical procedure may far outweigh a lifetime’s cost of medication of anti-depressant, anti-psychotics or antibiotics. If you could pinpoint a gene that causes a specific pain response, you might alter it to the point you may not need aspirin, too much of which causes bleeds. And if you could genetically locate what causes dementia in another person, would you not be considered unethical if you let the gene remain, thereby denying others the chance to live a quality life in their latter years?

Genetic editing may be a new technique for the moment but if there is sufficient investment into infrastructure and the corpus of genetic surgery information widens, don’t be surprised if we start seeing more of that in the next century. The cost of genetic editing may outweigh the cost of lifelong medication and side effects, and may prove to be not just more sustainable for the environment but more agreeable to the limited NHS budget.

Most of us won’t be around by then, of course. That is unless we’ve managed to remove the sickness and death genes.

Migraines could be a headache of the past

Is there hope for the many millions of migraine sufferers in the United Kingdom and around the world? Researchers at King’s College Hospital certainly believe that this is the case. While they are cautious about the findings of their latest research, the results certainly are one that point towards optimism for migraine sufferers.

It is estimated that the number of migraine attacks everyday in the UK number over 190,000. This figure was estimated by the Migraine Trust, and it was probably obtained by taking a sample size of the population, taking into account the number of migraine attacks experienced within that group and then multiplying it by the general population in the United Kingdom. This of course means two things: firstly, the figure was proposed by a group that has an interest in promoting awareness about migraines and is hence slightly biased, probably over-estimated. Secondly, bearing in mind that the UK population is over 66 million, and it is unlikely that the Trust surveyed 1 million people – or even anywhere near that – any differences could have been amplified by over 66 times.

What is the difference between a migraine and a normal headache? A migraine is a headache which happens frequently. Migraines themselves are classed as two types. Headaches which happen more than 15 days a month are known as chronic migraine, while episodic migraine is a term used to describe headaches which happen less than fifteen times a month.

The research uncovered that a chemical in the brain was involved both in the feeling of pain and sensitivity to sound and light. This chemical is known as calcitonin gene-related peptide, or CGRP. If CGRP is neutralised, or if part of a brain cell which it interacts with is blocked, then pain receptors are dulled and migraines are reduced.

There are currently four drug companies in the race to develop a CGRP neutraliser.

Race is an accurate term, for the company that develops and trials the drug successfully may win the patent for developing and marketing the drug over twenty years. Drug companies or pharmaceuticals are normally granted that period to reward them for the time and cost invested into research.

One such company, Novartis, trialled an antibody, erenumab on episodic migraine sufferers. Those who took part in the trial suffered migraines on an average of eight days a month.

955 patients took part in the trial and half of those who received injections of erenumab successfully halved their number of migraine days per month. 27% of patients also reduced their number of migraine days without treatment. The results suggest that the drug was successful, particularly as it worked for over 450 people, and that if it were used for those with chronic migraine it might be equally successful. Even if the same percentage were maintained (50% vs 27%), the number of working days saved by migraine prevention could have significant savings for the economy.
Another pharmaceuticals company, Teva, produced another antibody, fremanezumab, and trialed it on 1130 patients. Unlike Novartis’s trials, the participants in Teva’s were those with chronic migraine, with over 15 or more attacks each month. In the Teva trial, 41% of patients reportedly halved the number of days that they suffered migraine attacks. 18% reported the same effect, so the confidence interval in the trial is pretty high and suggests a high degree of positive use.

The study is very important and useful because of the understanding it offers in treating migraine, and the medical products can reduce the frequency and severity of headaches. It makes for fewer days lost to the disease and more positive, functioning people.

Besides CGRP antibodies, there are other current treatments for migraine such as epilepsy and heart disease pills. Even botox is sometimes used. However, all three come with side-effects and are not necessarily the best for everyone.

The hope is that CGRP antibodies, which are traditionally more expensive to manufacture, will in the long term be available at a more affordable cost, and would benefit those who currently get no benefit from existing therapies.

If the estimation that one in seven people live with regular migraine is accurate, migraine reduction could have significant life-improvement effects for humans. Chronic migraine is in the top seven disabling conditions and improvements in understanding it and how to manage it would not only improve the quality of life for those who suffer with it, but also in reducing the number of work days lost for the economy. But the benefits do not just remain with migraine sufferers. Having to live with chronic disabling conditions often leads to other symptoms such as depression. Who knows? Perhaps CGRP antibodies may even negate the effect of depression, resulting in a secondary effect. It may be possible that those who suffer from migraine alongside depression may even not require treatment for the latter if the CGRP antibodies prove to be effective.
Can you imagine a world without anti-depressants? At the moment millions live on some pain-relief medication of some sort. It would be great if they could be phased out. Although it might not be so great for the economy!

Should we be excited about the results? Well, yes. The combined large sample size of both studies, of over 2000 migraine sufferers showed that there was some weight behind the study compared to if – for example – it had been done only on one hundred participants. Secondly, while the research was undertaken by pharmaceutical companies, the outcome was actionable, meaning that it produced a result that was useful, rather than one that merely formed the prelude to a more extensive study. In previous posts I demonstrated how some – such as the coffee umbrella review – did not produce any significantly useful outcome. But we know from this particular research that it may work to neutralise either CGRP, or lessen its interaction with the particular brain cells in order to lower the effect of migraine.

Did the media have a field day with this? Unsurprisingly, no. You see, good research does not lend itself to sensationalist headlines.