Organ Donation (Wales)

A BBC report last week (http://www.bbc.co.uk/news/uk-wales-politics-20583179) detailed the plans by the Welsh Assembly to bring in an opt-out scheme for organ donation instead of the current opt-in scheme. This means that if you die and you have not stated whether you would or would not like your organs to be donated then you will be taken to be a willing organ donor.

"If passed by the Welsh Assembly it could come into force by 2015" (as above). This move would mean that in the situation where your wishes have not been stated your family would not be able to decide against you having your organs donated as it was never changed in your lifetime.

"The main reason families stopped organs being taken was because they did not know what their relatives' wishes were." Therefore it has been encouraged that these conversations are had at home to discuss the idea of 'presumed consent' and come to a decision on whether to opt-out of the organ donation process.

However, although the general thought is that it will increase the numbers of organ donors in Wales; "there are lower rates of organ donation in some countries that have already implemented presumed consent so it's important that this scheme is not seen as the only way to increase donation rates." This enforces the argument that this issue needs to be openly talked about and publicity increased in Wales but also across the whole of the United Kingdom.

A BMJ article (http://www.bmj.com/content/340/bmj.c2188) published in 2010 says that "in practice, even when people have expressed their willingness to donate by either carrying a donor card or, since 1994, signing up to the computerised NHS Organ Donor Register, their relatives are always asked for consent and relatives’ refusal overrides the deceased would-be donor’s decision." This is clearly wrong as it goes against the wishes of the deceased person and it is the hope that this new law, as well as brining in a presumed consent scheme, will act to stop the overriding that occurs by the relatives of the deceased.

The BMJ article also says that "in 2008, Prime Minister Gordon Brown asked an Organ Donor Taskforce to consider the potential effect of an opt-out system for organ donation in the UK." The Taskforce then did research and collected data on "the effect of presumed consent on organ donation rates" but contrary to the data that they collected they "recommended no change to current policy but renewed effort to increase the number of donors opting in."

In their report (http://tinyurl.com/32y8ktp) they set out 14 recommendations that "taken together, would create a structured and systematic approach to organ donation in the UK" but they also state that "the wishes of the potential donor or their family are ascertained and respected." But as I mentioned earlier this is where the issues are coming in, the overriding by the family of the potential donor.

What really needs to be focussed on are checkpoints 4.47-4.50 of the report under the heading ('public recognition and promotion of donation'). These underline the issues of publicity of organ donation, the lack of donation amongst certain communities, the risks that some communities face and the necessity of people from that same community donating organs.

However the most shocking statistic (as of 2008 when this report was created) is that "it is still the case that nationally, the relatives of 40% of potential donors refuse consent for donation." Therefore this Bill tabled by the Welsh Assembly is trying to dramatically decrease this percentage and make sure that people think about the huge benefits to other people's lives (sometimes saving lives) by giving their organs after death.




 

Polypill

Student BMJ- The polypill: a magic bullet against cardiovascular disease?(http://student.bmj.com/student/view-article.html?id=sbmj.e6386)

The polypill is "a pill containing a number of medicines that all treat the same condition" (Oxford Dictionary) from 'poly', meaning many.

 

"Cardiovascular disease remains the leading cause of mortality in developed countries, and has been described as a “global epidemic.” In 2003, Wald and Law proposed a new polypill: six drugs combined into one tablet that would work to reduce cardiovascular risk. They proposed the polypill as a way of targeting modifiable cardiovascular risk factors, both for adults with pre-existing cardiovascular disease (secondary prevention) and, more controversially, for adults over 55 years old without cardiovascular disease (primary prevention)."

"Wald and Law argued that over 80% of myocardial infarctions and strokes could be prevented if this strategy was adopted. The polypill would contain six ingredients: three blood pressure lowering drugs (a thiazide diuretic, a β blocker, and an angiotension converting enzyme (ACE) inhibitor), a statin, aspirin, and folic acid. Their idea ignited great debate in the medical community regarding its potential to reduce the global burden of cardiovascular disease" (BMJ reference above).

How well does the pill work?
"By using the right combination of active medicines, the Polypill can reduce the risk of a heart attack or stroke by two thirds. The key objectives of the medicines are to reduce blood pressure and cholesterol."

"In July 2012, the results of a Polypill trial conducted at the Wolfson Institute of Preventive Medicine, were published. The trial was conducted among individuals aged 50 and over without a history of cardiovascular disease and without selection on the basis of blood pressure or cholesterol. The reductions in blood pressure and cholesterol were recorded and compared with those predicted from published estimates of the effects of the individual components.
84 participants took a single Polypill (containing amlodipine, losartan, hydrochlorothiazide and simvastatin) each evening for 12 weeks and a placebo each evening for 12 weeks in random sequence (a randomised cross-over trial).

In this trial, participants and doctors did not know whether the Polypill or the placebo was taken during each period (double-blind). The reduction in blood pressure and cholesterol at the end of the Polypill period was compared with the levels at the end of the placebo period. The allocation of the placebo or the Polypill is coded, and is only revealed at the end of the study. This study design provides more precise and accurate estimates of the blood pressure and cholesterol lowering effects of the Polypill than other kinds of study. Systolic blood pressure was reduced by an average of 17.9 mmHg (12%) on the Polypill, diastolic blood pressure by 9.8 mmHg (11%), and LDL cholesterol by 1.4 mmol/L (39%). The results were almost identical to those predicted; 18.4 mmHg, 9.7 mmHg, and 1.4 mmol/L respectively" (https://www.polypill.com/evidence-for-polypill.html).

The two graphs below (https://www.polypill.com/evidence-for-polypill.html) show the effect that the polypill has on diastolic blood pressure and cholesterol respectively both lowering to almost the levl of a 20 year old.

 

Whilst showing a reduction in diastolic blood pressure and LDL (low density lipoproteins) cholesterol in the graphs, this considerably lowers the risk of coronary heart disease and also the risks of stroke (http://tinyurl.com/9ykwvnp and http://tinyurl.com/9uvkr6z).

 

"If people took the polypill from age 50, an estimated 28% would benefit by avoiding or delaying a heart attack or stroke during their lifetime" (http://www.bbc.co.uk/news/health-18883163).
 

However "The British Heart Foundation called for more research and said pills were not a substitute for a living a healthy life." (http://www.bbc.co.uk/news/health-18883163). This study was also a very small study of just "84" (BBC) over 50 year olds, a much larger study would have to be carried out to provide solid data and evidence to become valid and broadly used.



 

Sports Drinks

I found an article about sports drinks in THE WEEK 4th August 2012.

The article ran like this:

"The sports drink market is worth £1bn a year in Britain. But according to an article in the British Medical Journal, in most cases, people would do just as well, if not better, to drink water. The review of 104 popular brands found that although manufacturers make many grand claims for the effectiveness of their often calorie-laden drinks - whether in boosting performance or aiding recovery - there is a "striking lack of evidence" to back up most of them.

For instance, Lucozade Sport, the UK's bestselling sports drink, is said to have "an isotonic performance fuel to make you faster, stronger, for longer". But when Dr Carl Heneghan, director of the University of Oxford's Centre for Evidence-Based Medicine asked manufacturer GlaxoSmithKlise (GSK) if they could assess the research on which these claims rest, he was given what scientists call a "data dump" - 40 years' worth of research which included 176 studies. His team managed to examine 101, before concluding that "the quality of the evidence is poor, the size of the effect is often minuscule and it certainly doesn't apply to the population at large who are buying these products". They were similarly sceptical about claims that branched-chain amino acids - found in some of GSK's protein drinks - can enhance performance and recovery. One nutrition expert, Professor Mike Lean of the University of Glasgow, described the evidence for amino acids improving muscle strength as "absolute fringe", and in any case "totally irrelevant" in the context.However, GSK stands by it's claims, which it insists are backed up by science."

This article seems to play down the use of sports drinks branding them as a waste of money because there is no proof of their ability to increase performance or aid recovery. I then dug around in PubMed and on the BMJ to try to find some of the research papers where the data had come from and found this: http://tinyurl.com/cyzt7lp, a paper talking about the birth of sports drinks their use because of dehydration rather than thirst.

"The researchers also contend that much of the science behind sports drinks is biased or inconclusive and that empty calories from sports drinks are major contributors to childhood obesity and tooth decay" (http://tinyurl.com/coye356). So here we can see that there societal issues to do with the consumption of these drinks, although how many would one have to drink to lead to childhood obesity?

A BMJ article states that "Healthcare professionals should be encouraged to talk with patients about the calorific content of SSBs [sugar sweetened beverages] when discussing lifestyle modification to manage overweight and/or obesity . . . Consumption of water in preference to other beverages should be highlighted as a simple step towards healthier hydration: recommending 1.5 to 2 litres of water daily is the simplest and healthiest hydration advice you can give.” (http://www.bmj.com/content/343/bmj.d4280) So this article also agrees with the obesity issue arising from the consumption of sports drinks.

However I think that the killer argument came from the BMJ when Powerade were quoted on their website saying “water doesn’t have the performance benefits of a sports drink,”—but it does not go on to quantify what those benefits are" (http://tinyurl.com/cyzt7lp).

If you read the BMJ article (http://tinyurl.com/cyzt7lp then you can make up your own mind based on the evidence/lack of evidence of whether they actually are beneficial..?!
 

James Maskalyk

So there is this guy James Maskalyk. Doctor, writer, humanitarian worker.

Short overview.
"Practices emergency medicine in Toronto, founding editor of the open access journal Open Medicine (http://www.openmedicine.ca/). He has worked for Medecins Sans Frontieres (MSF) (http://www.msf.org.uk/) since 2005 as a writer and doctor. Wrote a memoir, Six Months in Sudan. Also written a blog about his experiences" (http://www.sixmonthsinsudan.com/page/blog/). (Student BMJ 2011;19:d6429). All of those links are worth checking out if you have a few minutes.

I read an interview on him in the BMJ and he seems like such an inspiration to young doctors after his travels to South America and I loved this comment, "I saw how sick people seemed compared with patients in Calgary, Canada where I was training. I knew that medicine could be a tool to working towards understanding and embracing an unfamiliar world." (Student BMJ 2011;19:d6429).