The Daily Telegraph - 19.08.2019

�he �urgery

Are drugs

causing

a rise in

fatal falls?

he main advantage of

our upright stance,

compared with that of

our knuckle-dragging

primate cousins, is in

freeing the hands, thus

permitting all those marvels of skilful

manipulation that made possible the

rise of human civilisation. Still, it is no

simple accomplishment, as the bony

skeleton, like an unsupported pole

balancing a heavy ball (the head), must

constantly defy the laws of gravity.

This required numerous anatomical

modifications for preventing our early

ancestors from toppling over:

powerful ligaments to lock the knee in

place, adaptations of the foot to

facilitate forward propulsion, as well

as the sophisticated balance

mechanisms of the brain and middle

ear and rewiring the nervous system

to interpret the flood of feedback

information from the millions of

sensors monitoring the relative

positions of the bones and muscles.

Like all physiological systems, these

adaptations become less efficient with

age, accounting for the predisposition

to falls in older people – and

increasingly so, with a doubling over

the past 10 years in the number of fall-

induced fatalities due to head injuries

or the complications of fractures. The

most likely culprits are the adverse

effects of drugs that predispose to

toppling over in fairly obvious ways:

fainting and dizziness (blood pressure-

lowering pills), muscle weakness

and impaired mobility (cholesterol-

lowering statins) and so on.

Two further less likely candidates

must now be added to the list. Earlier

this year, doctors at the Mayo Clinic

reported that proton pump inhibitors

(PPIs), the commonly prescribed acid

suppressants, such as omeprazole,

increased the risk of falls by a third.

The probable mechanism, they

suggested, was that these drugs

impaired the absorption of vitamin

B12 and magnesium, both of which are

essential for the proper functioning of

nerves and muscles.

Then, last month, Danish

researchers reported that over a

two-year period a fifth of those taking

medicines to control disturbances

of heart rhythm sustained a fainting

or fall-related injury – probably due

to excess lowering of the heart rate.

And the conclusion? “Continuous

reassessment of medicines in the

older population is essential to avoid

unnecessary harms”. Quite so.

Mystery condition

The woman troubled by an “ivory

white and always very cold” left

hand, as recently mentioned in this

column, has by common consent an

unusual variant of the circulatory

disorder Raynaud syndrome. This

mysterious condition of intermittent

narrowing of the blood vessels to the

extremities, brought on by cold or

stress, usually involves both hands

but may occasionally be unilateral,

and is caused by the presence of a

supplementary rib at the base of the

neck pressing on the nerves and

arteries.

There was at one tim, a vogue for

treating Raynaud’s by cutting the

nerves that control the calibre of the

blood vessels (a sympathectomy), but

the current approach emphasises the

importance of avoiding exacerbating

factors (exposure to cold, smoking,

etc), combined with the vasodilator

drug nifedipine.

Coming to a head

The optimum strategy for eliminating

head lice is inevitably of considerable

interest to parents of school-age

children, the more so since the hardy

creatures acquired a genetic mutation

that makes them impervious to the

effects of the chemical insecticides

permethrin and malathion.

Hence the renewed interest, as

reported in this paper last week, in

home remedies, notably mayonnaise

(coat the hair well, cover with a

shampoo cap, wash out after eight

hours) and garlic oil.

There are now, in addition, a

couple of ingenious compounds,

endorsed by the British Association

of Dermatologists, that interfere with

the louse’s water balance to cause

their death either by dehydration

(Hedrin Treat and Go) or the reverse,

preventing them from excreting

water through their spiracles, causing

rupture of the gut (Hedrin 4pc Lotion).

GETTY IMAGES

W

ill a no-deal Brexit

cause chaos for

Britain, or are the

dangers being overblown? Is

climate change real? We like

to think we’re reasonable and

open-minded, even when it

comes to our most passionate

beliefs. But research shows

that this is rarely true. Once

we’ve formed a belief, we

believe that it is valid and

well-founded; but, in reality,

if any information challenges

our views, we subconsciously

ignore or devalue it.

This was demonstrated

in a landmark 1979 study at

Stanford by Charles Lord and

colleagues. They presented

undergraduates with two

(fictional) studies, both

with convincing statistics.

One study claimed to prove

capital punishment works as

a deterrent, while the other

concluded it had no effect on

crime rates.

Before and after seeing the

studies, participants were

asked to give their views.

Those who believed capital

punishment is an effective

deterrent rated the study

supporting their views as

credible, while rating the one

that challenged their opinion

as unconvincing. Those who

were opposed to capital

punishment reached the

opposite conclusions.

This phenomenon

has become known as

“confirmation bias”.

Further studies went on to

demonstrate that our beliefs

are rarely based on a deep

understanding of a particular

issue. When it comes to

belief, it seems we remember

facts that support our world

view, but ignore or reject

information that runs counter

to our opinions – and the

more passionately we feel

about an issue, the more this

is so.

Not only do strong beliefs

inhibit learning, they also

cause us to make mistakes.

Dan Kahan and colleagues

at Yale gathered views on

gun control from over 1,

participants, then asked

them to solve a mathematical

problem. Some had to figure

out whether a new skin

cream was effective for

treating rashes, while others

were given the same statistics

to decide whether a law

banning concealed handguns

reduced crime rates.

In the skin cream example,

participants who were better

at maths solved the problem

more quickly and were right

more often. However, when

the subject was handguns,

if the data challenged their

opinion, people took longer

to reach their conclusion and

made more mistakes.

Given that belief so easily

sabotages reason, how can

you form opinions about

emotive issues in a more

balanced way? Deliberately

seek out individuals who

hold opinions different from

your own and try to listen

to their arguments non-

judgmentally. Read as much

material as you can that

challenges your views.

Explain in detail not only

what you believe, but why

you believe it. In their book

The Knowledge Illusion,

Steve Sloman and Philip

Fernbach cite a study that

asked participants to rate

their understanding of how

everyday items such as a

lavatory or a zipper work,

then to explain in detail the

mechanisms involved, then

once again to estimate how

well they understood them.

Afterwards, participants

rated their understanding

more realistically.

DOCTOR’S DIARY MIND HEALING

All on your head: getting rid of head lice is

one of the struggles of being a parent

Why belief

can so easily

sabotage

reason

Continuous

reassessment of

medicines in the

older population

is essential

T

Email medical questions confidentially to

Dr James Le Fanu at drjames

@telegraph.co.uk

James Le Fanu

Linda Blair

Linda Blair is a clinical

psychologist and author of

Siblings: How to Handle Rivalry

and Create Lifelong Loving

Bonds. To order for £10.99, call

0844 871 1514 or visit books.

telegraph.co.uk

come out of it,” she says. “You then

spend the next week apologising to

people that you’ve been weird with

or upset with and then you carry on.

Ultimately you just go through your life

stumbling from one month to the next.”

This was also the case for Laura

Murphy, founder of the PMDD support

network Vicious Cycle.

She says: “Near the end of my period

in my 30s, it felt like someone had died

every month. I would just sob and sob

and sob, and you can’t turn it off.”

She explains that, while her PMDD

began at 17 after she began taking

the contraceptive pill, she wasn’t

diagnosed until she was 34.

“I had no confidence because I’d

been told by my doctor, ‘This is what

everyone else goes through, you just

need to learn to live with it ...’ So I just

thought I was really weak and broken.”

For Alice Girling, a midwife and

founder of the advocacy group PMDD

& Me, the nature of her menstrual cycle

left her struggling for weeks at a time.

She said: “I think I had about three to

four good, symptom-free days a month.

So 26 days out of 30, I was in this hell.

“I would be a suicide risk leading up

to my period, because I just wanted the

pain to stop. I couldn’t live in this hell

any more and it was all-consuming.”

Both women founded online

groups in order to raise awareness and

signpost women towards the most

appropriate resources.

The International Association for

Premenstrual Disorders (IAPMD)

estimates that 30 per cent of PMDD

sufferers will attempt suicide in their

lifetime yet, despite the severity of the

condition, many women struggle to

receive a correct diagnosis.

This was certainly the case for Emily

Fazah, 29, the founder of the website

Moody Girl Period, who throughout

university found that her symptoms

were frequently dismissed.

She says: “The worst time I can

remember was when I was in the third

year of university. I had been to GP

after GP about my symptoms, asking:

‘What can I do, they are getting worse

and I can’t handle them?’, and each

time the doctor would recommend

Bake Off winner John Whaite: his sister

disappeared while suffering PMDD

The monthly

torture that doctors

struggle to spot

L

ast week, in a series of

increasingly desperate

tweets, John Whaite, winner

of the 2012 Great British

Bake Off, revealed that his

sister Victoria Cunningham

had disappeared from Faro airport in

Portugal’s Algarve.

Whaite explained to his 90,

followers that his sister had been

unable to board her flight “due to

breakdown and intoxication linked to

diagnosed depression & PMDD”.

The drama unfolded quickly, thanks

to thousands of retweets from people

including Amanda Holden and Duncan

Bannatyne, and Victoria returned

home safely after a stranger recognised

her and alerted the family.

The incident shed light on PMDD –

premenstrual dysphoric disorder – an

often misdiagnosed and misunderstood

condition. It is a hormone-related

disorder directly linked to the

menstrual cycle and is thought to affect

80,000 people in the UK.

Rachel Boyd, from the mental

health charity Mind, says: “Normally

symptoms last for a week or two

before your period starts, begin to

deplete during, and will usually have

disappeared by the time it’s finished.

“As well as symptoms including

headaches, muscle pains and breast

tenderness or swelling, people

experiencing PMDD may also have

mental health symptoms such as

depression, anxiety or sometimes

suicidal thoughts.”

People affected often find their

menstrual cycle is tied up with an

intense period of struggling, followed

by a more “clear-headed” spell in which

they have to pick up the pieces.

For 50-year-old Eleanor Ibi, who has

suffered from PMDD for most of her

life, “it is exhausting”.

“You go through such a change in

emotional state, and then you slowly

After a woman went

missing, linked to PMDD,

Jasmine Cameron-Chileshe

investigates the condition

going on the Pill. I think I tried six

or seven types of contraceptive pills,

and I was left on my bedroom floor at

university, suicidal. I couldn’t leave the

room and I had to delay deadlines.”

It was only a chance conversation

18 ***^ Monday 19 August 2019 The Daily Telegraph

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