Legal High Lies

It was terribly sad listening to the bother of a “legal high” victim on the radio this morning. The now banned N-Bomb LSD copycat drug had left his brother severely brain damaged and dependent on 24 hour care for the rest of his life.

Surely it is time to stop using the incredibly misleading term ‘legal high’ with its safe, non-addictive, not-bad-enough-to-be-banned connotations. It’s a lie. The internet is littered with websites selling untold numbers of chemical compounds, blithely labelled with seductive names and proclaimed as legal, ‘quality research chemicals and herbal incense’, getting away with it through a bold disclaimer of “STRICTLY NOT FOR HUMAN CONSUMPTION”.

To try and start classifying them is financially and logistically possible, even though the All-Party Parliamentary Group for Drug Policy Reform (clue is in the name) calls for the Utopian solution of the an introduction of a new category for psychoactive substances whereby their supply can be ‘regulated’ and a review of the government lead for drugs to ensure a health focus. Yeah right.

The first step from the government surely has to be to a serious focus on deterrence. Insist on accurate labeling such as ‘high risk unclassified highs’ in all commentary – because there is never, ever anyway of the public being sure what is in the psychoactive substance. Possession should automatically incur a significant fine – pills, powder, whatever – you are potentially endangering yours and others lives. It may be herbs and talc but life is too short to test everything – the European Monitoring Centre for Drugs and Drug Addiction identified 73 new substances in 2012 alone - and it sends a message of principle. It is ridiculous that they can have ‘not fit for human consumption’ on the packet as a legal requirement alongside names such as gogaine, spellweaver, charlie and e-scape.

The American example of “analogue” legislation which simply automatically bans any new substance that has a similar chemical structure to an already banned drug is worth considering but it can never keep pace with new products coming to market. There are hundreds if not thousands of labs in Asia where new synthetic drugs are synthesised to imitate the effects of existing legal drugs. We have to keep this simple, and act now, if we are to prevent more tragic episodes of injury and death.

Addiction is just too profitable to give up: Infographic on the effects of nicotine and tobacco

 

 

Thanks to #LoveInfographics for this one. Following on from yesterday’s press on Big Tobacco pushing e-cigarettes, this graphic illustrates the impact of the nicotine, although it doesn’t show what side-effects are due to nicotine, and which are due to tobacco smoke.

That said, we can be sure that the $6,000 profit that Big Tobacco makes from each smoker in their lifetime will continue to reward shareholders and contribute to their daily $23 million marketing spend – and that’s just in the US! No wonder so many people are addicted. (Infographic is large so will take time to resolve).

Big tobacco: wanting more profit from bad habits

I’ve just commented on LBC’s Iain Dale show about the report in today’s Guardian on Big Tobacco pushing for e-cigarettes to be prescribed on the NHS. The immorality of their position is staggering: the very companies who woo us to part with hard earned cash for their addictive highs are now after our tax money to maintain our addiction, via the NHS medicines budget! Have they no shame?

Nicotine replacement therapy (NRT) is already available on the NHS, though research shows that simply prescribing NRT (such as the gum or patches) without any formalised withdrawal programme or psychological support has a measly 5% success rate. There is no indication that Big Tobacco wants anything to do with helping people kick the habit. This is only about exploitation and profits, no altruistic concern with harm reduction.

Should e-cigarettes get approval, the article indicates that it will be down to local commissioners to decide whether they are available in your area. We can be certain that Big Tobacco will be doing what they can to persuade doctors to prescribe. Yet the bigger questions remain. Harm reduction is a controversial approach for any risky behaviour. Critics say that it implies that you can carry on with certain activities in a safer way, when the reality is people take more risks because they think perceive what they are doing to be less harmful. Of course, with e-cigarettes you cut out the health risks of inhaling smoke, but nicotine remains a highly addictive, mood altering drug that can cause blood clots, raised blood pressure, increased heart rate, muscular tremor and breathing difficulties. The push is to make smoking acceptable, even glamorous again, with it’s new ‘safe’ form. Harm reduction however doesn’t address the underlying issues: why you need a high in the first place?

And secondly, we cannot go on talking about paying for new NHS services without a fundamental review of what the NHS is for, on which I have written previously. Decisions about funding e-cigarettes should not be being taken in isolation: we desperately need a review of what the NHS can and should provide. I have no problem with people moving to e-cigarettes from the traditional tobacco variety, they will save themselves a lot of money, but it should not be at our cost and without a wider debate.

Diabetes rising: we can’t afford for this to happen

This graph should be a wake-up call to all governments. Whilst the minority of people (5-10% but rising) have the unpreventable (so far) Type 1 Diabetes we simply cannot afford the projections shown in this diagram to happen, which are made up in the main by preventable Type 2 Diabetes. It’s not just the cost of treatment, but the tragic impact of complications on individual lives and their families, especially in developing nations and for those on low incomes.

Credit: IDF

Solar powered fridges, bio-charcoal, micro-needles: great tech innovations by UK Universities

Great to see UK Universities developing innovative technologies to solve developing world public health problems.

Ban on smoking in cars: liberal individualism is a threat to individual liberty

Edmund Burke warned us: “Men are qualified for civil liberty in exact proportion to their disposition to put moral chains on their appetites.” In other words, freedom is a privilege that can only be sustained and deserved if we use our freedom to ensure the well-being of others. Freedom has never been, nor could be, a charter for selfishness, without itself being destroyed.

A vote will be taken today on an amendment that has been tabled to the Children’s and Families Bill by Labour Peers to ban smoking in cars when children are present. This isn’t the first time this idea has been proposed, and it will have cross party support in the Lords as the last attempt was a Private Members Bill introduced by Conservative Lord Ribeiro in 2012. The health arguments against exposing children to smoke -and of course the everyone is at risk – are well rehearsed, and neatly summarised here by the BBC. It is worth reflecting however why we need this law.

Much as I recoil from the thought of more legislation to dictate our behaviours, I also accept that we have brought this on ourselves. Over the past few decades we have seen the rise of liberal individualism and mistakenly seen it as an expression of, rather than a threat to, individual liberty. We have been blinded by the entitlement of choice, rather than seeing through to the consequences of choosing. What remains important is not choice per se, but what we choose, and unless we make choices for the common good we delude ourselves that we can remain free. As the brilliant former Chief Rabbi Lord Jonathan Sacks expanded in his ‘Politics of Hope‘, freedom is a moral achievement; it rests on self-restraint and regard for others.

The freedom to protect our children simply because it is the right and moral thing to do has been abused, so it is only right that legislators now step in to enforce the right of children to be protected from smoke.

Age should not be a factor in cancer treatment

For Christmas my daughter bought me Jodie Picoult’s moving novel ‘My Sister’s keeper’, the story of a girl who is genetically selected to be born as a bone-marrow donor match to treat her older sister Kate’s leukemia. Kate relapses as a teenager and a decision has to be made about whether she should have a kidney transplant from her ‘donor’ sister.  An ethical dilemma for all, but as far as Kate is concerned, there is no discussion about her age, only whether it’s worth the risk considering her poor health.

Today’s report from Macmillan Cancer Support and the National Cancer Intelligence Network (NCIN) on the reality of long-term survivorship from cancer of those over 65 years is contrasted with the larger numbers of survivors in the EU than in the UK. For the over 65′s in the UK, our five year survival rates are lower than in comparable countries. It would seem that the adage “what do you expect at your age?” is alive and kicking in too many hospitals, where the nature of a patient’s cancer and their fitness for treatment is given secondary consideration.

Most commentators still think that age should be a consideration. Having worked with older people for 20 years I would disagree. Fitness for treatment and the nature of the cancer should be the top considerations, never age. The huge variation in well-being of the over 65s would make any fixed age-based decision completely arbitary. More so, if we open the door to age inequalities – making relative decisions based on how old someone is – the economic pressure of an ageing population means that we will inevitably become more utilitarian. A decision based on age harms us all, because it reinforces the idea that your worth is relative to your abilities, your independence and the time period for which you have already lived. 

Jeremy Hunt rightly highlighted last autumn our national shame that so many older people are lonely; he talked about the ‘reverence and respect’ that he had seen for older people in Asian countries. I too have seen this in my visits to sub-Saharan Africa: older people are esteemed, yielded and listened to. We demean our society when we treat older people as inferior.

This subject isn’t going to go away. The organisation that rations our medicines, NICE, are about to start a consultation on how to allow for ‘societal benefits’ as they consider their equation for establishing the cost-effectiveness of new medicines. Last year they turned down all but one new cancer drug, hence the medical and political imperative for the Cancer Drugs Fund. And this was the concern behind the press headlines two weeks ago, stating that older people will be denied drugs as society has less to benefit from an older person compared with someone of working age.

I have already stated publicly that age should not be a consideration in the methodology of assessing new medicines, and the same goes for any treatment. If we are of value because of our humanity, then that is not age-dependent. If we start to make our value conditional on our abilities, then we embrace relativism. We would be opening the door to the discrimination that follows, wielded by those who have the most power, and we would end up with a culture of fear.