death

How much of [insert drug name] do I need to take to kill myself?

I'm slightly obsessive over checking my blog stats, and I've noticed a trickle of people finding my site by using such terms as the above.

So, if you have found my site by searching for a similar phrase, I just wanted to say a few things to you. I'm not saying this in my capacity as a pharmacist, or skeptic, or anything like that, but just as a human. Don't worry, I won't keep you long. 

Firstly: I know and I understand.

Secondly: It feels like this will last forever, but it won't. Give it twenty minutes or half an hour, and in the meantime, please ring these people. No, really, please do. After all, in the grand scheme of things, a delay of a few minutes wont make a massive difference.
In the UK, the number is 08457909090. In the Republic of Ireland, its 1850609090. In the US its 1-800-273-8255. There will be similar numbers in other countries. 
If you  could just do that for me, that will be brilliant. 

Thirdly: I'm sorry, but you wont find that kind of information on this site. 

Fourthly: I care about people, and that means I care about you. If someone who has never met you at all cares about you, then its highly likely that some other people out there do too. I know that might not be enough, but it should count for something. I and many others don't want you to. 

Oceans of love, 


Hxxx


P.S. There is a lesson here for other bloggers/ website owners/ healthcare professionals too. Please be aware of what you are writing if you are covering anything about toxicology.

Harry, who had seven hairs on his head.

I've been thinking a lot about my Grandad Harry recently. I'm not entirely sure why- it's not his birthday, or the anniversary of his death or anything in particular. I'm not going to bother trying to shoehorn this post into any recent news events or make any great points about skepticism or science in it. My intentions are purely to tell you about him, because he is a worthy subject.

Harry.

Harry.


At school we had to do an English project on someone who had inspired us.   Of course, it being the early nineties, my English teacher found himself wading through twenty or so biographies of Michael Jackson. But I did mine on my good old Grandad. I wish I still had a copy of that project now.

He was brought up in a Catholic orphanage. I believe his mother died and his father couldn't take care of him and his siblings. I know he had a horrible time there, but the details are sketchy. I know the orphans there were very starved of love and attention. I remember him telling me how, one Christmas, the nuns had told them all how they were getting a very special treat. The boys were each presented with a bit of spice cake, which in their eyes might as well have been manna from heaven. It gave them all a tiny ray of hope, of excitement. When they bit into it, it was full of cobwebs. Those nuns must have been having a right old laugh at that. 


Despite- or perhaps because of- all of this, he vowed that his life-and the life of his family- would be filled with nothing but love and warmth and joy. Where he could so easily have been consumed with anger, he instead became what I consider to be the very pinnacle of what everyone should strive to be. He was a true gentleman. 


He met my Grandma briefly, then again through some mix-up with ration books, and so it began. (i need to check that story actually, i remember it being desperately romantic, but I can't recall the details.) Those two have taught me everything I know about love. Through some hard, poor, and difficult times they were the most loving and romantic couple I have ever encountered. You know when you're in the first flush of a relationship, and you do everything you can think of for someone before the fatigue of familiarity sets in? They seemed to be like that despite being together for many, many years. Their flat was full to the brim of knick-knacks, those little impulse purchases they had bought each other over the years just because they were thinking of each other all the time. 


He was gregarious, and would welcome anyone to his home with a massive smile and a huge hug. Whenever I took boyfriends round to meet him for the first time, he'd welcome them with "hello, bonny lad!" along with a (often to their embarrassment and my amusement) big sloppy kiss. Within about 5 minutes of arriving, he'd be offering you food, tea and whisky, and you'd be totally charmed by him.


He loved whisky, so much so that on his 80th birthday he got 18 full size bottles of it as presents from his friends. I used to go round to see him for a few hours and emerge into the afternoon staggering somewhat from all of the "wee drams" we'd share. Highland Park was his favourite: for his birthday I bought him a bottle of the expensive stuff. The next time I went round he said he had drank it all already, but later on, when he was more sick and I had to retrieve some from the cupboard for him I could see the only-half-empty bottle there, the cheeky devil. 


He had an amazing sense of humour. When he and my Grandma came to stay with me once to look after me when my parents were on holiday they told all their friends they were going to Kingston for the week, neglecting to mention the Park bit which would denote a sleepy suburb of Newcastle rather than Jamaica. He tried his best to be modern: he loved playing on the wii, pottering about on a computer, and listening to his iPod. He had a better mobile phone than me at one point. And he-and my grandma, still- also had modern attitudes. They knew the world was changing around them and they did their best to understand it, not be set in their ways and disapproving if us unruly youngsters. They didn't bat an eyelid when I would traipse in looking all sullen in my goth days, they just gave me a massive hug and told me I looked lovely all the same. 


When he became very ill, there were about four or five occasions when we seriously thought he was going to die. Each time he fought back, but became more and more frail each time. I remember his consultant pretty much saying after the first time that he shouldn't have still been with us, and that he wish he knew his secret. My auntie probably put it best: "he'll do anything he can to stay with her (my grandma)". Perversely, I actually remember the first time this happened as one of the best times I have spent with my family. Waiting in the relatives room, us assembled cousins, aunties, uncles and parents roared with raucous laughter at everything going. We made our own hilarious entertainment using nothing but an old copy of the Evening Chronicle and  some plastic packaging. Some would think that's weird, but I know Grandad would have wanted nothing less. At his wake we holed ourselves up in a room with copious amounts of port and wine, and screamed with laughter as more distant friends and relatives turned their noses in the air and probably thought we were disrespectful.


But he would want us crying tears of laughter rather than sadness.


Now, as you'll probably know by now, I don't believe in an afterlife. But I do believe in a legacy, and if I manage to have a legacy that's even a quarter as powerfully loving as Harry's, I'll know I will have led a good life. 


Hxxx


P.S. The seven hairs thing was a long standing joke. He used to count them and declare that he had seven hairs on the top of his head. No more, no less, always seven.

P.P.S. Its been requested that I mention something else also, something that I actually can't believe I forgot about: The Toilet Of Joy. I have no idea why The Toilet Of Joy came about, but it stems from a family trip to Ilkley for one of Grandad's birthdays. We had a meal in one particular area of a pub which had been roped off for us, and for reasons best known only to the god of wine, the entire family ended up spending much of the night in a toilet cubicle, in hysterics over a hand-dryer. This became known as The Toilet Of Joy. Something very odd, very noisy, and very wonderful happens when my family get together. 

Take all of it, every scrap

There are many things in life that are not black and white. There are many arguments in which I can see where all sides are coming from, and I can understand the root of why people would disagree with me. Yet there is one area which is consistently contentious, and yet my brain can genuinely not comprehend the other side of the debate.

I'm talking about organ donation.

The news yesterday was good: there has been a 50% increase in organ donation since 2008. And yet there is still a long, long way to go.

"Last year, 125 families overruled an individual's intention to donate."- BBC News

I really, really struggle to understand why anyone would object to organ donation. I just cannot get my head round it. And overturning an individual's decision to donate their organs seems particularly bizarre to me. I understand that in the acutely shocking and devastating situation of a death you might not be thinking clearly, but... I really just don't get it. 

Maybe its my atheism. Maybe its the fact that I see death as just that and no more. I don't see it as the start of a new journey into the afterlife, or the first step on my way to meeting my maker. You just die and that's that. So I suppose its easy for me to disassociate myself from the shell that's left. I don't feel creepy about the idea that there could be bits of me in other people: in fact I feel positively proud that I might be able to help in any way.

Religions offer us a legacy. They give us the promise of a new beginning after our death, and so go some way to assuage the fear of nothingness that might follow. But it's a legacy that, in my opinion, is pretty useless. It might be comforting to our loved ones, but in the long term view of things on this planet, that doesn't mean a great deal when there are people whose lives could be made better by a chunk of my flesh being implanted into them when its no longer any use to me.

Not that I think every objection to organ donation is on religious grounds, but I suspect it may be a fairly important part of it for some people. Atheists are often told that we're evil, that we have no morals, and that we are going to hell, but to me it seems that organ donation is clearly the more morally good choice when the alternative is wanting to keep a dead person intact for ceremonial reasons. 

Some people just think its icky: the idea that a bit of you will be in someone else. I had an ex-boyfriend who thought organ donation was wrong "because its just weird" (he's an ex for a number of very definite reasons, and this is quite a prominent one). Well, I think a lot of things are icky, but they still get done because they have to be done. I can think of more pleasant things than having a smear test, for example, but I do it because it is a necessary evil. And, one has to remember a key point: you're dead. Things don't seem so icky or weird to you any more because you no longer exist. 

Fig 1. Handy flow chart for deciding whether to sign up for organ donation

Fig 1. Handy flow chart for deciding whether to sign up for organ donation

urely there is no better legacy than giving parts of ourselves to allow other people to go on living healthier, longer lives.  

And so, your homework is to (if you haven't already), think about it, speak to your loved ones about it, and sign up to the Organ Donation Register 

Hxxx

Some thoughts on quality and quantity

The sad news about Iain Banks has gotten me thinking today. 

I'll be honest here and say I've never read any of his books (so many books in the world, so little time!). I know nothing at all about him. Yet when I read his statement at work this afternoon, I had tears in my eyes. His words were so dignified, so stoical, and so noble that they really touched my heart. The ability to have humour at such a time is something I admire hugely.

I'm sure his words are the tip of the iceberg. I really can't even begin to understand what a lengthy, horrific process it must be to come to terms with such news. But what struck me most of all was his plans to spend his remaining time with his family, friends and loved ones. Isn't that, when it comes down to it, what we would all want? And yet it seems to me that cases such as his appear to be in the minority of those that are reported in the media. 

Many moons ago, at university, I went to a lecture by Sir Michael Rawlins. He discussed the thorny issue of how NICE assess drugs, and he touched upon quality of life measures. I remember being utterly shocked when he said that the majority of terminal patients choose longevity over quality of life. That's always stuck with me, as it seems so starkly counter-intuitive to me that I genuinely can't get my head around it. I also know that's very easy for me to say, and that I have absolutely no idea what it must be like to have to face such decisions. A few years ago I did my Diploma in Therapeutics, and we had to try out some of the quality of life rating scales that are used at NICE. Believe me, this really gets you thinking about how difficult these sorts of choices are. I also remember a really brilliant workshop with Claud Regnard, a palliative care consultant and author of some highly-esteemed books in the field. I remember being bowled over by how positive and creative such a potentially depressing subject could be.

We're a nation (and potentially a planet) that are very medicalised. We hunt for a cure for everything, and a miracle pill to make us cleverer, slimmer, healthier. When given the choice between taking a tablet and changing our lifestyles, I think it's safe to say that most of us would rather opt for the former. This is fuelled by any number of things, but I think the media has a lot to do with it: there's always a story about how some new drug is going to cure Alzheimer's, or obesity, or heart disease, and there's story after story of families desperately searching for a cure or treatment that can cure their love ones.

And here's what I've been thinking about: when all the options have been explored, and there is no cure, practitioners of conventional medicine (by which I mean medicine which is proven to work) will usually tell you so. 

At this point, the quest for something else, perfectly understandably, kicks in. Of course you would grasp at any straws, any vestige of hope. And so, right at the time where people should be spending their days doing what they love with the people they love, as Iain Banks is doing, some of them turn to alternatives. 

It could be weird diets, it could be homeopathy, it could be a certain well-known quack's clinic in Texas, it doesn't matter. What all of these things do is sell hope when all else has failed. They're a very seductive prospect, and it may well seem perfectly logical that you'd spend every penny in trying them, and you'd leave no stone unturned trying to find the perfect treatment for you, or your loved one. 

Just at the time when you should be kicking back and enjoying your time as much as you can, you end up on a plane across the world, which is stressful enough for anyone at the best of times. Or you might end up on a strict diet regime, having to deprive yourself of the foods you love just when you should be enjoying them more than ever. You might end up a slave to a complex regime of megadose vitamins, enemas, pills and injections when you should be being made as comfortable as possible with palliative care. 

These people who sell false hope rob patients not only of their money, but of their precious time as well. And that, in my opinion, is the most evil and unforgivable of sins. 

I hope that, eventually, we get to a place where a quality life and death become the most important thing to anyone with a terminal illness. 

This is yet another blogpost where I feel the need to write "hope this all makes sense" at the end. I probably should just plan posts better, but I've always found I'm usually better at just writing as I think at times. My humble apologies also for any typos... I'm absolutely rubbish at touch screen typing


Hxxx

Homeopathic Harms Vol 3: Poor Advice

And so begins the third installment in our Homeopathic Harms series, a collaboration between myself and @EBMScientist of the Evidence Based Skepticism blog. For this post, I have my lovely, wonderful friend @shandymarbles to thank for the idea and the action.

Indirect harms due to homeopathy can, as we're trying to cover in these posts, come in various different guises. In my opinion, there is none more dangerous than this: poor advice from homeopathic practitioners. 

To set yourself up as a homeopath in the UK, you don't need any medical background. You also don't need to register with any regulatory bodies or undergo any standardized training. Medical homeopaths, i.e. doctors who practice it on the side, are of course regulated by the GMC, but your common or garden variety homeopaths could basically be anyone.

And yet, they claim to practice medicine and give advice on your health. Scary stuff, in my eyes. And I can give you a specific example of how harmful this can be, because one of my good friends contacted a UK homeopath recently. This homeopath is, as is proudly declared on his website, an engineer by trade.

Under the pseudonym Stacey Slater (which apparently didn't appear to ring any alarm bells with the homeopath in question), my friend asked for help in treating bipolar disorder. She said she had stopped taking the medication prescribed for it because she was getting horrible side effects, and asked if there was anyway that homeopathic treatments could help her stay stable and avoid psychosis. There are a few things to note here: the question was very specifically asking if homeopathy could be used instead of conventional medicines, and was asking about avoiding psychosis- we're talking about serious symptoms here, not a vague sort of "could it help with me feeling a bit down" sort of question. The description of "horrible side effects" would immediately ring alarm bells to me- what sort of side effects, and how is she feeling at that time.

Here's the response I would have liked to have seen in a dream world filled with responsible homeopaths (actually, in my dream world there would be no homeopaths at all, but you know what I mean):

"Dear Stacey,
Thank you for your enquiry. I'm sorry that you've stopped talking your medication for bipolar disorder, and would like to advise you in the first place to speak to your GP first of all about the side effects you have been experiencing. You should also discuss with them your decision to discontinue your medicines, as stopping them suddenly may cause your symptoms to worsen.
Homeopathy may be a useful option to help treat some of your symptoms. However, I wouldn't recommend that it is used instead of your usual medicines, unless this is done with the agreement of your medical team. Once you have spoken to them, please do contact me again and I will be happy to discuss any homeopathic treatment with you then."

This response covers all bases. It makes sure that the primary outcome of patient safety is covered by referring them to their own healthcare provider, however its also helpful and leaves open the possibility of some homeopathic treatment as an adjunctive, complementary treatment. It does not suggest that homeopathy can be used instead of her usual medication.

Here, however, is the real-life response:

"To,
Dear Stacey Slater,
Yes I am happy to help you for your Bipolar Disorder and will try to restore your previous health. 
Recently, my grandmother has been treated for her 15 years long Bipolar disorder with only two weeks of homeopathic treatment. Now, my father-in law (Himself Medical Practishner) says she is 100% okay with homeopathic remedy and need not take any other medications. 
To help you, I need some more information, like; your physical, mental and spiritual condition.
1. Any skin diseases are you suffering from?
2. Do you have problem of thyroid dysfunction? hyper or hypo?
3. Diabetes?
4.High or low blood pressure?
5. Since how long are you suffering from Bipolar disorder?
6. Your family history, if any one in your blood relation have tuberculosis, diabetes, cancer or high blood pressure?
7. Your liking and disliking? Food,Drink, time and weather 
8. Your family life, etc..
Your detail will help me to prescribe best remedy.
Looking forward to your reply,"

There are a few things to note here, as I'm sure you can tell. This homeopath claims that they will "try to restore to previous health"- in other words, he is offering a cure to bipolar disorder. We've got some anecdotes in there, in lieu of actual clinical evidence, and an extraordinary claim that longstanding bipolar disorder can be cured with only two weeks of magic woo water therapy. Now, given that bipolar is, by its very nature (and name!) a relapsing-remitting disease of two extremes, there is no way that an anecdote could be used as evidence of successful treatment. Who’s to say his grandmother wasn't just going through a good period that just happened to coincide with taking a couple of week’s worth of homeopathic medicines. How do we know she wasn't using effective conventional medicines at the same time? Who's to say she even exists? I can't help but wonder about his grandmother's right to confidentiality as well- has she given consent to be used as an anecdote in his consultations with other patients?

Who is this father-in-law mentioned? If he is so happy with the treatment, why isn't he happy to be named, and why is he even commenting on the grandmother's treatment? What relevance does this have to this homeopath's practice? The advice given that she "need not take any other medications" is a clear indication that this homeopath thinks that the homeopathy he advises can be used to "cure" bipolar disorder on its own, as an alternative to conventional medicine. By trying to make it seem like the advice has come from an actual medical practitioner, the homeopath is clearly trying to give this advice more credibility.

Lets have a think about the consequences of this advice: Our Stacey Slater is reassured that she doesn't have to continue on with her conventional medicines. She responds to the email above, goes on to have a consultation with the homeopath online (which costs £50 by the way- we're not talking pennies here. £50 for an email exchange!) She slips into psychosis, or mania, or a deep, deep depression. Eventually, she can't take anymore and she commits suicide. This homeopath has directly contributed to her death by not advising that she sees her medical team before discontinuing her medicines, and by claiming that she can be cured by inert sugar pills instead of continuing on with effective, evidence-based medication

The problem is, we can't gather robust evidence on this sort of thing, as it would be too unethical to do good, clinical studies. Maybe Stacey hasn't mentioned to anyone that she stopped taking her medicines and she was under the "care" of a homeopath- how would anyone know that the death was caused by him? And even if they did know, they're probably too upset and shocked at that point in time to think about raising a complaint. Who would write up a case report to publish in the medical literature? Certainly not the homeopath in question, he's not going to incriminate himself, and her medical team have probably had little contact with her since she's been advised not to bother with them anymore. And so homeopaths can continue to claim that their treatment is "safe", because we just don't know the scale of these sorts of cases. 

The only bright side here is that, of course, my friend will most definitely not be taking this shoddy advice. She's well aware that homeopathy is a whole load of nonsense and just contacted this guy to see what the response would be. However, we have to wonder how many other emails he's getting, from people who are genuinely seeking help. And we have to wonder what's happening to them, and whether they are safe.As an interesting, and rather creepy, aside the homeopath started following my friend on Google plus and Twitter a couple of hours after responding to her. This is at best weird and unprofessional, and at worst, really quite frightening. I can't think of any healthcare professionals who would do such a thing, just randomly looking up a patient on social media and then following them after one consultation- what about confidentiality? 

Hxxx

Let's talk about death, baby

Yep, settle in, dear friends, and lets have a think about death. Specifically, assisted suicide. 

This subject has come up quite a bit recently in the field of pharmacy and medicine. The PJ online are asking me to vote on whether or not I would refuse to dispense a prescription as part of an assisted suicide. The GMC is revisiting guidance to Drs. It's time to have a bit of a think about how we as pharmacists feel about playing a part in death.

There's a word which I think should be associated with death, and that word is dignity. People on the brink of death are still people, and I think in such discussions that fact is often forgotten,. We talk about our professional ethics, our religious choices, the impact it would have on us and our consciences, but I think we should talk-and think- more about the thoughts and needs of each dying patient. 

We're all frightened of death of course. I've been lucky enough that I haven't had much experience of it so far, but I've had enough to have experienced the lack of control one feels when faced with the death of a loved one. And all the bizarre rituals, funerals, cremations, all of these things that we do are desperate attempts to claw some control and dignity back from the situation. 

And so it is that I personally don't really need to think that much about this decision. I wouldn't hesitate to dispense medicines for assisted suicide, if it is going to give someone the dignity that they so richly deserve. 

People who believe in a god may think this is a typical example of an immoral atheist wanting to go on a legal murder rampage, playing god and interfering with when someone's "time" is. But in actual fact i think it's more about caring for the person involved, giving them respect for the person they are-and were. We need to remember that they remain a person to the end- and so should be allowed the right to choose, right up until the end.

Hopefully that makes sense. 
Hxxx