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Policies that criminalize drug users fuel the spread of AIDS and should be reformed, experts preparing for an international conference said Monday.
Instead, governments, international organizations and the U.N. should promote policies that include opiate substitution therapy and needle and syringe programs that have been shown to reduce HIV rates without increasing rates of drug use, said the experts from groups such as the International AIDS Society, the International Center for Science in Drug Policy and the British Columbia Center for Excellence in HIV/AIDS. They also want compulsory drug treatment centers to be scrapped, saying they are ineffective and violate human rights.
“The criminalization of illicit drug users is fueling the HIV epidemic and has resulted in overwhelmingly negative health and social consequences. A full policy reorientation is needed,” the experts said in a declaration issued ahead of an AIDS conference that gets under way in the Austrian capital on July 18.
Among other things, the declaration says there is no evidence that increasing the “ferocity” of law enforcement reduces the prevalence of drug use and claims that the number of countries in which people inject illegal drugs is growing.
“Many of us in AIDS research and care confront the devastating impacts of misguided drug policies every day,” Julio Montaner, president of the International AIDS Society and director of the BC Center for Excellence in HIV/AIDS, said in a statement.
“As scientists, we are committed to raising our collective voice to promote evidence-based approaches to illicit drug policy that start by recognizing that addiction is a medical condition, not a crime,” added Montaner, who will serve as chairman of the Vienna conference.
The declaration urges governments, international organizations and the United Nations to carry out a transparent review of the effectiveness of current drug policies and to implement a science-based public health approach.
While legal barriers to needle programs and opiate substitution therapy mean hundreds of thousands of people become infected with HIV and hepatitis C every year, the criminalization of drug users has resulted in record incarceration rates, the experts said in joint statement.
They added that opiate substitution therapy, and needle and syringe programs, are cost-effective, help drug users access health care and have not been shown to have negative consequences.
“The current approach to drug policy is ineffective because it neglects proven and evidence-based interventions, while pouring a massive amount of public funds and human resources into expensive and futile enforcement measures,” said Evan Wood, founder of the International Center for Science in Drug Policy.
“It’s time to accept the war on drugs has failed and create drug policies that can meaningfully protect community health and safety using evidence, not ideology.”
Wood appeared to be echoing a comment made by U.S. drug czar Gil Kerlikowske last month. In an interview with The Associated Press, he said that after 40 years the United States’ $1 trillion war on drugs has not been successful.
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If you’re planning to pack prescription drugs when traveling by air, there are steps you can take to avoid trouble taking them on board.
The U.S. Centers for Disease Control offers this advice:
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We fret about airport scanners, power lines, cell phones and even microwaves. It’s true that we get too much radiation. But it’s not from those sources — it’s from too many medical tests.
Americans get the most medical radiation in the world, even more than folks in other rich countries. The U.S. accounts for half of the most advanced procedures that use radiation, and the average American’s dose has grown sixfold over the last couple of decades.
Too much radiation raises the risk of cancer. That risk is growing because people in everyday situations are getting imaging tests far too often. Like the New Hampshire teen who was about to get a CT scan to check for kidney stones until a radiologist, Dr. Steven Birnbaum, discovered he’d already had 14 of these powerful X-rays for previous episodes. Adding up the total dose, “I was horrified” at the cancer risk it posed, Birnbaum said.
After his own daughter, Molly, was given too many scans following a car accident, Birnbaum took action: He asked the two hospitals where he works to watch for any patients who had had 10 or more CT scans, or patients under 40 who had had five — clearly dangerous amounts. They found 50 people over a three-year period, including a young woman with 31 abdominal scans.
When other radiologists tell him they’ve never found such a case, Birnbaum replies: “That tells me you haven’t looked.”
Of the many ways Americans are overtested and overtreated, imaging is one of the most common and insidious. CT scans — “super X-rays” that give fast, extremely detailed images — have soared in use over the last decade, often replacing tests that don’t require radiation, such as ultrasound and MRI, or magnetic resonance imaging.
Radiation is a hidden danger — you don’t feel it when you get it, and any damage usually doesn’t show up for years. Taken individually, tests that use radiation pose little risk. Over time, though, the dose accumulates.
Doctors don’t keep track of radiation given their patients — they order a test, not a dose. Except for mammograms, there are no federal rules on radiation dose. Children and young women, who are most vulnerable to radiation harm, sometimes get too much at busy imaging centers that don’t adjust doses for each patient’s size.
That may soon change. In interviews with The Associated Press, U.S. Food and Drug Administration officials described steps in the works, including possibly requiring device makers to print the radiation dose on each X-ray or other image so patients and doctors can see how much was given.
The FDA also is pushing industry and doctors to set standard doses for common tests such as CT scans.
“We are considering requirements and guidelines for record-keeping of dose and other technical parameters of the imaging exam,” said Sean Boyd, chief of the FDA’s diagnostic devices branch.
A near-term goal: developing a “radiation medical record” to track dose from cradle to grave.
“One of the ways we could improve care is if we had a running sort of Geiger counter” that a doctor checked before ordering a test, said Dr. Prashant Kaul of Duke University.
He led an eye-opening study that found that U.S. heart attack patients get the radiation equivalent of 850 chest X-rays over the first few days they are in the hospital — much of it for repeat tests that may not have been needed.
How much radiation is risky?
It’s hard to say. The best guess is based on the 1986 Chernobyl nuclear power plant accident and studies of Japanese atomic bomb survivors who had excess cancer risk after exposures of 50 to 150 millisieverts (a measure of dose) of radiation.
A chest or abdominal CT scan involves 10 to 20 millisieverts, versus 0.01 to 0.1 for an ordinary chest X-ray, less than 1 for a mammogram, and as little as 0.005 for a dental X-ray. Natural radiation from the sun and soil accounts for about 2 millisieverts a year.
A big study last year estimated that 4 million Americans get more than 20 millisieverts a year from medical imaging. Two percent of people in the study had high exposure — 20 to 50 millisieverts.
Another study by Columbia University researchers, published in 2007, estimated that in a few decades, as many as 2 percent of all cancers in the U.S. might be due to radiation from CT scans given now. Since previous studies suggest that a third of all tests are unnecessary, 20 million adults and more than 1 million children are needlessly being put at risk, they concluded.
Just because a scan didn’t find anything wrong doesn’t mean a test wasn’t needed. Scans are useful for many diagnoses. But many studies suggest people are getting too much imaging now. For example, Mayo Clinic researchers reviewed the medical records of 251 people given heart scans in 2007 and found that only a quarter of them were clearly appropriate.
Reasons for overuse:
Which tests are overused? A scientific group, the International Commission on Radiological Protection, cites routine chest X-rays when people are admitted to a hospital or before surgery; imaging tests on car crash victims who don’t show signs of head or abdominal injuries; and low-back X-rays in older people with degenerative, but stable, spine conditions.
Even when tests are justified, they often include more views than needed and too much radiation. Top offender: chest CT scans looking for clogged arteries and heart problems. Cardiologists are increasingly aware of this risk and are seeking solutions.
At Columbia University, a study on dummies by Dr. Andrew Jeffrey Einstein found two dose-modifying techniques could lower the needed radiation dose by 90 percent without harming image quality.
Another cardiologist and radiation safety expert, Dr. Gilbert Raff, showed the same in real life. A study he led of nearly 5,000 patients at 15 imaging centers in Michigan found that radiation dose could be cut by two-thirds with no loss of quality.
What should patients do?
“You should question everything — what’s the dose, why am I getting it? You should be an informed consumer,” said Dr. Fred Mettler, radiology chief in the New Mexico Veterans Administration health care system. He led a study of health effects after the Chernobyl accident and is a U.S. representative to the United Nations on radiation safety.
He advised challenging “big ticket” tests like CT scans that deliver a lot of radiation to the chest and abdomen — places where cancer is likely to develop. “You shouldn’t get too excited about feet and knee X-rays,” Mettler said.
Questions to ask about radiation scans:
Mettler suggests bringing a blank CD or thumb drive with you.
“You should have all of your stuff digitally on something,” he said. “I keep mine on my laptop.”
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In an unusual step, a dozen competing drug companies have agreed to share data on thousands of Alzheimer’s patients in hopes that the extra information will spark new ideas for treatments.
The database being announced Friday covers 4,000 patients and counting. It was created in consultation with government regulators and the National Institutes of Health.
The effort may sound wonky, but attempt after attempt to create new Alzheimer’s medications — ones that might help before too much of a person’s memory is destroyed — have failed.
In pooling resources from clinical trials, scientists can hunt trends that may suggest what to study next. The database also will be available to brain researchers not affiliated with drug companies, to compare their own findings, and eventually will address other neurodegenerative diseases such as Parkinson’s.
“This is the kind of thing that’s not going to produce a new treatment next week,” cautioned Food and Drug Administration Deputy Commissioner Joshua Sharfstein. But, “it’s the kind of collaboration that does represent a major shift in thinking about how to accelerate drug development.”
It’s detailed information — memory tests, brain scans, blood samples — that the FDA already receives from companies. But Sharfstein said having the data recorded the same way in one spot also may help regulators more easily analyze questions about safety or standards for new studies.
Called the Coalition Against Major Diseases, the collaboration pairs patient-advocacy groups with such pharmaceutical giants as GlaxoSmithKline, Pfizer Inc. and AstraZeneca. It is led by the Critical Path Institute, a nonprofit partnership with the FDA that aims to speed discovery of new drugs.
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One in five US high school students has abused prescription drugs, including powerful medications such as OxyContin and Percocet, a study published Thursday showed.
White teens were the most likely to say they had abused prescription drugs, with 23 percent admitting they had taken a drug such as OxyContin, Percocet, Xanax or Ritalin without a doctor’s prescription, the study by the Centers for Disease Control and Prevention (CDC) found.
Seventeen percent of Hispanic teens and 12 percent of blacks said they had abused prescription medications.
The 2009 study, which surveyed 16,000 US high school students, also found that nearly three-quarters of US teens have used alcohol, more than a third — 37 percent — have used marijuana, 6.4 percent have used cocaine, nearly seven percent have used ecstasy and four percent have use methamphetamine.
“Some people may falsely believe that prescription drugs are safer than illegal drugs yet their misuse can cause serious adverse health effects, including addiction and death,” said Howell Wechsler, director of the CDC’s division of adolescent and school health.
The findings come from the National Youth Risk Behavior Survey (YRBS), which has been conducted every other year since 1991.
The survey monitors six “priority health-risk behaviors,” including drug and alcohol use, which contribute to the four main causes of death of US teens and young adults.
Those causes of death are motor vehicle crashes (30 percent), unintentional injuries (16 percent), homicide (16 percent) and suicide (12 percent.
Other risky behaviors that common among teens and young adults were seatbelt use — one in 10 teens rarely or never wore a seatbelt when riding in a car driven by someone else — and motorcycle helmet use.
More than a quarter of US teens surveyed said they had ridden a motorbike in the 12 months before the poll, but only around a third had worn a helmet.
One in 10 young Americans also admitted to driving a car after drinking alcohol, and 28 percent said they had been a passenger in a car driven by someone who had been drinking.
Nearly one in five students said they had carried a gun, knife or club at least once during the 30 days before they took the survey, and nearly six percent said they had taken a weapon onto school property.
White boys were the most likely to say they had carried a weapon — just over 29 percent — followed by 26 percent of Hispanic boys and 21 percent of black boys.
Around a third of the students said they had been in a physical fight in the last 12 months, and one in 10 had experienced “date violence,” or been “hit, slapped or physically hurt on purpose by their boyfriend or girlfriend,” the study found.
The question about prescription drug use was asked for the first time last year.
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Americans prefer drugs to talk therapy for depression, with nearly 80 percent taking a pill for the condition, Consumer Reports said on Tuesday.
The most popular class of drugs remain the so-called SSRIs such as Prozac, the group found. People found newer, pricier antidepressants less desirable because of side-effects.
Patients benefited just as much from therapy — almost any kind of therapy, the consumer group found in its survey of 1,500 readers.
Those surveyed said they improved just as much after seven or more sessions of talk therapy as if they took drugs and it did not matter if the therapist was a psychiatrist, psychologist or social worker.
Nearly 80 percent of people who had been diagnosed with depression or anxiety were prescribed antidepressants.
Patients were happiest with the selective serotonin reuptake inhibitors or SSRIs, a class that includes Eli Lilly and Co’s Prozac or its generic equivalent fluoxetine;, Pfizer Inc’s Zoloft or sertraline, and Celexa or citalopram and Lexapro o escitalopram from Forest Laboratories Inc.
People complained of more side-effects from serotonin-norepinephrine reuptake inhibitors or SNRIs, a newer, often more expensive class of antidepressants, the survey found.
These include venlafaxine, made by Pfizer-owned Wyeth under the Effexor brand name and Lilly’s duloxetine, sold as Cymbalta.
The survey found a range of side-effects, but the most common one — loss of sexual interest or ability — was less common than in past surveys, the consumer group said.
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