What to Drink While Expecting: Study Says Moderate Booze OK

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June 20th, 2013

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Alcohol isn’t generally the first drink that moms-to-be reach for, but if they do, they may not be doing as much harm to their children as previously thought.

According to a British study, children born to mothers who drank moderately while pregnant did not show signs of balance problems when they were 10; trouble with balance is a good indicator of problems with brain development in utero, the authors say.

The researchers, who published their results in the journal BMJ Open, studied nearly 7,000 ten-year-olds enrolled in the Avon Longitudinal Study of Parents and Children who were born between 1991 and 1992. The children were given three different balance tests, including walking on a balance beam and standing still on one leg with their eyes closed. Those whose mothers reported drinking three to seven alcoholic beverages a week during their 18th week of pregnancy were more likely to fall into the top 25% of performers on the balance exercises compared to those whose moms abstained.

These findings support those of a previous study out of Denmark that reported light to moderate drinking early in pregnancy was not associated with declines in intelligence, attention or self-control in children at age 5. But this study did caution that heavy drinking was linked to negative developmental effects.

Despite the fact that better balance is an indicator of healthy brain development in the womb, the current results don’t necessarily mean that it’s time to rethink the advice that pregnant women shouldn’t drink. Research has shown that drinking can cause physical deformities as well as behavioral and cognitive symptoms in babies, including fetal alcohol syndrome. The scientists in the UK study accounted for other factors that might explain the results of the balance test, including the mothers’ age, smoking and previous pregnancies, and they found that the moderate drinkers tended to have more education and more comfortable socioeconomic backgrounds. These environmental effects, they say, could explain the improved balance results among their children as the youngsters may have benefited from more education, physical activity training and other opportunities that made up for any potential cognitive deficits caused by the alcohol.

The researchers also say that the majority of the mothers in the study (70%) did not drink at all while expecting and only about 25% drank rarely to moderately. About 5% drank seven or more alcoholic beverages a week, and one in seven of these women regularly consumed four or more drinks in one sitting, which the scientists considered binge drinking.

Adding to the possibility that the children’s education and socioeconomic status were compensating for any potential harms from the alcohol, the scientists also studied women who possessed genes that prevented them enjoying alcohol as much. If alcohol had a positive effect on brain development and enhanced balance, these children would be expected to do worse on balance tests, but they performed as well as the other youngsters.

The study doesn’t suggest whether there is a safe level of alcohol consumption for pregnant women, so most experts say the current recommendation that moms-to-be avoid alcohol while expecting is still good advice; there’s no evidence yet that wine is good for the womb.

Opinion: Alternative healing or quackery?

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June 19th, 2013

By Dr. Paul Offit, Special to CNN

It used to be called “fringe” or “unconventional” medicine — or simply quackery. Today, it’s called “alternative,” “complementary,” “holistic” or “integrative.”

And it has moved into the mainstream. Hospitals now have dietary supplements on their formularies (list of stocked medications); offer reiki masters to cancer patients; or teach medical students how to manipulate healing energies.

Forty-two percent of hospitals offered some form of alternative therapies to their patients, according to a 2010 survey of 5,800 facilities. When asked why, almost all responded “patient demand.”

Further, private practitioners encourage megavitamins, dietary supplements, acupuncture, chiropractic, homeopathy and naturopathy.

Although nontraditional therapies can be valuable, sometimes a line is crossed. So how can you tell if your alternative healer is a quack? Here are a few red flags:

The therapist offers medicines that don’t work instead of those that do

Steve Jobs, for example, suffered from a neuroendocrine tumor of the pancreas. With early surgery, Jobs had a 95% chance of recovery. But Jobs chose acupuncture, herbal remedies, and bowel cleansings instead, and died as a consequence.

Homeopaths have recommended their products (which are diluted to the point that active ingredients aren’t there anymore) for treatable diseases such as cancer, malaria, cholera and AIDS.

In 2006, a 6-year-old boy with severe asthma was treated with a homeopathic remedy instead of the bronchodilator that would have saved his life. In Canada, homeopathic vaccines, which have no chance of preventing illness, are worrisomely popular.

Also, naturopaths’ objections to the contrary, many studies have shown that garlic doesn’t lower low-density-lipoprotein cholesterol (bad cholesterol), chondroitin sulfate and glucosamine don’t treat arthritis, and saw palmetto doesn’t treat prostatic enlargement; in each of these cases, conventional treatments are available that actually do work.

Warning: Men’s natural sex supplements may not be

The therapist doesn’t tell you about the dangers of alternative therapies

Alternative medicine is perceived as more natural and less harmful than conventional medicine. But medicine is medicine, and any drug or therapy that has a positive effect can have a negative effect.

For example, at least 86 people have died when acupuncture needles have lodged in hearts, lungs or livers or inadvertently transmitted viruses like hepatitis A, hepatitis B, or HIV. Chiropractic manipulations have killed at least 26 people, virtually all by ripping the vertebral artery in the neck.

Dietary supplements also have unseen harms. For example, kava can cause severe and occasionally fatal liver damage; blue cohosh can cause heart failure; nutmeg can cause hallucinations; comfrey can cause hepatitis; monkshood can cause heart arrythmias; wormwood can cause seizures; stevia leaves can decrease fertility, concentrated green tea extracts can damage the liver, bitter orange can cause heart damage, and Aristolochia, found in Chinese herbs, can cause kidney failure and bladder cancer.

Because dietary supplements and herbs aren’t regulated by the Food and Drug Administration, most people don’t know about these problems.

The therapist makes a fortune off your misfortune

Perhaps no one is more susceptible to quackery than parents of children with autism: a disorder without a clear cause or cure.

Bogus treatments have included ion-exchange machines, lymphatic drainage massage, electrical or magnetic stimulation, Rife machines, hyperbaric oxygen chambers, intravenous immunoglobulins, and stem-cell transplantation. Some of these same therapies are offered for “chronic” Lyme disease and cancer.

Dramatically different disorders, identical cures. All quite expensive and all without any chance of actually working.

Docs should know about kids and alternative medicine

The therapist promotes ‘magical thinking’

Reiki masters who claim they can manipulate healing energies; chiropractors who claim that all diseases are caused by misaligned spines; homeopaths who claim that their highly diluted potions contain even a single molecule of an active ingredient; acupuncturists who claim that healing can only be achieved by balancing yin and yang; or naturopaths who claim that a drug found in nature is different from a drug synthesized by a pharmaceutical company (when they have the exact same molecular structure) are appealing to our sense of magic.

And although the notion of something beyond our level of understanding is attractive, current gaps in medical knowledge aren’t going to be filled by energy fields, acupuncture meridians, or the notion that all things natural must be good for you.

“Isn’t it enough to see that a garden is beautiful,” wrote Douglas Adams in “The Hitchhiker’s Guide to the Galaxy,” “without having to believe that there are fairies at the bottom of it, too.”

Like conventional therapies, alternative remedies shouldn’t be given a free pass. They should be held to the same high standards of safety and efficacy. And where scientific studies don’t exist, we should insist that they be performed. Otherwise, we’ll continue to be susceptible to the worst kinds of quackery.

Complementary and alternative medicine: Evaluate treatment claims

The opinions expressed in this commentary are solely those of Dr. Paul Offit.

Viewpoint: Losing a son to suicide

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June 14th, 2013

The suicide of Dick Moore’s 21-year-old son Barney led the former headmaster to immerse himself in the emotional wellbeing of adolescents. Here he tells Barney’s story and questions whether schools do enough to protect adolescents with mental health problems.

Have you got children? It’s a standard dinner party question, often an area of common ground. But it’s a question that I find hard to answer.

Friends, relatives and teachers all say that our four boys are delightful, but they haven’t half put us through the mill over the last 30 years!

Numerous visits to head teachers’ offices on disciplinary matters (including my own when I was their headmaster), drink, body piercings, dodgy cars and dodgier women, African bandits, police helicopters, South American conmen and any number of calls for help. Is this par for the course for parenthood? Or have we made some ghastly mistakes?

It seems to me that the pleasures generated by children are largely passive – a warmth that gently glows deep within like a large sip of whisky on a cold day – while the pain they provoke is anything but passive. It strikes hard and low (and usually by telephone) and when you least expect it. You’re left breathless, emotionally battered and several years older. But still your love as a parent remains unconditional.

Let me tell you a little about Barney, the third of our four sons.

He was reluctant to enter the world, arriving late and by Caesarean section, bawling as if to say: “Put me back. I don’t want to be here.” He was long, slim and, as babies go, beautiful.

Growing up he was challenged by the new – indecisive, gentle, wilful, kind, but painfully shy. His friends, and there were many, called him “The Gnome”. He was always there, reliable and unassuming, but saying very little.

He could laugh at himself, too, for example at his inability to pronounce the word “bulb”. His brothers teased him about “belbs”, to be rewarded with his infectious grin and chuckle.

Following his 15th Christmas, Barney entered a dark depression where going to school was not an option.

Stubborn, unhappy and uncommunicative, he would not be moved. In the weeks and months that followed and with the support of friends, family, kind doctors and medication, the true extent of his difficulty in coping with growing up – becoming independent and mixing with his peers – became apparent.

A longed-for girlfriend he met on the internet helped him to join the sixth form at the local school. A-levels and a place at university followed. During his gap year he qualified as a master scuba diving instructor and all seemed set fair.

Yet confidence was still a big issue and when he fell deeply in love again, he seemed to retreat from the world at large, devoting his whole self to his beloved.

When she, not unreasonably, wanted to spread her wings, Barney resented the perceived implication that he was not enough. He wanted them to live forever in their own little box. The relationship ended at the beginning of August 2011 and there followed a month of deepening depression and desperation.

Sunday, 11 September 2011, was a beautiful autumnal afternoon. The grounds of the girls’ boarding school where my wife and I lived and worked were bathed in soft, warm sunlight.

Suddenly, the peace was shattered by four police vehicles careering up the drive between the main school buildings. They had responded to our frantic call about Barney who was threatening to kill himself if his girlfriend did not return to him. The police were lovely, bumbling and well-meaning, telling Barney in firm but friendly tones to be more considerate to his parents.

The next day, Barney drove away from us in his little red car. During the five days that followed we received some texts in which he tried everything to cajole us – and especially his mother – to persuade his girlfriend to get in touch.

Eventually, in the early hours of Sunday, 18 September, having told us that he no longer had a family and that his mother was unfit for purpose, he informed us that the final deadline for his girlfriend to contact him was noon.

Monday, 19 September, was unremarkable. At 6pm I was working in the staff room when a colleague poked his head around the door. “Some people are here to see you,” he said quickly.

The people turned out to be a gentle policeman and a very beautiful young policewoman. It’s funny how you can notice such things at such moments. My world tilted.

My wife and I sat down. Barney had been found in a hotel room in Reading. It appeared that he had taken his own life. I remember thinking how sensitively these two people had delivered their terrible message and I apologised to them for their having such a foul job to do.

Continue reading the main story

Warning signs of depression

If you, or someone you know, experience at least four of the following symptoms over a period of weeks, professional advice should be sought, usually from your GP:

  • Decreased energy
  • Appetite and weight loss
  • Restlessness
  • Insomnia/Irregular sleep
  • Difficulty making decisions
  • Tearfulness
  • Persistent sad, anxious, or empty mood
  • Thoughts of death or suicide
  • Changes in mood
  • Feelings of hopelessness or pessimism
  • Feelings of worthlessness or guilt

Twenty months have passed since that awful day. There has been much soul-searching and many tears. Each of us – my wife and I, and Barney’s three brothers – deal with Barney’s death in our own ways. I find the word “death” difficult to dwell upon.

Waves of grief still roll in from time to time and there isn’t a day that goes by that a memory is not stirred, a wistful thought provoked by a smell or a song or a photograph. But we are OK; we have survived and, perhaps oddly, we are able to enjoy life again.

For me, that restorative process has been directly linked to my search for knowledge about the emotional wellbeing of young people. And with knowledge has come some understanding. Not about how Barney’s story may have had a less tragic ending, but about the epidemic of emotional turmoil that can threaten to engulf some young people. About the efforts of some to make a difference. About the apparent lethargy of others in positions to make a difference but who fail to do so.

I can remember my mother and father telling the 15-year-old me that they hoped that my headmaster was correct in his assurance that I would emerge from this “horrid phase”, this “adolescent tunnel”, and that I would become the charming young man they yearned for.

Adolescence, which presents huge and frightening challenges, begins with the onset of puberty but it doesn’t end until as late as 25. It is only then that the part of the brain responsible for decision making, planning and organising, for common sense, catches up with that area of the brain which develops earlier and which, amid contortions of shape and size, is responsible for our developing emotions.

Depression, anxiety, self-harm, eating disorders and suicidal thoughts are now common place among young people.

Seventy-five per cent of mental health disorders originate in adolescence.

The statistics are horrendous:

  • About 13% of sixteen year olds have self-harmed. Why?
  • Suicide is now the most common cause of death – above even road traffic accidents – in men aged 17 to 34. Why?

Too many schools appear to prioritise academic results above the emotional wellbeing of their pupils, without seeming to appreciate that the former rely on the latter.

They won’t admit as much, of course, but sticking plasters don’t work – bolt-on counsellors and one-off training are a drop in the ocean. Real progress requires long-term commitment and a genuine desire to change the culture in our schools, our universities, our politics, our medical services and our homes – not least so that those suffering from emotional distress don’t feel too embarrassed and stigmatised to access help and support.

Distressed young people often need to trust before they will engage. Such trust is no longer conferred by status, by labels such as “father”, or “doctor” or “teacher”. GPs are often the first point of referral. But it is increasingly likely that the GP will not know their patient. If they do, it is a 50/50 call whether they have any mental health training. How, then, can they be expected to earn the trust, the engagement, of a person in an average consultation of 11.1 minutes?

School staff, too, are often overwhelmed by planning and targets and emails and paperwork. Young people need to be listened to too, patiently, regularly and non-judgementally. Parents may try, but the sting of emotional involvement makes such listening difficult.

Some schools have been triggered into action by tragedy – just as I have. But some have their heads stuck firmly in the sand. Some schools have invested in a sophisticated network of preventative measures, and support services – a full time counselling psychologist, a retained psychiatrist, health education specialists attached to each group of pupils, open and structured communication between medical and pastoral staff, and a structured programme of training for all staff.

Too many other schools, judging by their websites and their policy documents, have no such provision and prefer instead to talk proudly of their excellent sports injury rehabilitation clinic.

Regrettably, too many schools are akin to the council who fail to respond to the village campaign for a speed limit outside the local school until a child is killed by a speeding motorist. We need to act before the tragedies happen.

The stiff upper lip was arguably indispensable in the 20th Century. Talking about our emotions may not have helped in times of world war and widespread carnage. But the world has changed. The stiff upper lip is a deformity and it’s causing so much damage.

I implore school leaders, politicians, and parents to remove their heads from the sand and smell the heartache. Life is not wholly about grades even during this, the exam season. It is time to reassess priorities. It is time to talk. It is time to act. It is time to educate. It is time to invest – for there can be no health without mental health.

Life is not about waiting for the storms to pass. It is about learning to dance in the rain – a lesson our Barney didn’t manage to master and which led him to leave the world with more determination than when he joined it.

This piece is based on an edited version of Dick Moore’s Four Thought on BBC Radio 4

Coming out — as a couple

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June 14th, 2013


Between celebratory parades for Pride Month and increased calls for marriage equality, it would seem that, for the lesbian, gay, bisexual and transgendered community, things are indeed getting better.

But what happens if you’re in relationship with a partner who just isn’t comfortable being “out” with his or her sexual identity? Does the desire to keep your sexuality private create tension, or can an LGBT couple still succeed when one person isn’t ready to go public? I recently asked some of my colleagues for their insight on this issue.

“With most of the LGBT couples that I see, both partners are out, but to varying degrees,” said New Jersey-based psychotherapist Israel Martinez, who specializes in LGBT therapy. “One partner may be out with his or her family but not at work, and the other is out in both situations but is shy about holding hands in public, for example.”

That may not always pose a problem for couples, but it can certainly be an issue when one partner doesn’t publicly acknowledge being homosexual at all.

“In my experience, the partner who is more ‘out’ tends to see the partner who is more ‘closeted’ as less emotionally healthy,” explained Gordon Powell, a psychotherapist in New York. “Meanwhile, the closeted partner may feel judged and criticized.”

Such emotions can simmer, creating tension for even the happiest couples. “If the couple is closeted because of one partner, that person often feels guilt, anxiety and fear of abandonment,” sex therapist Margie Nichols added. “And the ‘out’ partner may feel anger and eventually distance and disconnection from the relationship.”

Timeline: The Battle For Plan B

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June 12th, 2013

By Alexandra Sifferlin

On Monday, the Obama administration announced it is ending its fight to keep age restrictions on the morning-after pill. The Department of Justice will no longer appeal the ruling by Judge Edward Korman of the District Court of Eastern New York that overturned Health and Human Services (HHS) Secretary Kathleen Sebelius’ decision to keep the age limit of 17 on obtaining Plan B without a prescription.

Instead, it plans to move forward on making the morning-after pill available to girls of all ages, over-the-counter and without a prescription.

For over a decade, reproductive rights advocates, politicians, the FDA, and Plan B manufacturers have clashed in a back and forth of regulation and restriction with advocates for the pill pushing for the greater availability and opponents arguing for limiting access for girls considered by some to be too young to understand the risks.

Here is a timeline of the key legal moments in the battle to get Plan B over-the-counter:

1999: The FDA approves Teva Pharmaceutical Industries Ltd to market the emergency contraceptive drug levonorgestrel as Plan B, and offer it as a prescription-only drug. At the time, Plan B was two tablets. The first tablet was taken within 72 hours of unprotected sex and another was taken 12 hours later.

2001: The Center for Reproductive Rights and over 70 other public-health groups file a citizen petition to make Plan B available over-the-counter and without a prescription.

2003: Teva files an FDA application to make the drug available over-the-counter. This spurred political conflict over wether the drug should be easily accessible to minors.

2005: The Center for Reproductive Rights files a lawsuit in Brooklyn federal court to force the FDA to respond to their petition. They argue the FDA is holding Plan B to stricter standards compared to other drugs and not embracing evidence.

2006: The FDA denies the Center for Reproductive Rights’ citizen petition. But a few months later, the federal agency gives the OK for  Plan B to be sold without a prescription to women ages 18 years and older. Minors still need a prescription.

2009: U.S. District Judge Edward Korman in Brooklyn rules that FDA acted without good faith in denying the petition, and orders morning-after drugs to be made available to women 17 and older. Korman says the FDA should think about lowering the age and access restrictions.

The FDA also approves Plan B One-Step, which allows women to take only one pill instead of two pills.

August 28, 2009: The FDA approves Next Choice, a generic version of Plan B. Next Choice is also available over-the-counter for women ages 17 and older and with a prescription for anyone younger.

February 2011: Teva files an application with the FDA to move Plan B from “dual label” status–which requires it to be sold under over-the-counter and prescription-drug regulations– to a full over-the-counter status without age limits. This would make the drug easier to buy off the shelves, like condoms and other medications. The FDA has until Dec. 7 to make a decision.

December 7, 2011: After reviewing Teva’s application and available research, the FDA‘s Center for Drug Evaluation and Research (CDER) determined the drug was safe and effective for girls of all ages, and concluded that adolescents were capable of using and understanding the risks of Plan B without their doctor’s aid. In a statement, FDA commissioner Margaret Hamburg says there is adequate evidence that the morning-after pill is for “all females of child-bearing potential.”

But, the FDA ultimately rejects Teva’s application after receiving a memorandum from Sebelius that overruled the recommendation, saying TEVA failed to provide research showing that young girls could use the drug safely. President Obama, backed up Sebelius’ decision, saying, “As I understand it, the reason Kathleen made this decision was she could not be confident that a 10-year-old or an 11-year-old going into a drugstore should be able — alongside bubble gum or batteries — be able to buy a medication that potentially, if not used properly, could end up having an adverse effect.  And I think most parents would probably feel the same way,” according to the New York Times.

December 12, 2011: The FDA dismisses the Center for Reproductive Rights’ citizen petition again [PDF], stating that there is still not enough research on whether users comprehend labeling and usage for the two-dose Plan B version.

February 2012: The Center for Reproductive Rights re-opens their lawsuit against the FDA for its restrictions against morning-after drugs. This time, they also add Sebelius as a defendant for her overruling on the FDA’s decision to make Plan B available over-the-counter in 2011.

April 5, 2013: Judge Korman overturns Sebelius’ decision to have age limits for getting Plan B without a prescription. Korman says the ruling was made in “bad faith and improper political influence.” Writing in his decision he states that, “it is hardly clear that the Secretary had the power to issue the order, and if she did have that authority, her decision was arbitrary, capricious, and unreasonable.”

April 30, 2013: FDA announces that the Plan B morning-after pill will move out from behind the counter and be available for girls ages 15 and older without a prescription. The FDA says the new approval was independent of Judge Korman’s April 5 order, and was for an already pending application from Teva that requested its product be made available over-the-counter for women aged 15 or older. A spokesperson for the HHS told TIME that Commissioner Hamburg briefed Sebelius about the review process and the amended Teva application, and Sebelius felt the new decision met her concerns.

May 1, 2013: The Obama administration announces it is appealing Koman’s order to lift all age limits on buying Plan B without a prescription.

June 5, 2013: The 2nd U.S. Circuit Court of Appeals in Manhattan permits girls of all ages to purchase generic versions of morning-after drugs without a prescription.

June 10, 2013: The Department of Justice announces it will no longer seek an appeal. The federal group alerted Judge Korman that it plans to submit a compliance plan and if the judge he approves it, the Department of Justice will drop its appeal.