Category: Health

Sociological Observations on the UK’s Vaccine Role-Out

The UK has vaccinated more people (proportionate to population) than any other country:

This is probably due to a combination of the following:

  • A successful ‘social policy’ initiative by the UK government – a sustained focus on getting as many people as possible vaccinated in as short a time as possible and the funding to match.
  • Our National Health Service – so having the infrastructure in place already to enable a relatively easy roll-out of the vaccinations.
  • The fact that UK companies are in the front-line of researching and producing the vaccine – so our ‘industrial and knowledge infrastructure’.
  • Possibly the high level of trust people place in the medical profession (not so much in the government).

However, ethnic and class inequalities are still in evidence:

It’s interesting that the UK is so far ahead of the rest of the EU in rolling out the vaccine, so clearly this isn’t just a matter of ‘developed’ countries being better equipped to roll out mass vaccination programmes.

However I think it’s certainly the case that without a functioning Nation State a mass vaccination programme would be much more difficult to roll-out and track.

Ethnic minorities are less likely to have received the vaccine

Lower social classes are less likely to have received the vaccine:

You should be able to apply some perspectives and sociological concepts to analyse why this may be the case – perhaps lower levels of trust in institutions by these groups?

Interestingly India has just started a mass roll-out of vaccines, aiming to inoculate 300 million people by August – I have a feeling they are going to hit their target, despite the much larger number of people and larger geographical area!

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Strategies for Improving Health in Developing Countries

These obviously stem from people’s theories about what the ‘causes’ of poor health are.

Long term economic growth

The first and probably most important point is that there is a broad, if not perfect, correlation between a country’s per capita income and its levels of health, as measured by life expectancy, infant mortality, overall death rates, and incidents of particular diseases. As countries get wealthier, they get healthier – thus increasing economic growth appears to be the best long term strategy for improving health. Theories of how to promote economic growth differs with different theories.

No one demonstrates the relationship between income and life expectancy better than Hans Rosling:

Biomedical Intervention

Currently two of the main global projects are the mass vaccination programme to eradicated polio and the mass distribution of free mosquito nets to populations in Malarial regions.

Improving water sources and sanitation

This is widely seen as one of the most effective means of reducing deaths from diarrheal diseases and involves such things as drilling bore holes to reach underground water sources in rural areas, or treating water in urban areas, as is done in the developed world. Improving sanitation might mean building sewage systems and installing flush toilets. In urban settings, both of these would involve massive infrastructural projects to install. 

Better diets

Many people in the world still effectively die of malnutrition – which weakens the body’s resistance to infectious diseases. Young children are especially vulnerable.

Improving women’s rights and maternal health

The importance of which is illustrated in the ‘Worst Place to a Midwife – Liberia’

Political solutions

Ending Corruption and Conflict – Obviously both of these are a drain on a country’s resources – corruption might mean money does not get effectively spent on developing health services while overt conflict can mean

Providing cheaper drugs

It is Western Pharmaceutical companies which manufacture anti AIDs drugs, and antibiotics, which they then patent and sell for a profit. Eventually other companies make cheaper copies of these drugs, but frequently The World Trade Organisation does not allow the cheap copies to be sold until the original patent has run out – this can be several years. The WTO could put the right to life before the right to Corporate Profit.

Controlling Corporations

Dependency Theorists point out that if Corporations are allowed to make workers work for 12 hours a day in dangerous, toxic conditions, this will have a long term detrimental effect on the health and life expectancy of workers.

Relevance to A-level Sociology

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Theories of Development applied to Health

As a genera rule, people in developing countries suffer from poorer health than people in developed countries – with higher rates of deaths from preventable causes resulting in higher child mortality rates and lower life expectancies.

Theories of development aim to explain why this is the case and what the most effective solutions to improving health should be.

Modernisation Theory

Modernization Theorists would expect health patterns of developing countries to follow those of the developed world in the past. They believe that developing countries are entering the ‘epidemiological transition’ associated with economic development and rising GDP

Before the transition, infectious diseases are widespread and are the major causes of death; life expectancy is low and infant mortality high. With Industrialisation, urbanisation and economic growth come improvements in nutrition, hygiene and sanitation which lead to falling death rates from infectious diseases. After the transition, health improves.

It follows that the best way for developing countries to improve the health of the nation is to focus on industrialization, urbanization and economic growth. Improvements in health should follow.

Modernisation Theorists also argue that targeted aid can play a role in improving the health of developing nations

This can mainly be done through ‘Selective biomedical intervention’ – Such as mass immunization against disease, or distributing vitamin supplements to populations, or handing out mosquito nets.  One of the best examples of this is the work of the Bill and Melinda Gate’s Foundation work on combatting Malaria, the reduction of which has been one the great success stories of the last decade.

The eradication of Smallpox is a good example of this strategy working:

One limitation of using selective biomedical intervention is that theexpense means that it is difficult to maintain, and, where the distribution of mosquito nets is concerned, this may lead to choking off local entrepreneurs, as Dambisa Moyo argued in ‘Dead Aid’.

Dependency Theory

Dependency Theory points out that attempts by developing countries to improve health may actually be hindered by the West

Firstly, if you remember, Dependency Theorists point out that it is exploitation by developed countries that keep developing countries poor and they receive very little income from their dealings in world trade which means there is little money left over for investment in health care. 

Secondly, there is the problem of the ‘brain drain’ from the developing to the developed world. At least one in ten doctors in the west has been poached from the developing world – it is obviously much more appealing for people in Africa and Asia to work in Britain where they can receive several times the salary they would in their native country.

Thirdly, Many African companies have had to pay high costs for pharmaceuticals manufactured by Western corporations. This is especially true of AIDS drugs. Western companies are thus accused of exploiting desperate people in Africa.

Finally, some Transnational Corporations have actually contributed to health problems through selling products that would not be regarded as safe in the West, not to mention polluting in the pursuit of profit. 

Relevance to A Level Sociology

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Sociological Perspectives on the Coronavirus

The UK government today declared that the Coronavirus was a ‘serious and imminent threat to public health‘.

This certainly seems to be justified as the number of UK confirmed cases has recently doubled from 4 to 8, and the virus does seem to spreading in South East Asia and beyond.

There’s no doubt this virus is very contagious and the consequences of catching this virus are severe

Based on it’s R0 score (interesting article that, and worth a read!) scientists believe this viurs is more infectious that SARS or Ebola, so there is a high risk of catching it if you come into contact with someone whose got it.

And given the death toll is now approaching 1000, out of 40000 confirmed cases, the stats suggest that you’ve got a a 1/ 4o chance of dying from it, a chance I wouldn’t like to take!

Measures of control as a response

You’ve no doubt heard of the Chinese authorities putting Wuhan in lock-down, and borders being closed, and people being placed in quarantine on return from China to the UK.

All of this is a great example of the continued power of the Nation State to control people’s lives in response to ‘risks to public health’.

A global threat

It’s obvious by now that this is a global threat with global consequences, especially as people are stopped from moving between countries, as are goods, which means there are possibly sever health and economic consequences.

Apparently it’s having a very negative effect on the global education market, the Chinese are big consumers of education, especially in the UK!

Social media, uncertainty, misinformation and fear

This article in the conversation reports on how rumors about the virus have spread, even in China where there are penalties for reposting non-official content about the virus.

But then there’s the fact that we know we can’t trust the Chinese authorities reports on how many people have contracted the virus – it was the Wuhan province authority underplaying the extent of the virus in the first place which led to its rapid spread.

So despite its very ‘real’ nature, the lack of certainty surrounding its spread of tmakes the Coronavirus a very post-modern phenomenon.

Coronavirus – like the Borg but worse, apparently!

The World Health Organisation is meeting today to decide whether the Coronavirus constitutes an international global health emergency.

The first human case of the virus was found in the Chinese city of Wuhan, but it has since spread beyond into other parts of China and internationally to other countries such as South Korea and Japan.

I listed to an interesting item this morning on Radio 4’s Today programme which featured an interview with David Quammen, the author of Spillover: Animal Infections and the Next Human Pandemic.

Quammen says that the characteristics of this latest virus were predicted by the various health experts he spoke to when he wrote his book, which was 10 years ago. The experts he spoke to said the next major Pandemic would probably have the following features:

  • It would be a single strain RNA virus
  • It would probably come from the Corona family
  • It would be spread through respiratory transmission
  • And possibly from a live market in China

The problem with the single strand RNA virus is that they make a lot of mistakes, they don’t copy directly, the evolve and adapt, which means when the virus transmits from an animal to a human, it can adapt so that it can replicate and then transmit between humans.

NB – that’s the bit that reminded me of The Borg (from Star Trek) – they adapt to Phaser attacks, rendering further attacks impotent – just like the Coronavirus might adapt to treatments in the future, except that virus works inside humans, which kind of makes it more terrifying!

It is also a possibility that it can become more harmful when it mutates, however it could become less harmful – we just don’t know, there is a lot uncertainty.

Relevance to A-level sociology

This is a great example of how we live in a Risk Society – we simply don’t know what the consequences of this virus will be, so we have to put in place extreme measures to deal with it – The Chinese Authorities have put Wuhan into lock-down, shutting transport hubs for example.

It also reminds us about how global problems transcend national boarders – the virus has already spread to other countries, and the World Health Organisation is coordinating a global response.

However, it also maybe reminds us of the importance of the Nation State for dealing with a crisis like this – it’s difficult to see how an effective strategy to stop the spread of the virus could work without a massive power like the Nation State putting in place measures of control.

The challenges of Ebola in the Democratic Republic of Congo

Ebola recently resurfaced in Democratic Republic of Congo, and has now infected more than 2500 people in the Eastern part of the country, near the border with Uganda.

ebola congo 2019.PNG

Ebola is one of the world’s most infectious and deadliest diseases: as of 22nd July 2019 the World Health Organisation reported 2503 cases in this latest outbreak, with 1764 deaths. (Source: Relief Web).

The World Health Organisation first declared an Ebola outbreak in the DRC in August 2018, but the number of cases have increased dramatically since Spring of 2019. This is now the second largest Ebola outbreak after the 2014-16 epidemic in Liberia, Guinea and Sierra Leone, which killed 11, 300.

Health workers have a new vaccine which appears to work to deploy to help keep the disease under control but they face the following barriers to treating people:

  1. There is ongoing conflict in Eastern DRC. This extends to attacks on health care facilities – there have been around 200 such attacks reported which have killed 5 people.
  2. Local people are being displaced as a result of the conflict – at least 300 000 so far, and some of these are heading across the border to Uganda, where there have been some reported cases of Ebola.
  3. There is a local rumor that aid workers are actually infecting people with Ebola because they are ‘paid by the corpse’ – and in a country mired by corruption and conflict, I guess this sounds plausible.

It remains to be seen whether the Ebola outbreak can be kept under control: the ongoing conflict and local suspicions are certainly going to hamper efforts, and it seems aid agencies are going to have to spend a lot of time working with locals and building trust in order to keep things under control!

Relevance to A-level Sociology 

This recent tragedy should be of interest to any students studying the Global Development module in A-level sociology. The case of Ebola in the DRC illustrates the relationship between conflict and health problems and it also shows some of the local challenges Aid agencies face when trying to deliver emergency aid.

Additional Sources 

The Week, 29 June 2019

What is the significance of the ‘increase’ in student suicides?

How doe we explain the recent increase in higher education student suicides? Are there any underlying causes, or is this just a ‘moral panic’?

There has been an increase in the suicide rate among Higher Education students, from 3.8 per 100, 000 in 2006/07 to 4.7 suicides per 100, 000 in 2016/17, according to new data released this week by the Office for National Statistics (ONS).

student suicides.png
Google headlines for ‘student suicide’ search, June 26th 2018

NB this isn’t only the latest data, it is also ‘new’ in the sense that this is the first time that the ONS has published data specifically focussing on ‘higher education student’ suicides, so in this sense I guess it is inherently news worthy, and the release of the data on the 25/06 certainly caused quite a stir in the mainstream news and talk shows following the release, with the main focus seeming to be on ‘what we should do about the problem of increasing student suicides’, and the fact that this is ‘new data’.

However, to my mind, while I appreciate the fact that there is an underlying increase in students reporting mental health issues that seems to correlate with the increase in suicide, I also believe there’s reason to be sceptical about the usefulness of the above data, especially since the ONS itself refers to these stats as ‘experimental statistics’.

Below, I summarise what the ONS data tells us about HE student suicides, and then contrast two sociological approaches to interpreting this data: the first being a broadly ‘structuralist’ perspective which accepts that the data is basically valid and asks ‘why are there more student suicides?’ (which was pretty much the narrative in the mainstream news); and a second, broadly Interpretivist approach which questions the validity of this data, and asks whether or not all of this might be something of a moral panic?

What does the data tell us?

Firstly, there has been an increase in the suicide rate among higher education students if we compare the data from 2006/07 to 206/17

student suicide rate 2017.png

However, although the data appears to have stabilized in the the last three years, the ONS reminds us that these rates are based on such low numbers (95 suicides in 2016/17) that it’s hard to draw any statistical significance from these figures.

Secondly, male students are approximately twice as likely to commit suicide than female students

male female student suicide rates england.png

Between the years of 2001 and 2017, a total 1,330 students died from suicide, of which 878 (66%) were male and 452 (34%) were female.

Thirdly, older students are more likely to kill themselves than younger students

student suicide rate age.png

This actually surprised me a little (note to self about ‘stereotypes’ of suicidal students): higher education students aged 30 or over are twice as likely to commit suicide compared to students aged 20 and under.

Some limitations of the above data

I recommend checking out the publication (link above and below at the end) by the ONS, they mention several limitations with this data: for example, the low overall numbers make it hard to draw any conclusions about the suicide rate with any degree of confidence (statistical significance); and the year on year on year data might not be accurate given delays in recording a death as a suicide, due to inquests taking a long time in some instances (e.g. a suicide which happened in 2016 might appear as a recorded suicide in 2017).

What are the underlying ’causes’ of the ‘increase’ in student suicides?

The mainstream media narrative pretty much took the increase in student suicides at face value, and offered up some of the following possible reasons to explain the increase:

  1. The suicide stats are the ‘extreme ‘tip’ of something of a ‘mental health crisis’ in universities – higher number of students are making use of mental health services, which are under-resourced: universities aren’t giving enough support to vulnerable students who are suicidal.
  2. The increase in mental health problems/ suicide could be due to the fact that university life has become more stressful: there’s more pressure to succeed and get at least a 2.1, and students no longer go to university to have ‘three years off’ (like I did ;)).
  3. Related to the above, mental health problems could be related to the ‘double adjustment’ (my invention that!) students have to go through: they have to adjust not only to the fact that university life isn’t as much fun as its been made out to be (at yer glossy open day), and they have to adjust to the fact that they are just not ‘that clever’ (the later probably applies more to hot-housed privately schooled students, and to those students who are more likely to have had their predicted grades inflated).

A broadly Interpretivist approach to understanding these stats… 

Interpretivists would be much more likely to question the validity of these stats, and thus the validity of the view that there is an increase in higher education student suicides, and the opinion that this is something which we should be concerned about.

There are certainly sufficient grounds to be sceptical about these stats:

  • If you were to compare the three year average for 2002/03 to 2004/05 with the three year average for 2014/15 to 20016/17 the ‘increase’ is much less significant.
  • The ONS itself says you cannot draw any significant conclusions from the small numbers used to derive these stats. And again, they even explicitly refer to them as ‘experimental stats’!
  • The overall number of student suicides is half that of the suicide rate in the general population: surely the headlines should be: ‘”great news, going to university helps lower suicide risk”?

There might also be an argument to made that this is something of a moral panic: it seems to me that the media perpetuate the idea that the typical suicidal student is a 19 year old female, when actually this is atypical – a 30+ year old male student is about 4 times more likely to kill himself.

I also think ‘class’ might come into this: Bristol University (A Russel Group, and thus a very middle class  university) has been in the news recently due to its high suicide rates:

bristol university suicides.png

So, might this uncritical news reporting just really be about stoking a moral panic not so much about the ‘increase’ in higher education student suicides (of which there appears to be no significant evidence), but really about the increase in suicide among our ‘precious’ middle class male students? 

Sources 

 

How do we explain the 500% increase in prescriptions for Cow’s Milk Allergy between 2006 to 2016?

In a recent BBC documentary: ‘The Doctor Who Gave Up Drugs’ Dr Chris Van Tulleken (Dr CVT) set out to answer the above question. Here I summarise this documentary and throw in a few links and additional commentary

You can watch the documentary on BBC iplayer until Late June 2018, although TBH you may as well save yourself 50 mins and just skim read what’s below.

There has been a dramatic increase in prescriptions for children with Cow’s Milk Allergy (CMA) in recent years: A 500% increase in the 10 years to 2016 in fact!

A ‘prescription’ basically means that children with CMA get put on a specialist cow milk free ‘alternative milk’ formula, which costs twice as much as regular milk formula for children, and costs the NHS £64 million/ year.

In this section of the second episode of the series: ‘The Dr Who Gave Up Drugs, Dr CVT asks why there has been such a rapid increase in prescriptions for specialist formula to treat Cow’s Milk Allergy.

He says that as a new parent, he keeps hearing about it, which is odd because only 2% of children suffer from it, and so he’s wondering whether or not the above increase in prescriptions is due to increase in the underlying numbers of children who actually have cows milk allergy (or better detection) or whether there is something else fuelling the increasing public awareness of the condition.

The Normalisation of diagnosing and treating CMA

The documentary also visits one parent who thought her child had CMA when he developed XMA (one of the possible symptoms, but also something which 20% of babies suffer from), she visited her GP, who confirmed he didn’t have CMA. However, when she took her child to hospital for a bump, the pediatrician there noticed the XMA and prescribed specialist formula for CMA.

The child hated it, and so often went to be hungry. It too a visit to a Dr Robert Boyle (in the skeptical about CMA camp) who confirmed the child didn’t have CMA and so normal milk service was resumed.

The worrying thing about the above case is that alternative formula is being pushed on parents against their will, the normalisation of the diagnoses and treatment for a condition which in this case didn’t actually exist.

Health sociology.png

Industry lead education for NHS staff

One of the reasons Dr CVT is sceptical about the increase in awareness and prescription being linked to an actual underlying number of cases of children with CMA is that a lot of the education provided to Doctors about food allergies among children is sponsored by the companies who make alternative, specialist formulas to treat allergies.

To illustrate this point, the documentary visits a training day for NHS staff in Newcastle, aimed at educating staff about food allergies in babies – the event is sponsored by Danone, the company which makes one of the specialist CMA formulas, and what Dr CVT finds is advertising literature (various ‘glossy mags) and product samples alongside proper medical advice.

Another ‘test’ for the involvement of industry in educating about food allergies is to simply Google ‘cows milk allergy’ – which Dr CVT does and finds that most of the advice websites which help parents to self-diagnose their children are run by the companies who make specialist formula to treat the condition.

He also explores the web sites which parents and professionals use to diagnose for CMA, again run by the companies, and finds that the ‘symptoms’ which indicate Cow’s Milk Allergy are pretty much the kind of symptoms which every child has at some point, whether or not they have the allergy – things such as ‘colic’ and ‘vomiting’

Finally, he interviews Dr Adam Fox, who is a consultant  for the ‘Allergy Academy’, sponsored by Danone, and he doesn’t seem able to convince Dr CVT that there isn’t a conflict of interests between the companies who profit from increased diagnoses of Cow’s Milk Allergy providing education on how to diagnose for the condition.

Application to Sociology

There are lots of applications – mainly centering around labelling theory and the power of corporations to shape agendas! Also risk society.

Image Source:

screen capture, BBC from documentary above.

 

Why are we relying more on drugs to treat teenagers’ mental ill-health?

we’re relying more on drugs to treat teenagers’ mental ill-health, but could we be giving out pills to thousands of teenagers which are not only ineffective but actually have severely dangerous side effects.

In a recent BBC documentary: ‘The Doctor Who Gave Up Drugs’ Dr Chris Van Tulleken (Dr CVT) set out to answer the above question. Here I summarise the section of part 2 of this documentary (which deals with teen mental ill health and antidepressants) and throw in a few links and additional commentary.

You can watch the documentary on BBC iPlayer here at least until Late June 2018, although TBH you may as well save yourself 50 mins and just skim read what’s below.

You will also find this post on ‘steemit.com‘ – a most excellent crypto-currency based blogging platform where users get paid in cryptocurrency (steem) for posting, commenting and even just upvoting other people’s work. I recommend you check it out!

Introduction: why are prescriptions for antidepressants in the UK increasing?

The general gist of the documentary is that we’re relying more on drugs to treat teenagers’ mental ill-health, but we could be giving out pills to thousands of teenagers which are not only ineffective but actually have severely dangerous side effects.

The number of British teenagers prescribed antidepressants has almost doubled in 10 years: in 2005, 30 000 teenagers were prescribed antidepressant drugs, increasing to 58, 000 in 2015.

The Increase in antidepressants: a visual representation

Each ping pong ball represents 4 teenagers prescribed antidepressants

2005

increase teenage depression UK.png

2015

teenage depression UK

This increase might be because more people are getting diagnosed and more effectively treated, however it might reflect the fact we are quicker to seek medicalised solutions to ‘depression’, and that these drugs are not effectively dealing with the underlying causes of depression, and maybe this doubling of prescriptions in 10 years is no a long term solution to depression.

A case study of teenage depression

To provide us with a ‘human face’ of depression, the documentary now visits Jess, 15 year old teenager who has been on antidepressants for 8 months and  whose suffered from anxiety since she was a young girl, finds school stressful because she feels trapped (30 odd kids in a class, with everyone close together). She hasn’t been in lessons for 10 months, and may not be doing her GSCEs.

Following counselling, she was put on Sertraline to combat her depression, 100 mg, double the normal dose of 50 mg. We now get the usual trawl through the possible side effects of the drug, and it’s not pretty: clinical trials have shown an increased risk of suicidal behaviour in adults aged less than 25 years, and Jess says she has felt more suicidal since starting the medication.

Interestingly, Jess states a desire to be free of the drugs, while her mother appears more relaxed, saying that there’s evidence that they work, and that her daughter shouldn’t be afraid of the stigma attached to taking antidepressants: the idea of just ‘pulling yourself together’ and coping is outdated.

Research evidence on the effectiveness of antidepressants

Dr CVT now looks at a recent study conducted by professor Andrea Cipriani of the University of Oxford. This study summarised all available evidence of how effective 14 antidepressants are in children and adolescents specifically, (rather than just evidence from adult trials). The basic research question was ‘do these drugs work’ (not ‘how do these drugs work), and they compared the drugs with each other and against the effectiveness of a placebo, a sugar pill.

depression drugs don't work.png

They found that only one drug: fluoxetine, or prozac, was more effective than a sugar pill in combatting depression among teenagers, which is worrying given that around 40% of teenage prescribed antidepressant drugs are on Sertraline. However, there is still a level of uncertainty around the research on the effectiveness on Fluoxetine – because people respond very differently to the drug.

Where Sertraline  there is good evidence that it works for adults, but the problem here is that teenagers brains are wired differently, and professor Cipriani’s research suggests what works for adults may not work for teenagers.

Wilderness Therapy as an alternative means of treating mental ill health

Dr CVT says there’s lots of evidence that being active out of doors is effective in treating mental ill health, especially depression.

To test this out, the documentary now returns to Jess, one month on, who has now had her prescription of Sertraline increased to 125 milligrams, and feels increasingly panicky and has upped her rate of self-harm, and expose her to a ‘therapeutic intervention’, in the form of the ‘Wilderness Foundation’ which uses activities in wild spaces and one on one counselling to help teenagers suffering from mental ill-health.

Research conducted by the University of Essex suggests that 83% of the kids on the charity’s leading scheme have successfully gone on the further education or full time employment.

Jess gets taken along to the the Wilderness Foundation for a day to do ‘stuff’ outdoors, and we get treated to footage of Jess in an extremely pleasant wooded glade sparking a fire to life and putting up a hammock. Wilderness therapy is apparently well established in the USA, and it certainly seems to work for Jess, who spends 6 hours out of doors.

Do antidepressants ’cause’ an increase in teen suicides?

The documentary also visits one mother, Sarah, whose daughter Rachel killed herself within 11 days of an increase in her dose of Sertraline.

Rachel’s story seems similar to Jess’: she found secondary school difficult and hit a wall at GCSEs, finding it difficult to cope with the stress. After a visit to the Child and Adolescent Mental Health Services, she was prescribed fluoxetine and experienced the following side effects after 2 weeks:

  • Violent thoughts
  • Disturbing dreams
  • Bodily shaking
  • Nosebleeds

Rachel tried to hang herself at one point, and after several months of this, she was prescribed a different drug: Sertraline. She actually wanted this herself, she wanted something to work, but within 11 days of an increase in her dose of this second antidepressant Rachel killed herself.

Rachel’s mum Sarah doesn’t blame the Doctors as they were just following the approved ‘pathways’ to treating mental illness laid down in the formal guidelines, she blames the system which seems to based on inadequate knowledge of the harmful side effects of these drugs.

NB – we cannot actually prove a causal link

Could antidepressants actually be harming our children’s health?

Drug trials should not only tell us if the drugs are effective, they should also tell us if the drugs have any harmful side effects. The problem is that many of the drugs trials are run by drugs companies, with a vested interested in making their drugs look both effective and sage.

Dr David Healy is one of the few people to have done independent research into the effectiveness and safety of antidepressants with the raw data provided by the company. He argues that we need to see the raw data to uncover how the drugs affect individual patient – and this raw data can run into several reams of paper if there 100s of people in a trial.

It is extremely rare for drugs companies to release this original data, in fact, it’s only happened once when in 2004 legal challenges were made against claims made about the effectiveness of Seroxat, and antidepressant manufactured by the pharmaceutical company GlaxoSmithKline.

Dr David Healey analysed this original data and found that the claims made in the original 10 page article summarising the findings of the trials which claimed the drug was not only effective but also sage, were basically false, with Healey’s team finding that not only did the drug not work, but that the number of teenagers who developed suicidal thoughts following the use of the drug was three times greater than intimated in the original study, in which this side effect was described as ‘some teenagers becoming more emotionally labile’.

This research actually led to GlaxoSmithKlein being fined $3 billion in penalties and fines for health care fraud.

Dr David Healy says that in between the raw data and the sometimes misleading ‘main articles’ on the research findings published by the drugs companies, there are ‘company reports’, and even if we dig into these, there is cause to be concerned over the safety of many of antidepressants.

The rest of the documentary

The documentary returns to Jess, who has kept up her therapy for 6 months (I think it’s 6 months, it’s not that clear) and after some ups and downs (including one suicide attempt at school) the therapy seems to be working – she gets taken through a process of gradually having things she finds difficult added into the programme, and eventually manages to cope with going shopping and buying something (progress for her, in dealing with crowds).

After 6 months, Jess even manages to return to school and sit her mock GCSE exams, and at the very end of the documentary, we even see her at her 16th birthday party on stage singing, in front of friends and family.

The documentary also pays the standard visit to the Clinical Lead for Child Mental Health Care Services who reiterates that all Doctors are doing in prescribing antidepressants is following NICE guidelines, which are based on the best available evidence, however, Dr CVT’s point is the best available evidence is shaky at best.

NICE refuse to be interviewed, but do say they are reviewing their guidelines

Conclusions

The whole point of the documentary seems to be to inform us of the uncertainties surrounding the effectiveness and safety of many of the antidepressants we are increasingly prescribing to our teenagers.

Dr CVT suggest we are far too trusting of the research done by drugs companies, and we shouldn’t allow them to control the information we have about these drugs… we should be much more sceptical, and in the meantime, we should pursue alternative treatments such as wilderness therapy and mindfulness which are unlikely to cause harm.

K.T.’s Commentary

One thing I want to pick up on his the ‘social causes’ of Jess’ anxiety. Basically, it seems she just hates the crowded environment of the school, along with all the stress of testing that goes along with it….

Personally, I get this, it has exactly the same effect on me as a teacher.

I also get the ‘wilderness therapy’ as a solution  – I love being outdoors, walking: it’s just that I don’t need anyone to structure it for me, I also don’t really regard it as ‘therapy’ – rather it’s just ‘doing something enjoyable’.

It appears to me that Jess’ depression is pretty much 100% socially induced – by the school system. Get her back to nature, and doing something ‘naturally’ empowering, and she’s O.K, as she is singing in front her friends and family – surely it’s the social context that’s the problem?

It’s not rocket science is it! What needs to change here is society, although that’s easier said than done.

I also have to admit being a bit taken aback by the size of that GSK fine – $3 billion for health care fraud, that’s something I’m going to have to come back to later!

Sources/ find out more!

Disclaimers/ health advice provided in the documentary

Doctor Chris Van Tulleken reminds us that it might be dangerous to stop taking antidepressants suddenly and that any change of dose should only be made with medical supervision.

 

Indicators of Health in International Development

Health is a crucial indicator of development – The International Aid community believe that health is the most important thing to spend money on – with around 90% of the aid budget being spent in this area.

Four basic measurements of health in development

It is possible to classify these indicators differently, but for the purposes of A-level sociology, I think four are sufficient:

  • Life Expectancy – The average number of years people are expected to live in a country (which if you remember makes up one of the three indicators of the Human Development Index).
  • Child Mortality – The number of children which die before their first birthday (measured per thousand).
  • Maternal Health – The number of women who die as a result of pregnancy or childbirth. 
  • Disease indicators – The proportion of the population that has AIDS, Malaria, diarrheal and other infectious diseases.

On all of the above four ‘indicators of health’, things are generally worse in lower income countries than higher income ones.

Life Expectancy

in the UK average life-expectancy is 81.25 years and while this has been reduced by one year due to coivd-19). It is still far better than in the poorest countries on earth. According to statistics from Our World in Data Life Expectancy in Nigeria is 54.7 years, and in neighbouring Central African Republic it is 53.3 years.

Child Mortality

According to the World Health Organisation substantial global progress has been made in reducing child deaths in the last three decades. Since 1990, the global under-5 mortality rate has dropped by 59%, from 93 deaths per 1,000 live births in 1990 to 38 in 2019.

However, Sub-Saharan Africa remains the region with the highest under-5 mortality rate in the world, with 1 child in 13 dying before his or her fifth birthday. Nigeria and India alone account for almost a third of all deaths.  Half of all under-five deaths in 2019 occurred in just five countries: Nigeria, India, Pakistan, the Democratic Republic of the Congo and Ethiopia.

Maternal Health

According to the World Health Organisation in approximately 295 000 women died from preventable causes related to pregnancy and childbirth, equivalent to almost 900 per day.

Women die from complications such as severe bleeding (mostly bleeding after childbirth), infections (usually after childbirth), high blood pressure during pregnancy (pre-eclampsia and eclampsia) complications from delivery and unsafe abortions.

86% of these preventable deaths were in Sub-Saharan Africa and young adolescent women aged 10-15 are especially at risk of dying maternal related deaths.

Disease indicators

In developing countries, the main causes of death are:

Most of the above causes of death are preventable and linked to poverty, poor nutrition and low standards of maternal care.

The main cause of death ‘neonatal conditions’ is clearly related to the relatively high child mortality rates and poor maternal health in low-income countries.

Lower Respiratory Infections – means mainly pneumonia, a complication which can develop from having the flu if you have a more immune system, in turn due to a poor diet.

Diarrhoeal diseases are linked to poor water and sanitation.

Heart Disease and Stroke are the main causes of death in high income countries, so the fact that these are increasing (kind of ironically) is a sign of economic development taking place!

Progress in improving health…

It’s worth noting how much progress has been made on improving health since the year 2000 and the start of the Millennium Development Goals.

In 2015 the main causes of death were:

  1. Lower respiratory infections11.3%
  2. Diarrheal diseases8.2%
  3. HIV/AIDS7.8%
  4. Heart disease 6.1%
  5. Malaria 5.2%
  6. Tuberculosis 4.3%
  7. Prematurity and low birth weight 3.2%
  8. Birth asphyxia and birth trauma 2.9%
  9. Neonatal infections 2.6%

Note how today Malaria and HIV have fallen down the league tables and Heart Disease and stroke, both diseases associated with longer life expectancy, have entered the top 10!

Relevance to A-level Sociology

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