Tag Archive | Smoking

Giving up EU subsidy: so hard to do

 

Are holidaymakers from the UK still seeing EU-subsidised tobacco growing in Southern Europe?

The EU’s website states that “In the interest of public health, direct tobacco subsidies were phased out by 2010.” But in February this year, UK members of parliament expressed “disappointment at the continuing subsidy…to the tune of some £260 million each year”.

I can report seeing just as much of the large-leaved crop this year in the part of South-West France I have visited every August since 2007, although a friend who knows a different area well says tobacco planting is much reduced.

Readers may remember the EU tobacco subsidy being a big focus of campaigning throughout the 1990’s. It was said that much of the tobacco was too low-grade to be smoked by Europeans, so it was dumped on non-EU countries at a loss, encouraging people on low incomes to become nicotine-addicted. If that is true, then stopping (or greatly reducing) the subsidy has taken a long time.

Tobacco is linked to ADD / ADHD in two ways. Symptoms in teenagers predispose to starting smoking, and also to difficulty in giving up later. This is often said to be due to risk-taking, but some of my patients report big improvements in cognitive function when they smoke. As mentioned two weeks ago, the UK-licensed smoking cessation drug Zyban (bupropion) can be effective in reducing ADD / ADHD features.

Secondly, children of mothers who smoke during pregnancy go on to develop ADD / ADHD more frequently. A recent study suggests this is more of a genetic than a brain-toxicity mechanism (1), but there is a wide range of other evidence which strongly indicates maternal smoking to be bad for the developing foetal brain.

Many people find a Southern European field full of mature tobacco, with white trumpet-shaped flowers rising several feet above the leaves, to be a beautiful thing. But it is a deadly beauty which we seem to be in no hurry to get rid of.

 

 

(1) http://www.ncbi.nlm.nih.gov/pubmed/20413131 

This post appeared late due to problems with technology and organisation

Published at www.DrNM.org.uk on 20th August 2010, and transferred to DrNMblog.wordpress.com on 10th October 2011

“No” to the knife, “Yes” to Ritalin?

 

Obesity surgery has grown in the UK, as it has worldwide. But unless it can be shown that it saves money which could be transferred from elsewhere (diabetes care, for example), less than 5% of eligible patients might receive NHS operations in the next few years.

With couple of internet searches, today I found plenty of advertisements for self-funded surgery, including centres in India and Central America. The demand is clearly huge.

On Wednesday this week Joan Bakewell’s Radio 4 medical ethics programme addressed the previously little-publicised problems with obesity surgery (1). In particular, careful follow-up is needed as banding operations may need to be repeated or redone. For patients who go abroad, continuity of care may be less than optimal if they need to turn to the UK NHS later.

A study published last year (in a Nature group journal) suggested ADD / ADHD may be a significant, and treatable, cause of obesity (2). One third (78/242) of patients in an independent Toronto weight loss clinic were found to have ADD / ADHD, and with treatment they lost 10% of body weight. That is as good as obesity surgery.

More research is of course needed, but I find the idea that some people with ADD / ADHD overeat makes clinical sense. Many of my patients, successfully treated, get on with their lives more effectively, and find they “snack” less. Because the underlying dissatisfaction and discomfort is reduced, so is the need for “comfort eating”.

In my view this treatment effect is separate from the “appetite suppressant” effect, which is often transient anyway, of medications such as methylphenidate and amfetamine.

Interestingly, another large study on obesity, recently published in The Lancet (3), showed good results for a medication combination which included bupropion (available in the UK only as the smoking cessation drug Zyban, but more widely used in the US for years). Bupropion is thought by many developmental disorder specialists to be effective in ADD / ADHD.

I am sure we will see many overweight and obese people in the UK considering whether they might have ADD / ADHD. Surely having assessment and possibly treatment in London is a reasonable thing to try, before flying off for surgery in Cancun or Delhi (4) ?

 

 

(1) http://www.bbc.co.uk/programmes/b00t6zqs#synopsis

(2) http://www.nature.com/ijo/journal/v33/n3/abs/ijo20095a.html

(3) http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2810%2960888-4/abstract#

(4) No disrespect to Mexican or Indian surgeons intended at all. The point is about continuity of care. It also seems possible to me that people with severe ADD / ADHD might have a poor outcome with apparently successful surgery: I understand this is not uncommon.

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