Monday, September 27, 2010

Pediatricians Want to Restrict Ads for Tobacco, Booze, Viagra

US News & World Report

The American Academy of Pediatrics doesn't want children exposed to tobacco ads at all, and wants to limit their exposure to alcohol marketing and advertisements for erectile dysfunction drugs and other prescription medications.

Those are just a few of the recommendations in its new policy statement, "Children, Adolescents, Substance Abuse, and the Media," published in the October issue of Pediatrics.

"Although parents, schools and the federal government are trying to get children and teenagers to 'just say no' to drugs, more than $25 billion worth of cigarette, alcohol and prescription drug advertising is effectively working to get them to 'just say yes' to smoking, drinking and other drugs," wrote the policy's authors.

Every year, more than 400,000 people in the United States die from smoking-related illness, according to the policy statement. And, more than 100,000 deaths can be attributed to excessive alcohol consumption.

The AAP is targeting advertising because it works. Advertising may be responsible for as much as 30 percent of alcohol and tobacco use, the authors say. When Camel cigarettes started an ad campaign using a cartoon camel as its mascot, its market share went from 0.5 percent of teen smokers to 32 percent. And, exposure to tobacco marketing more than doubles the risk of a teenager starting to smoke, the paper states.

Alcohol ads are getting through to younger kids, too. A study of 9- and 10-year-olds found that as many kids who could identify Bugs Bunny could also identify the Budweiser frogs. In another study, 75 percent of fourth-graders could identify a ferret used in a Budweiser advertisement.

The AAP would like to see a ban on all tobacco ads and an end to smoking in movies. If characters are smoking, they shouldn't be glamorized, the statement advises.

Some other highlights of the statement include:

    * Limit advertising and product placement for alcohol in venues where more than 10 percent of the audience are children. Alcohol use in teens shouldn't be portrayed as normal in movies or TV shows, and no one should be shown as being "funny-drunk."

    * The White House Office on Drug Control Policy should conduct anti-smoking and anti-teen-drinking public service campaigns.

    * Drug companies, public health groups and the medical communities should have an open debate on the necessity of advertising prescription drugs.

    * Ads for erectile dysfunction drugs should only be shown after 10 p.m., and they shouldn't be overly suggestive.

    * Schools should try to incorporate media education into their curricula.

    * Parents should limit unsupervised media use.

"Alcohol remains the greatest public health problem, and it remains the most lethal drug for young people. Parents need to understand this, and protect their children," said Dr. John R. Knight, director of the Center for Adolescent Substance Abuse Research at Children's Hospital of Boston. "Advertising glamorizes alcohol and really primes our kids to think they can't have fun unless there's booze."

Knight said prescription drug ads contribute to the idea that these drugs are safe for anyone to take and lead to greater prescription drug abuse in teens.

Of the new policy statement, Knight said he's "proud of the AAP" for taking a stand.

Lori Evans, a psychologist at the New York University Child Study Center, agreed that the AAP recommendations are important. "We know the impact of advertising. That's why advertisers spend money on it. For kids, the images are so vivid and clear that it's a good thing to limit access."

But, she added, "No matter how much we limit access, we still have to watch with our children because we need to know what they're seeing and hearing." For example, she said, if you're watching a football game with your children, you'll likely see beer ads. She suggested that parents point out that beer isn't necessary to have a good time.

Knight's approach is a bit more radical. "I love the Super Bowl and I think they have the greatest ads, but I would not encourage my kids to watch that game. I don't want them exposed to it. Parents have the ultimate power and can vote with their feet by not watching."

If you just can't give up watching the big game, Knight suggests using technology to your advantage: Record the game, so you can fast-forward through the commercials.

Sunday, September 19, 2010

Opinion: Doctor Ignores 12-Step Success

Lexington Herald

Recognizing that Dr. Bankhole Johnson is a renowned authority in the field of alcoholism and addictions, his Sept. 12 column, "Medicine needed to treat addiction," is the ultimate of intellectual arrogance. There are millions of recovering alcoholics and drug addicts living happy and productive lives who could challenge his assumptions.

He, like many academicians, assumes Alcoholics Anonymous doesn't work because there are no long-term controlled studies on the efficacy of AA. There will never be. These studies cannot be accurately performed because it is anonymous, which is one of the very strong reasons AA works. Also, AA is a recovery program and not a treatment program.

I have no problem with Johnson questioning the efficacy of treatment centers; some are good and some bad. I have observed over 32 years that all the good centers get their patients started on a 12-step recovery program.

It is unrealistic to think all patients are going to quit drinking with any treatment. Alcoholism and drug addiction are chronic diseases, subject to relapse, and need lifelong attention to maintain abstinence and healthful living — if they do the 12 steps. Many never get it and die.

I also would challenge Johnson to produce any long-term studies to show that psychiatry and behavioral medicine approaches have proof they work. It also is expensive; AA alone costs virtually nothing.

Many in AA have failed every form of known treatment and finally accept AA after exhausting all available resources. Johnson wants to treat them with a pill. What pill works over the same long-term follow-up he demands of AA?

While Johnson searches for a pill, he should visit Lexington's Hope Center recovery programs and observe the many restored lives and families for hopeless street alcoholics and drug addicts.

Alcoholics need lifelong attention to their problems, and they get that in AA, if they continue. The No. 1 cause of relapse is failure to continue in their maintenance program. These people are destined for death, prisons or institutions without help.

The Hope Center has 100 percent follow-up in our jail recovery program. Those completing the program are on probation, are required to report frequently and are subject to random drug screens.

With seven years of experience, 61 percent are sober, most are working and the return to jail rate has been cut by 60 percent with up to two years follow-up. It is a win-win program for the patients and society.

Fortunately, the University of Kentucky is more understanding and tolerant and has many research studies going on — some involving the Hope Center, Chrysalis House and other AA recovery programs in Kentucky.

They also have many millions of dollars of research into not only advanced neuropharmacology, which is Johnson's field, but many other behavioral, genetic and neuroscientific studies involving advanced neurobiology. This is facilitated by Dr. Carl Leukefeld, who occupies the Bell Chair in Alcoholism at UK and who supports AA because he has seen it work.

There is a real danger publishing a column like Johnson's; it may delay many in seeking help in 12-step programs. For example, a RAND study in the 1970s advocated controlled drinking, causing many to try it.

A study 10 years later of people following that study showed only one was able to control his drinking; over 90 percent had further severe problems with alcohol and 20 percent had died.

I do support Johnson's efforts to study these illnesses and develop treatment. We need more research and understanding of what goes on in the human brain. It should be remembered that much of Johnson's research is necessarily funded by pharmaceutical firms. But when he writes distorted accounts of AA, there is a conflict of interest.

Hopefully he will finally come to see (as do doctors at UK) that 12-step programs have a real place in the treatment of addiction diseases.

Wednesday, September 15, 2010

Thousands of American Pilots Treated for Alcohol Abuse

Malaysian News

At least 292 American pilots have attempted suicide in the past three years.

Another fifteen U.S. pilots have been diagnosed with, or been treated for, schizophrenia.

The shock figures have been revealed by the Boston Herald, quoting figures from the Federal Aviation Administration.

The news follows a serious incident at Boston's Logan International Airport in May when a distraught JetBlue pilot threatened to “harm himself in spectacular fashion” an hour before takeoff.

The Herald's Jessica Heslam's review of FAA medical records for 2008, 2009 and 2010, found that 2,700 pilots have been treated for alcohol abuse, and that nearly half of these have been diagnosed as alcoholics.

A similar number, 1,377 pilots, were found to be abusing drugs, while another ninety four were diagnosed as being drug-dependent.

23 pilots have been treated or diagnosed with post-traumatic stress disorder, while another eighty have suffered major affective disorders, including bipolar disorder, and another two have been diagnosed with paranoia.

The Boston Herald article said the FAA was unable to confirm what number, if any, of the affected pilots had been grounded.

More than half-a-million pilots are certified medically fit to fly in the United States. “The FAA is committed to making sure our nation’s commercial and general aviation pilots are medically fit to fly,” FAA spokeswoman Laura Brown was quoted by the Boston Herald as saying. “We have rigorous medical standards and will not issue medical certificates if the pilot has a condition that would create an unsafe situation for the pilot or passengers.”

Pilots are required to undergo medical evaluations every year. Once they turn forty they are subjected to bi-annual tests.

If a pilot is determined to be an alocholic, he or she is disqualified from flying, and must go through an “extensive” medical re-certification process and post-rehabilitation follow-up program before they are recertified to fly, according to the FAA.

Wednesday, September 1, 2010

Liquor Initiatives Stir up old Dispute

Seattle Times

People who think the state should get out of the liquor business could push it out with two measures on the November ballot. One initiative goes even further, killing Prohibition-era regulations meant to keep alcohol relatively expensive and hard to get.

The battle is starting to look like it did in the 1930s, with free-market advocates fighting against people who view cheap, easily available alcohol as a precursor to increased abuse and violence.

"Both initiatives would make it more convenient to buy alcohol, and I think that's why consumers are so interested. They move in from California and other states, and they're going, 'Why can't I buy a bottle of liquor after 8 p.m.?' " said Jan Gee, president and chief executive of the Washington Food Industry Association, which represents independent, family-owned grocers. Washington has been among the strictest states in limiting access to alcohol, dating back to the end of Prohibition in the 1930s.

Privatize liquor sales

The two ballot measures — Initiative 1100, backed by Issaquah-based Costco Wholesale and other big retailers, and Initiative 1105, crafted by alcohol distributors — would privatize liquor sales in Washington state.

If either passes, the state would close its stores and distribution center.

Initiative 1100 would remove price regulations, allowing retailers to receive discounts based on the quantities of liquor they sell and buy alcohol on credit from manufacturers, practices that have been banned for more than 75 years.

It also would allow retailers to buy directly from manufacturers rather than going through distributors.

Costco has worked for years to try to make alcohol sales in Washington pencil out more like selling toilet paper, trying unsuccessfully in the Legislature and the courts to change the state liquor-control system.

Initiative 1105, the distributor's initiative, would allow retailers to have volume discounts on liquor, but not wine and beer. Under this measure, retailers would still have to buy alcohol through distributors.

Under both measures, the 5,200-plus stores that sell beer or wine in Washington could apply to sell liquor, dramatically raising the number of stores selling liquor from 315 now.

If both initiatives pass, differences can be resolved in the courts or by a two-thirds vote of the Legislature, said David Ammons, a spokesman in the Secretary of State's Office.

Back to Prohibition

The debate is largely economic, but it also reaches deeply into the roots of the American West, when saloons were a divisive issue, seen as public-safety threats by some and engines of economic growth by others.

"For us, 'saloon' is just an old, classy word for a bar," said Dean Gerstein, vice provost and director of research at Claremont Graduate University in California and co-editor of the book "Alcohol and Public Policy: Beyond the Shadow of Prohibition."

Before Prohibition, he said, "for a lot of people, a saloon was a place where guys went to throw away their money so they could come home and beat up their wives, a place where criminal deals were done and people got knifed, and where prostitution was as much what the house did as drinking."

Washington was among 13 states that rebelled against saloons so strongly that they banned alcohol earlier than the nationwide ban in 1920, in Washington's case, six years earlier.

After Prohibition ended in 1933, Washington became one of 18 so-called control states that tried to squelch the profit motive by putting the government in charge of liquor distribution and sales.

It remains one of the most restricted states for alcohol sales, with liquor available only at state stores, most of which close by 9 p.m. Only one-third are open Sundays.

Washington also has markups, taxes and rules that keep prices high, and it bans advertising.

"The noble intent behind things like state liquor stores is so that people are not promoting alcohol like snake oil," Gerstein said.

Idea to limit access

Indeed, it is the rare liquor-store worker who pushes the latest tequila or touts the best scotch for your dollar.

"The system was set up to limit access," right down to the way liquor-store workers are paid, said Rick Garza, deputy director of the Washington State Liquor Control Board.

"If I give a person the same salary whether they sell one or five bottles, you're going to have what we have, a really high 'no-sale-to-minors' compliance rate," he said.

About 95 percent of the time, minors who try to buy liquor in state stores are turned away, Garza said. At grocery stores that sell beer and wine, stings show that minors are turned away 76 percent of the time.

That will change if one of the voter initiatives passes, said Snohomish County Sheriff John Lovick.

"There will be 10 times as many places to buy hard liquor, and that's going to increase the chances of children buying liquor illegally," he said. "The word's going to get around. With every minimart out there selling liquor, they're going to try it."

He does not speak for the department but personally opposes Initiatives 1100 and 1105 because of problems with underage drinking, drunken driving and alcohol-related domestic violence.

The state has a conflict of interest in selling alcohol while also overseeing alcohol laws, said Ashley Bach, spokesman for the businesses behind Initiative 1100.

Over the past 75 years, "the notion of controlling consumption has been replaced with alcohol as an unlimited source of state revenue," he said, pointing out that only 80 of the liquor board's 1,200 employees work in enforcement.

Washington residents drink alcohol responsibly, Bach said, and "should be allowed reasonable access to it."

Per-capita consumption

It is impossible to know how alcohol consumption might change if liquor were available along with wine or beer.

Under the current system, per-capita consumption is about the same as in California, where there are 359 stores selling liquor for every million residents, compared with 48 stores per million in Washington.

That does not mean Washington consumption would remain steady if the number of stores rose, said Jim Cooper, vice president of the Washington Association for Substance Abuse and Violence Prevention.

"If we're selling liquor until 2 a.m., to me there's a natural jump to an increase in crime, violence and automobile deaths, especially in the wee hours of the morning," Cooper said.

He also likes Washington's high prices, which studies show deter alcohol abuse.

The World Health Organization said last year that increasing alcohol prices can reduce alcohol abuse. Even heavy drinkers are sensitive to price changes, it said.

And that is one thing all sides agree on with the new initiatives: They would mean lower prices for consumers, especially on liquor.

As an example, Costco said a 1.75 liter bottle of Maker's Mark Bourbon costs $61.95 at a state liquor store in Issaquah. In Stockton, Calif., Costco charges $33.99 for the same bottle.

A bottle of Absolut Vodka at a state liquor store is $42.95. In Stockton, it's $22.99.