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Coming up in today’s programme: Radiotherapy – it’s a crucial part of modern cancer treatment, so why does it get so little attention compared to other therapies like drugs? An injustice one of our listeners thinks Inside Health should address. So we do by visiting the department where she works.
Smoking – we all know it’s detrimental to health but new research highlights just how important it is for patients undergoing radiotherapy to kick their habit. Radiation and tobacco making particularly poor bedfellows.
And we’ve an update on the latest research into using daily low dose aspirin to protect against cancer – so called chemo-prevention.
But first, growing concerns about the widespread use of PPIs – the acid suppressing family of drugs that includes omeprazole and lansoprazole used to treat indigestion, and now among the most prescribed drugs in the world.
Since their introduction in the ‘80s the number of people taking a PPI in the UK has soared from around 1 in 500 in 1990, to over 1 in 10 today. And while NICE advises limiting courses of treatment to weeks in typical cases of heartburn, most people, myself included, take them for months or years. But at what cost to our health? Well, PPIs have now been linked to a number of problems – ranging from fragile bones to an early grave. Dr Margaret McCartney has been looking at the evidence.
So I remember when these drugs were brought in and it was quite exciting at the time, they were very powerful drugs. And because they were very expensive they were mainly prescribed by specialists in hospitals and it took a few years before they were rolled out to people, like me, GPs prescribing them, but of course you don’t get something for nothing and lots of people have raised concerns about some side effects, quite rare side effects so uncommon that you only really pick up in a population, day to day most people put up with these tablets pretty well. So in 2003 there was concerns that people who were taking PPIs long term had a higher risk of a nasty gastric infection called clostridium and since then there was also another concern that people were at higher risk of another infection – pneumonia. In 2006 people started to notice that long term use of PPIs led to a higher risk of lower magnesium in the blood. And then there was a concern that this might lead to hip fractures, to the bones being thinner than you would expect. We’ve also had concern about a type of kidney disease and there’s now been at least two studies saying that there is an increase in mortality, death rates, when people are taking PPIs in the longer term. There’s also been a study that seems to have found an association between long term PPI taking and an increased risk of being diagnosed with dementia.
The one that’s going to catch people’s eye there obviously is that if you take a long term PPI you’re more likely to die earlier.
Well yes, so this was a big study, an enormous cohort study, that was published earlier this year in BMJ Open, looking at a core of army and military service veterans who’d been taking PPIs for a long time. And the researchers found that for every 500 people taking these drugs for a year there was one extra death that they say would not have otherwise occurred. Now there’s big problems with this kind of study, I absolutely think it’s important that we should pay attention to it but what we don’t know is why people were being prescribed them. Were they being prescribed them because they were already ill with another disorder that was then going to cause their demise or were these tablets somehow leading to their death? That’s what we don’t know and we don’t have a study that tells us that we can reduce death rates if we take people off them or if we don’t prescribe them, that’s the problem.
Because is there a plausible mechanism to explain why there might be these associations? You can imagine with things like clostridium difficile – C. diff – that we’re affecting the acidity in the gut and that might have an impact on the bacteria that live there for instance. But people dying early, non-specifically, seems odd.
Well the cause hasn’t been established, nobody really knows. One theory is that it may change the chemical balances in your body, particularly magnesium, which we need for our hearts and for our lungs and for our brains, so it could be something like that. But the bottom line is we just don’t know. And what’s really important to note is that these big cohort studies tell us there’s an association, it tells us there’s a link but it doesn’t tell us what is cause and what is effect.
Looking at your own practic