MJA Review January 2011: Should the law on assisted dying be changed?

This is a report I wrote for the Medical Journalist’s Association January 2011 newsletter.  In the above picture taken at the debate I’m the devilishly good looking chap in the front row.

The MJA discussed this contentious issue on November 25 at the Medical Society of London. Four speakers, ‘widely respected for their integrity but divided by their beliefs’, in the words of John Illman, who organised and chaired the meeting, spoke for and against modification of the law on assisted dying. Stephen Ginn reports.

Support for a change in the law came first from GP and MJA member Dr Ann McPherson. She is behind a new group called Healthcare Professionals for Change, set up to challenge the medical establishment’s stance against assisted dying for terminally ill people, and to lobby for a change in the law. Ann’s support of assisted dying is not academic; she herself is suffering from a terminal illness, a situation that, she said, made her ‘really start thinking about death’, and led her to publish an article in the BMJ explaining her views.

Ann told us that, during her working life, she had cared for many terminally ill patients, seeing many die in a way she would not wish for herself. In her view, doctors were ultimately unable to provide humane help for the terminally ill because of their inability to offer assisted dying. She wanted to see assisted dying incorporated into the palliative process. She said that she was only calling for a change in the law for specific cases: for the terminally ill who had clearly stated their wishes when of sound mind.

Baroness Ilora Finlay, professor of palliative care at Cardiff University, opposed this proposal, based on her faith in palliative care and pragmatic concerns about how assisted death decisions would be reached. For her there was a paradox inherent in the debate: increased discussion of assisted dying came at a time when palliative care was improving. She had practical doubts as to the accuracy of a terminal prognosis, the degree of internal and external coercion put upon patients, and the reliability with which patients in distress were able to make clear end-of-life decisions.
She related the case history of a patient who, with what was thought to be only days to live, had requested an assisted death in 1991, but was still alive today. She spoke of ‘societal considerations’, concluding that licensing assisted dying was not only about personal autonomy: ‘To talk about it simply as a choice is to trivialise the enormous decision we take if we change the law.’

Baroness Mary Warnock, who spoke third, is a respected moral philosopher who has expressed strong, sometimes controversial, views in favour of assisted death. She said many people wish for a good death, and some stockpiled the necessary pills, but this was ineffective because most deaths took place in hospital where medication was controlled. She was critical of doctors’ resistance to change. ‘It is simply derogatory to suggest the medical profession has the right to override the longthought- out wishes of the dying,’ she said. In her judgement, if someone wished to die, this moral decision should be taken seriously and no one else should be able to gainsay it.

She thought that the possibility some people might seek assisted death because they wished to unburden their relatives was in fact an honourable motive, to be admired. ‘Why shouldn’t I shorten my life for the sake of my children?’ she asked. Nor did she accept that a change in the law would threaten disabled people, if they made their wishes clear. ‘No one is suggesting doctors make the decision to end a life,’ she said.

Professor Mayur Lakhani, chair of the National Council for Palliative  Care, was the last to speak. In his estimation, ‘the case for a change in the law has not been made’. He reminded us that in the past 10 years little over 100 UK subjects had sought an assisted death at Dignitas, while during the same time period six million had died elsewhere. Although he felt it was important for doctors to facilitate end-of-life care, this did not imply assisting dying. In contrast to the two speakers who spoke in favour, Professor Lakhani thought it was ‘undignified to hasten death’.

The debate was opened to the floor and the audience posed questions and shared personal experiences. Someone asked about withholding medication, and Dr McPherson clarified the difference between giving medication to assist death (illegal) and withdrawing medical treatment (permitted) that resulted in death. There was general agreement that healthcare professionals found themselves as unprepared as lay people for the death of a loved one. Although there was no concluding vote, my impression was that most present were in favour of a change in the law. Debate continued over dinner, some saying that their opinion had been changed by the arguments they had heard.

(June 2018 note – it seems that Healthcare Professionals for Change is no longer an active group)

Mephedrone

mephedrone-crystal

Last week the British Government made clear its intention to ban the currently legal stimulant 2-methylamino-1-p-tolylpropan-1-one also known as mephedrone.

For anyone who lives in a cave, mephedone is a chemical that has stimulant properties when ingested and has recently become very popular on the club scene as a ‘legal high’.  It’s from the cathinone class of compounds.  This class also includes the active ingredient in khat, a plant whose leaves are chewed with great enthusiasm in Yemen.  It’s not difficult to see why mephedrone has purportedly become so popular (no figures actually exist).  It’s been legal up until now so has been extremely easy to acquire without consorting with grubby drug dealers.  Further it’s cheap and the quality of supply is reasonably reliable, unlike illegal equivalents.

Some things about the mephedrone story are quite novel.  Legal highs, which once had a reputation for poor efficacy are now causing a great deal of interest.  The internet is making the drug much more easily available than it would have been under similar circumstances twenty years ago.  The emergence of China’s economy has meant that there is plenty of capacity for manufacture.

What’s less new is this reminder of quite how much we British like getting off our heads.  The stereotyped response from the media and UK Government also comes as no surprise.  The media have focussed their attention on a number of deaths with which mephedrone has been associated, although no causal link has established.  The Government’s actions in banning the drug appear dictated by tabloid furore and based on moral panic and a wish to seem decisive with an election six weeks away.

The use of psychoactive substances of unknown toxicity being used recreationally is a legitimate focus for government concern.  However the advice to ban this drug was provided by an advisory council (The Advisory Council for the Misuse of Drugs) on which three places remain unfilled and prohibition under these circumstances may not be legal.  The ACMD’s report on mephedrone has not been made available for public scrutiny.

The ACMD’s enfeeblement may matter little to the Home Secretary. He appears not to listen to his advisors anyway.  Another AMCD member yesterday over the affair.  He wrote in his resignation letter:

“We had little or no discussion about how our recommendation to classify this drug would be likely to impact on young people’s behaviour. Our decision was unduly based on media and political pressure”

Unfortunately evidence based drugs policy does not exist in this country.  If it did any deliberation of this new drug would surely have been more considered and we’d be able to admit that mephedrone is a side show compared to the damage done to health by alcohol and cigarettes.  It is also inconsistent to ban mephedrone and not khat, which was omitted from the ban presumably to avoid pissing off ethnic minorities.

It’s true that based on its chemical class mephedrone use is unlikely to be without hazard.  However banning it will throw up another set of issues from fatalities owing to adulterated supply to deadly turf wars.  Moderate voices, including the former head of the ACMD, suggest that the most appropriate way of dealing with drugs of unknown toxicity is a ‘class D’ whereby a drug is “quarantined” and sale of it to anyone under 18 is prohibited.  Thereby allowing time for a thorough examination of harms.

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Further reading:

Druglink blog: Media muddle over mephedrone

 

(August 2018 update – I note that khat is now banned)

Smart Drugs

super-smart-drugs

In a debate that’s only going to get more interesting, there were recently calls for universities to consider dope testing to detect the use of ‘smart drugs’ amongst their students.  These drugs, also known as nootropics (an inelegant name; from the Greek roots noo-, mind and -tropo, turn, change) or cognitive enhancers are becoming increasingly widely used.   If the high estimates of use are to be believed then the debate about and reporting of their use has been remarkably restrained, especially when compared to the perpetual state of conflict over cannabis classification and the coverage given to mephedrone.

Cognition enhancement by pharmaceutical means is not actually a new phenomenon; caffeine is in fact a cognitive enhancer with which we are all already well acquainted.   Modern cognitive enhancers were not originally developed with the intention of improving concentration in healthy people.  Methyphenidate (also known as Ritalin) was originally licensed for attention deficit hyperactivity disorder and modafinil for narcolepsy.  Other drugs such as donepezil are licenced for use with people suffering from dementia.  Most of the drugs effect the chemical pathways of neurotransmitters dopamine and noradrenaline in the brain.

The main effects of cognitive enhancement drugs are said to be to improved cognition, memory, intelligence, motivation, attention, and concentration.  Research has found that they improve the performance of healthy people on tests of cognitive function. They are easy to purchase over the internet and appear to display minimal adverse effects.  Most people agree that there are large groups of people for whom prescription of cognitive enhancement medication is extremely appropriate, such as those suffering from neuropsychiatric disorders.  It is their use in the healthy which is likely to become increasingly controversial.

There are of course plenty of drugs that healthy people like to take, but most of the others have been made illegal.  This prohibition been justified on basis of harm to the individual and society, but fear of the consequences of unrestricted hedonism of the proles also plays its part.  This latter issue may tell us why drugs that encourage studious academic application are not causing much of a stir.  Complacency may be misplaced as methylphenidate is a stimulant and does have addictive potential; anyone who works more efficiently has additional time for carousing.

Cognitive enhancers would seem unsuitable to join the ranks of banned substances and are likely to be here to stay.  The current economic situation may necessitate many of us to work into our 70s, and cognitive enhancement may allow older employees to remain more competitive.  They have already thought to have been used to improve the performance of soldiers in Iraq, and the UK Ministry of defence may haveacquired a supply.  Baby-Boomer dementia may lead to high demand and pharmaceutical companies are unlikely to forsake a major market for their products.  The appetite for regulation does not appear to be particularly strong.  The Advisory Council for the Misuse of Drugs’s 2008-2009 report (sadly I can no longer find this online) only mentions that the UK Government has “asked for advice”.

Some people see no problem with using pharmaceuticals to improve on our abilities, whilst others feel that to use substances to gain advantage is unfair.  Anyone who seeks to restrict cognitive enhancement drugs on this basis must answer the charge that unfair advantage is already ubiquitous and generally tolerated in our education system.  Cognitive enhancers could in fact actually correct rather than exacerbate educational inequality.  The argument that students will feel obliged to take cognitive enhancers should all their colleagues be doing so is a stronger one, but restricting the autonomy of all people for fear that it may influence the actions of some is philosophically fraught.  Drug testing students before exams is unlikely to be practical, especially since advantage could be gained by students using cognitive enhancers using revision periods.

Maybe the most pressing concern is that many users are buying their medication off the internet.  This is unregulated and possible drug interactions and side effects go unsupervised.    There are also concerns about the effects of long term use of cognitive enhancers and also of their effects in the young on the developing brain.  One option to introduce some supervision and expert advice would be for medical professionals to more routinely prescribe these medications, although this is unlikely to be something that publically funded health services could underwrite .  Many doctors may feel uneasy about administering medication to the healthy, but it may not be long before we begin to recognise and treat “poor concentration”.

See also:

Cakic V. Smart drugs for cognitive enhancement: ethical and pragmatic considerations in the era of cosmetic neurology. J Med Ethics 2009;35:611–615

Turbocharging the Brain–Pills to Make You Smarter? Scientific American October 2009

 

Energy use in Hospitals

SwitchItOff

Here’s a short piece I wrote for BMJ.com blogs:

According to a recent article in the Guardian newspaper I’ve worked in the two most polluting buildings in the UK. Over the course of one year the Royal London Hospital in Whitechapel was responsible for the emission of 46,218 tonnes of CO2, (rated G). Cambridge’s Addenbrooke’s hospital – in whose A&E department I worked – was the second worst, receiving an F rating. Overall eight of the ten worst polluting buildings in the UK were hospitals which on average emitted 4089 tonnes of CO2 per institution yearly. At the other end of the scale, tourist information centres emit on average 140 tonnes per year.

Hospitals are always going to struggle to be energy efficient. Despite modernisation many are still sprawling behemoths with “legacy” buildings whose origins sometimes stretch over the course of more than a century. Unlike offices, the nature of health care means that hospitals never close and heating costs will be high due to the needs of ill patients.

But still, walk into any hospital department and you’ll find every room is lit at all hours and every computer terminal is on whether or not it is being used. Heating systems are unresponsive and temperature regulation tends to involve opening the windows. This profligacy is hardly surprising as there’s little incentive to conserve* and things like computers aren’t designed to be powered down anyway. Some lights have most likely not been turned off for several years and I’ve only every worked in one place with motion activated lights.

All this will change I hope, although compared with, say, hand disinfecting energy efficiency has a very low profile in the NHS.

* NB: Lest it be thought I am preaching, I am no better than anyone else in this regard.

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Links

NHS sustainable development unit

 

(August 2018 note – they’ve entirely rebuilt the Royal London since I wrote this – I wonder if it’s any better now?)

 

Assisted suicide, Dignitas, Sir Edward Downes

I wrote a post about rational suicide a few weeks ago which attracted a lot of interest, and even spawned a post on another site dedicated to debunking my viewpoint.  This issue and that of physician assisted suicide is rarely far from the headlines and clearly is a subject which excites strongly held opinions.  Most recently conductor Sir Edward Downes and his wife are reported to have died together at the controversial Swiss assisted suicide clinic Dignitas.  For a small organisation it attracts an impressive amount of coverage and its actions may have a substantial influence on future UK legislation.

For many people the discussion of the right to die is a simple one: people should not have to suffer toward the end of their lives and have the right to choose the time and means of their own passing.  This attitude is in line with the increasing emphasis on choice and self determination in our society of which suicide is perhaps the ultimate expression.  There are strong emotions involved and polarized viewpoints, but shouldn’t mean that we shy away from discussion both about philosophical underpinnings as well as more practical aspects.

I am concerned that where assisted dying to become legal in this country doctors would be expected to take a central role and this would sit unhappily with our usual duties.  Psychiatrists would regularly be called up to make difficult assessments about capacity and some of us might find being asked to assist in someone’s death very distressing.  Outside these professional concerns, and more fundamentally, is the message that legalised assisted dying would send out to vulnerable people who are near to the end of their lives.  Elderly people may worry that they are a burden or that their care is costing too much, and with a legal way of reaching a swift resolution may feel a duty to move on.  I cannot see how we could safe guard against this.

Sir Edward was elderly and frail but not terminally ill when he chose to take his life.  Apparently decided that he could not live without his wife and choose to end his life when she was choosing to end hers.  Most discussion about assisted suicide has focused on incurable conditions, which Sir Edward did not have.  Enabling people in similar situations to Sir Edward to take their own lives is disquieting to me.

Addendum 16 July 2009
What I think about Sir Edward Downes’ decision to ‘die with dignity’ Guardian

The lost child

 

There’s an mildly interesting spat in the press at the moment and, being about drugs, is just about within my remit.  Novelist Julie Myerson has written a book The Lost Child, which weaves two stories.  The first is about Mary Yelloly, a girl who died of tuberculosis in the 1820s leaving a  album of precocious watercolours; the second about her son, whom she and her husband threw out of their house aged 18 because of his fondness for cannabis and the ensuing family disruption.

Given that young people in crisis usually do better with more, rather than less, support, can this really have  been the only appropriate course of action?  Teenagers are often pretty foolish (but not me obviously) and most of them see sense fairly quickly.  Mark Twain captures this process nicely:

When I was a boy of 14, my father was so ignorant I could hardly stand to have the old man around. But when I got to be 21, I was astonished at how much the old man had learned in seven years

Myerson said in her initial interviews that her son had consented to be written about, an assertion that he has since disputed.  It’s hard to see the justification for writing about one’s family in this way as Jake, her son, has now had his business widely aired and will have to live with the consequences, whilst someone else takes the literary acclaim.  Myerson has said that her motivation for publication was to help other people in a similar situation, but does this wash?  Or is it that Myserson has fallen for the narcissistic trap that befalls so many celebrities: the notion that they are different to the rest of us and so important that we, their people, cannot possibly not wish to know.

Why I had to write the book about my son’s drug trauma Guardian 1 March 2009
Terence Blacker: Writers should spare their families Independent 3 March 2009
How could any mother throw her son out of the house for smoking dope – and then profit by writing a book about it? The Daily Mail 5 March 2009 (I’ve included this as a link, but for some reason the tone of it makes me feel really cross)

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Update: if I’d have known how big this story was going to be, I probably wouldn’t have bothered posting about it.  Today in the Guardian This is an emergency Jonathan Myerson justifies his and his wife’s decision to publish.  This now has the air of an unseemly family squabble; Myerson’s tone reminds me of Reefer Madness

If anyone else has an opinion about this, please leave a comment below

Psychiatry in the news 3 March 2009

I’m sorry I’m not writing much at the moment, I’ve got another bloody exam, but in the meantime:

Britain’s highest decorated serving soldier has criticised the provision of mental health care for UK soldiers: BBC: Veteran mental care ‘a disgrace’ and Ex-soldier’s battle for mental health 28 February 2009 / Guardian: Minister defends care given to war veterans 1 March 2009 / Independent: Soldiers rally to VC hero’s defence 2 March 2009 / Mirror: Young war veterans are three times more likely to kill themselves than civilians – exclusive / Independent: Dr Walter Busuttil: Some veterans have traumas from four conflicts 28 February 2009.  What interests me the most is that PTSD is always referenced in press and in popular discourse uncritically as if its validity were established beyond doubt, which illustrates how willing British society has become to describe our difficulties in terms of psychological disorders. 

Whilst I am on the subject, it may soon be quicker to list the things that don’t give you PTSD than the things that do.  Here the the Guardian website reports, with the help of the BMJ Strokes can give you post traumatic stress 27 February 2009

AstroZeneca is in trouble with its antipsychotic medication Quetiapine regarding when the company knew this medication increased the risk of developing diabetes.  Nine thousand US citizens are taking court action, saying that they have been harmed by the medication.  The Wall Street Journal reports that there are allegations that the company sought to suppress unflattering studies.  The Times reports on 27 February that concern about AstraZeneca’s conduct over Quetiapine has cost the company 7% of its share price.

In mid February, it was speculated that psychiatrists might recommend that Peter Sutcliffe the Yorkshire Ripper could be realised – Ripper’s fit to be released from Broadmoor – Sun February 17 2009  Since the only UK prisioner less likely to be released is Ian Brady, one wonders why they didn’t save their breath.  And so it turned out:  Yorkshire Ripper Peter Sutcliffe likely to spend rest of life in jail Times 18 February 2009

As a science/medicine blogger, it’s sometimes difficult to find something current to write about that Ben Goldacre at Bad Science and Vaughn at Mindhacks haven’t already covered better than you.  Goldacre has an acute ear for folly, and is an expert at exposing bullshit.  Vaughn at Mindhacks is a powerhouse of intellect.  It’s been phasers on kill for them both against the article Well connected?: the biological implications of social networking Riposte: “Facebook causes Cancer” – Bad Science / Facebook causes marble loss – Mind Hacks.  Also try Age Concern backs social networks but Ben Goldacres blood pressure still rising – Technology blog Guardian 25 February 2009 and Facebook: it’s not neuroscience – Guardian Comment is Free 25 February 2009

Psychiatry in the news January 16

These nice people have mentioned me on their list 101 Fascinating Brain Blogs

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From the Independent, more reasons to keep teenagers at home Ketamine tops cocaine as new drug of choice. The day before they reported that coffee causes hallucinations

The great obesity myth in the Guardian Dr David Ashton argues that it is inappropriate that obese people are psychiatrically assessed before they have gastric banding surgery. He may be right, I don’t know, but the article didn’t point out that he was writing on behalf of his own weight loss company. He is thus bias with an interest in framing obesity as an addiction and anything that gets in the way of his approach (presumably anything psychological or psychosocial) as inappropriate.

And whilst I was looking into obesity, I happened upon a new condition that someone has made up. Orthorexia Nervosa which appears to apply to those people who have an anorexia type disorder and they will only eat healthy food. Sounds to me like you would need a fine pair of scales to distinguish it from common and garden variety anorexia nervosa. But what do I know?

Finally, in a week where there has been speculation about whether there will soon be a test for autism, and whether this will deprive us of the gifted. Anya Ustaszewski writes in the Guardian I don’t want to be cured of autism thanks. This one, as they say, will run and run.

Did anyone else see anything in the newspapers?

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Added 21 January 2009

Read about the ‘coffee causes hallucinations’ headlines on Bad science blog

Suicides following financial collapse

In his classic examination of the 1929 Wall Street crash John Galbraith disabuses us of a widely held notion:

In the week or so following Black Thursday, the London penny press told delightedly of the scenes in downtown New York. Speculators were hurling themselves from windows; pedestrians picked their ways delicately between the bodies of fallen financiers.

In the United States the suicide wave that followed the stock market crash is part of the legend of 1929. In fact there was none. For several years before 1929 the suicide rate had been gradually rising. It continued to increase in that year, with a further and much sharper increase in 1930, 1931 and 1932 – years when there were many things besides the stock market to cause people to conclude that life was no longer worth living (chapter 8).

Galbraith goes on to say that in the two months following the crash the number of suicides in New York were actually comparatively low. There were in fact only two suicides on Wall Street, but these were undoubtedly dramatic. On Nov. 5, Hulda Borowski, a clerk who had been working at a Wall Street stock brokerage house for 28 years, leapt off a 40-story building; on November 16, three days after the market had taken another dive, G.E. Cutler, the head of a produce firm, climbed onto the ledge of his lawyer’s office and similarly plunged to this death.

Thankfully you can’t open the windows on tall buildings these days.

On the day Lehman Brothers was wound up I took a bus through the city and looked up once or twice from my book to see if there was anyone standing on any ledges. To my relief there was no one to be seen. Although vast sums of money have been lost, the crisis we are currently experiencing is nothing like as severe as the 1929 crash. Furthermore, thinking more broadly, predicting suicide is difficult; especially at the primary care level as depressive symptoms are common, but suicide rare. In 1998 Jenkins contended that in the UK every week 10% of 16-65 year olds report suicide depressive symptoms and 1% admits suicidal ideation, but set against this, only 0.01% will kill themselves. Previous attempts and self harm are risk factors for subsequent successful attempts; around a quarter of suicides are preceded by non-fatal self harm in the previous year (Owens and House 1994) and suicide incidence in those who have committed recent non fatal self harm is 1 in 100 over the next year, rising to 1 in 15 during 9 or more years.

The BBC has an interview with the grandson of a man who killed himself during the crash

There is one report of a banker taking his life.

Wall Street Suicides Slate

Time Magazine 80 days that changed the world – 1929

‘Roid Rage

Stop Press:
Discussion (and speculation) about Olympic doping including 100m/200m results
Science of Sport
Steroid Nation

I was listening on the radio just now about UK medal hopes at the Beijing Olympics. It seems we’re doing quite well. Unfortunately I have an anti-talent at sports; at primary school I would only be picked second last if my brother beat me to the wooden spoon. Many years later I lived with a girl and she would watch football on our ancient TV, whilst I sat in my room with the door shut reading ‘The Road to Wigan Pier’.

What’s more my bag is the speculation about the scale of abuse of performance enhancing drugs and their psychiatric sequelae. There are a number of substances used by athletes in order to improve performance. and of these the most common are anabolic steroids.

In the UK anabolic steroids are class C drugs and can be sold only by pharmacists with a doctor’s prescription (most often for hypogonadism). It’s legal to possess or import steroids as long as they’re for personal use, but possession or importing with intent to supply is illegal and could lead to 14 years in prison and an unlimited fine. A UK government source states that in 2003 300,000 steroid tablets were seized.

Use of anabolic steroids in the UK is suspected to be widespread and is not just the preserve of elite athletes; in a survey of 687 students at a British college the overall rate of current or previous use was 2.8% (4.4% in males, 1.0% in females) and, of these, 56% had first used anabolic steroids at the age of 15 or younger. A BMA report in 2002 found that as many as half of the members of dedicated bodybuilding gyms admitted to taking anabolic agents, and that steroid use ran as high as 13% even in some high street fitness centres.

Anabolic steroids are synthetic derivates of the hormone testosterone and allow the user to increase both the frequency and intensity of workouts, in addition to increasing muscle capacity, reducing body fat, increasing strength and endurance, and hastening recovery from injury. Users have varied aims. The majority may wish to enhance their physical appearance in order to achieve a ‘perfect body’, whilst a smaller proportion have experienced physical or sexual abuse, and are trying to increase their muscle size to protect themselves. A further group (possibly between 5 and 10%) includes people who have a form of body dysmorphic disorder (sometimes called ‘reverse anorexia nervosa’), in which they believe that they look small and weak, even if they are large and muscular (Brower et al, 1991).

The steroids are taken orally, or by intramuscular injection and according to a number of regimes – ‘stacking’, ‘cycling’ and ‘pyramiding’.

Misusers of anabolic steroids subjectively report significantly more fights, verbal aggression and violence towards their significant others during periods of use compared with periods of nonuse. Other work has suggested that adolescents who abuse anabolic steroids have nearly triple the incidence of violent behaviour. Clinical presentations include grandiose and paranoid delusional states that often occur in the context of a psychotic or manic episode. Symptoms usually resolve in a few weeks if steroid use is discontinued, although may persist for as long as a month even if adequately treated with antipsychotics.

Steroid users have been shown to have a higher prevalence of cluster B (histrionic, narcissistic, antisocial and borderline) personality traits than community controls . Self report questionnaires and informant histories have been used to retrospectively assess the personality type of anabolic steroid misusers before their first use. Such work suggests that they start out with personalities similar to those of non-using bodybuilders, but develop abnormal personality traits that could be attributed to steroid misuse.

A study involving 41 steroid-using bodybuilders used structured interviews to measure affective symptoms according to DSM–III–R criteria. They identified 5 participants (12.2%) who met the criteria for a manic episode during steroid exposure; a further 8 (19.5%) only narrowly missed the diagnosis. Significantly more participants developed a full affective syndrome during periods of steroid exposure (22%) than non-exposure (5%), and 10 were ‘stacking’ when they experienced manic symptoms.
Symptoms of steroid withdrawal include mood disorders (with suicidal depression as the most life threatening complication), apathy, feelings of anxiety, difficulty in concentrating, insomnia, anorexia, decreased libido, fatigue, headache, and muscle and joint pain. It is difficult to distinguish symptoms that may be physical in origin from those more psychological. Observing oneself to lose muscle mass, strength, performance and confidence after cessation of steroid use has a powerful negative effect on mood, and this may lead to a strong desire to take steroids again.

So, you’re all asking yourself, what’s FP’s advice? Listen to Noam Chomsky:

‘Take, say, sports — that’s another crucial example of the indoctrination system, in my view. For one thing because it … offers people something to pay attention to that’s of no importance; that keeps them from worrying about things that matter to their lives that they might have some idea of doing something about. And in fact it’s striking to see the intelligence that’s used by ordinary people in [discussions of] sports [as opposed to political and social issues

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Sources for this posting:

General

I have leant very heavily on Anabolic androgenic steroids: what the psychiatrist needs to know

This BBC Ethics page has a concise summary of the arguments for and against use of performance enhancing drugs in sport

The talk to Frank site anabolic steroids page

News reports:

Steroids a dangerous new trend BBC February 2 2004

BBC 8 June 2006 Body builder misuse alarm

BBC 11 April 2002 Steroid misuse widespread

Radio programmes (I can’t get these to work, but perhaps you can…)

BBC Radio 4 Diet and Drugs 24 April 2002

BBC Radio 4 The Long View 14 October 2003

Woman’s hour East German doping 7 November 2005