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News2009March › Heavy metal detox › March 2009

Heavy metal detox

The dramatic evidence of FIR benefits has produced a rash of products-from home-installed FIR saunas to FIR blankets, knee wraps, hairdryers and gloves

The dramatic evidence of FIR benefits has produced a rash of products-from home-installed FIR saunas to FIR blankets, knee wraps, hairdryers and gloves. However, most of the evidence for non-sauna FIR products is only anecdotal, although a study of 542 people using FIR radiation disks embedded in their bedclothes reported health improvements in a majority of users (Int J Biometeorol, 1989; 33: 145-50).

In the UK, a number of allergy clinics, such as the Burghwood Clinic in Banstead, Surrey, routinely use such products for general heavy-metal detoxification-with great success. Nevertheless, far more research is currently needed to clarify how, when and who should use FIR.

New and not so improved

The latest review shows that the 'new' generation of antipsychotics are no improvement over the older drugs.

Drug companies are masterful at convincing the medical profession that their latest products always represent an improvement. For this reason, each new development in pharmaceuticals is usually presented as a 'new genera-tion' of the drug in which they've managed to eliminate all the unwanted effects of the old.

Yet, the latest evidence concern-ing the second generation of atypical antipsychotics exposes these claimed improvements as a sham. A review of 150 scientific studies demonstrates conclusively that the new drugs are no better than the drugs they were designed to replace.

According to a scathing editorial in The Lancet (2009; 373: 4-5), written by two members of the Department of Psychological Medicine at Imperial College London, "As a group they are no more efficacious, do not improve specific symptoms, have no clearly different side-effects profiles than the first-generation antipsychotics and are less cost effective."

Indeed, the ordinarily tame peer-reviewed journal allowed the two authors of the editorial-Drs Peter Tyrer and Tim Kendall-to charac-terize atypical antipsychotics as a "spurious invention" that has been "cleverly manipulated by the drug industry for marketing purposes".

In the review to which Tyrer and Kendall were referring, published in the same issue (Lancet, 2009; 373; 31- 41), German researchers examined 150 double-blind studies of more than 21,000 participants comparing second-generation antipsychotics (amisulpride, aripiprazole, clozapine, olanzapine, quetiapine, risperidone, sertindole, ziprasidone, and zotep-ine) against the earlier generation of these drugs.

The multicentre study, spear-headed by researchers at the Tech-nical University of Munich, found that only four of the 10 reviewed drugs were better than the earlier forms-and only modestly so. The remainders were no more effective than the older drugs, not even in the prevention of adverse symptoms.

Although the drugs caused fewer extrapyramidal effects (uncontrolled parkinsonian-like movements)-a hallmark reaction seen with this class of drugs-the new drugs also caused more weight gain than the first-generation drugs.

More interestingly, the new drugs had no consistent effects, with some sedating patients better than others. The researchers concluded that there was little evidence that these compounds could even be considered a drug class, as many had individual actions.

This study represents a huge blow to the drugs industry, which quickly spent $7.5 billion in the US alone touting an entire class of expensive newcomer antipsychotics as second-generation atypical drugs that were supposed to prevent the unwanted effects of the old drugs.

Perhaps the most worrying aspect of this exercise was its exposure of how the drugs industry stacks the deck to make new drugs look good. In most cases, researchers in individual studies chose to compare the second-generation drug with haloperidol, a high-potency agent notorious for severe parkinsonian extrapyramidal side-effects, rather than with a drug that could be taken at lower doses or works just as well

as the new drug, but with no nasty effects. Comparing any drug with haloperidol was bound to make it look good.

The investigators also found proof of the 'file-drawer effect': evidence that trial reports had been selectively published to keep unfavourable data hidden.

"It is difficult not to conclude that the trials of the second-generation antipsychotics seem to be driven more by marketing strategy than to clarify their role for clinicians and patients," wrote the authors of the editorial.

The only second-generation drug shown to be consistently better was clozapine, first introduced in the 1970s.

Finally, Tyrer and Kendall argue that any so-called benefit of an antipsychotic drug has to be weighed against the fact that every drug in this category is associated with serious adverse side-effects. This observation was borne out by new British evidence showing that Alzheimer's patients given anti-psychotics are almost twice as likely to die prematurely as those not given the drugs (see box below).

Lynne McTaggart

Antipsychotics: the chemical cosh

Dr Clive Ballard, of the Wolfson Centre for Age-Related Diseases at King's College London, and his colleagues randomized 128 Alzheimer's patients to receive one of several antipsychotics-thioridazine, chlorpromazine or haloperidol-or a placebo. The study, published in The Lancet Neurology (Jan 8, 2009 online), found that, after three years, less than one-third of patients on antipsychotics were alive compared with nearly two-thirds of those given a placebo. Over time, the survival rates between the two groups grew even wider, with a death rate over the entire study period that was 42 per cent lower among placebo patients vs those given treatment.

This was the first study to examine the long-term use of antipsychotics in Alzheimer's patients. Although antipsychotics are licensed for use only in patients with schizophrenia, they are commonly given to quiet agitation, delusions, aggression and sleep disturbances in patients with dementia.

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