The effect of tolerance: how drinking can have really killed Amy Winehouse

Amy Winehouse died of alcohol poisoning, according to the British coroner released Wednesday. The singer had a blood alcohol level five times the legal limit for driving at the time of his "death by misadventure", said the report. But the ultimate cause of his death have ignorance: Amy Winehouse was probably not aware of the change potentially deaths of tolerance of alcohol following a period of sobriety.

Obviously, soulful singer had been sober for about a month, before recurring in the days preceding his death. Police recovered three empty vodka bottles in the apartment in London where his body was found. Amy Winehouse had been prescribed a sedative to reduce withdrawal symptoms, but no other drugs were found in his body when she died, and the coroner found that drugs do contribute to his death.

In view of the well-known story of Amy Winehouse to excess, it is probably safe to assume that in the past that she had consumed the same amount of alcohol that killed, probably without experiencing many more pass and wake up with a hangover. Then why was it different this time?

It was perhaps because of recent abstinence from Amy Winehouse. Amy Winehouse had built almost certainly tolerance to alcohol while she was drinking, he loses then in a few weeks of sobriety. Tolerance develops in part because the brain is a very conservative body. When drugs grow some brain systems in one direction, other systems try to balance the effect by pulling back the opposite way.

This means that the same dose of a drug will be, over time, producing a smaller effect. And this increasingly unsatisfactory experience invites to take more and more addicts. Finally, users need to extreme doses to get the same high.

More: Amy Winehouse and the pain of addiction

This is precisely why doctors cannot always determine if any given dose of a "lethal" drug, and coroners may not be able to establish whether it was the cause of death. Heroin addicts often take doses that would kill 10 people re-engineering, and they can do without even feeling high or impaired. (Indeed, methadone treatment is based on the fact that a regular, scheduled product substance dose this predictable tolerance that it does not affect cognitive functioning or skills such as driving.)

However, important periods of abstinence, can eliminate or significantly reduce the tolerance. If you need 10 drink to get drunk before leaving alcohol, then you can slug their bottom before go you account how much stronger the effects are now. It is possible that in the case of Amy Winehouse, such an error was fatal.

Research shows that a higher overdose risk periods is in the early days of relapse, immediately after a period of abstinence. This is true if the substance is alcohol, opioids such as heroin or - as is often the case — a mixture of several drugs. This aspect of the gap of tolerance is an important cause of death by overdose.

PHOTOS: The life and times of Amy Winehouse

Obviously, it is more secure avoid becoming a drug addict or alcoholic in the first place - and if you become addicted, it is certainly preferable to avoid relapse. But the relapse is not to be fatal. Awareness of the problem of tolerance can at least give people a chance to reduce the risk of overdose, so that they can hopefully return to recovery. If you relapse, be aware that the dose that you have taken the day before leave you can now be fatal.

R.I.P., Amy Winehouse.

Maia Szalavitz, is a writer of health at TIME.com. Find him on Twitter at @ maiasz. You can also continue the discussion on the time Facebook page Healthland and on Twitter at @ TIMEHealthland.

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What Does a 400% Increase in Antidepressant Use Really Mean?

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Antidepressant prescribing has risen nearly 400% since 1988, according to data from the Centers for Disease Control and Prevention (CDC). More than 1 in 10 Americans over age 12 now takes an antidepressant, the study finds, and yet two-thirds of those with severe symptoms of depression do not take antidepressants at all.

The new research, led by CDC epidemiologist Laura Pratt, was based on responses from about 12,000 people who took part in a national annual health survey in 2005-08. The findings were released on Wednesday as a National Center for Health Statistics Data Brief.

The findings reflect the paradoxical reality of depression treatment in the U.S. While some observers complain that antidepressants are being handed out like candy, the data show that patterns of prescription generally adhere to what is known about depression prevalence in the U.S. In fact, the research suggests that depression is consistently undertreated.

First of all, depression is common: 9.1% of American adults will suffer from the illness at any given time, according to earlier CDC research. Although the current study finds that antidepressant prescriptions (11%) are more common than depression, earlier data show that about one-fifth of those prescriptions are written to treat conditions other than depression, such as anxiety disorders, pain and menopausal symptoms. That means the "excess" 2% of prescriptions aren't likely to represent overprescribing. Current rates may even reflect underprescribing: the CDC study finds that only one-third of people with symptoms are taking medication.

(MORE: What Salt and Prozac Have in Common)

Further, depression is seen twice as often in women than in men. The CDC found that women were overall 2.5 times more likely to take antidepressants than men. That could mean either that women are more likely to seek help than men (which has been shown in earlier studies) or, again, that women are also being treated for anxiety and other disorders, which skew female too.

In terms of age, depression most frequently hits people between the ages of 45 and 64. And indeed, the CDC found that Americans in this age group were more likely than other age groups to receive prescription drugs to treat it. Nearly 23% of women between 40 and 59 took antidepressants in 2005-08.

Fears of overprescribing have also centered on young people — particularly given data suggesting that some of the medications can increase suicide risk among teens — but researchers found that only 2.8% of boys and 4.6% of girls ages 12 to 17 took antidepressants. According to an analysis of data from the National Household Survey on Drug Use and Health in 2005, about 9% of teens in that age group had experienced a major depressive episode in the previous year.

(MORE: Study: How Chronic Stress Can Lead to Depression)

Perhaps the most concerning finding in the CDC report is that people who take antidepressants are taking them long term. About 60% of people had taken the medications for two years or longer, and 14% had taken antidepressants for more than a decade. On its face, that sounds scary, but since depression can be a chronic disorder, and since research shows that maintenance on antidepressants cuts the risk of relapse in half, long-term use can be appropriate. However, as with the vast majority of medications, there is not much research on long-term effects of the drugs and, clearly, such study is needed here.

The agency did find several areas where prescribing rates failed to follow trends of depression prevalence. One involved race: although blacks and Hispanics are more likely to be depressed than whites, the data showed that antidepressants were taken by 14% of whites, compared with just 4% of blacks and 3% of Hispanics.

Moreover, although depression is much more common among the poor and unemployed, there was no difference in prescribing rates by income.

(MORE:
Even for the Insured" href="http://healthland.time.com/2011/07/21/timely-treatment-for-depression-hard-to-get-even-for-the-insured/">Timely Treatment for Depression Hard to Get, Even for the Insured)

The real story here is that depression is depressingly common in the U.S. and that depression sufferers aren't getting adequate treatment, especially if they are young, poor or members of a minority group. The study also found that less than a third of those taking the medications had seen a mental-health professional within the past year, which means they probably get their prescriptions as their only treatment from a primary-care doctor.

But our overburdened mental-health system isn't a sexy story — at least not compared with tales about heedless, pill-popping hedonists and the antidepressant makers who supply them.

Maia Szalavitz is a health writer at TIME.com. Find her on Twitter at @maiasz. You can also continue the discussion on TIME Healthland's Facebook page and on Twitter at @TIMEHealthland.

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Contagion: Could it really happen?

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21 October 2011 Last updated at 23:39 GMT By Caroline Parkinson Health editor, BBC News website The film shows how panic and chaos spread Hollywood blockbusters are not normally known for their scientific accuracy. So how realistic is the new disaster movie Contagion, which depicts the spread of a killer virus across the world?

'Too late to contain swine flu', 'Sars virus 'mutating rapidly', 'Bird flu fear as mutant strain hits China and Vietnam'.

These are not lines from the film. They are all real headlines from the past decade.

They all relate to illnesses which it was feared could spread around the globe and kill millions.

But, while each has claimed lives, none has become the feared "modern plague".

So how realistic is the depiction of the spread of the fatal infectious disease in Contagion?

According to a one scientist who has already seen the film, the answer is very.

Prof John Edmunds, of the London School of Hygiene & Tropical Medicine, who looks at how best to tackle epidemics of disease, said: "It's obviously a worst-case scenario."

He added: "We can't rule it out as a possibility. And the science in the film was very good."

Likely candidates?

Contagion begins with Gwyneth Paltrow on a business trip in Hong Kong. It then shows how a virus she contracts spreads from person to person as she travels back home to the US and the chain of transmission begins.

Kate Winslet plays one of the scientists who tracks the virus

Prof Edmunds said it was possible to "quibble" about some of the scientific detail and the speed at which some things, like the development of a vaccine, happen in the film, which also stars Matt Damon, Jude Law and Kate Winslet.

But he added a great deal, such as the epidemiology - the investigation of the outbreak - and the involvement of the Center for Disease Control (CDC) was accurate.

"For example the 1918 flu pandemic was at least as severe as what's represented in Contagion.

"And in 2003 we had Sars (severe acute respiratory syndrome) - that was close to becoming a Contagion-like scenario.

"There were just two things that stopped it. People with Sars weren't infectious until they were showing symptoms, and by then they were in hospital. Also the hospitalisation and isolation provision was good."

But he said if those two things hadn't happened and the virus had spread more quickly and to places which didn't have the same healthcare systems, it would have been a different story.

And he said: "Aids is another example of a virus that has spread around the world. The only difference there is the mode of transmission."

When people think about viruses spreading around the world though, they tend to think of flu.

Bird flu - H5N1 - first appeared in 2003. Experts had been predicting that the world was due a major flu pandemic that would kill millions - and bird flu was seen as a likely candidate.

In the event, it has killed about 330 people since then, according to official statistics. But these were overwhelmingly people who farmed birds, or who had them in their own home.

At the moment it is self-defeating. It cannot spread easily between people because it kills its hosts quickly, thereby preventing its spread.

"Bird flu is extremely lethal," says Prof Edmunds. "About half the people with it have died. What has stopped it is it's not transmissible between humans, but it's not beyond the realms of possibility that it could become transmissible."

Where and when?

And then there was swine flu.

Continue reading the main story Sars - 2002-04 - originated in China - 10% of the 8,100 infected died.Bird flu - 2003 onwards. H5N1 has infected 565 people globally, more than half of whom died. Reports in August suggested a mutated strain had been seen.Swine flu - emerged in Mexico in 2009. H1N1 affected millions, and almost 16,000 died.That first emerged in Mexico in 2009. It spread from country to country extremely quickly, because it was a new form of flu - H1N1 - that people did not have any resistance to.

By the end of February 2010, the pandemic had caused 15,921 deaths worldwide. However, by summer last year levels of the virus were falling and the World Health Organization (WHO) was able to declare the pandemic over.

But H1N1 was the prevalent strain of flu in the UK last winter, and it will be present again this year. It is different to most flus, in that it kills previously healthy adults. But for most, it is no worse than a normal flu.

It therefore has the capacity to spread like Contagion's virus, but isn't as likely to be fatal.

Gwyneth Paltrow is the first person affected

So, if Contagion depicts a possible, if worst-case, scenario, what's the most likely real-life candidate?

Well the scientists say it could be any of the things they know about, if they change or mutate in some way.

Prof Mike Catchpole, of the Health Protection Agency, said: "The one we watch particularly is flu. You only need to look back to the 1918 pandemic to see it can cause a huge number of cases - and a huge number of deaths.

"And we just don't know when or where the next pandemic flu will come along."

Or, perhaps more likely, the next global disease could be something that no-one has thought of yet.

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Will we really keep getting fatter?

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29 September 2011 Last updated at 12:32 GMT By Michael Blastland GO FIGURE - Seeing stats in a different way The media constantly warns of an obesity epidemic Pick up a paper and you'll read that people are destined to get fatter and fatter, but is this right, asks Michael Blastland.

Ready to play a data detective game? The case is obesity.

Your task is to decide which way the trend is going. Isn't that obvious? Here's the first piece of evidence.

Exhibit A: What people say about obesity in the UK.

We're in the midst of a fat explosion, basically, would be my summary of the public argument and media coverage, with recent projections that half of UK men will be obese by 2030 - and women not far behind.

That's the top end of expectations, rounded upwards, of course. The bottom end is that about 40% of UK men will be obese by 2030.

Exhibit B: The source of the reports.

The figures came from a series of articles in the Lancet. The authors point out that they are extrapolations of current data and the past might not be a good guide to the future.

Exhibit C: What is the currently available data?

Here in a chart is the latest data for England - not the whole UK, note.

The lines show the percentage of adult men and women who are either overweight or obese, according to the Health Survey for England, as measured by body mass index.

Where do you reckon these wobbly lines are going? Still soaring upwards or turning flat-ish? And if flat-ish, what does that mean? Is it a temporary break in a long-term rise, or a real and lasting change of direction?

Some commentators suggest that this is not a rising tide but flat water.

What's your judgement? Time for more evidence.

Exhibit D: The data for obesity only, excluding the merely overweight.

What do you reckon now? Not such an evident flattening in the last decade but still a slower rate of increase, perhaps. Or still too soon to tell? And then there's the figure for 2009, the latest available, dipping like that. What do we make of it, if anything? It is only one year, after all. Mass weight-loss during the recession?

Whatever the explanation, if even the best-case recent projections are to prove accurate we'll need about a 90% rise in obesity in 21 years, after something a little above flat in the preceding nine years.

Exhibit E: Predictions for obesity made in the past.

These have tended to be on the high side. The one reported here suggested the figure for men would reach 33% by 2010 and 28% for women. That now looks way too pessimistic. But does the past, including past projection errors, provide any guide?

Exhibit F: How the latest projections look compared with the latest data.

Is it plausible that we will go from here to there? I wouldn't rule it out. But I'd also say that it looks as if the 2030 projections assume the recent decade is an aberration. But what do you think?

All right, enough with the exhibits. But you might still say you want more evidence. Good. Like, what's happening among children?

Or you might want international comparisons, or methodological evidence about whether the measurement changed in any way, by altering who's included in the survey or adjusting for non-response, which these surveys used not to do.

And how about the most serious cases of obesity, the morbidly obese or the numbers operated on for obesity by the NHS? Both sharply up in the last few years.

Then of course there's the rest of the UK. Scotland continued to go up a bit throughout the 2000s for adults, not so for children.

But perhaps most interesting of all, since these are average rates of obesity, are there differences of class?

Then it's decision time.

So, what do you think, Sherlock? We're all capable of a bit of sleuthing here, once presented with some data.

So you might say there's a lot of hype in obesity stats. You might say the lines are still mostly on the way up, even if not so fast, and that's bad enough. We're much fatter than we used to be a generation ago, no doubt about that.

But current trends are less clear, despite the headlines, let alone what will happen in the longer term. Or maybe you don't think so.

Go Figure has trouble understanding why data like this can't simply be presented to the public so that we can listen to the experts, look at their figures, then make up our own minds.

The data for England is here.

The current figures for Wales are here, and similar to England's.

And here for Scotland.

Interpreting ups and downs is seldom easy. Even when numbers go clearly in one direction, they tend to go up and down along the way. And whenever there are significant ups and downs and flats and wobbles, the question is how long you need to look before you know which way things are really going.

And this is only the "what" question, as in "what's happening?" We haven't touched the "why?".

The next few years will be fascinating. But watch the evidence, not the headlines. Fat could be in the balance.

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Will we really keep getting fatter?

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29 September 2011 Last updated at 12:32 GMT By Michael Blastland GO FIGURE - Seeing stats in a different way The media constantly warns of an obesity epidemic Pick up a paper and you'll read that people are destined to get fatter and fatter, but is this right, asks Michael Blastland.

Ready to play a data detective game? The case is obesity.

Your task is to decide which way the trend is going. Isn't that obvious? Here's the first piece of evidence.

Exhibit A: What people say about obesity in the UK.

We're in the midst of a fat explosion, basically, would be my summary of the public argument and media coverage, with recent projections that half of UK men will be obese by 2030 - and women not far behind.

That's the top end of expectations, rounded upwards, of course. The bottom end is that about 40% of UK men will be obese by 2030.

Exhibit B: The source of the reports.

The figures came from a series of articles in the Lancet. The authors point out that they are extrapolations of current data and the past might not be a good guide to the future.

Exhibit C: What is the currently available data?

Here in a chart is the latest data for England - not the whole UK, note.

The lines show the percentage of adult men and women who are either overweight or obese, according to the Health Survey for England, as measured by body mass index.

Where do you reckon these wobbly lines are going? Still soaring upwards or turning flat-ish? And if flat-ish, what does that mean? Is it a temporary break in a long-term rise, or a real and lasting change of direction?

Some commentators suggest that this is not a rising tide but flat water.

What's your judgement? Time for more evidence.

Exhibit D: The data for obesity only, excluding the merely overweight.

What do you reckon now? Not such an evident flattening in the last decade but still a slower rate of increase, perhaps. Or still too soon to tell? And then there's the figure for 2009, the latest available, dipping like that. What do we make of it, if anything? It is only one year, after all. Mass weight-loss during the recession?

Whatever the explanation, if even the best-case recent projections are to prove accurate we'll need about a 90% rise in obesity in 21 years, after something a little above flat in the preceding nine years.

Exhibit E: Predictions for obesity made in the past.

These have tended to be on the high side. The one reported here suggested the figure for men would reach 33% by 2010 and 28% for women. That now looks way too pessimistic. But does the past, including past projection errors, provide any guide?

Exhibit F: How the latest projections look compared with the latest data.

Is it plausible that we will go from here to there? I wouldn't rule it out. But I'd also say that it looks as if the 2030 projections assume the recent decade is an aberration. But what do you think?

All right, enough with the exhibits. But you might still say you want more evidence. Good. Like, what's happening among children?

Or you might want international comparisons, or methodological evidence about whether the measurement changed in any way, by altering who's included in the survey or adjusting for non-response, which these surveys used not to do.

And how about the most serious cases of obesity, the morbidly obese or the numbers operated on for obesity by the NHS? Both sharply up in the last few years.

Then of course there's the rest of the UK. Scotland continued to go up a bit throughout the 2000s for adults, not so for children.

But perhaps most interesting of all, since these are average rates of obesity, are there differences of class?

Then it's decision time.

So, what do you think, Sherlock? We're all capable of a bit of sleuthing here, once presented with some data.

So you might say there's a lot of hype in obesity stats. You might say the lines are still mostly on the way up, even if not so fast, and that's bad enough. We're much fatter than we used to be a generation ago, no doubt about that.

But current trends are less clear, despite the headlines, let alone what will happen in the longer term. Or maybe you don't think so.

Go Figure has trouble understanding why data like this can't simply be presented to the public so that we can listen to the experts, look at their figures, then make up our own minds.

The data for England is here.

The current figures for Wales are here, and similar to England's.

And here for Scotland.

Interpreting ups and downs is seldom easy. Even when numbers go clearly in one direction, they tend to go up and down along the way. And whenever there are significant ups and downs and flats and wobbles, the question is how long you need to look before you know which way things are really going.

And this is only the "what" question, as in "what's happening?" We haven't touched the "why?".

The next few years will be fascinating. But watch the evidence, not the headlines. Fat could be in the balance.

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Is Sperm from Redheads Really Less Desirable?

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Redheaded men are probably feeling a little hurt this week in light of news that one of the world's largest sperm banks is up-to-here and has stopped accepting their gametes.

In a cringe-worthy choice of words, the head of the Cryos International sperm bank in Denmark told MSNBC.com that — inasmuch as it relates to sperm donated by redheads — "our stock is about to explode."

Cryos' surplus includes 140,000 doses of redhead sperm, and that's more than enough for now. And by the way, they've got plenty of quintessential blond-haired, blue-eyed Scandinavian sperm too. Unless you're a brown-eyed gent, in fact, don't bother Cryos.

For the record, it's nothing personal against redheads. It's just that Cryos, like any sperm bank, strives to have on hand a diversity of donor characteristics. Scandinavian men tend to have blond or red hair, handed down from their Viking forebears. While that's desirable in places like Scandinavia and Ireland, Cryos supplies sperm to people in more than 65 countries, not all of whom are eager for their offspring to resemble Conan O'Brien.

No offense to O'Brien, but people generally want their children to look like them. Red hair is the exception in this world — striking, for sure, but no more inherently appealing to couples than any other trait.

LIST: Top 10 Redheads

Naturally conceiving couples are at the mercy of their partners' genes, but people who rely on assisted reproduction to have a baby have more choice. In theory, they've got the ability to build a really great version of themselves: choose the right sperm or egg, and it's possible to wind up with a cello-playing, science-fair-winning, future World Cup forward.

It's actually not possible to ensure red hair, however: despite a vial of meticulously selected sperm, that musician-cum-scientist-cum-soccer star may or may not have auburn tresses, depending on a complex interplay between a mutant gene called MC1R, which expresses itself in a build-up of pheomelanin — the pigment that results in redheads.

So why all the hubbub over redheads' sperm?

Perhaps because people get squeamish around the idea of designer babies. "It makes people uncomfortable because it makes them think about eugenics and designing a super race," says Julie Shapiro, a law professor at Seattle University who blogs regularly about how the law defines the concept of family. "What bugs people is that they have to make these choices. It makes them feel like they're shopping for the perfect child as opposed to just having a child with the person you love."

MORE: Where Do (Some) Babies Come From? In Washington, a New Law Bans Anonymous Sperm and Egg Donors

But that's the nature of having options. If there are none, you take what you get. But if the situation dictates selection, you become choosy — Grape Nuts over Cheerios, or brown eyes over green.

When it comes to selecting gametes, reproductive specialists agree that most people do their best to ensure a mini-me: it's already less than ideal to have to use a stranger's sperm; angling to make a future baby resemble you helps make the situation more tenable.

As for the maligned redheads, they can take heart in knowing that at least in the U.S., they're a valued commodity. According to Ty Kaliski, director of operations for Cryos International New York, red-haired donors are an endangered species in his clinic: there are just two.

"That's not a result of us weeding out redheads," Kaliski told CTVNews.ca. "That's a result of redheads not necessarily applying. The redheads we have, they move. Product is not flying off the shelf, but people are buying them."

MORE: Why Surgeons Dread Redheads

Bonnie Rochman is a reporter at TIME. Find her on Twitter at @brochman. You can also continue the discussion on TIME's Facebook page and on Twitter at @TIME.

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HEALTH MANAGEMENT. Guys, Quitting Smoking Makes It Bigger. Really.

Forget Viagra. A new study suggests that for firmer, faster erections, men should quit smoking. The researchers found that men who successfully kicked cigarettes had thicker, more rigid erections and reached maximal arousal five times faster than smokers who relapsed.
The study involved 65 sexually active male smokers who wanted to quit and were willing to have their erections measured in the lab. The participants were enrolled in an eight-week quit program, which involved using nicotine patches (and no other drugs) and counseling, and were brought in for erectile testing three times: before the quit date, halfway through the program, then again one month after the program's conclusion. To test men's erections, the researchers used a device called a penile plethysmograph, which measures changes in circumference and hardness, while the men watched porn.
Thirty-one percent of the men had successfully stopped smoking by the end of the study. Compared with men who relapsed, those who remained nicotine-free had wider, firmer erections and reached maximum sexual arousal (but, importantly, not climax!) much more quickly. These improvements were not seen, however, until after the men had stopped using the nicotine patches.
MORE: Study: A Mysterious Gene Variant That Makes Quitting Smoking Easier
Twenty percent of the participants reported having erectile dysfunction (ED) at the start of the study. By the end, 75% of these men who had quit smoking, no longer suffered erectile problems. But 61% of men with ED who had not stopped smoking also saw improvement in their condition. The difference between the two groups was not statistically significant, however, researchers said.
Despite the fact that the researchers' objective measurements showed improvements in sexual health among the quitters, there was no change in men's own ratings of their sexual functioning, including perceptions of arousal, orgasmic function and strength of erection.
"It might take longer for men to actually notice their level of difference subjectively outside of the lab, which is also dependent on their relationship with their sexual partner," study co-author Christopher Harte, of the VA Boston Healthcare System, told Reuters.
The current study isn't the first to connect smoking with sexual health. Smoking is known to damage blood vessels and hinder proper blood flow, which can also affect erectile function. Just this week, researchers from the Mayo Clinic found that men who made lifestyle changes to improve their cardiovascular health — by lowering cholesterol and blood pressure, losing weight and exercising — also improved their symptoms of ED.
The new findings, published in the British Journal of Urology International, suggest it's not just smoking, but nicotine itself that causes erectile problems, since improvements in men's erections weren't seen until after use of the patch was stopped.
The good news is that doctors may now have a new strategy to help people quit smoking. For many people, the long-term fear of cancer or heart disease isn't enough to motivate them to quit — or, worse, it can backfire by increasing stress and, in turn, the urge to smoke — but the promise of immediate and measurable improvements where it counts might be just the incentive male smokers need.
So, guys, the next time you have the urge to light up a post-coital Lucky, you might stop to think about whether it'll keep you from your next chance to crave one.

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