Slashdot Mirror
Those Sleeping Pills May Be Killing You
dstates writes "A recent article in in BMJ Open reports a strong association between the use of prescription sleeping pills and mortality. The study used electronic health records for 2.5 million people covered by the Geisinger Health System to find 12 thousand who had been prescribed sleeping pills and a matched set of controls. Death rates were much higher in the patients taking sleeping pills and the risk increases with age. Kudos to the authors for publishing this in an open access journal."
The people taking the medications might be dying sooner because they have insomnia which is not fixed by sleeping pills easily. The study should not compare with the general populace since they are, by definition, better sleepers than the group that isn't able to get good sleep.
This space for rent.
I couldn't find anything in it to suggest they had actually done a double-blind trial, or even a half-assed blind trial, so their results are purely correlation, and not causation, despite the time they spent talking about causation. They do suggest that 'hangovers' from the drugs are a cause of traffic accidents and such, though, so they at least thought of that.
No mention about mental stability that I saw.
"If you make people think they're thinking, they'll love you; But if you really make them think, they'll hate you." - DM
Drug companies spend more on marketing than they spend on research. Is it any surprise that these stories keep coming up? SSRIs were going to cure everyone's depression. Now we find out that they're addictive, and only effective in the very worst cases of depression. Vioxx was going to usher in a new age of pain relief for arthritis, turns out it killed tens of thousands of people. Hormone replacement therapy was considered essential to prevent osteoporosis in women. Turns out it also causes bone remodeling that makes certain types of fractures even more common. Don't be surprised if we find out in the future that wonder drugs like statins carry risks we haven't been made aware of.
Pharmaceutical companies should not be allowed to market. Not to the general public, and not to doctors either.
Give me Classic Slashdot or give me death!
They're called "statistical studies" and they are used as evidence that a real study should be done, not that there's an actual effect in play. The problem with such studies is that they try their best to select an identical control group, but it's hard to do so. In this case it means matching the 15,000 people on the drug with 15,000 people who also have been diagnosed with insomnia (and for similar reasons), but all elected not to be medicated for it. Then you hope that that decision isn't in any way correlated with other behaviors that might increase or decrease the death rate.
ASCII stupid question, get a stupid ANSI
Most people taking prescription sleeping pills have been fighting sleep disorders for a long time, probably their entire adult lives. Getting terrible sleep for 30 or 40 years will probably increase your mortality regardless of what pills you're taking. Do the same study again only this time instead of looking at what drugs they're on, give them a sleep disorder questionnaire, drowsiness survey, and a sleep study. Then you'll have enough data that I actually care to look at your results.
I'm glad they discovered that death risk increases with age.
Did you ever wonder how they come up with death rates that are less than 100%?
You never really know how close to the edge you can go until you fall off.
Sounds to me like data mining and meta analysis, which is all the rage today.
This study followed their subjects for an average of ONLY 2.5years. They clearly didn't follow them prior to the prescriptions.
Further the "controls" were selected based on superficial categories (age, gender, smoking, body mass index, ethnicity, marital status, alcohol use and prior cancer). Nowhere near a complete list of things that keep people awake at night.
And the causation argument still is the key here, since these drugs (several common hypnotics, including zolpidem, temazepam, eszopiclone, zaleplon, other benzodiazepines, barbiturates and sedative antihistamines) are not usually prescribed for people who have no problem sleeping.
Selection of controls was really the weak point here.
If you are under enough stress, or have some other problem keeping you awake, its as likely those issues are to blame as the use of these drugs. The headlines could just as well have been "Trouble Sleeping may be Killing you".
Sig Battery depleted. Reverting to safe mode.
No. When you do an experiment, i.e. purposely manipulate one variable, you establish a causal connection. Identifying and explaining the mechanism is nice, and establishes the character and directness of your causal relationship. Trials are experiments.
Correlation comes from observational studies where you do not manipulate any variables yourself, you just look for natural or preexisting variation.
A simplified example - if I look at a bunch of people who take sleeping pills and a bunch who don't, and measure how likely they are to die, I get a correlation (maybe) - dying and taking sleeping pills are correlated, but I don't know if dying causes people to take sleeping pills, whether sleeping pills tend to cause you to die, or whether some other factor (being crazy maybe) causes you to both take sleeping pills and die.
If I take a bunch of random people and give some sleeping pills and others no sleeping pills, if the ones I give the pills die significantly more often then I can conclude that sleeping pills cause death (by some mechanism I don't yet know).
None of these is satisfactory as they obviously don't adjust for things you can't measure
Or things you won't measure for whatever convoluted reason.
For example, back pain patients given powerful painkillers recover slower or not at all compared to no painkillers.
Example of false reasoning: I overstrained my back doing some overambitious carpentry alone. Intense pain when sitting or standing, laying on back not so bad. Went to doc, did not accept script for painkillers because I slept on my back just fine and everything I do sitting or standing is not allowed while on pain killers anyway (can't even drive to work if I'm high on painkillers). Also doc is all nervous that I'm dr shopping for abuse meds and really chilled out and got more helpful once he realized it was perfectly clear that I was only genuinely trying to fix my back. blah blah blah. The point is the diagnosis of "back pain" is the same for me and someone who's in agony even when lying down so they need painkillers just to sleep. No great stretch of imagination that the guy in more agony than myself is more F'd up and takes longer to recover (took me only about half a week, but I've heard if you really F up your back it can be semi-permanent, months maybe). Multiply this by 15K and you get a whopper like "taking painkillers means it takes months to recover from back pain diagnosis instead of days"
"Science flies us to the moon. Religion flies us into buildings." - Victor Stenger