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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."
Bingo, this is like comparing the death rates of people taking heart medications versus people who don't and then claiming the medications are killing the folks when it could be that heart disease is what is killing them and the pills are not 100% effective at all times to deal with the problem.
Also, it has been proved that bad sleep is a killer by itself, so comparing the death rates of people with sleep issues who did and who did not take medications may actually show that not taking sleeping pills might kill you if you have insomnia, which is the exact opposite of what the headline is claiming.
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
A matched set of controls in your example would be people with comparable heart disease who were not given the medixation. It appears that they have done that in this study:
Models addressing potential confounding of mortality association by health status To further address the possibility that hypnotic-associated hazards were due to use of hypnotic drugs by patients with a greater burden of disease, so that elevated risks of death might be attributable to comorbidities rather than to hypnotic medications, we conducted analyses within subgroups of hypnotic non-users and users defined by diagnoses in specific disease classes (supplemental table 7). Allowing for differences in sample size, hazards in subgroups restricted to patients with specific diseases were generally consistent with the overall findings. We also observed no statistically reliable differences in death HR in subgroups constructed to assess the overall burden of disease by stratifying on the total number of comorbidities diagnosed for each patient, and no reliable differences in death HR comparing groups diagnosed with different numbers of comorbidity classes. Whereas the raw death rate of the user cohort was 4.86 times that of non-user controls (table 1), adjustment for all covariates (eg, age, gender, BMI, smoking) with stratification by comorbidities only reduced the overall HR to 4.56 (95% CI 3.95 to 5.26).
Not screaming in terror, like his passengers.
Have gnu, will travel.
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.
The patients did not know they were being monitored (blind.) The doctors/nurses who entered the charts didn't know their patients' data would be used for this research (double-blind.) The people who analyzed the data, however, had everything upfront to poll and draw whatever conclusions they were looking for. "Using a query into the EHR..." "A further query of this subset..." "For each hypnotic user, we attempted to identify two controls with no record of a hypnotic prescription..." Sounds like they need a triple-blind experimental design.