Month: October 2020

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Are we as logical as we think?

We like to believe we always think logically, but sometimes we fool ourselves or others trap us with faulty logic. This is so common, that philosophers have categorized these gaps in our reasoning and named them to help us recognize when our logic has failed us.

Here are 8 types of failed logic, along with the interesting names they have been assigned:

  • 1. Slippery Slope – Tying a mild negative consequence to a similar but more extreme one and arguing that one will lead to the other. Example: Using marijuana will lead to use of harder drugs and eventually addiction, crime and jail. Like alcohol, there has never been any evidence produced to show that using marijuana socially results in increased risk of drug addiction and its consequences. In Canada, this is reflected in changes in our marijuana laws in recent years. Decriminalization of simple possession of marijuana has meant a reduction in criminal charges that can have a long-lasting detrimental effect on a person’s future, but this was blocked for years by slippery slope fallacies.
  • 2. False Dichotomy – An either/or set of options is presented as if only these 2 possibilities exist, when there are really many more options. “Either you’re with us or against us” is a classic false dichotomy – a person can be partially for or against or just not care! This is also a type of logic fallacy people use against themselves in negative self talk: “If I was just better/smarter/worked harder, I’d make fewer mistakes and be more successful.” Really…smart and hard-working people make mistakes too but, perhaps, may be more likely to learn from them and avoid putting themselves down.
  • 3. Begging the Question – The argument relies on itself to explain its reasoning, also called Circular Reasoning. “My father/husband/politician knows what’s best for me because he told me he always knows what’s right for me, and he’s always right.” You’re right because you say you are right… Yeah, right!
  • 4. Red Herring – Using an argument that seems relevant but really isn’t, also referred to as a Smoke Screen. The argument is designed to mislead or distract, and is often used when the first argument didn’t work. “When you tell me I should eat healthier and exercise, that says to me you think I’m fat. I like myself the way I am, and more people should have better self-esteem.” This fallacy is often used in politics to avoid answering a question…just keep talking and segue to something completely unrelated while no-one notices…
  • 5. Appeals to authority, pity or the “majority” – Using an argument that completely skips logic and, instead, appealing to an outside influence/source that feels/sounds resonant but really isn’t. It seems we’ve been hearing a lot of this faulty logic recently:
  • a. Authority – “The politicians say it’s true so it must be.” If it’s a science issue, we need to listen to the scientists.
  • b. Pity – “I know we need to follow public health precautions, but we’re just too tired of all these restrictions.” Is fatigue really a reason to do something experts tell us is dangerous?
  • c. Majority – “Everyone I know says masks/vaccines are dangerous, so it must be true.” Again, science and experts say otherwise…
  • 6. Ad Hominum Fallacy – When someone points out you’re wrong and you can’t think of a way to defend yourself, so you just insult them instead. This one is also popular in politics – it’s so sad to see personal attacks that have nothing to do with the issues that really concern voters. These fallacies distract from discussion of the issues voters should be learning about.
  • 7. Straw Man Fallacy – Substituting a distorted, exaggerated or misrepresentative version of the argument to make it easier to attack while not actually addressing the original topic. “I think we should spend more money on public health during this pandemic.” “Don’t be ridiculous – we can’t spend all our budget on public health.”
  • 8. Correlation is Not Causation – This is the most important fallacy of all to know about and probably the most often missed. Just because 2 things occur together doesn’t mean one causes the other. For example, heavy smoking can cause fingers to become yellowed, and smoking is associated with lung cancer. Therefore, one could mistakenly reason, yellow fingers cause cancer because the same person often has both. Sound ridiculous? Yes, but we too often see this logic used in science. Here is one: High cholesterol is believed to be a contributing cause of heart disease, and heart disease and stroke occur through common mechanisms; therefore, high cholesterol is cited as a risk factor for stroke even though no studies have proven this is true. Interpreting an association or correlation as a cause is also rampant in diet studies. How many times have we heard that eggs, for example, are bad for us one week then that they are part of a healthy diet the next?

What to do?

So, how do we avoid these errors in logic or refute them when used against us in a discussion? The first step is to recognize them when they occur. Calmly call out the person using the fallacy and bring the discussion back to the original argument. “It seems you don’t have a response to my argument if you’ve resorted to insulting me” or “You’ve changed the topic (or exaggerated the facts); let’s get back to the issue we were discussing” or “If you’re going to quote anyone, be sure you’re quoting someone who’s an expert or knows about the subject” or just quote the true authority on the subject yourself, as in “Well, here’s what the scientists say…”.

And, to avoid being duped by a Correlation is Not Causation fallacy, always check whether the original study concludes that the factors are “associated” with each other rather than whether one has actually been shown to cause the other. It isn’t always easy to detect the difference but watch for “observational” studies – this means a trend was observed but the study was not actually set up to prove causation. Often, they will end these studies by saying “further studies are needed” …

Can’t always win…

Lastly, depending on who your argument is with, try to do this in the spirit of discussion. While discussing ideas with others can be challenging and stimulating, friends have been lost and families divided over arguments that have gone sour. It’s also important to show respect for the other person. If you belittle them for a lack of knowledge or challenge their right to autonomy to choose what they believe, they are likely to dig in their heels and refuse to consider changing their opinion, even when they’re dead wrong and know it. No-one likes to “lose face”.

So sometimes it’s best to state the facts and concede that everyone’s entitled to their opinion except, perhaps, if there is the potential for harm to occur. However, if an opinion is deep-rooted, the person may need to think about what’s been said before considering a change of mind. Just leave them with the facts, agree to disagree and walk away… you can’t win them all on the first try!

References:

8 Logical Fallacies that Mess Us All Up – Medium

Red Herring Examples – Yourdictionary.com

Comprehensive Motivational Interviewing Training for Health Professionals – CCCEP Educational Program 2020

What Does Losing Face Mean? – Yoyo Chinese

Types of strawman arguments – Effectiviology

And I love SuperTramp, so here’s a link to The Logical Song – YouTube

#logicalfallacy #winningtheargument

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Confusion with drug names?

I received a question from a reader about generic drugs… Our generic/brand naming system for medications can be confusing, so I thought I’d try to explain it from a pharmacist’s point of view. All drugs have a generic name (the name of the actual drug) and a brand name (the name given by a particular manufacturer of the drug.) Sometimes the generic name is part of the brand name that the company uses to make it more obvious what the active ingredient is in the product.

Here’s how it works…

The first company to market a drug generally applies for a patent on their new drug to prevent other companies from selling it for a defined number of years. This gives the company time to recover the costs of developing the product by controlling the price and being the only source of the medication. The price of a new drug is not just based on what’s in the pill – it also includes the cost of the experiments and testing that were required to invent the drug, to ensure it was safe and to make sure that it actually worked. Governments generally limit the number of years through legislation because they know the price will drop once the patent expires.

Once the patent expires, other companies can begin to sell their version of the medication. These other companies only need to show that their version contains the right amount of the right drug, and that it’s absorbed and distributed throughout a person’s body in the same way as the original version. This means they have far fewer expenses than the original manufacturer because the drug itself has already been shown to work. We refer to these subsequent brands as “generic equivalents” or “generics”, as these products contain the same drug (known by its identical generic name) and are considered equivalent to the original brand by governments and drug plans.

Of course, this increased competition tends to lower prices. I’ve noticed the price drops some when the first generic version hits the market, but then there’s another (sometimes larger) drop when a third brand becomes available. As a pharmacist, it was a bit of a balancing act to avoid having too much on the shelf at first, knowing its value would decrease soon. The original manufacturer, of course, must ensure they recoup their development costs before other versions are allowed on the market.

Ultra-generics and Authorized generics

There’s another somewhat odd situation that sometimes occurs. In some cases, the original brand name company will make its own generic equivalent and sell it at the lower price, while still making their original brand at its original price. Usually these are a completely identical product (including the non-drug ingredients and how the tablet is made) but sold through a separate branch of the company, under a different brand name and with different markings on the tablet or capsule. We call these “ultra generics” in Canada and I believe they are called “authorized generics” in the US. It seems strange to me that they wouldn’t just lower the price of their original brand to compete – and occasionally they do – but often they must have enough people willing to pay the extra cost of the original brand to make it worthwhile to keep manufacturing both.

Once in a while, a company will decide that it’s not feasible to continue manufacturing the original brand any longer, and it will be discontinued. This is what happened to the original brand of the blood thinner, warfarin, called Coumadin. Most doctors ordered the medication by its generic name, warfarin, so pharmacies could dispense any brand unless the doctor specified the more expensive Coumadin brand. However, when I did some relief work in the north of our province, I was surprised to find that doctors there still ordered it as Coumadin even though the brand had been discontinued years before. I couldn’t help thinking this must make it difficult for patients and new pharmacists – requiring them to learn, not only brand and generic names of drug, but brands that have been discontinued years before and wouldn’t be found in current drug references!

Non-drug examples

A non-drug example of generics might be Kleenex…many people (me included!) refer to our facial tissues as Kleenex, even when they’re a different brand…essentially a generic equivalent. We go “Skidooing” even if it’s on an Artic Cat or Polaris. But we always call other products, like Robin Hood flour for example, by their “generic” name. Interestingly, people are often willing to pay more for Robin Hood brand, though, probably because it’s perceived to be better (more expensive must mean better quality, right?). Whether it is or not, it’s hard to say… my bread and pies seem to turn out the same whatever flour I use!

Occasionally there are problems…

However, this double naming brand/generic system can sometimes create problems in communication between doctors and patients when the different names are used. For example, I once had a patient whose doctor told them to double their dose of Lasix (generic name furosemide). At home, his prescription bottles were labelled as Apo-Furosemide (furosemide) and Lanoxin (digoxin). Remembering the drug the doctor was talking about began with the letter “L”, he increased the dose of Lanoxin by mistake. Not only did he not get the drug action he needed, he developed a toxic reaction to his now overdosed Lanoxin. This is one reason we suggest bringing a list of your medication with you to all appointments, and that all medication changes should be written out by your doctor or nurse practitioner.

There is a trend, mainly promoted by hospitals who see the results of problems like this, to encourage everyone to use generic drug names all the time. Unfortunately, brand names are often simpler to pronounce and remember, so this can be difficult for many patients. But the more generic names are used, the more familiar they become.

Watch the suffix – the end of the name

The other interesting advantage to generic names, is that they usually have the same ending if they are in the same drug family. For example, beta blocker drugs (used for high blood pressure and to slow the heart rate) end with “-olol”. So, acebutolol, metoprolol, and labetolol are all beta blockers. Examples of other name endings are “-cillin” for antibiotics similar to penicillin, “-profen” for anti-inflammatories, “-vir” for antivirals, “-azepam” for the benzodiazepine tranquilizers (diazepam, oxazepam) and “-mab” for drugs to treat auto-immune diseases like rheumatoid arthritis and multiple sclerosis. You should never be taking 2 “-profens” or 2 “-azepams” as this would be a duplicate therapy that would increase your risk of side effects. There are a few exceptions to this naming rule however – one is triazolam, a benzodiazepine which ends with “-azolam” instead of “-azepam” – but it’s close.

Do generics work as well as the “brand”?

Finally, one question pharmacists are often asked is, are generics as good as the brand? In the vast majority of cases, the answer is yes. They contain the same medication in the same strength and are tested to make sure they are absorbed and circulated in the body the same way before they are approved. Essentially, they are the same thing, just made by a different company, and still a high quality product that has been approved by drug regulators.

Governments do allow a small percentage difference in the amount that is measured in the blood, but generally this difference is too small to make any difference in the overall effect of the treatment. A possible exception is with drugs that have a “narrow therapeutic range”. This means that the difference between a blood level that doesn’t work, and one that is too high and causes problems, is not very large. Two common examples of drugs with narrow therapeutic ranges are warfarin and the thyroid replacement, levothyroxine.

People taking either of these drugs need to have blood tests regularly to make sure the amount of drug is in the correct range. If the brand you are taking is changed, it is advised to have extra tests shortly after the change to make sure the new formulation is still providing the correct amount of medication. Tell your doctor if you have changed brands of warfarin or levothyroxine and ask him/her about verifying your blood level of drug.

Very rarely, people will report a change in how they feel after changing the brand of medication they take. In all my years as a pharmacist, I have only seen this happen once. Doctors have channels to report drug problems and, when a problem is identified, the government acts quickly to investigate and remedy the situation. That company’s product is usually either removed from the market or made non-interchangeable with other brands.

Overall, generic equivalent medications have saved millions of dollars, allowing free market competition to do what it does best!

I hope this helps your understanding of the system of generic drug substitution. Generic equivalent medications are safe and help to keep drug costs under control, even if the system seems confusing sometimes.

Remember that any time you have a question about your medication your pharmacist is always happy to help!

#genericdrugs #brandvsgeneric

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Sunshine, Vitamin D and COVID-19… What’s the connection?

Researchers are working hard to find good treatments for COVID-19 and strategies to prevent it from being as severe. A new study suggests one possibility might already be in many medicine cabinets… Vitamin D3.

Vitamin D is known to play a role in our immune response and to reduce potentially harmful inflammatory responses in the body. We make large amounts of this vitamin when the sun shines on our skin and we can also get it from our food or by taking a supplement. In northern countries, like Canada, a vitamin D supplement is recommended from October until April, when the sun’s rays are not strong enough (and we’re too bundled up due to cold temperatures!) to produce adequate amounts for ideal health. But sunshine is good for us in more than one way.

Benefits of sunshine

We’ve all noticed that viral infections, like colds and the flu, tend to be less common in the summer when the sun’s rays are stronger. There are several mechanisms that have been proposed that could explain this:

  • Vitamin D helps the body to produce more macrophages, immune system cells that destroy invading germs by essentially “eating” them.
  • Ultraviolet rays destroy microbes in the air, so more sunshine means viruses will not live as long outside the body in the air or on surfaces outdoors.
  • Vitamin D helps prevent inflammation from getting out of control, as is noted in severe cases of COVID-19.
  • Skin that is exposed to the sun also releases large amounts of nitric oxide into the bloodstream. Nitric oxide relaxes blood vessels, reduces clotting (a problem associated with COVID-19) and, at least in lab cultures, prevents SARSCoV2 and other similar viruses from reproducing. Interesting side note: drugs like Viagra, used to improve men’s sexual function, work by blocking the breakdown of nitric oxide resulting in increased blood levels and dilation of blood vessels.
  • Vitamin D increases the action of an enzyme called angiotensin-converting enzyme-2, or ACE2, that is associated with improved COVID-19 outcomes.

Pigment in the skin filters the sun, providing protection from harmful rays, but it also reduces the amount of vitamin D formed in the skin. This has been suggested as one possible factor contributing to higher rates of vitamin D deficiency as well as increased rates of severe cases of COVID-19 among people of colour. Social and economic issues are also believed to be contributing to these excess cases.

Our general health affects how much active vitamin D we have in our bodies. The healthier you are, the more your vitamin D levels will rise naturally. Eating right, exercising, not smoking, spending time outside in the sun and keeping a healthy weight all help.

Of course, a vitamin D supplement won’t raise nitric oxide levels as sunshine does, but researchers are testing medications that can raise nitric oxide blood levels as well as whether inhaling nitric oxide gas can raise blood levels in a similar fashion. A preliminary study, done on cells from monkeys, showed that nitric oxide has antiviral action against SARSCoV2 and reduced blood clotting as well as dilating blood vessels.

There are those who point out that we don’t yet have concrete evidence that higher levels of vitamin D will protect us from severe forms of COVID. Like so much else with this new coronavirus, we will need to wait for the results of studies to know for sure whether this approach will save lives.

But this makes me think of the discussion about masks, where we were discouraged from wearing them at first because they weren’t “proven” to help (I think they actually said “there was no evidence they helped”…). Vitamin D supplements are considered safe in doses up to a maximum of 4000 units daily in adults and taking a supplement in the winter, when the sun’s rays are too weak to form vitamin D in our skin, has been encouraged for health reasons for as long as I can remember. A common dose is 1000 units daily and it’s readily available and inexpensive in pharmacies and many grocery stores.

Coronavirus spikes may be a pain reliever…

The other interesting COVID-related news I read this week, was that the coronavirus appears to have a pain-numbing effect. The Centers for Disease Control and Prevention (CDC) in the US estimate that about 40% of people with the virus do not have any symptoms. Scientists suggest that this could be because the coronavirus can block a pain signalling pathway, resulting in some of those infected being unable to feel the discomfort the virus infection. This would explain the asymptomatic cases and lack of symptoms early in the course of the infection, allowing increased spread of the virus as people don’t realize they are sick.

The spikes on the coronavirus attach to the ACE2 receptor on the surface of our body’s cells, like a key fitting into a lock. This is how they get into cells to infect them. But the spike proteins can also attach to another receptor on the cell surface called neuropilin and block it. Since this receptor is part of a pain pathway, the virus (or just its spikes, as was used in an experiment done on rats) blocks the pain signals that would otherwise be sent to the brain through this pain system.

So, besides providing a possible explanation for why people with milder forms or in the early stages of the infection don’t feel sick, these scientists may have found a new way to relieve pain in the future. If they could create a drug that mimics this action of these spike proteins, without the rest of the virus, we might have a new class of pain medications. Of course, this would be far off some time in the future, but it’s interesting to see how science works – often by observing an action in nature, analyzing how it occurs, then using this information for our benefit.

Can you catch the virus through your eyes?

Another article I read this week was about the potential to catch COVID through the eyes. It is thought that very few cases of the disease are caused by virus entering the body through the eyes, although they do tell us it’s a possibility. However, someone thought to assess what percentage of a group of hospitalized patients in China wore glasses daily, as compared to the local population. They noted that, although 31.5% of the population wore glasses at least 8 hours a day, only 5.8% of those in hospital at that time for severe COVID did so.

Of course, this is just an “observational” study that doesn’t prove anything, but it does suggest that the eyes could be a more important route of entry for viruses than we currently believe. It suggests that we should take another look at this issue. Meanwhile, I think I might wear my glasses instead of my contacts when I go out… just in case it does make a difference, Besides, I really like my new glasses!

And I always take a vitamin D 1000iu supplement in the winter unless I go somewhere warm and sunny. I guess I’ll be taking one all winter this year while I look at photos of Florida and Spain to lift my spirits when it’s too stormy to go outside…

#COVID #vitaminD

References:

Vitamin D for Covind-19: New Research Shows Promise – Medium elemental

How Sunlight, the Immune System, and Covid-19 Interact – Medium elemental

COVID-19: Nitric oxide shows promise as antiviral treatment – Medical News Today

Association of Daily Wear of Eyeglasses With Susceptibility to Coronavirus Disease 2019 Infection – JAMA Network

COVID-19: What role does vitamin D play? – Medical News Today

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The key to COVID-19

Researchers have been trying to figure out why large numbers of COVID-19 cases occur in some areas but only a few cases in others. Here in New Brunswick, we are getting about 1 new case a week (almost all travel related) while, next door in Quebec, there are over a thousand new cases daily. COVID-19 sometimes spreads to many people all at once and other times it is only passed to 1 or 2 people…or none at all. This is different than the flu, where it usually spreads evenly through a community and you’re almost guaranteed to catch it if you get too close to someone who has it (barring having been vaccinated, of course…got mine this week!). Researchers think this difference may be an important key to what we need to do to control this novel coronavirus.

You may have heard references to the “R0” measurement (pronounced “R-zero” or “R-naught”), sometimes also called the basic reproduction rate. This number indicates the average number of people who are infected by each new case of an infection. If each sick person infects 1 other person, the R value would be 1 and the number of cases would remain constant, with each case replacing itself. If less than 1 is infected on average, the number of cases will reduce over time; if more than 1, the number of cases will grow.

The R0 factor has been called a key factor in understanding what is happening with the pandemic, whether it is getting better or worse. But the problem with the R0 system, is that it is based on averages, while COVID-19 spreads mostly in batches at “super spreading” events, so it doesn’t show the true picture of what is happening.

But there is another type of measurement for disease spread that you may not have heard about: the “k” value, a measure of dispersion or how a disease spreads. Does it spread in a steady manner or in big bursts? The k factor, although complicated, captures viral behaviour that alternates between super infectious and noninfectious. Data collected in the first 9 months of the pandemic suggest that COVID-19 is an “overdispersed” pathogen, one that spreads in clusters. We need to take this into consideration when we assess the risk we will encounter from any given activity we are thinking of attending.

A study done in New Zealand found that only 19% of 277 separate introductions of virus resulted in more than one new case, while analysis of outbreaks in other countries have shown a single person to have infected as many as 5,000 known cases – that one occurred at a megachurch service in South Korea. The scientific term for this type of disease spread is “stochastic” – dominated by a small number of individuals and driven by super-spreading events. Even if the virus spread in a population is relatively under control, just a few super-spread events can turn that around quickly, as we are seeing in Quebec and Ontario right now.

The key to controlling spread

Multiple studies have suggested that as few as 10 to 20% of infected people may be responsible for 80 to 90% of transmission of COVID-19 through super spreading events. These include long-term care facilities, meat-packing plants, fish factories, cruise ships, family gatherings, house parties and night clubs. Researchers have realized that, if they want to get the pandemic under control, they need to prevent these super-spreading events that are driving the increase in cases. This is now believed to be the key to controlling the coronavirus.

This concept of unevenness is sometimes referred to as the 80/20 Rule or the Pareto Principle (named after economist, Vilfredo Pareto, who first noticed the phenomenon) , where approximately 80% of effects are often generated by about 20% of the causes. In addition to occurring in nature, we also see it in various human activities like 80% of business coming from 20% of customers or 80% of taxes being paid by 20% of citizens. If you’re interested in reading more about the 80/20 Rule, Wikipedia has a good explanation.

The three C’s of superspreading events…

So, what made events that resulted in many cases, different from similar gatherings that resulted in no new cases? Researchers found 3 factors in common, referred to as the 3 C’s:

  • Crowd – Many people at an event increase the chance that one will be carrying the virus. Holding an event in a community where the virus is less controlled also increases the chance someone who is highly infectious will be included in the group.
  • Close – Not being able to maintain a distance 2 meters or 6 feet from others increases the chance of viral spread, as we all know now. Prolonged contact is also known to increase the chance of the virus passing from person to person. It is believed that a contact time of 15 minutes or longer of contact increases the chance of passing on the virus.
  • Closed space – An indoor venue with poor ventilation allows tiny droplets containing viruses to hang in the air as an aerosol for much longer. Singing and loud talking (for example, talking over loud music in a bar) readily generate these aerosols, but normal talking and even just breathing also generate droplets. A mask of any kind, even a homemade cloth one, will trap these particles and reduce the chance of viral spread. Masks generally were not being worn at super-spreading events.

Backward contact tracing

Since this coronavirus spreads differently, we should be looking at contact tracing and testing differently, too, researchers say. Because only 20% of cases or less are responsible for most of the spread, it is important to identify those 20%. Statistically, It’s more likely that the person who gave the virus to a new case will be a super-spreader than the case at hand.

This suggests, especially if tests are limited, that it would be most efficient to trace the source of an infection and then test the source’s contacts, rather than try to test everyone’s contacts and not be able to keep up. If more than 1 or 2 cases are found amongst the contacts of a source, then there’s a good chance that a super-spreader may have been found. In lieu of testing all of the source’s contacts, isolation can simply be recommended when sufficient tests are not available. Tracing back to the source then checking their contacts is called “backward contact tracing”.

Using this information

This weekend is Thanksgiving in Canada, and many families will want to celebrate together. In some provinces, where the virus is spreading quickly and many new cases are being reported daily, governments are telling people to stay at home… and instead to share the holiday remotely, by video chat or phone call, instead.

But what about our “Atlantic bubble” where we have had very few new cases daily here in Atlantic Canada and no community spread for months? This week, we had an outbreak in a nursing home in a nearby city…15 cases there plus 2 family members who work at Costco and St. Hubert’s restaurant, plus 3 other separate cases that were travel related and already in quarantine. They are still trying to identify the source of the nursing home outbreak (backward contact tracing!) and the extent of the spread, and have finally mandated that masks be worn in all public places in our province.

So, although it might seem to be fairly safe to gather in small groups, we can’t let our guard down. The pandemic is still at our doorstep and it’s looking like the second wave is beginning its spread around the globe. We can’t forget that the virus is potentially everywhere…and we need to continually improve our systems and practices until we stop the spread and protect the most vulnerable.

References:

This Overlooked Variable Is the Key to the Pandemic – Medium.com

Stochasticity and heterogeneity in the transmission dynamics of SARS-CoV-2 – B.M.Althouse, et al, Institute for Disease Modeling

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Motion sickness… Many ways to treat it

I’ve suffered from motion sickness ever since I was a kid… I still remember trips to the cottage (over rough dirt roads!) that left me sick all afternoon. And I’ve tried plenty of different strategies to overcome it. Some worked better than others…

One of the first things I noticed, is that I’m more likely to get carsick in the back seat than in the front. Of course, I only discovered this once I was an adult. But I’ve used this strategy in recent years on the rare occasion when I end up in the back of a car. If I avoid looking out the side window at the landscape rushing by, I can usually avoid getting queasy. I often volunteer to ride in the middle (the least desirable seat!) so I can look out the front window. Or I simply try to look at my lap or the floor (boring but it helps!).

I’ve also learned that reading makes me nauseous in a car very quickly, even in the front seat. I can notice it starting even if I try to read the mail on the ride home from the community mailbox at the top of our road! So I avoid any activity in a car that requires close concentration, like reading or a complicated knitting project (although I can usually handle simple knitting). Fortunately, I can concentrate on driving without getting ill!

What causes it?

Motion sickness is thought to be caused by a conflict between the movement detected by the balance mechanism in the ear (the vestibular system) and the motion the eyes are seeing. For me, the worst conflict is scenery rushing past while my vestibular system is telling me I’m just bumping around a little from the vehicle vibrations. Luckily air travel doesn’t bother me, and only once did I have a problem on a boat, and that was caused by strong winds the last day of a cruise we took. I managed that by pretending I was being rocked to sleep…mind over matter!

Strong smells, like cigarette smoke or spicy/greasy foods, can make the nausea worse, too. I once “lost my lunch” when we pulled into the parking lot of a fast food joint, just at the thought of a greasy burger and fries…

Treatments

Of course, anti-nausea medications, such as Gravol (dimenhydrinate), Dramamine (meclizine) or Transderm-V (scopolamine) patches can help prevent the problem, but they cause side effects, like drowsiness and dry mouth. And they take a while to kick in, so are really most useful for a planned trip. Unfortunately, non-drowsy antihistamines and ginger are not considered as effective in preventing or treating motion sickness, although some references suggest ginger can be tried.

Fresh air can also be helpful. Opening the car window (or putting the top down!), using a fan or directing the air vent in a plane toward your face can sometimes be enough to reduce nausea, especially if you do this at the first sign of the problem and also stop any aggravating activity. Although not often available to you when travelling, peppermint and chamomile teas relax the digestive system and can reduce nausea as well.

Another strategy, is an accupressure device called “Sea Bands”. These are small elastic bands with a knob on the inside. The idea is to place the knob so it puts pressure on an accupressure point on the inside of the wrist. These have been clinically shown to reduce nausea. The point is located about 6-7 cm (2-2.5 inches) or 3 finger-widths above the inside fold of the wrist (palm up), between the two large tendons in the center of the arm. You can also just massage this accupressure point with the tip of your finger if you don’t have the bands.

A new preventive strategy…

This week I read about a small experiment where researchers found “visuospatial training”, manipulating 3D objects in one’s imagination for 15 minutes a day for 14 days, helped reduce motion sickness by over 50%. This involved identifying which 3D shapes matched when rotated, paper folding, and analyzing patterns.

The researchers got the idea for the study from previous research that had noted a link between visuospatial abilities and motion sickness. This research also found that males are less likely to have motion sickness than females and, correspondingly, also tend to have better visuospatial abilities than women.

My 3D talents are close to zero… I was hopeless at trying to solve the Rubic’s Cube puzzle, and I remember being totally frustrated by trying to print and assemble a multi-page folded pamphlet that my pharmacy student was able to whip up in no time! So, this connection makes sense to me…

I also like the possibility that this might permanently reduce the risk of nausea when travelling, as you never know when motion sickness can strike. With the development of self-driving cars, researchers suggest the technique may become more useful in the future. They envision it being used before test-driving a new autonomous vehicle, or by the navy or cruise passengers.

Brain training games are available on Google Play or Apple App stores. I’ve decided to try out one called Train your Brain—Visuospatial Games and another called Mental Rotation looks good too. I’ll be interested to see if playing the games helps to make my next road trip more pleasant!

Surprisingly, my first game session left me feeling a little disoriented, almost queasy. It seems likely to me that 3D games and motion sickness must use the same area of the brain. Exercising this area by playing a video game probably helps to develop improved function, resulting in less chance of motion sickness. Cool. Isn’t the brain fascinating?

Let me know in the comments if you try this technique or any of the above ones… and whether any of them work for you…

#motionsickness #nausea

References:

Prevention and Treatment of Motion Sickness – American Family Physician

Motion sickness: First aid – Mayo Clinic

Top 16 Ways to Get Rid of Nausea – Healthline

Sea-Band

Can we ease motion sickness through mental training? – Medical News Today

Worksheet packet – Cognitive Therapy Worksheets for Visual & Spatial skills