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GPs prescirbing drugs inappropriately

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    #92
    steddyeddy
    Registered Users Posts: 27,564 ✭✭✭✭steddyeddy


    But what does happen is students in science go to the GP and say I got nervous giving a presentation un front of people. She/he comes back and says "hey guys these are great" and then more people go to the GP asking for them. Seriously would alarm bells not ring if someone asks for beta blockers by name instead of saying she gets nervous in front of people?


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    #93
    El_Dangeroso
    Users Awaiting Email Confirmation Posts: 5,620 ✭✭✭El_Dangeroso


    steddyeddy wrote: »
    But what does happen is students in science go to the GP and say I got nervous giving a presentation un front of people. She/he comes back and says "hey guys these are great" and then more people go to the GP asking for them. Seriously would alarm bells not ring if someone asks for beta blockers by name instead of saying she gets nervous in front of people?

    Beta blockers are not recreational or addictive. They would only be considered 'performance enhancers' in those who are nervous. If you're not nervous they won't make you Steve Jobs or anything.


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    #94
    steddyeddy
    Registered Users Posts: 27,564 ✭✭✭✭steddyeddy


    El_Dangeroso wrote: »
    Beta blockers are not recreational or addictive. They would only be considered 'performance enhancers' in those who are nervous. If you're not nervous they won't make you Steve Jobs or anything.

    Tell that to musicians using them as performance enhancers.


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    #95
    El_Dangeroso
    Users Awaiting Email Confirmation Posts: 5,620 ✭✭✭El_Dangeroso


    steddyeddy wrote: »
    Tell that to musicians using them as performance enhancers.

    Probably mostly placebo effect. Also there's some thing to be said for nerves giving you an edge, when your heart is pumping the mind will be more focussed, it's when it gets past a certain point it starts to work against you. I'll need to see some studies before I would believe that it truly makes you a better performer bar removing the barrier of debilitating nervousness.


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    #96
    sleepyheadh
    Banned (with Prison Access) Posts: 582 ✭✭✭sleepyheadh


    El_Dangeroso wrote: »
    Probably mostly placebo effect. Also there's some thing to be said for nerves giving you an edge, when your heart is pumping the mind will be more focussed, it's when it gets past a certain point it starts to work against you. I'll need to see some studies before I would believe that it truly makes you a better performer bar removing the barrier of debilitating nervousness.

    Its not a placebo effect in musicians taking B-blockers for nerves.

    B-blockes are beta-adrenergic antagonists, they block endogenous catecholamines, i.e adrenaline and noradrenaline. These are what mediate the fight-or-flight.

    Ever been in fight and you start to shake? That is a sympathetic response. Now, imagine you are on stage, with 5,000 people watching you make intricate movements on a flute, or violin, a shake would be a pretty bad thing to develop at that moment.


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    #97
    El_Dangeroso
    Users Awaiting Email Confirmation Posts: 5,620 ✭✭✭El_Dangeroso


    sleepyheadh wrote: »
    Its not a placebo effect in musicians taking B-blockers for nerves.

    B-blockes are beta-adrenergic antagonists, they block endogenous catecholamines, i.e adrenaline and noradrenaline. These are what mediate the fight-or-flight.

    Ever been in fight and you start to shake? That is a sympathetic response. Now, imagine you are on stage, with 5,000 people watching you make intricate movements on a flute, or violin, a shake would be a pretty bad thing to develop at that moment.

    I said placebo for performance enhancement. Playing as you would in a room by yourself is not performance enhancement, more performance correction. And it remains to be seen whether it 'dulls' the heightened mental focus that you get when slightly nervous.


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    #98
    echo beach
    Registered Users Posts: 1,252 ✭✭✭echo beach


    steddyeddy wrote: »
    But what does happen is students in science go to the GP and say I got nervous giving a presentation un front of people. She/he comes back and says "hey guys these are great" and then more people go to the GP asking for them. Seriously would alarm bells not ring if someone asks for beta blockers by name instead of saying she gets nervous in front of people?

    The consultation between a patient and their GP is confidential so we don't know what happens. Any responsible doctor will TALK to the patient, find out why they want a particular medication and decide if it is appropriate to prescribe in that situation. That is why these are prescription only medicines.
    There may be some people fooling doctors into prescribing inappropriately. That is always a risk of being fooled with any system that depends on human judgement, including judging how good a person is at giving presentations.


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    #99
    sleepyheadh
    Banned (with Prison Access) Posts: 582 ✭✭✭sleepyheadh


    El_Dangeroso wrote: »
    I said placebo for performance enhancement. Playing as you would in a room by yourself is not performance enhancement, more performance correction. And it remains to be seen whether it 'dulls' the heightened mental focus that you get when slightly nervous.

    The Post you replied to specifically mentioned musicians.

    In my post I specifically mentioned a flutist playing in front of 5,000 people.

    I would count that as a performance enhancer, and it has been shown to be just that as far back as 1976 in The Lancet.

    That last bit about "dulling" the heightened mental focus is a bit waffly. I presume are talk about the move to a gamma rhythm, from an alpha?

    They appear to be two completely separate physiological phenomenon though. One dealing with sympathetic nervous system and the other with neural oscillations.

    Do you understand how beta-blockers have their effect, pharmacologically?


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    #100
    steddyeddy
    Registered Users Posts: 27,564 ✭✭✭✭steddyeddy


    They block the Beta adrenergic receptor. A g-protein coupled receptor. They're antagonists meaning they block adrenaline binding to the receptor. Thereby blocking the physical effects of adrenaline e.g. shakiness, stammering ect. Of course they could be used as performance enhancers.


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    #101
    sleepyheadh
    Banned (with Prison Access) Posts: 582 ✭✭✭sleepyheadh


    steddyeddy wrote: »
    They block the Beta adrenergic receptor. A g-protein coupled receptor. They're antagonists meaning they block adrenaline binding to the receptor. Thereby blocking the physical effects of adrenaline e.g. shakiness, stammering ect. Of course they could be used as performance enhancers.

    Great user name for this discussion!


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    #102
    El_Dangeroso
    Users Awaiting Email Confirmation Posts: 5,620 ✭✭✭El_Dangeroso


    sleepyheadh wrote: »
    The Post you replied to specifically mentioned musicians.

    In my post I specifically mentioned a flutist playing in front of 5,000 people.

    I would count that as a performance enhancer, and it has been shown to be just that as far back as 1976 in The Lancet.

    That last bit about "dulling" the heightened mental focus is a bit waffly. I presume are talk about the move to a gamma rhythm, from an alpha?

    They appear to be two completely separate physiological phenomenon though. One dealing with sympathetic nervous system and the other with neural oscillations.

    Do you understand how beta-blockers have their effect, pharmacologically?

    Oh great! So you'll have some citations then?


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    #103
    sleepyheadh
    Banned (with Prison Access) Posts: 582 ✭✭✭sleepyheadh


    El_Dangeroso wrote:
    Oh great! So you'll have some citations then?


    On a train at the minute, so I'll attach them later. A quick Google will show you if you can't wait


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    #104
    El_Dangeroso
    Users Awaiting Email Confirmation Posts: 5,620 ✭✭✭El_Dangeroso


    sleepyheadh wrote: »
    On a train at the minute, so I'll attach them later. A quick Google will show you if you can't wait

    I can find plenty papers on reduction of anxiety in musicians and thus level the playing field between nervous and non-nervous players which I don't dispute but none that show objectively that they play any better which is what the 'enhancement' part of performance enhancement means.


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    #105
    sleepyheadh
    Banned (with Prison Access) Posts: 582 ✭✭✭sleepyheadh


    Do you think i am trying to claim that beta blockers will turn you into a better player? That they are some magic pill that's makes you able to play an instrument?

    Not having a tremor, whilst playing a violin will allow you to play better, therfore b- blockers are a performance enhancer!


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    #106
    El_Dangeroso
    Users Awaiting Email Confirmation Posts: 5,620 ✭✭✭El_Dangeroso


    sleepyheadh wrote: »
    Do you think i am trying to claim that beta blockers will turn you into a better player? That they are some magic pill that's makes you able to play an instrument?

    Not having a tremor, whilst playing a violin will allow you to play better, therfore b- blockers are a performance enhancer!

    Then you don't know what the word enhance means.

    enhancement
    ɪnˈhɑːnsm(ə)nt,
    noun
    an increase or improvement in quality, value, or extent.

    Anabolic steroids are performance enhancers as they allow achievement above and beyond what someone is normally capable of. Beta blockers don't do this.

    To avoid getting totally bogged down in semantics, my original point stands, the prescription of beta blockers for anxiety do not in my opinion fall outside prudent prescribing by a GP.


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    #107
    RobFowl
    Moderators, Science, Health & Environment Moderators Posts: 11,667 Mod ✭✭✭✭RobFowl


    El_Dangeroso wrote: »
    Then you don't know what the word enhance means.

    enhancement
    ɪnˈhɑːnsm(ə)nt,
    noun
    an increase or improvement in quality, value, or extent.

    Anabolic steroids are performance enhancers as they allow achievement above and beyond what someone is normally capable of. Beta blockers don't do this.

    They are listed as performance enhances by WADA and are banned in sport as a result.


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    #108
    El_Dangeroso
    Users Awaiting Email Confirmation Posts: 5,620 ✭✭✭El_Dangeroso


    RobFowl wrote: »
    They are listed as performance enhances by WADA and are banned in sport as a result.

    Again my central point is dramatically missed. Does anyone think beta-blockers are incorrectly prescribed by doctors for people giving college presentations and thus conferring an unfair advantage for students who take them and as such comprises abuse?


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    #109
    RobFowl
    Moderators, Science, Health & Environment Moderators Posts: 11,667 Mod ✭✭✭✭RobFowl


    El_Dangeroso wrote: »
    Again my central point is dramatically missed. Does anyone think beta-blockers are incorrectly prescribed by doctors for people giving college presentations and thus conferring an unfair advantage for students who take them and as such comprises abuse?

    I think there is evidence that they are performance enhancing and that their use in gives an unfair advantage yes.

    In sport you need to apply for a TUE if you are to use medications like this and an independent panel makes the decision on whether they are permitted.


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    #110
    steddyeddy
    Registered Users Posts: 27,564 ✭✭✭✭steddyeddy


    D
    El_Dangeroso wrote: »
    Again my central point is dramatically missed. Does anyone think beta-blockers are incorrectly prescribed by doctors for people giving college presentations and thus conferring an unfair advantage for students who take them and as such comprises abuse?

    Do you not think some of these students might be wasting GPs time?


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    #111
    sleepyheadh
    Banned (with Prison Access) Posts: 582 ✭✭✭sleepyheadh


    El_Dangeroso wrote: »
    Then you don't know what the word enhance means.

    enhancement
    ɪnˈhɑːnsm(ə)nt,
    noun
    an increase or improvement in quality, value, or extent.

    Anabolic steroids are performance enhancers as they allow achievement above and beyond what someone is normally capable of. Beta blockers don't do this.

    To avoid getting totally bogged down in semantics, my original point stands, the prescription of beta blockers for anxiety do not in my opinion fall outside prudent prescribing by a GP.

    Can I ask what authority do you have to say that?

    Study from 1991 - http://www.ncbi.nlm.nih.gov/pubmed/1686251
    In short, beta-blocking agents, and especially propranolol, should be considered as potential therapeutic agents in the pharmacological treatment of anxiety disorders besides benzodiazepines, antidepressant compounds and the newer azapirones, eg buspirone.

    Another Paper - read the opening paragraph!
    http://jdc.jefferson.edu/cgi/viewcontent.cgi?article=1284&context=jeffjpsychiatry


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    #112
    partyatmygaff
    Registered Users Posts: 10,992 ✭✭✭✭partyatmygaff


    steddyeddy wrote: »
    D

    Do you not think some of these students might be wasting GPs time?
    If someone feels anxious enough for their anxiety to start physically manifesting itself as tremor and a racing heartbeat, it's perfectly ok to go visit the GP. It's unreasonable calling that wasting the GP's time. Treating anxiety and its physical manifestations using a beta-blocker (if suitable) is perfectly valid and not inappropriate at all.

    Whether or not that's ok according to whatever competition or sporting body the patient is in is immaterial.


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    #113
    RobFowl
    Moderators, Science, Health & Environment Moderators Posts: 11,667 Mod ✭✭✭✭RobFowl


    partyatmygaff wrote: »
    If someone feels anxious enough for their anxiety to start physically manifesting itself as tremor and a racing heartbeat, it's perfectly ok to go visit the GP. It's unreasonable calling that wasting the GP's time. Treating anxiety and its physical manifestations using a beta-blocker (if suitable) is perfectly valid and not inappropriate at all.

    Whether or not that's ok according to whatever competition or sporting body the patient is in is immaterial.

    The treatment of anxiety is not being questioned, its the use of drugs which are used for anxiety and performance enhancing drugs in students who probably don't have true anxiety (as a clinical diagnosis)
    This article puts it fairly well.
    http://jme.bmj.com/content/35/10/611
    http://www.imt.ie/clinical/mental-health-cns/2009/10/increase-in-%E2%80%98academic-doping%E2%80%99-could-spark-routine-urine-tests-for-students.html


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    #114
    Kurtosis
    Moderators, Science, Health & Environment Moderators Posts: 2,881 Mod ✭✭✭✭Kurtosis


    Can beta blockers really be considered performance enhancing in managing anxiety relating to public speaking? Would they provide a qualitative improvement in performance in public speaking in someone not suffering from anxiety?


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    #115
    partyatmygaff
    Registered Users Posts: 10,992 ✭✭✭✭partyatmygaff


    RobFowl wrote: »
    The treatment of anxiety is not being questioned, its the use of drugs which are used for anxiety and performance enhancing drugs in students who probably don't have true anxiety (as a clinical diagnosis)
    This article puts it fairly well.
    http://jme.bmj.com/content/35/10/611
    http://www.imt.ie/clinical/mental-health-cns/2009/10/increase-in-%E2%80%98academic-doping%E2%80%99-could-spark-routine-urine-tests-for-students.html
    Beta-blockers like propranolol aren't normally considered nootropics nor are they normally considered to be anxiolytics in the sense that they don't really have any significant effect on the psychological symptoms of anxiety.

    Exam anxiety or stage fright shouldn't normally cause physical symptoms such as tremor and a racing heart but if it does, i'd struggle to call that level of anxiety anything less than pathological and worthy of treatment. If the issue could be resolved without using drugs, that would be ideal. However if that's not possible, I don't see what's so wrong with using a beta-blocker.


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    #116
    sleepyheadh
    Banned (with Prison Access) Posts: 582 ✭✭✭sleepyheadh


    penguin88 wrote: »
    Can beta blockers really be considered performance enhancing in managing anxiety relating to public speaking? Would they provide a qualitative improvement in performance in public speaking in someone not suffering from anxiety?

    Obvisouly not, but the thing is if the person who would normally suffer from anxiety doesn't due to the b-blockers, then their performance has been improved.

    The drop in performance is caused by the physiological processes which the b-blockers prevent. If you didn't get the physiological response, i.e. you weren't nervous, then they would obviously do nothing, except maybe drop your heart rate a bit.


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    #117
    Kurtosis
    Moderators, Science, Health & Environment Moderators Posts: 2,881 Mod ✭✭✭✭Kurtosis


    sleepyheadh wrote: »
    Obvisouly not, but the thing is if the person who would normally suffer from anxiety doesn't due to the b-blockers, then their performance has been improved.

    The drop in performance is caused by the physiological processes which the b-blockers prevent. If you didn't get the physiological response, i.e. you weren't nervous, then they would obviously do nothing, except maybe drop your heart rate a bit.

    My opinion would be similar. It's difficult to consider this scenario inappropriate if they reduce the ill effects of anxiety on public speaking and provide no real benefit to those without anxiety.


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