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How we can improve health for all

From Dr Kausar Jafri, Stoke-on-Trent, Staffordshire

I have been mulling over what the next few years might bring for us as GPs and for our colleagues and patients.

Some of the things on my wishlist are probable, some unlikely and the rest purely speculative.Old drugs may find brand new uses. The story of aspirin from a headache tablet to a panacea is well documented. Now ß-blockers such as propranolol may find new indications. Propranolol is now believed to have a preventive effect for post-traumatic stress syndrome – it can be used to weaken troubling memories.Stressful events such as rape, severe traffic accidents, being the victim of a violent robbery or a witness to terrorist activity, leave emotional scars that take a long time to heal and are best prevented with whatever means are available. Sooner or later, servicemen and women will be returning home from Iraq and Afghanistan carrying a baggage of painful memories that could soon turn into PTSD.If given early enough, propranolol may help to block the impact of stress hormone on memory formation. It would thus reduce the intensity of recall.In contrast, there are now more than 40 cognitive enhancement drugs under study globally, according to The Economist. Ampakine drugs target the initial phase in memory formation, boosting communications between cells of the cortex, as well as stimulating synthesis of new protein in the brain. Initial studies in animals have given cause for optimism. Doctors dream of discovering a drug that could turn back the clock of declining memory function. The fulfilment of that dream may not be so distant.But there will need to be a debate as to which of these drugs we need as a society. There are some unanswered questions when it comes to meddling with nature – for example, could the criminal community benefit from a lessening of guilt if we can loosen their memories of their crimes?Trust is at stake in every decision doctors make, and unchecked clinical enthusiasm can threaten our professional integrity. The relationship between society and medicine is likely to change towards more openness and honesty. By personal and collective action, we health professionals can contribute to the health of our own and future generations.

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