Month: November 2015

Thank you, Digital Cinema Media

Popcorn

Digital Cinema Media, which manages advertising for Odeon, has refused to show an advertisement which was basically Christian proselytising, as people may find it offensive. The Archbishop of Canterbury, who features in it, says (as quoted in The Times) that its “about as offensive as a carol service on Christmas Day… I think people need to watch the film and come to their own conclusions as to whether it is offensive or upsetting.”

Thus demonstrating that the Archbishop of Canterbury has completely missed the point. What’s offensive is subjecting people who’ve paid good money to go and see Star Wars to religious proselytising. I don’t go to my local church and stand up at the front and say “OK guys, before you do all the god stuff, I’d just like to tell you a bit about atheism.” I respect religious people’s right to be religious on their own time and in their own chosen place. Religious people should do the same and respect my right not to have their beliefs shoved down my throat when all I want is a good lightsabre fight and some cool spaceships.

People do not need to watch an advertisement for a prayer website telling them how to pray, and then decide whether or not they were offended by having their viewing pleasure interrupted. They do not need to be subjected to proselytising without their consent, when it gives them a choice between sitting through it and walking out of the cinema.

I suppose one might think I’m getting rather exercised over what is, (in my opinion!) basically, someone wanting to talk about their imaginary friend. I suppose I should smile nicely, and say “Yes, dear, whatever you say, that’s lovely.” Or just doze through the whole thing, like any other boring advert for a product that I’m slightly less interested in than a penis enlargement. But since these people use their imaginary friend to get free seats in the House of Lords, and to force people with serious diseases to live in pain and misery, I’m slightly less sympathetic to them than to less dangerous people with imaginary friends.

Not for nothing are religion and politics no-go areas at polite dinner parties (or so I hear). What the Archbishop of Canterbury fails to realise is that there is a time and there is a place for proselytising. Any time that people have paid to experience something completely different, and any place where people can’t leave without abandoning what they’ve paid for, is not it.

Of course, on the other hand, maybe I should be glad that the Archbishop of Canterbury – in this time of falling congregation numbers – clearly doesn’t feel that voluntary recruiting is cutting the mustard, and he has to ambush a captive audience. What next, I wonder? Press gangs? Will Sundays become a time of danger as roving parties of deacons patrol the streets, bashing the unwary over the head and dragging them off to Evensong? Or getting people drunk and incapable, then locking them up until they wake up in a choir stall?

The Archbishop has made a fool of himself over this – twice: once in having the advert made at all, and once in not taking his rejection with good grace. Really, is that the impression he wants to give of the Church of England? An organisation that is not only so desperate for new blood that it ambushes filmgoers, but also is a bad loser?

If I were Anglican, it would be like that moment when your friend says something utterly, utterly stupid/racist/homophobic in public, and you just don’t know where to look (it happened; we’re not friends any more).

Good thing I’m not Anglican. I’m an atheist, and I can watch the whole train wreck from a distance. With popcorn.

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Crushing Circadin® MR tablets

Whether or not it’s OK to crush Circadin® MR tablets is a question that keeps coming up over and over again. This is because it’s the only licensed melatonin tablet in the UK, and it’s probably also the cheapest and easiest to for pharmacies to obtain. This is all good. The problem is that it’s not licensed in kids, and a lot of prescriptions for melatonin are for children. Furthermore, Circadin is a modified release tablet, and as we all know, crushing modified release tablets is a Bad Thing because it’s liable to release all the drug (which someone has taken a great deal of trouble to make release slowly) all at once.

People have died from crushed modified release tablets (though not melatonin).(1-3)

However, in the case of Circadin®, the situation is a little less lethal. Melatonin is often used in immediate-release tablets, and lots of patients don’t need the modified release properties. So it doesn’t matter so much – for those patients – if the modified-release properties are destroyed by crushing.

In fact, the manufacturer – on their Circadin® website, in the Q&A section(4) – states:

Crushing a Circadin® tablet will not damage the active ingredient (melatonin). There are no safety concerns with crushing Circadin®, however it will affect prolonged-release properties of the product. The tablet matrix maintains its prolonged-release properties as long as it is ingested as a whole. The prolonged-release properties will be maintained to some extent also if the tablet is halved or divided into 4 quarters. If it is crushed it will release melatonin similarly to an immediate release formulation. According to the SmPC the tablets should be swallowed whole in order to get the full prolonged-release properties.

The information leaflet on the very nice Medicines for Children website(5) also states:

Modified-release tablets (Circadin) should be swallowed whole unless your doctor or pharmacist has told you otherwise. Your child should not chew the tablet. Sometimes, your doctor or pharmacist may have told you to crush it – this will make it act faster, but the effect will not last as long.

However, anyone advising patients to do this should bear in mind that crushing tablets generally renders them off-licence (although Circadin use is off-licence in children anyway). The GMC has guidance regarding off-licence prescribing here.

So, in short, Circadin® tablets may be crushed if:

  • The patient cannot, or will not, swallow the tablets whole AND
  • The modified release characteristics are not required (e.g. in a patient who would otherwise be prescribed a non-modified release formulation, such as melatonin liquid.

If a patient requires a modified-release formulation, but cannot swallow Circadin® tablets whole, then cutting them in half or into quarters (preferably half rather than quarters if possible) will preserve the matrix formulation which provides the modified-release characteristics to some extent.

Health Warning

If patients (or carers) are advised to crush or divide Circadin® tablets, they should be counselled carefully to ensure that they understand that this recommendation applies only to Circadin® tablets, as it is known that causing the immediate release of all of the drug in the tablet is not harmful in this case.

This advice does not apply to other modified-release products; serious adverse effects have been reported when modified-release formulations have been crushed without first establishing the safety of doing so.

References

  1. ‘I will always blame myself’. BBC [Internet]. 2006 Oct 26 [cited 2015 Aug 5]; Available from: http://news.bbc.co.uk/1/hi/health/6085292.stm
  2. Schier JG, Howland MA, Hoffman RS, Nelson LS. Fatality from administration of labetalol and crushed extended-release nifedipine. Ann Pharmacother. 2003 Oct;37(10):1420–3.
  3. Cornish P. ‘Avoid the crush’: hazards of medication administration in patients with dysphagia or a feeding tube. CMAJ Can Med Assoc J. 2005 Mar 29;172(7):871–2.
  4. Q&A | Circadin® [Internet]. [cited 2015 Nov 13]. Available from: http://www.circadin.com/about-circadin/qa/
  5. Melatonin for sleep disorders | Medicines for Children [Internet]. [cited 2015 Nov 13]. Available from: http://www.medicinesforchildren.org.uk/melatonin-sleep-disorders