I thought about this too, it may be the case, but I can also think that it may be that the bias is in exactly the opposite direction: For example people with serious health issues that also have insomnia (say MS, Lupus etc) might be seen be a proper specialist that describes serious drugs for their issues but not something more bening like melatonin. I doubt there's many specialists at university hospitals prescribing melatonin.
I think one would really have to have a closer look at the cohorts.
I wasn't aware that it was only available as prescription in the UK, but as
@DHagen mentions in the US things are very different, so things are much harder to interpret, for it to become part of your medical records might mean you have some serious health incident or something else happened, which could again shift the bias in one direction.
I think it is by using the UK even more skewed than they are hinting at. I'm really intrigued by what they mean by 'matched pairs' and whether those who were being matched were really looked into for not diagnosed comorbidities and were real matches particularly for things related to heart failure.
It feels like that would theoretically be a fascinating follow-up to look at how many of those who died or had heart failure turned out to have something else and whether it was related to either insomnia (ie meds not working
enough)
or the melatonin or something else was either underlying both, or whether this is 'something that happens when insomnia
gets bad enough/is left too long' or is melatonin. Because it feels there must have been red flags along the way.
And because given the context of how limited who can get melatonin on prescription in the UK it is a much more select group they are potentially looking at and perhaps therefore says as much about how serious insomnia impacts are when left if you have a system that wants to try all the other obvious for too long (and does it check everyone for comorbid like apnea which I think
is related to causing heart issues? are there other things?)
From what I remember the 'can prescribe' has really tight guidelines regarding different age groups. Something like it being somewhat allowed to be very liberally prescribed to those who are in the 'old age' bracket,
but working age you have fat chance unless you see a consultant and they can manage the care plan of it, ie I'm not sure even getting it from a GP with barn door sleep issues is possible. And of course that doubly means that those who in the UK of that age to try melatonin there is a stronger chance they've been put on other sleep drugs before?
I think also there is some leeway for kids short term, but they'd surely says kids here if it included those.
And of course UK is absolutely obsessed with putting off anyone whose issues fall into certain categories such as sleep through the years long hoop-jumping of IAPT, mindfulness apps etc and 'go away and try that for 6months' on cycle to have to prove all the obvious don't work. I also get the impression in the UK that melatonin is one of the
last/harder to get of any sleeping medication. I think there are only a few biomedical sleep clinics/hospitals in the UK too, with most that bear that name just at best ruling out apnea then putting someone thru hygiene assuming if it aint that then those are the only tools that they have. So it would be a case of being in the part of the country or knowing how to get a referral and able to travel and keep going to and not be discharged from one of those few big centres. Which likely due to all of this are having to focus on certain cases.
So it isn't even just a case of 'need to have good reason' that most prescriptions in other countries would be assumed to be.
