Wednesday, January 30, 2013

8 Drugs Doctors Would Never Take

8 Drugs Doctors Would Never Take

Hey, it wasn't my headline.

This is apparently from 2008 here:

Contradicted, partially, here:

But the internet being the internet it has arisen from the grave like a Romero extra here, here, here, and most curiously here.

Merely a sampling.
You no doubt get the picture.

So now that four years have passed since the initial scary-title article, where are those devilish eight meds and what are they up to?


Because who needs a liver anyway?
Never noticed it looks like a baseball cap. Or a snail. Or something.

Had been used for sinusitis and respiratory tract infections. Now likely to only be encountered in pneumonia cases.

I was in Charlotte for a seminar when the Observer ran a story on Ketek. Just happened to read the story. Turned out to be a good thing I did.

Much belated congratulations to the doctors at Carolinas Medical Center that put Ketek/liver destruction together.
(Apologies for not finding the original print article.)

Here we have a damning piece on the malfeasance related to ketek approval.


Interestingly, in the comments section of the article where these 8 baddies are listed, a commenter identifying himself as a pharm tech requests an article on the "The Biggest Rx Drug Jokes". He suggests Lovaza head the list. Because of what it is and what it costs, apparently.

Lovaza is Omega fatty acid. 

Yes. Same stuff you take as fish oil caps, basically.

"$150 for fish oil!", he wrote.

Advair stops the arichidonic acid cascade. Stops bronchial inflammation.

Omega 3 will also stop the arichidonic acid cascade. Stop the inflammatory cascade. Improve markers of lung function.
Nice article here.

And you don't have to spend $1.50/cap. More like 20-50 cents for good quality. Or eat fish.

But you're not going to rely on fish oil when you can't breathe, so...
Advair is a two part drug.
Side effects of advair are increased possibility of infection and fungal overgrowth from the steroid part.
Tachycardia, palpitations, anxiety, hyperactivity, insomnia, headaches, from the beta-agonist part.


This diabetes drug is thought to have precipitated over 80,000 heart attacks. In the U.S. alone.
And stroke.
And fractures, as reported by the manufacturer.
And hepatitis.

The regulatory arc of this drug is interesting.
FDA approval in 1999.
In 2007 there were calls, even within FDA, to withdraw it.
Then in 2010 FDA voted to restrict it. Good insight into FDA workings here.
In 2011 the manufacturer withdrew the drug and it was only available by mail order through certain pharmacies.
Finally the manufacturer paid billions (yes, 'B'illions) in a settlement with the government over charges of sin by ommission in reporting the effects of the drug. Brilliant timeline and more here.


Was nexium a scam that should never have been patented?
This guy thinks so.
Interesting, but not to the point.

I made the point in the blog entry "FDA Adds Eight Drugs to Watch List".


Gotta preach to the people where you find 'em.

Why was this on the list?
Because of this?

Sure there are side effects.
But plenty of meds are worse.
The article puts it down to dilatory effect.

It's telling that pseudoephedrine is recommended against in those with coronary artery disease, hypertension, cardiovascular disease and closed angle glaucoma (ocular hypertension).
It is a central nervous system stimulant that causes insomnia, nervousness, excitability, and anxiety.
It can cause tachycardia (racing heart), arrhythmia (irregular heartbeat), palpitations (skipping beats).

It sure will dry a runny nose.

This is a non-steroidal antiinflamatory drug used to treat pain and inflammation.

Gastrointestinal ulceration (hole in your gut) is a possibility.
Stroke is possible.
Most of the fear over celebrex comes from heart attacks.

Pfizer, manufacturer of celebrex, has paid out hundreds upon hundreds of millions of dollars settling claims related to celebrex.

In '09 a celebrex researcher admitted he had falsified results in 20 studies to make celebrex appear better at pain control than it actually was.

Flasified data?
Say it ain't so.

Friday, January 25, 2013

FDA Adds Eight Drugs to Watch List

Medscape reports on eight drugs added to FDA's watch list.
All eight are interesting for the secondary effects of which they are accused.
However, two in particular stood out for me.
Two that many, many, many people take.

Proton pump inhibitors (PPIs) block acid secretion in the stomach.
They have become associated with increased incidence of pneumonia.
One hypothesis is that by reducing your stomach acidity, you are no longer protected from invasion/colonization by unwanted microbes. Once established in your body, you breathe them down into your lungs.
Another hypothesis is that PPIs may reduce the acidity of the upper digestive tract,  resulting in microbial colonization of the larynx, esophagus and lungs.
So you see, whether postulate number one or two, the problem is thought to be that PPIs are diminishing a front line immune defense and allowing unwanted microbes to become established in our bodies.

To glimpse just how big a nightmare the secondary effects of PPIs could be, in 2008 113 million prescriptions for PPIs were filled at a cost of $13.9 billion.
A most excellent explanation of PPIs and their several pitfalls published by the National Institutes of Health here.

What other pitfalls?

It was probably in the mid '00s that PPIs became widely discussed as a link to fractures. That's when I recall a flood of articles on the topic.
Low stomach acid (achlorhydria) has been associated with bone fracture for much longer, however.

The problem is poor absorption of calcium.
Generally, lower your stomach acidity, the less calcium you will dissolve and absorb.
This is particualry problematic with calcium carbonate, the cheapest and most widely used calcium supplement. The stuff is chalk. Makes up 4% of the earth's crust. No wonder it's cheap.
As your stomach acid lessens, calcium carbonate is less and less soluble.

So what to do? Aside from dropping PPIs and getting a normal stomach acidity?
Calcium citrate will dissolve where carbonate will not. It is possible that everyone on PPIs should also be taking calcium citrate.

As an aside, PPIs will also deplete vitamin B12.
That pearl comes from one of the most useful books in my office.
Please Dr. Pelton. We need a new adddition!

Wine and vinegar

Vinegar is, of course, acidic. It has traditionally been used as a remedy for stomach ache.
Consider that: 113 million prescriptions for PPIs and who knows how many Tums/Rolaids etc. every year to tamp down acid because of stomach pain attributed to excessive stomach acid. Yet a traditional remedy is adding more acid. How can this be?
The answer is that some people actually need more acid and by medicating themselves into an even lower acid state are worsening their condition.
That is what I most often find.

We have been given wise dietary habits through our cooking traditions. Types of foods, methods of preperation, combinations of foods in a dish or meal.
Two such are vinegars and wines.
Salad with vinaigrette to start a meal adds acidity that aids digestion.
Wine with the meal adds acidity to aid digestion, as wine is also acidic.
In marinades and sauces, wine and vinegar contribute to dietary acidity which aids digestion.

And what happens to wine that has too little acidity?
Same as us. It becomes prone to infection.

Pitfall Two

Infection by pneumonia due to PPI use started this post.
Infection on the other end by Clostridium dificille will end it.

PPI use has been linked to increased clostridium infection.
They have been found to double infection rates.

Healthy people shouldn't normally be troubled by this organism.
A course of antibiotics will increase your chances of infection, just as PPIs will.
Stomach acid is a barrier to infection and colonization of pathogens.
Antibiotics are indescriminate and kill off pathogens and desirable, necessary, life sustaining, friendly microbes that reside in us, as I've covered here.XXXXXXXXX

Our traditional diets provided us with friendly microbes through fermented foods.
How often do we eat fermented foods now?
Maybe a yogurt occasionally.

Friday, January 4, 2013

Finally, It's Chilly/Chile/Chili Weather

Looked like we were going to escape wintery temperatures here in the mountains this season. Not a chance. Winter is chili time for me, largely thanks to my stint in Albuquerque. Anyone traveling in the southwest has seen the ristras of chiles used for decoration.

Originally, of course, this was the method of preserving the chile for the oncoming winter.
Jane Butel tells the tale that a southwestern family had to put up ristras equal to the height of each family member to have enough to last until the new crop. Charming. She also said they were the primary source of vitamin C for the southwestern peoples. Perhaps. Probably? A green chili pod can contain six times the C as an orange. However, as the green turns to red the C content diminishes dramatically. However, however, the vitamin A content grows to more than that of a carrot as the pods darken. They also contain high amounts of B1,2,3, and E.

So as a primary source of vitamins the chiles would stave off scurvy (vitamin C deficiency page here is short and sweet) nyctalopia/night blindness (vitamin A deficiency the ancients treated by eating liver. Case study here:) beriberi (thiamin/B1 deficiency) pellagra (niacin/B3 deficiency )

Ugly as homemade soup.

Green chiles must be canned/jarred/frozen. Best frozen. That green mess above is forty pods, or what I call one batch of stew.

In the fall the chile men come to Albuquerque. In parking lots all around the city they set their propane heated roasters. You choose the chiles fresh and they roast them on the spot. Large swathes of the city would smell like roasted chile.

Now I have to have the chile shipped. Two cases lasts one year. And I have to do the roasting myself. On the grill outside. Very important point. I once had a couple bushels roasting in all three ovens in the house at the same time. It didn't end well.

Here is how I make green chile stew:

2 lbs pork, skip the lean, lean cuts, save the bones, cube the meat
flour sufficient for dredging
bacon fat for browning, because, of course bacon fat
1 medium onion chopped
2 or 3 cloves garlic, minced
3 cups tomatoes, peeled and chopped, minimum. Try 2 cans of the fire roasted variety.
1/4 tsp smoked cumin, ground
1/2 tsp oregano. A little oregano goes a long way.
20 green chiles, or there abouts,  roasted, peeled, and chopped.

Take any bones, cover with water, and high simmer/low boil them to a broth, skimming any froth.
Coat the pork in flour. Lightly. Brown in fat. Brown means brown; not black nor tan.
Cook onion and garlic until onion is translucent.
Add tomatoes, cumin and oregano. Stir it up to combine.
Cover, simmer one hour. If you don't know the difference between simmer and boil, unhappiness will ensue.
Stir occasionally. If it is sticking, stir in some of the hot broth.
At one hour taste and adjust seasoning. Possibly add salt. Be careful.
Add and mix in green chiles. Continue simmer for forty-five more minutes.

Serve with grated cheese. Sour cream. Tortillas.
I make double batches. Freeze it. Always seems to taste better from the freezer.
I've seen recipes using canned chiles and even Rotel.
Ain't cutting it.
I've tried canned chiles in stew.
I'll go without first.


When purchasing a vitamin C supplement,  I look for both mixed ascorbates (multiple types of vitamin C) and buffering. Vitamin C is ascorbic acid. It can, and at high enough dose will, burn your stomach. Hence the buffering.

I prefer a mixed, buffered, ascorbate powder. One that dissolves readily. Some dissolve poorly and you have a gritty slurry to drink. With a powder I am able to adjust the amount of vitamin C I ingest. With buffering I can ingest up to bowel tolerance.

Pellagra bonus:
And saving you a trip to a prepper site:
"It was eventually discovered that the Native Americans learned long ago to add alkali—in the form of wood ashes among North Americans and lime (calcium carbonate) among South and Central Americans—to corn meal.  This liberates the B-vitamin niacin, the lack of which was the underlying cause of the condition known as pellagra.  This is known as Nixtamalization."
 Attribution. Fascinating. The subtle unintentional revenge of the conquered.