Volume 12 • Number 12 • December 2011

The pharmaceutical revolution of the 50’s and 60’s has most certainly helped a lot of people. Prescription drugs will always be a significant tool in doctors’ bags. But, ignoring the inherent problems and limitations this symptomatic approach has is not a good idea. Fortunately, many scientists now feel that the “pharmaceutical revolution has petered out.”[1]

Four articles about pharmaceutical issues are reviewed below; three of them are so remarkable in their implications that I have only posted quotes from them below.
~ Hugo Rodier, MD

 

Principles of Conservative Prescribing[2]
Judicious prescribing is a prerequisite for safe and appropriate medication use. Based on evidence and lessons from recent studies demonstrating problems with widely prescribed medications, we offer a series of principles as a prescription for more cautious and conservative prescribing. These principles urge clinicians to (1) think beyond drugs (consider nondrug therapy, treatable underlying causes, and prevention); (2) practice more strategic prescribing (defer non-urgent drug treatment; avoid unwarranted drug switching; be circumspect about unproven drug uses; and start treatment with only 1 new drug at a time); (3) maintain heightened vigilance regarding adverse effects (suspect drug reactions; be aware of withdrawal syndromes; and educate patients to anticipate reactions); (4) exercise caution and skepticism regarding new drugs (seek out unbiased information; wait until drugs have sufficient time on the market; be skeptical about surrogate rather than true clinical outcomes; avoid stretching indications; avoid seduction by elegant molecular pharmacology; beware of selective drug trial reporting); (5) work with patients for a shared agenda (do not automatically accede to drug requests;consider non-adherence before adding drugs to regimen; avoid restarting previously unsuccessful drug treatment; discontinue treatment with unneeded medications; and respect patients’ reservations about drugs); and (6) consider long-term, broader impacts (weigh long-term outcomes, and recognize that improved systems may outweigh marginal benefits of new drugs).”

 

Pharmaceutical Fraud and Abuse in the United States, 1996-2010[3]
Prescription drug spending totaled $234 billion in 2008 (up from $40 billion in 1990) and accounted for 10% of health care expenditures. Pharmaceutical fraud may be an important component of health care costs. Between 1996 and 2005, $3.6 billion was recovered for 13 pharmaceutical fraud cases initiated by “whistle blowers” (termed qui tam relators). These recoveries, despite accounting for 3% of the number of federal fraud cases involving health care, accounted for 40% of federal fraud financial recoveries involving qui tam relators.

 

Communicating Uncertainties About Prescription Drugs to the Public: A National Randomized Trial [4]

Thirty-nine percent mistakenly believed that the FDA approves only “extremely effective” drugs; 25% mistakenly believed that the FDA approves only drugs without serious side effects. Explanations affected choices: 71% of those in the directive group, 71% in the nondirective group, and 59% of controls chose the cholesterol drug that reduced myocardial infarctions. For the heartburn drugs, 53% of the directive group, 53% of the nondirective group, and 34% of controls chose the older drug.”

 

Ibuprofen-like drugs, inflammation and heart attacks

In 1998 the country was shocked to learn that these types of drugs are responsible for most of the pharmaceutically related annual 100,000 deaths in the United States. Subsequent studies have shown that these drugs are associated with kidney, liver, intestinal problems and clotting that may lead to heart problems. The latter was felt to be seen only in long-term users, but:

Even short-term treatment with most NSAIDs was associated with increased risk of death and recurrent MI in patients with prior MI. Neither short- nor long-term treatment with NSAIDs is advised in this population, and any NSAID use should be limited from a cardiovascular safety point of view.”[5]

Some may find cold comfort in the fact that the study involved patients who had already had a heart attack. But, do you feel lucky if you have the risk factors for a heart attack? In my opinion, anyone with diabetes (or prediabetes,) hypertension, high triglycerides/low HDL, high uric acid, gut problems and poor lifestyles (unrelenting stress, pollution exposure, smoking, drinking and lack of physical activity) ought to think twice before taking ibuprofen-like drugs.

 

If you suffer unrelenting pain you may need to take the risk; this is understandable and in many cases advisable. But, I would strongly consider a morphine derivative for patients over 65 instead of ibuprofen or celebrex/vioxx. Also, I would try previously reported safe and effective natural anti inflammatory agents like SAMe, boswellia, stinging nettle, curcumin, goat’s whey, cherry juice, glutathione, MSM sulfur, ndole-3-carbinol and capsaicin.

 

And for those having heart problems and inflammatory problems, don’t forget green tea; 4 cups a day reduce the risk of heart attacks by 69%.[6] Now that green tea has been shown to reduce skin wrinkling, we will all start taking it![7] The common denominator here is reduction of inflammation and oxidation, which improves circulation and protects against premature aging of cells. Of course, the main way to maximize cellular protection is our diet. High refined sugar diets promote oxidative/inflammatory agents like asymmetric dimethylarginine that worsen “fatty liver,”[8] a condition related to pre diabetes, diabetes and metabolic problems, the slippery slide leading to heart disease.

 

Refined foods also promote tooth decay and periodontal disease; these problems have also been associated with heart disease through several mechanisms, like oxidation and inflammation of lipid molecules.[9] Remember that lipids are harmless and necessary molecules to make hormones and maintain the integrity of cell membranes that constitute organs like the lining of arterial walls and the brain. It is only when lipids are inflamed and oxidized that they become “sticky” and harmful; then, plaque is formed in arteries, leading to circulatory problems.[10]

Equal time: questionable “natural” practices
Once in a while this newsletter highlights “medical practices” that have no scientific evidence in an attempt to be integrative with criticism as well as praise. In other words, both “natural” and mainstream practitioners may be offended once in a while.

  1. Blood type diet: the studies were done by analyzing blood cell clustering/lumping in petri dishes when different foods were added. Bypassing the natural digestive/metabolic processes of the intestines (i.e., probiotics’ action) invalidates this diet. However, there is some theoretic merit to this concept: blood types are sugar molecules on the cell membrane of blood cells. This is why blood type O (no sugars on cell membrane) patients seem to be particularly sensitive to refined carbohydrates.
  2. HCG diet: not only there is no evidence for it, but it may be harmful. The only reason it “seems” to work is the ultra restrictive amount of calories (500kcal/day) that it recommends, which results in regaining the weight within a year due to hormonal changes.[11]
  3. Bioidentical hormones: They do work and women prefer them; I do, too, because they are extracted from wild yams, which makes them less synthetic and easier to detoxify. They are also more balanced; they contain 3 estrogens that balance each other and they also have testosterone, DHEA and progesterone to balance the former. The problem with these hormones is that some practitioners make patients draw serum or salivary levels, which are well known to be unreliable; they vary from hour to hour. These practitioners rely on said levels to make frequent adjustments to the dose of these hormones, thus triggering more visits and lab fees that end up costing unsuspecting patients thousands of dollars for something that could have been regulated with only a couple of visits, no labs and very little hustle and money.
  4. Oxygenated water: when I asked the company to send me studies showing that their questionable product work, I got a dozen references saying that the human body needs oxygen to thrive. well, blow me over with a feather.

 

Telegraphed Articles

Efficacy of Brief Behavioral Treatment for Chronic Insomnia in Older Adults
J. Arch Intern Med. 2011;171(10):887. Stress management, clock rotation, avoiding TV and EMF late at night, eating light food (protein), etc. work as well as sleeping pills.

More than adequate iodine intake may increase subclinical hypothyroidism and autoimmune thyroiditis Eur J Endocrinol 2011 164 943. I ended up with a damaged thyroid by taking iodine.

Central Obesity and Survival in Subjects With Coronary Artery Disease: A Systematic Review of the Literature and Collaborative Analysis With Individual Subject Data
J Am Coll Cardiol 2011;57: 1877. This means that a beer-belly decreases your chances of survival if you have heart/circulatory problems. Stay away from ibuprofen-like drugs.

Excess Visceral Adipose Tissue/Ectopic Fat: The Missing Link in the Obesity Paradox?
J Am Coll Cardiol 2011;57: 1887. Yeah, the beer belly is sending hormonal messages to your brain perpetuating your metabolic problems; your thermostat in the brain is thus disrupted.

Antipsychotics Increase Mortality Risk in Elderly J. Family Practice News, May 15th 2011, p32. They also promote obesity. These drugs are seriously over prescribed.

Adherence to French Nutritional Guidelines Is Associated with Lower Risk of Metabolic Syndrome. J. Nutr 2011 141: 6 1134. Joyeux Noël!

[1] J. Science 2002;296:698

[2] J. Arch Intern Med 2011;171(16):1433

[3] J. Arch Intern Med 2011;171(16):1503

[4] J. Arch Intern Med 2011;171(16):1463

[5]Duration of Treatment With Nonsteroidal Anti-Inflammatory Drugs and Impact on Risk of Death and Recurrent Myocardial Infarction in Patients With Prior Myocardial Infarction: A Nationwide Cohort Study,”
J. Circulation 2011;123:2226

[6] J. Arch Int Med 1999;159:2170

[7]Green Tea Polyphenols Provide Photoprotection, Increase Microcirculation, and Modulate Skin Properties of Women,” J. Nutr 2011;141:1202

[8]Plasma levels of asymmetric dimethylarginine in patients with biopsy-proven nonalcoholic fatty liver disease,” J. Metabolism Clinical and Experimental 2011:60:776

[9]Periodontal disease and hypertriglyceridemia in Japanese subjects: potential association with enhanced lipolysis,” J. Metabolism Clinical and Experimental 2011:60:823

[10] JAMA 2008;299:2287

[11] JAMA 2011;306:2206

Hugo Rodier, MD is an integrative physician based in Draper, Utah who specializes in healing chronic disease at the cellular level by blending proper nutrition, lifestyle changes, & allopathic practices when necessary.

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