Wednesday, January 30, 2008

A (Sterile) Needle in a Haystack

As much as I hate to flagellate a deceased equine, I really don't think my last entry drove home the point about why we need to provide clean syringes and needles to injectable drug abusers.

There are numerous arguments made by those opposed to selling (or even giving) syringes and needles to drug users. It "doesn't work; addicts will use dirty needles anyway." It "sends the wrong moral message about drug use," which we all know is of primary concern to good, patriotic citizens. And, my personal favorite, it encourages drug abuse by making it "safer."

The first argument can be refuted with science. The second can't be strictly refuted because it relies entirely on subjective opinion; despite what some people seem to think, morals are cultural values, and they vary from person to person instead of being absolute or inherent.

The last argument annoys me more than the others because it blatantly ignores reality. IV drug users may be concerned with their safety, but what constitutes "acceptable risk" for abusers of illegal drugs is not the same as it is for you and I. In clinical practice, we never have patients self-administer IV injections, partly because it is considerably more difficult than giving a subcutaneous or intramuscular injection. Not only is the technique more complicated, but the risks are considerably greater. Forget about dirty needles for a moment; let's look at all the other "safety" issues being bypassed.

1: No way to verify purity of product. You don't know how much heroin you actually have and how much of that product is fillers--many of which do not belong in your veins. Even seemingly innocuous fillers such as talc or cellulose can cause tissue death.

2: Product concentration considerations. Injectable products have to be carefully balanced so that their osmolarity does not disrupt existing tissues. A solute (drug + additives) concentration that is too high will cause cells to shrink as water is sucked out of them to equalize the concentration gradient. A concentration that is too low will result in water rushing into cells and bursting their membranes.

3: Product and injection prep environment sterility. Even if you're using a clean needle, I doubt most IV drug users prepare their doses in a laminar flow hood. When pharmacists or technicians prepare injectable drug products they must meet many standards. You can potentially contaminate your product by touching any one of various critical needle/syringe areas, failing to wipe injection ports with alcohol, cleaning the hood improperly before use, taking your hands out of the sterile environment, leaning too far into the hood...the list goes on.

A "clean" needle is just the first step to sterility. You don't buy heroin in multidose glass vials that meet USP standards for purity and stability, buffered to appropriate pH and preserved with appropriate IV-safe additives. You buy heroin from a shady drug dealer in a back alley somewhere. You have no idea where he got it. There's no one you can complain to about manufacturing standards or product flaws. The fact is that drug users are willing to introduce a substance they bought in a back alley directly into their veins, bypassing all the body's barriers against infection and introducing contaminants or particles that can directly damage blood vessels.

It is so risky to abuse IV drugs that denying addicts access to clean needles is not going to be the straw that breaks the camel's back and turns them away from their dangerous habits forever. It is going to be added to the laundry list of hazards that addicts have already classified as "acceptable risks." And it isn't just addicts; new users aren't really concerned about their safety, either, and if they tell you that they are, they're lying, whether they realize it or not. There's a serious contradiction between "I prioritize being safe" and "I'm willing to inject substances of indeterminate origin and quality directly into my veins."

So we can ignore the reality that hard-core addicts are going to shoot up whether we give them clean needles or not and live in a political fantasyland where people don't do dangerous things. Or we can face the facts.

The fact is that IV drug users don't tend to pay their medical bills when they OD or contract hepatitis. They wind up in the ER, where they cannot be legally denied care, and everyone else absorbs the shock through increased healthcare costs. When addicts end up on Medicaid, you are paying for their AZT. You are paying for their hospital stays when they're suffering from liver failure. Your healthcare costs more when you deny clean syringes to drug users and more of them become seriously ill. I'm not saying you have to approve of their habits. I'm saying that you have to consider the economic ramifications of disease control. More sick people who can't pay their hospital bills means higher hospital fees for everyone so that hospitals can recoup their losses.

The fact is that the moral paternalists who oppose needle programs--and Narcan--don't care about the lives of drug addicts. They cloak their lack of empathy with layers of political doubletalk. But even if you can't bring yourself to have basic human empathy--or honesty--look at the situation from a pragmatic perspective. You are increasing costs for the entire healthcare system every time you deny that syringe sale because Johnny the addict doesn't have an insulin prescription.

Tuesday, January 29, 2008

Narcan, or: Why You Deserve to OD and Die

Pharmacy colleague (and I hope he doesn't mind my calling him that) and fellow blogger Abel Pharmboy provides a most excellent summary of the current buzz in the blogosphere about statements made by Dr. Bertha Madras. Dr. Madras, in the event that you were unaware, is a head member of the White House Office on National Drug Control Policy. And Dr. Madras would rather see opioid abusers die than distribute rescue kits that "encourage" opioid use.

I'm sorry, I thought we lived in a country that gave a damn about whether or not its citizens lived or died. Apparently, moral paternalism trumps compassion, which should be no surprise considering the government's track record with the "war on drugs."

This provides me with a handy segue into a topic that bothers me immensely: Pharmacists who refuse to dispense needles and syringes without a prescription, even in states that have laws that protect them from liability. Dispensing syringes without a prescription is clearly legal in 26 states, and most states that permit dispensing without a prescription absolve pharmacists (and technicians) of all responsibility.

The risk of contracting AIDS, hepatitis, or other blood-borne illnesses is not an effective deterrent for IV drug-users. Thinking otherwise is just flat-out delusional. If you believe that denying clean needles to drug users is going to make the give up their habit, you are way off. Drug use, especially injectable drug abuse, is a risky behavior, and it is an all-consuming urge. The fear of withdrawal symptoms is often considerably more powerful than the fear of contracting an illness. Many AIDS or hepatitis patients have no symptoms; they don't even know they carry the disease. They can and will pass that disease to others. It isn't that they don't know that sharing needles is dangerous. Using heroin is dangerous, too. The issue is that the risk is acceptable, given the information that they have. And if you don't know you're a carrier for a disease, you don't have all the information, which means that you're going to incorrectly evaluate the odds.

What denying needles (and Narcan) to addicts does do is send a powerful message. It says "society doesn't care about you, and we're secretly hoping you die so that we don't have to deal with the problem anymore." These are the same people who think you deserve to be punished for unintentionally getting pregnant. They don't care about outcomes. They don't care any more about addicts than they care about single mothers. They can all die, and decrease the surplus population.

They just want you to shut up and pay your taxes.

Seeing the Forest for the Trees

I have mentioned my aggravation with Forest Pharmaceuticals before in the context of their excessive promotion of Namenda, a drug to "delay the progression" of Alzheimer's disease. While Namenda is effective, the drug reps I've talked to have a tendency to really push it as being significantly better than it actually is, especially since we're looking at doubling the cost per patient and increasing "pill burden" for patients or their caretakers. There's nothing more depressing to me than seeing families spending a fortune on medications for Alzheimer's while watching their loved ones deteriorate despite treatment.

On the other hand, Forest's Lexapro is a follow-on drug that's actually been demonstrated to be better than its parent. So maybe they aren't all bad.

Then they released Bystolic.

Bystolic is a beta-blocker. The market is positively overflowing with beta-blockers. Metaprolol, atenolol, propranolol...a dozen or more drugs. Granted, they have subtle differences, but Bystolic doesn't bring anything new to the table.

Beta-blockers reduce adrenergic (adrenaline-mediated) stimulation of the heart and blood vessels, slowing heart rate and dilating arterioles to decrease blood pressure. B-blockers aren't as good at lowering BP directly as some other drugs, but they are quite useful in preventing further damage to the heart after a myocardial infarction (heart attack) and in treating irregular heartbeats. Intriguingly, propranolol can even be used to prevent migraines, though the precise mechanism of action is not well-understood.

Bystolic is only approved to lower high blood pressure, but Forest is hoping to get it approved for patients with heart failure as well. Unfortunately for Forest, we already have a great cousin drug that has both indications--carvedilol--and it's available generically as of last year.

I realize that sometimes drugs get stuck in the research pipeline and the company gets so far into development that not releasing the drug is a bad financial move even if the drug is not likely to "sell." But Forest has likely spent enough money producing Bystolic that they must find a way to get physicians to prescribe it despite the fact that Bystolic is a "useless" drug. Sure, it works, but no sane clinician is going to prescribe it given a myriad of equally effective alternatives that cost one-fourth as much.

Unless, of course, Forest sends out their reps to promote it. Which means that it's a safe bet that Forest is going to spend a lot of money to advertise a drug that you'd have to be incredibly foolish to prescribe. Drug research and development costs are very high, but pharmaceutical advertising inflates prices beyond what is reasonable. And if given a sufficiently convincing sales pitch, many physicians might prescribe the drug anyway. Many doctors just don't know how much drugs cost. I have personal experience in the matter; I make a lot of phone calls when I'm working to ask physicians to switch to cheaper alternatives or to permit generic substitution when they've signed something "dispense as written" for no good reason (dermatologists, I'm looking at you).

Come on, Forest. You can do better than this. I know I saw your vague, almost viral ads in pharmacy magazines and got a little excited about your "new development in the treatment of hypertension." At least throw us another direct renin inhibitor instead of trying to pass off a totally underwhelming drug as the next big thing.

Friday, January 25, 2008


I'd like to point you all in the general direction of RxWiki.

RxWiki is a wiki that only licensed pharmacists are permitted to edit; it's being compiled as a resource for anyone, but it's generally being directed at patients. I've been browsing it a bit myself, and I'm very impressed so far. Apparently they have a panel of pharmacists who review everything and approve articles, and they're endorsed by the APhA.

I do take serious issue with their little blurb that's currently on the front page about placebos. The information presented in the articles seems solid, though.

Check it out. I think it might just become my new source for links whenever I cite a drug name.

Wednesday, January 23, 2008

Feel the Buzz

A friend of mine specifically asked for my opinion on a novel product. Now, I must say. From a marketing standpoint, this is brilliant and hilarious. It's the kind of thing I might be willing to spend a couple dollars to buy if I saw it on the shelf just because it would increase my geek score by ten points. After being provided with the supplement facts for the product, I began an in-depth analysis.

This product is analogous to 5-hour Energy and similar "energy shot" products, which, if you really want to, you can get at any drugstore, gas station, or supermarket for a couple dollars apiece. The common claim is that products like 5-hour energy provide you with a long-lasting jolt without "jitteriness" associated with caffeine use or "carb crash." Energy shots typically contain little or no carbohydrates, so they won't elevate your blood sugar directly. The caloric content is generally very low. Which means that any energy boost these products provide is all due to the stimulant content--in other words, the caffeine.

Red Bull comes in 8.3 ounce cans. One can has approximately 80 mg of caffeine. A 12-oz Mountain Dew has about 50 mg of caffeine, a Dew Game Fuel has 72 mg, and a can of Coke has about 25 mg. The caffeine of coffee varies depending on preparation, but you're looking at an average of 100 mg per 8 ounce cup. Typical caffeine tablets have 200 mg per tab. For more information on the caffeine content of various products, check out this handy table.

Energy shot products claim to be different from caffeine because they contain B-vitamins, amino acids, and enzymes.

The B-vitamins aren't likely to have toxic side-effects, even at very high doses. They also aren't likely to do anything beneficial, because B-vitamins are water-soluble and you're going to end up dumping all of the excess out in your urine. B-vitamins are important for energy metabolism, but they're also in everything. Most grains are fortified with B-vitamins, including breakfast cereal. Very, very few people have legitimate B-vitamin deficiencies. And they're not something you would miss; insufficient B12, for example, can cause nerve pain and other neurological problems. Extra B-vitamins will not make you more energetic, much like intranasal, sublingual, or injected B12 will not give you a "boost," unless of course you have pernicious anemia, which is best diagnosed by a physician able to test the levels of B12 in your blood.

The "enzyme blend" in the product is presumably being touted as aiding in the metabolism of whatever energy stores you have or whatever food you've eaten. Amylases break down carbs. Cellulases break down indigestable starches (cellulose) found in plants. Lactases break down milk sugar (lactose), lipases break down fat, and proteases break down protein. The claim is that by putting these things into your stomach you will better digest anything that's in there and get more energy. The even more far-fetched claim is that by consuming lipases, for example, that you will break down stored fat in your body.

This is all wrong. Enzymes are proteins. Proteins are rapidly digested and broken down into component amino acids in the human stomach. Those enzymes will suffer the same fate as any hamburger. And they won't do anything in the stomach because enzymes have very specific pH requirements; it is unlikely that they will be active in the acidic environment of the stomach.

There are exceptions to this; it is possible to take lactase capsules to overcome lactose intolerance, for example. But this works because the lactase is protected by a coating to allow it to survive the stomach and reach the intestine. Lactase suspended (not dissolved; proteins are not water-soluble) in some liquid is going to get chewed up by gastric proteases, as are other enzymes thrown into the stomach.

L-taurine is an amino acid that might have some stimulant effects. Glucuronolactone is a by-product of glucose metabolism in the liver; it is touted as a fatigue-fighter, but there's not a lot of evidence to support this. And of course, there's a lot of caffeine. As I said before, the majority of effect of this product will come from the caffeine, which means that it will have the exact same effects--and side-effects--as heavy caffeine use, such as tremors, anxiety, heart palpitations, increased blood pressure, and insomnia. Mana Potion, like 5-hour Energy, is no different from taking a caffeine tab alongside a B-complex vitamin. As far as pharmacologic effect goes, that's a much more economical way to achieve the same outcome as this product. And an ounce or so of fluid is not doing you any favors in the hydration department, so that's not a good reason to prefer liquid shots over solid tablets.

Coffee, without sugar or cream, doesn't contain carbohydrates, fats, or proteins. As such, it is non-caloric. So if you really want a low-cal caffeine fix and you think popping Vivarin makes you a junkie, drink black coffee.

If you don't like coffee and really want a no-cal caffeine fix, and you don't want to pop caffeine tabs,'re out of luck, I guess. You could always switch Mountain Dew?

Or you could shell out for overpriced "energy shots."

Monday, January 21, 2008

Saturday, January 19, 2008

Politics + Science = Plug

The SHARP Network, provided by Scientists and Engineers for America, is a really neat website/database where you can look up your congressional representatives and see how they've voted on various important issues (education, energy, health, grants, stem cell research, etc). These issues are important to everyone, not just scientists, and having handy access to information is always a good thing.

Thursday, January 17, 2008


News flash to a patient who chewed me out at work the other day because we didn't have the dosage of theophylline in stock that her pet dog had been prescribed (100 mg capsules, to be precise):

No one is on theophylline. Yes, I know theophylline is an asthma drug and that in theory that means it is an important, life-saving medication. There might be two people in this whole state on theophylline. Your suggestion that we should stock theophylline because it is a life-saving drug is analogous to being upset that we don't have a huge supply of thalidomide on hand. Thalidomide is used for renal cell carcinoma. We don't stock it because we might get one prescription for it by the end of this century.

You should train your dog to use an albuterol inhaler. We have one patient whose cat uses one. I don't know how she managed that, but she deserves some sort of award.

Questionable Diagnosis, FDA-Endorsed Treatment

The New York Times ran an interesting article the other day about the use of Lyrica for fibromyalgia. Lyrica was recently approved by the FDA to treat the condition in addition to existing approvals for nerve pain and seizure disorders.

The question on the minds of a lot of medical professionals is whether or not we now have an approved treatment for a disease that may not exist.

Fibromyalgia is kind of weird. My clinical assessment professor, an emergency department doctor specializing in internal medicine, expressed the opinion that fibromyalgia was essentially a BS diagnosis that drug-seeking patients rode as far as they could to get their hands on painkillers to abuse. He seems to have overlooked the fact that most fibromyalgia sufferers say they don't get relief from opiates. In any case, I wouldn't go that far, myself, but as I understand it, the literature on fibromyalgia is iffy.

Most theories suggest that fibromyalgia is a chronic pain disorder characterized by abnormalities in nervous conduction that result in a lower pain threshold in affected patients. However, fibromyalgia has also been used as a "blanket diagnosis" of sorts for patients with non-specific aches and pains, fatigue, or other symptoms that are difficult to pin to a particular disorder.

Fibromyalgia might be a real disease with a clear cause. It might not. I don't have data on hand to form an opinion one way or the other. But I would be willing to bet very large amounts of money that only a fraction of patients "diagnosed" with fibromyalgia are actually ill in any medically identifiable way. Fibromyalgia, like "chronic fatigue syndrome," is essentially a diagnosis that your poor, stressed doctor can make when he's at the end of his rope and ready to give up.

I say this because no MD in his right mind is going to jump to fibromyalgia as a first diagnosis. For example, acute trauma, infection, and diabetes are all going to be considered first as sources of weakness, tiredness, or pain. All of these can be screened for or quickly ruled out by physical exam. Psychogenic illness--in essence, the idea that faulty brain chemistry is responsible for your problem--will probably be proposed at some point. Sufferers of depression, for example, frequently present with fatigue or difficult-to-explain aches and pains. You will try SSRIs, tricyclics, Wellbutrin, SNRIs, lithium, and electroconvulsive therapy before you get tired of treatments that aren't helping.

A dozen lab tests, MRIs, and lumbar punctures later, your poor doctor will conclude that it's not Lupus and be forced to diagnose you with fibromyalgia for lack of any better ideas.

In any case, studies demonstrated that patients diagnosed with fibromyalgia improved more when given Lyrica than when given a placebo. So you could make a case that Lyrica isn't a sham treatment; it's not like using homeopathy for fibro, but I'm sure people have tried it--and felt better afterward.

So it all comes back to placebophilia. What's worse, giving patients with non-specific symptoms of a questionable disease a drug with potentially inconvenient side effects or the same patients treating themselves with fake medicine? Ethically, I'm opposed to "therapeutic placebo usage," but the question is still there. We don't want to give patients medication that they don't really need. Are we doing that here?

Only time and research will tell. Maybe someday we'll get a handle on fibromyalgia. Maybe not.

Tuesday, January 15, 2008

Old News: Still Sucks

Laws like these have been getting pitched around a lot lately, mostly in the wake of the Plan B "controversy" perpetuated by people who think they have more right to control what goes on in a woman's uterus than individual women do. And if they can't pass laws making contraception, abortions, or premarital sex illegal, then by God, they're at least going to try to shame everyone on the face of the earth into submission.

And by "everyone on the face of the earth" I mean Americans. Who else is there? I suppose there are those outside-the-box thinkers that are willing to look at the problems of Africa.

Here's what bothers me. It's not that the bill is being discussed, because that's old news. It's not the reality-blind moral paternalism that's associated with these issues. It's the fact that the Indiana Pharmacist's Association is supporting the bill. The priorities of the IPA are clear. They really are the Indiana Pharmacist's Association, because they definitely don't represent patients.

This whole issue hinges on the idea that a pharmacist's sense of moral culpability is going to cause emotional damage to a pharmacist forced to dispense "objectionable products" against their will. That's totally more important than the emotional and financial culpability of an unwanted child. That's what you get for fooling around, I suppose. There's your lesson. There are people--and more frighteningly, health care professionals--who think you deserve to be punished for having sex.

Incoming ad hominem: I am not one bit hesitant to say that those people are inhuman monsters. I suppose it's not really an ad hominem. I'm not saying they're wrong because they're monsters. I'm saying they're monsters after the fact. Move along, no logical fallacies here.

You know, type II diabetes is typically caused by insulin precipitated by obesity. Obesity is commonly caused by overeating, and gluttony is a sin. I think I'm going to stop dispensing metformin, glipizide, Actos, Januvia, Byetta, and every other medication used to treat type II diabetes, because clearly, type II diabetics did it to themselves. They know the risks of unhealthy diets and lack of exercise. They're to blame if they didn't listen. I'll still dispense insulin, though, but only to type I diabetics who can provide the results of lab testing proving that their condition is genetic or autoimmune. Those people are being challenged in the strength of their faith by god, which is why they were created with terrible birth defects.

And no more cholesterol-lowering drugs, either. We all know that diets high in cholesterol are unhealthy, and the most prominent sources of cholesterol in the diet are animal products. The use of animals for food is unethical. If everyone were vegan, we wouldn't need Lipitor. The patients who die of heart attacks due to atherosclerotic occlusions are totally responsible for their own undoing.

I would say something about antidepressants in mockery of Scientology, but that ship has sailed, and they launched it themselves. I hope they didn't waste good champagne.

Come on, people. We've been through the Jehovah's witness scenario a dozen times. Is a JW physician allowed to refuse to give blood transfusions because he believes he's endangering the patient's immortal soul? Don't become a medical professional if you aren't willing to do your job.

Fair and Balanced Reporting

The real problem with taking on quacks and misinformation in popular media is that if I spent all my time doing it I wouldn't have time to go to class, eat, sleep, or breathe. I've come to expect depressing amounts of credulity from the media. Honestly, I'm less bothered by the idea that reporters aren't doing proper fact-checking (because that's an eternal issue) and more annoyed by the fact that stories like this one legitimize fraud as actual medicine.

Ann Arough at the Little Rock Wellness Center, she listens carefully and mulls over their conversation before suggesting a remedy. Some of the things Arough, a naturopath, might suggest are herbal supplements, diet or lifestyle change, a visit to a medical doctor or with her husband, Mark, who specializes in acupuncture and Chinese medicine. Or she might suggest that they try a homeopathic remedy.

This article follows a lot of similar articles on the subject of questionable medical practices, especially those run by local newspapers desperate for stories. They always contain a certain set of specific elements:

1: Introduce the practice (homeopathy, acupuncture, ear candling, whatever is on sale at Whole Foods this week) with a brief overview of its history.
2: Touching personal story about a patient who used method X and "achieved miraculous results."
3: Quotes from an "alternative" practitioner who supports method X.
4: Short sound bite from a "skeptic" that gets turned into a variation of "X is unconventional...but...some patients say it works, so good for them."

The "skeptic" quotes are what bug me the most. The writers of these articles are trying to give the illusion that they're giving you "both sides" of a "complicated issue" by interviewing or quoting a mainstream medical professional, but what they're really doing is trying to lend an air of legitimacy to their story by getting an implicit endorsement of the s-CAM of the week.

Allopathic doctors, the physicians most people visit, tend not to understand the diluted remedies, says Dr. Stephen Hathcock, a general practice physician at the Center for Integrative Medicine in Little Rock. “I don’t know that anyone understands the science of it and Western medicine doesn’t function in that realm,” he says.

He goes on to say some silly stuff about how "energy medicine is cutting edge" and what have you. No. No no no. There is nothing cutting edge about misunderstanding quantum physics. Biotechnology, immunology, and biochemistry are the fields driving medical advancement. Not poor interpretations of electron entanglement.

I get really tired of reading these because it's like watching a bad horror movie. You know how you want to scream at the screen when the protagonists are doing something so stupid that there's no possible way they aren't doing it on purpose, unless we assume that horror movie characters have never seen a horror movie themselves? I get the same way about these sorts of statements about homeopathy. Maybe you "don't understand the science of homeopathy" because homeopathy is magic. There is nothing vaguely scientific about it unless we're talking shifting from physics and chemistry into the realm of psychology. At that point, it becomes easy to understand how homeopathy, like many CAM treatments, can be effective: Ye olde placeboe effecte.

Of course, as I've said before, patients like placebos. I recall hearing a story about a patient who wanted his doctor to sign a contract saying that his doctor would try to maximize the placebo effect whenever possible, essentially giving the physician license to "fool him" if it would help with his symptoms. The doctor, on totally reasonable ethical grounds, refused. But the story illustrates my point well. Patients don't typically care how they get better; they just want to do it. And if homeopathy, megadoses of vitamins, or acupunture make them feel better, or give them a sense of empowerment regarding their illnesses, they're going to go for it. But they wouldn't have tried those methods in the first place if someone hadn't recommended them, directly or indirectly. And the lack of willingness of many medical professionals to condemn outright CAM for fear of alienating their patients--or worsening their treatment outcomes--creates a nasty ethical quagmire.

Sometimes you get item 5, which is "alternative medicine practitioner really, really wishes they would license practitioners of X in their home state to ensure quality of care."

She and her husband returned home to Arkansas about two years ago, and she intends to lobby for licensure legislation here, which would allow her and others to practice medicine according to her training, and, she says it would create standards that would ultimately protect patients.

Yeah. I'd much rather see a witch doctor with a degree from Harvard than a witch doctor who picked up his trade from correspondence courses online.

I may write the editor of NWAnews. I may not. I have a feeling my words will fall on deaf ears. Personally, I think this represents the ultimate failure of the media; its tendency to portray and even create controversy where there is none. The scientific consensus--which is the only one that matters, when we're talking about science--is that homeopathy is nothing more than a ritualized placebo. Science isn't like politics. You can't put reality to a vote if you don't like it, and there are such things as absolute truths. "Fair and balanced" reporting implies that both sides of a "controversy" have equal weight. In this case, they do not.

Why can't we bury this issue once and for all?

Saturday, January 12, 2008

A Taste of "Duh"

Label on a pack of oral birth control:

"Do not take this medication if you intend to become pregnant."

That would be a little counterproductive, wouldn't it?

My other personal favorite is probably the "may cause drowsiness" warning on Lunesta and Ambien. If they didn't, I'd probably demand a refund.

Friday, January 4, 2008

The REAL Cutting Edge of Medicine

Has anyone else ever noticed the fact that proponents of alternative/integrative medicine, most notably the NCCAM, are always talking about altmed like it's the "cutting edge" of medicine? As though CAM "research" and the use of "holistic" therapies are what separate the wheat from the chaff in today's medical world? After all, they're the ones that are really curing diseases. "Allopathy" can only subdue symptoms with toxic drugs, enslaving patients with chronic illnesses to big pharma for life. (Somehow buying supplements for the rest of your life is different.)

I'm going to abandon professionalism and make a rude gesture at those talking heads for a moment, because they (obviously) haven't the faintest idea what they're talking about. You want to see the cutting edge of medicine?

This is some amazing stuff. According to JAMA and several other sources, Swiss researchers are working on a promising new vaccine that may be a more effective way to control high blood pressure. The vaccine works by stimulating the body to create antibodies against a human protein called angiotensin II.

When the kidneys are recieving insufficient blood, the kidneys secrete a substance called renin. Renin, in turn, stimulates the formation of angiotensin, which is then transformed by angiotensin-converting enzyme (usually called ACE) into angiotensin II. Angiotensin II has a powerful effect on blood vessels, promoting constriction and increasing pressure. This system is a major means of controlling fluid volume in the human body. In fact, you may have heard of ACE before. ACE inhibitors, such as lisinopril, are commonly used to lower blood pressure; these drugs work by blocking the formation of angiotensin II. Other drugs for hypertension, such as angiotensin-receptor blockers (ARBs) and the new direct renin inhibitor Tekturna all work to accomplish the same goal--reducing the effect of angiotensin II.

The new vaccine works by stimulating the human immune system to produce antibodies to attack and break down angiotensin II. This is an absolutely incredible use of biochemistry--modifying the immune system to eliminate a protein that the body is making in excess. Because the effects of the vaccine are long-lasting, patients shouldn't need to take daily medications to decrease their blood pressure. In fact, it may be necessary for patients to have medication on hand to raise their blood pressure in the event of an emergency, much like diabetics who carry glucose tablets to rapidly raise their blood sugar in case of an insulin overdose. Further time and testing will tell, but early trials are very promising--4 and 12-month follow-ups suggest that the vaccines are well-tolerated.

And this same theory is being applied elsewhere in medicine as well. Cancer vaccines are in development that can be used to treat various cancers by reprogramming the body to attack cancer cells without harming healthy cells. Even Alzheimer's disease might be treatable with a vaccine that degrades the "plaques" that form on neurons and are understood to be a major cause of the disease.

What kills me is that this is the sort of thing that altmed is always claiming to do--modification of the body's immune system to produce a long-term cure for a disease that isn't caused by an infectious agent. Forget about balancing vibrations or whatever. This is real high-tech medicine. If human beings are going to someday conquer all forms of illness, the work will be done by biochemists, not reiki masters.