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    "When many cures are offered for a disease, it means the disease is not curable" -Anton Chekhov




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    Saturday, March 09, 2002

    Claritin is going over-the-counter, but don't worry, Schering is already pushing it's prescription alternative, Clarinex. This new one has only been out on the market for two months and already I have had the managed care pharmacy, Caremark calling to ask me to switch my patients from Allegra and Zyrtec to Clarinex. Caremark is predisposed to using Schering products. No doubt it has cut a deal with them for lower prices, but I'm wary of using new drugs without adequate safety information. Once upon a time, the FDA could be relied on to confirm a drug's safety before approving it, but no longer. Too many drugs have had to be recalled for deadly side effects in the past ten years. (Some examples: Baycol, Duract, Redux, Posicor, Rezulin, the Rotavirus vaccine). My advice is wait until a drug has been on the market for a few years before you trust it.
     

    posted by Sydney on 3/09/2002 12:38:00 PM 0 comments

    Friday, March 08, 2002

    More on the pros and cons of mammograms. I still think the cons outweigh the pros.
     

    posted by Sydney on 3/08/2002 07:40:00 PM 0 comments

    So this is why the FDA has been dropping the ball so often in the past ten years.

    The most disturbing part of the story is that the FDA actually meets with the drug companies to negotiate the fees they're going to charge to review the drugs. Why do they even have to debate it with them? Just raise the price like the government does with any other user fee: licensing fees, toll roads, taxes. I had no idea the FDA was in the pocket of the industry to this extent. Remember this the next time you hear of some hot new drug being taken off the market for fatal side effects.
     
    posted by Sydney on 3/08/2002 07:35:00 PM 0 comments

    Thursday, March 07, 2002

    Taking away their reproach among women.

    It's hard to believe someone would endure complicated surgery and oppressive immune supressing drugs for the discomfort of pregnancy and the torture of child birth, but evidently in the Muslim world it's worth it. I guess some women would do anything to avoid being considered an "empty vessel."

    This really can not be considered a success, and I would hesitate to recommend it to anyone if it had been a success. There's an awful lot of risk involved: complicated, prolonged surgery, side effects of drugs to suppress the immune system, and then the risk of bearing a child in a transplanted uterus. Who knows how well a transplanted uterus would respond to the stress of childbearing? It's far too much risk to justify it as a means of achieving the romance of motherhood, which like all romance quickly fades in the face of reality. Wouldn't it be easier for Islamic law to change their edicts and allow adoption?
     

    posted by Sydney on 3/07/2002 11:02:00 PM 0 comments

    A good article on unproven therapy.

    This is a real problem and it goes much deeper than hormone replacement therapy or new cancer treatments. Drug companies use their dubious findings and misleading statistics in television and print advertising to convince consumers their products are superior. The FDA needs to do a better job of policing this.
     
    posted by Sydney on 3/07/2002 08:41:00 AM 0 comments

    Wednesday, March 06, 2002

    The weekly art history lesson, courtesy of JAMA.
     

    posted by Sydney on 3/06/2002 09:07:00 AM 0 comments

    Researchers confirm the stoner stereotype. Well, duh, dude.
     
    posted by Sydney on 3/06/2002 09:06:00 AM 0 comments

    COLDS AND FEVERS II: If you want a sensible approach to treating colds and fevers, click here, and
    here, and here.
     
    posted by Sydney on 3/06/2002 09:01:00 AM 0 comments

    The New York Times treats its readers to an example of some of the worst in health care reporting.

    The article, ostensibly about a new drug to treat life-threatening infections, begins with the attention-grabbing but misleading statement that a healthy, middle-aged man died of a common cold. He couldn't and he didn't. Many paragraphs later the writer reveals the man died of a rare but deadly form of bacterial pneumonia, not the cold or the viral pneumonia the author leads with. This revelation only comes after yet more misleading drama as the writer relates the tale of the man's illness. She accuses his doctor of misdiagnosing him and treating him improperly; never mind that his presenting symptoms were not consistent with pneumonia or with sepsis. Truth and fairness are sacrificed for a dramatic lead-in to her story. In the process she misleads her readers into thinking that a common cold and fever have a good chance of turning deadly and that they can't rely on their doctors to make the proper diagnosis. This is especially disappointing because the writer is Jane Brody who usually writes clear and cogent health care columns. Is she getting old and weary or just succumbing to editorial pressure to jazz up her stories?

     
    posted by Sydney on 3/06/2002 09:01:00 AM 0 comments

    Tuesday, March 05, 2002

    Are scans a waste? In a word, yes.

    Lump this with "executive physicals" as a way for physicians to work the system and exploit the fears of the worried well to make a quick buck. There are many diseases these scans would not detect: colon cancer, for example, or prostate cancer. They would not tell you whether your heart functions properly, or whether you have colon polyps or kidney disease or asthma or emphysema. In these cases, they would only give a patient a false sense of security. In addition, the chances of a total body scan finding a meaningful abnormality in a healthy, asymptomatic person are exceedingly small.

    It is aggravating to see physicians promoting such garbage, especially when the ones doing the promoting are those who stand to profit from it. Shame on them. They taint all of us when they behave this way and only further undermine the trust between patient and doctor.
     

    posted by Sydney on 3/05/2002 08:49:00 AM 0 comments

    Monday, March 04, 2002

    The Europeans are noticing a few problems with herbal medicinals.

    This is worth noting. One of the arguments of the pro-herbal movement in this country is that they have been used for years in Europe without any problems. Wrong. As this article makes clear, products have been pulled off the shelf in Europe and in England because of toxic side effects and drug interactions. In the United States, however, no one has the authority to police these herbal drugs. They are considered "dietary supplements" as if they were as harmless as Flinstone vitamins. If only that were the case. Some choice excerpts from the article:

    "In the year 2000 evidence surfaced that St John’s wort could interfere with certain prescription medicines, including drugs used to treat transplant patients (cyclosporin), heart conditions and blood clots (warfarin, digoxin), asthma (theophylline), depression (selective serotonin reuptake inhibitors — SSRIs) migraine (triptans), HIV infection and the Pill."

    "But that is only St John’s wort. “There is a real lack of research into drug-herb interactions,” says Dr Jo Barnes, of the Centre for Pharmacognosy and Phytotherapy at the School of Pharmacy, University of London. Lists of potential interactions are compiled on the basis of what is known about the chemical constituents of plants and conventional drugs. This knowledge is considerable. Dong quai, feverfew and ginkgo could all theoretically interfere with the anticoagulant warfarin. Ginseng, if taken with caffeine, could increase blood pressure. Echinacea can be toxic to the liver and should not be combined with drugs that can cause liver damage. A recent study, in Clinical Infectious Diseases, one of the few carried out so far, found that garlic supplements halved the effectiveness of the anti-HIV drug saquinavir, valerian is inadvisable with sedatives and so on."

    And so on, indeed.
     

    posted by Sydney on 3/04/2002 09:44:00 PM 0 comments

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