Tuesday, 26 May 2020

Medication: For Every Action An Interaction

 Dave R May 2020
Unfortunately many people with a chronic illness, also have to deal with other conditions at the same time. Given that the meds for the most serious problem must come first; how can we be sure that other prescribed drugs, or vitamins, or minerals and herbal supplements are not interacting negatively?

Most people have to deal with various illnesses and complaints during their lifetime and by definition, the older you get, the more likely something will come along to ruin your year. If you are unlucky enough to have a chronic condition, then that’s something that most other people will have avoided but for you, it’s an extra burden on top of the illnesses you might have reasonably expected to get according to your age and lifestyle. This means that at one time or another or if you’re really unlucky, you’ll be permanently taking multiple medications at the same time to deal with what’s ailing you. This is when you really need to watch out for what you’re putting into your body because the very things meant to cure or control your problem may end up fighting each other in your system, to the detriment of one, or the other, or both. Not only medications can interact negatively but supplements and vitamins can influence the working of your medical treatment. You need to be on top of your game…it’s a veritable minefield!

Drug interactions are a serious issue and for people living with HIV, or cancer, or any other serious condition, it’s not just a question of avoiding the famous medication influencers, grapefruits and St. John’s wort. It requires careful checking of each of your HIV drugs and components against anything else you might be taking, to see if one reduces the efficiency of another, or worse, interferes with it to the point of making it dangerous.

Most people take medications on trust. They go to their doctor or specialist and are prescribed something to treat a specific problem. If you’re lucky you’ll be warned about possible side effects but mostly you take your doctor’s word as being gospel and swallow your drugs at the appointed times each day without a second thought. Furthermore, most people don’t read the information leaflet inside the box, a) because they don’t want to become paranoid about all the possible side effects and b) because the print is sometimes so small you need the Hubble telescope to read it or c) because they just can’t be bothered.

The list of potential side effects is indeed intimidating but if you remember that it’s there to cover the pharmaceutical company’s ass if something goes wrong – “Well, you were warned in the leaflet!”; you can read the most common side effects and then do your own research on the internet. However, reading the leaflet anyway is not a bad idea, if only to see whether the recommendations match up with what your doctor has told you. If they don’t then you’re entitled to phone and ask why; there may well be a reasonable explanation but leave nothing to chance.

Doctors are also human beings who make mistakes; they shouldn’t but they do and we should be able to forgive them for it, considering their workload and stress levels plus the fact that you may be patient number 35 of the day and he/she can’t remember that this particular antibiotic actually clashes with this other particular medication. It happens more frequently that you may think and when something goes wrong it may be some considerable time later and the mistake may be very difficult to trace back. HIV and cancer meds for instance, are complex compounds and in order to work to the optimum, they have to be taken at the recommended times and regularly but if they are mixed with other chemical drugs meant for other diseases, the clashes may have consequences. It’s logical really. In the best of all possible worlds, the right prescription is given for the right disease and the eventual interactions will flash up on your chemist’s computer screen before you even begin the course. However, in the real world things will be missed; especially when it comes to taking supplements over which your doctors or pharmacists generally have little control.

It’s up to us then to check everything we throw down our throats because simply put, it’s in our own best interests. The links shown here are two of the best sites for checking both what’s in your drugs, what the side effects are and what the possible interactions with other drugs can be.
How do your medications interact with others? (http://www.drugs.com/drug_interactions.html)

There are other good drug comparison sites on the Net but these two are trustworthy and you really need accurate information. If in doubt double check somewhere else.
Whenever you come away from the doctor or specialist, take a few minutes (it really doesn’t take long) to use these sites to see exactly what you’re taking and what its purpose is and then check its interactions with any other medicines, or supplements you may use. 

N.B sometimes you will need to enter the proper name of the drug and not just its market name. For example, Truvada is a combination of Tenofovir and emtricitabine and Isentress is Raltegravir. This is because different countries often have different brand names for drugs but you will always find the proper name on the box, generally in brackets after the brand name. Most common supplements can also be checked on the second link.

If you have any doubts at all about clashes or contra-indications, or even side-effects; first check that you haven’t misread the information and then don’t hesitate to contact the person who has prescribed it for you. They may be slightly irritated that you’ve had the nerve to question their judgement but really they should be pleased that you’re so on the ball because if there is a problem and your HIV or other drugs are compromised by something else you’re taking, then they won’t work properly and the last thing you want is to be resistant to this that or the other because of other chemical influences. Doing a bit of research on your own may save wasting time and money due to complications later.

If you think that you’re perfectly healthy; your HIV regime is working fine and everything is hunky dory, remember that you may become diabetic, or be unlucky enough to get a cancer, or any one of a myriad of lesser or greater diseases later in life – it happens! Remember also, alcohol is one of the commonest negative interacters with drugs so everybody needs to keep their wits about them. Besides that, even antibiotics issued for common infections, can interact with your primary meds for other conditions. There are almost always enough good alternatives, so why put yourself through more misery for the sake of a few minutes reading up the facts.

I’m aware that this all sounds a bit like a lecture from your parents and I apologise for that but so many people are unaware of both what they put into their bodies every day and how one chemical can work against another, that it can’t do any harm to at least consider adding these two links to your favourites, in case something comes up in the future. Don’t rely 100% on doctors; they just don’t have the time or the resources any more to check absolutely everything in the pantheon of medicines and remember your case is unique; you may react badly to a certain drug while others don’t. It seems a no-brainer to be at least partially responsible for looking at our own treatment efficiency and sharing the load with our doctors. Your treatment should ideally be a partnership between you and your doctor instead of being one-sided and assuming that ‘God doesn’t fuck up every now and then’. Don’t let yourself be caught out by ignorance; you’re the only one who may suffer in the end.

Further information:

Wednesday, 13 May 2020

Quackademia: Medicine On The Downlow

Quackademia: Medicine On The Downlow

Dave R May 2020

The History of Medicine

“I have an earache.”

2000 B.C. – Here, eat this root

1000 A.D. – That root is heathen; say this prayer.

1850 A.D. – That prayer is superstition; drink this potion.

1940 A.D. – That potion is snake oil; swallow this pill.

1985 A.D. – That pill is ineffective; take this antibiotic.

2000 A.D. – That antibiotic is artificial; here, eat this root.

 Quacks and charlatans have been around since man first said ‘ouch’ and the acceptance of alternative therapies and treatments into mainstream medicine, has made it easier than ever for them to operate. People living with chronic illnesses such as neuropathy, cancer and HIV and recently the threat of another deadly virus covid-19, have been particularly susceptible to these fraudsters.

Ever since man walked on two legs and discovered that a particular herb soothed a particular hurt, there have been people who have tried to take advantage, by pretending that their ‘cure’ was both better and more valuable than any others. These people were called charlatans, mountebanks, or quacksalvers (from old Dutch, meaning people who bragged about their ointments). Today we just call them quacks and they’re just as much in evidence as they always were; perhaps more so with the technological possibilities of the internet. If people are afflicted with something for which there is no cure, they become desperate and desperate people take desperate measures. Because their ailment is too scientifically complex to understand, they don’t have enough knowledge of the physiology to know when they’re being sold a dud or not. It is into this arena of despair that quacks step in with dollar signs in their eyes.

You probably know the saying, ‘caveat emptor’ meaning ‘let the buyer beware’ but too many of us ignore it completely when ordering stuff on-line – am I right? It also becomes an excuse to let fraudsters off the hook when they’re tackled about their morality. Counterfeit medicines are a multi-billion dollar, worldwide industry and still growing. It’s thought that +- 15% of all drugs sold worldwide are fake and that would be much higher if badly-made copies were added to the mix. In Africa and parts of Asia, it can be more than 50% but nowhere is immune because of the growth of on-line buying. You’ve all seen them in your spam boxes; the on-line pharmacies that look utterly professional on the surface but are ruthless con men underneath. It began with Viagra, which of course was way over-priced, forcing people to look for cheaper alternatives and copies with supposedly the same components. Soon enough, con-men realised that there was money to be made by exploiting people’s fears of other diseases too and birth control pills, hormone replacements, schizophrenia meds, cancer drugs and cures, weight loss miracles and HIV therapies were all addressed. The official drug companies have to bear some responsibility for mushrooming on-line businesses in drugs because in their quest for profits, they price themselves out of many people’s reach and where drugs aren’t available or are just too expensive, people find alternative sources on-line. The risks become secondary; it’s human nature.

“The Center for Medicine in the Public Interest estimates that fake medicine sales in the United States totals $75 billion every year, and has doubled since 2005.”  More info here (http://www.safemedicines.org/2011/12/most-common-fake-drugs-in-us-prey-on-chronic-diseases-389.html).

 Fortunately, in an attempt to control the problem, an international effort to do something about it has just begun. You may have noticed in the media some time ago, the International Internet Week of Action (Operation Pangea), which was coordinated by Interpol. It involved 81 countries and has led to dozens of arrests, the closure of internet sites and the seizure of millions of potentially dangerous medicines. 

Aline Plancon Head of Pharmaceutical Crime Unit at Interpol gave specific figures. “We have shut down more than 10,000 illegal pharmacy sites online and taken almost 10 million medicines.”

It’s a start but as we all know from attempts to shut down media download sites, where one shuts down, another pops up to take its place. This will be a long-term operation.

Quacks and Health

"The medicine that I use has two things that distinguish it from some other forms of "medicine:" 1. It appears to work anywhere on the planet. 2. I don't have to believe in it for it to work.” David Ramey, DVM

It’s funny how things change. Non-medically approved medicines and treatments used to be called ‘fringe’ medicines, or ‘unconventional’ treatments and those two words carried an implicit warning with them. They weren’t approved by doctors or scientists therefore you indulged at your own risk. Today the language has changed and the boundaries have blurred; so much so that ‘alternative’, ‘complementary’, holistic’, ‘homeopathic’ and ‘integrative’ are almost seen as the equals of and sometimes preferable to, chemical, science-based treatments. Mainstream doctors, clinics and hospitals often have dietary supplements in their medicine closets and offer treatments like reiki, massage, chiropractic and acupuncture as a matter of course. Why is this? Are the alternative treatments now seen as trustworthy alternatives to regular medicine? Not necessarily but many are accepted as being intrinsically harmless and may actually improve many conditions. This is really the result of clever marketing and the gradual trend since the 60’s, of regarding chemical drugs with a modicum of suspicion. Mainstream medicine has taken alternative medicine on board mainly because of patient demand and even the largest drug companies have their fingers in the alternative medicine pie.
Marketing has been so successful that many critics have moderated their attitudes and now subscribe to the following:

"There cannot be two kinds of medicine - conventional and alternative. There is only medicine that has been adequately tested and medicine that has not, medicine that works and medicine that may or may not work. Once a treatment has been tested rigorously, it no longer matters whether it was considered alternative at the outset. If it is found to be reasonably safe and effective, it will be accepted." - Angell M, Kassirer JP, ‘Alternative medicine--the risks of untested and unregulated remedies.’

So the rise and rise of alternative medicine has not been due to hundreds of proven studies and deep scientific research but more to an unstoppable marketing force and public opinion that these things are natural, therefore must be good. Logically, every sensible person will conclude that that can’t always be the case.

Quacks and HIV
Of course if you’re reading this on this site then you may be more interested in what sort of effect quack medicines have had on people living with HIV. You might reasonably assume that anybody offering a cure for HIV/Aids is a fraudulent operator; in 2013 we know that for a fact, yet countless people across the planet are still taken in every day by false claims for worthless products and lose their money (and sometimes their health) accordingly. It has to be said that in Africa and Asia the problem is almost endemic. This is partly because access to effective ARV treatment is more difficult; partly because people have been less exposed to the sly tricks of advertising than in more developed lands and partly because local medicine (sales)men are culturally far more acceptable. However, whatever the reasons, where there is a desperate need for help, quacks take full advantage, with often tragic consequences. In 2006 in South Africa, even the government health minister endorsed a mix of beetroot, lemon and garlic as being definitely able to delay the onset of AIDS and furthermore, defended the use of traditional medicines in helping combat the virus. When your own government is hampered by ignorance, it’s difficult to dissuade people from turning to quacks. More info here (http://www.iol.co.za/news/south-africa/eat-garlic-beetroot-and-lemon-manto-repeats-1.280721#.UeO0Oo1dySw). Overwhelming facts have probably improved the situation since then but who would dare say that their own health ministries always get it right, wherever in the world you come from! 

In the rest of the world, quack treatments and medicines have been offered since the beginning of the virus (and are happening again with Corona). You can generally split them into three groups: those who sell worthless and sometimes dangerous products which sound so unlikely they must be true; those from the burgeoning health food industry who play on our ignorance of how the body actually works and sell supplements, vitamins and herbal therapies for every aspect of HIV/AIDS and those who offer ‘alternative’ treatments. The last two groups make money by claiming to boost the immune system and people’s psychological states so that they can in some way resist viral attack and degradation. Now before going any further, it’s important to acknowledge that certain supplements are undoubtedly helpful for certain side effects of ARV treatments, as are certain treatments like acupuncture, Reiki and yoga but these generally address the state of mind of the patient and not the virus itself. Any claims to the contrary travel along that tightrope between credible and fraudulent.

HIV/AIDS has had more than its fair share of false cure claims. Take a glance through the following to see the range of ‘cures’ for HIV/AIDS that have had people both believing and wasting money and energy on since the beginning of the virus.

From eating vultures to clear up syphilis and Karposi’s syndrome, to treating HIV with garlic and beetroot.

Ozone Rectal Therapy! Ozone was seriously researched but of course to no effect.

Injecting goat serum and eating goat dung.

Charismatic aids ‘denialists’ who claim you’re not infected in the first place and therefore not in danger, or equally charismatic preachers who claim that exorcism or a return to God’s grace will cure your disease.

Microwaves or non-ionising radiation.

Magnetism or blood electrification.

Chinese herb combinations, banking on the fact that most people haven’t a clue what they’re taking.

Pills derived from mice given the AIDS virus.

Herbal capsules of various mixes.

Bottles of "T cells".

Thumping on the thymus gland.

Freezing and storing bone marrow, claiming that it could be used to restore an AIDS victim's marrow. EXP," a colloidal silver solution that sold for $50 per quart; it claimed that "EXP" would prevent and cure AIDS by "hyper oxygenating the blood".

Coconut milk.

Chiropractic care.

Holistic therapies.

High dose Vitamin C.


Bloodletting in the medieval style.

You may laugh but these are just a few of the weird and wacky quack cures that have been sold and promoted. They give you an idea but the list goes on far too long to publish here. You only have to look at the Quackbase page (http://www.quackdown.info/quackdown/claims/ ) to see lots more false claims that have been made around treating or curing HIV and Aids

If you’re snorting in disbelief and thinking that these are things only the gullible and uneducated have been taken in by, think again:-

· “A study of patients hospitalized in Illinois found that 18 out of 50 with AIDS and two of 30 patients with cancer had used "alternative" treatments. Acupuncture was used by 15 of the AIDS patients, mental imagery by 12 of them, massage therapy by 11, megavitamins by 10, acupressure by 8, unapproved medications by 7, and a high-cereal diet by 1 patient.”

· “A study of 79 patients attending the St. Louis AIDS Clinical Trials Unit found that 44 (56%) had tried an "alternative" remedy. The most commonly used were vitamins (46% of patients), herbal therapy (16%), imagery or meditation (14%), and non-approved drugs (14%). Most patients using these methods thought they had improved their general well-being but readily admitted that the benefit was largely psychological. The average yearly cost was $356, but 14 of the patients spent between $500 and $2,700, and two patients spent more than $9,000 each.”

· “Interviews with 114 patients attending the AIDS Clinic of the University of California San Francisco Medical Center indicated that 25 (22%) had taken one or more herbal products during the 3 months before the survey. The study's authors expressed concern that herbal extracts can produce diarrhoea, liver toxicity, and other symptoms common in AIDS itself.”

 “Dutch sociologists who interviewed people who used alternative treatments reported that 46% assumed that the treatment was effective, 66% thought it would strengthen their resistance, and 34% said they felt better because they had the feeling of being actively involved in their treatment.” See more information and source here (http://www.quackwatch.com/01QuackeryRelatedTopics/aids.html). 

So why did the onset of HIV and AIDS cause a resurgence of quack operations across the world and cause people to take risks? The answer is fairly obvious. If you have a disease for which there is no known cure or effective treatment and you see people around you dying horrible deaths, you clutch at any straw that floats by and that’s exactly what happened. During the worst of the AIDS years in the 80’s, people heard of new possibilities via word of mouth and as with Chinese whispers, the claims became more exaggerated and more ‘corroborated’ as the information moved along the chain. Mainstream medicine could offer nothing at the time, except for toxic medications which delivered awful side–effects and killed many prematurely. Little wonder that there was a genuine craving for anything else that might work. Spotting the opportunity, the unscrupulous set up shop and used the popular New Age philosophies and thinking of the time to promote ‘natural’ cures and treatments. Many ‘practitioners’ were misguided and genuinely wanted to help but the whole ‘cure for AIDS’ snowball became unstoppable and along with ‘cures’ for other illnesses, became the multi-billion alternative medicine industry of today.
The ‘anything’s worth a try’ philosophy is what keeps quackery going strong. I must admit, I do it myself in relation to neuropathy which is another incurable condition, although I do research things to make sure I’m not actually harming myself. That may turn out to be the answer to quackery; improving our own knowledge of how the body and our own particular health problem works. Understanding the physiology of our disease may help us to recognise when a treatment is utter nonsense or not. The internet has provided never-before imagined sources of information and we can educate ourselves at the click of a button. That however, is also the reason why modern-day quacks are still doing so well. They can and do make their websites, convincing, professional and fitted with all the medical references and recommendations they need. Pictures of doctors and nurses, shiny clinics and technological medical apparatus, plus a carefully worded text which gives you a certain amount of accurate information to lull you into a false sense of security, may hide the fact that this web-based quack lives in back room, in an apartment on 24th street, in Averageville. It’s very difficult to know unless you know how to research a company’s background on the web.

Many charlatans, cranks and quacks may seem relatively harmless on the surface of it (after all they have the words, ‘natural remedies’ ‘eastern medicine’ and ‘new age’ thinking to back them up) but if they’re taking your money and providing you with miracle cures or treatments that have no basis in scientific truth, they’re acting criminally to put it mildly. Think about it. If you or a family member or friend, or elderly relative is taken in by one of these people, they’re being shamelessly exploited by con men who prey on illness and distress. ‘Caveat emptor’ is all well and good but when you’re ill, it’s all too human to be convinced by smooth talk and a great website. Talking to your doctor, doing your own research and learning about your own disease, will help to sniff out the quacks who are only too willing to take your money but equally looking out for others who may be more easily convinced, should be something we do automatically. Quackery will never disappear but we should make sure there’s no room for it in the field of long term illnesses; life’s difficult enough.