"Treat the disease, you win some, you lose some. Treat the patient, you always win."
~Patch Adams~

Tuesday, January 31, 2012

Confessions of a Frustrated Pharmacist

Orthomolecular Medicine News Service, January 30, 2012

by Stuart Lindsey, PharmD.

(OMNS, Jan 30, 2012) When an insider breaks ranks with pharmaceutical orthodoxy, it is time to take notice. "Whistleblower" may be an overused term, but the article that follows might be well worth readers' consideration before standing in line for their next prescription refill. - Andrew W. Saul, OMNS Editor

I'm a registered pharmacist. I am having a difficult time with my job. I sell people drugs that are supposed to correct their various health complaints. Some medicines work like they're supposed to, but many don't. Some categories of drugs work better than others. My concern is that the outcomes of treatment I observe are so unpredictable that I would often call the entire treatment a failure in too many situations.

How It Started

In 1993, I graduated with a BS in Pharmaceutical Sciences from University of New Mexico. I became pharmacy manager for a small independent neighborhood drug store. Starting in the year 2000, nutrition became an integral part of our business. The anecdotal feedback from the customers who started vitamin regimens was phenomenal. That same year, my PharmD clinical rotations began with my propensity for nutritional alternatives firmly in place in my mind. On the second day of my adult medicine rotation, my preceptor at a nearby hospital informed me that he had every intention of beating this vitamin stuff out of me. I informed him that probably wouldn't happen. Three weeks later I was terminated from my rotations. The preceptor told my supervisor at UNM that there were acute intellectual differences that couldn't be accommodated in their program. What had I done? I was pressuring my preceptor to read an article written by an MD at a hospital in Washington state that showed if a person comes into the emergency room with a yet to be diagnosed problem and is given a 3,000-4,000 mg bolus of vitamin C, that person's chance of dying over the next ten days in ICU dropped by 57%! [1]

One would think that someone who is an active part of the emergency room staff might find that an interesting statistic. His solution to my attempting to force him to read that article was having me removed from the program.

Pecking Order

The traditional role of the pharmacist in mainstream medicine is subordinate to the doctor. The doctor is responsible for most of the information that is received from and given to the patient. The pharmacist's responsibility is to reinforce the doctor's directions. The doctor and the pharmacist both want to have a positive treatment outcome, but there is a legally defined 'standard of care' looking over their shoulder.

The training that I received to become a PharmD motivated me to become more interested in these treatment outcomes. After refilling a patient's prescriptions a few times, it becomes obvious that the expected positive outcomes often simply don't happen. It's easy to take the low road and blame it on "poor compliance by the patient." I'm sure this can explain some treatment failure outcomes, but not all. Many (indeed most) drugs such as blood pressure regulators can require several adjustments of dose or combination with alternative medicines before a positive outcome is obtained.

Wrong Drug; Wrong Disease

One drug misadventure is turning drugs that were originally designed for a rare (0.3% of the population) condition called Zollinger-Ellison syndrome into big pharma's treatment for occasional indigestion. These drugs are called proton-pump inhibitors (PPI). [2] After prolonged exposure to PPIs, the body's true issues of achlorhydria start to surface. [3]

These drugs are likely to cause magnesium deficiency, among other problems. Even the FDA thinks their long-term use is unwise. [4]

The original instructions for these drugs were for a maximum use of six weeks . . . until somebody in marketing figured out people could be on the drugs for years. Drug usage gets even more complicated when you understand excessive use of antibiotics could be the cause of the initial indigestion complaints. What you get from inserting proton pump inhibitors into this situation is a gastrointestinal nightmare. A better course of medicine in this type of case might well be a bottle of probiotic supplements (or yogurt) and a few quarts of aloe-vera juice.
Many doctors are recognizing there are problems with overusing PPI's, but many still don't get it. An example of this is my school in NM had a lot of students going onto a nearby-impoverished area for rotations. They have blue laws in this area with no alcohol sales on Sunday. The students saw the pattern of the patients going into the clinics on Monday after abusing solvents, even gasoline vapors, and having the doctors put them on omeprazole (eg. Prilosec), long term, because their stomachs are upset. This is medicine in the real world.

Reliability or Bias?

Mainstream medicine and pharmacy instill into their practitioners from the beginning to be careful about where you get your information. Medical journals boast of their peer review process. When you discuss with other health professionals, invariably they will ask from which medical journal did you get your information. I actually took an elective course in pharmacy on how to evaluate a particular article for its truthfulness. The class was structured on a backbone of caution about making sure, as one read an article, that we understand that real truthfulness only comes from a few approved sources.

I was never comfortable with this concept. Once you realized that many of these "truthfulness bastions" actually have a hidden agenda, the whole premise of this course became suspect. One of my preceptors for my doctoral program insisted that I become familiar with a particular medical journal. If I did, she said, I would be on my way to understanding the "big picture." When I expressed being a little skeptical of this journal, the teacher told me I could trust it as the journal was non-profit, and there were no editorial strings attached.

Weirdly enough, what had started our exchange over credibility was a warm can of a diet soft drink on the teacher's desk. She drank the stuff all day. I was kidding around with her, and asked her if she had seen some controversial articles about the dangers of consuming quantities of aspartame. She scoffed at my conspiracy-theory laden point of view and I thought the subject was closed. The beginning of the next day, the teacher gave me an assignment: to hustle over to the medical library and make sure I read a paper she assured me would set me straight about my aspartame suspicions, while simultaneously demonstrating the value of getting my information from a nonprofit medical journal. It turned out that the article she wanted me to read, in the "nonprofit medical journal," was funded in its entirety by the Drug Manufacturers Association.

Flashy Pharma Ads

As I read the literature, I discovered that there is very decided barrier between two blocks of information: substances that can be patented vs. those substances that can't be. The can-be-patented group gets a professional discussion in eye-pleasing, four-color-print, art-like magazines. This attention to aesthetics tricks some people into interpreting, from the flashy presentation method, that the information is intrinsically truthful.

The world's drug manufacturers do an incredibly good job using all kinds of media penetration to get the word out about their products. The drug industry's audience used to be confined to readers of medical journals and trade publications. Then, in 1997, direct-to-consumer marketing was made legal. [5]

Personally, I don't think this kind of presentation should be allowed. I have doctor friends that say they frequently have patients that self-diagnose from TV commercials and demand the doctor write them a prescription for the advertised product. The patients then threaten the doctor, if s/he refuses their request, that they will change doctors to get the medication. One of my doctor friends says he feels like a trained seal.

Negative Reporting on Vitamins

A vitamin article usually doesn't get the same glossy presentation. Frequently, questionable vitamin research will be published and get blown out of proportion. A prime example of this was the clamor in the press in 2008 that vitamin E somehow caused lung cancer. [6]
I studied this 2008 experiment [7] and found glaring errors in its execution. These errors were so obvious that the experiment shouldn't have gotten any attention, yet this article ended up virtually everywhere. Anti-vitamin spin requires this kind of research to be widely disseminated to show how "ineffectual" and even "dangerous" vitamins are. I tracked down one of the article's original authors and questioned him about the failure to define what kind of vitamin E had been studied. A simple literature hunt shows considerable difference between natural and synthetic vitamin E. This is an important distinction because most of the negative articles and subsequent treatment failures have used the synthetic form for the experiment, often because it is cheap. Natural vitamin E with mixed tocopherols and tocotrienols costs two or three times more than the synthetic form.

Before I even got the question out of my mouth, the researcher started up, "I know, I know what you're going to say." He ended up admitting that they hadn't even considered the vitamin E type when they did the experiment. This failure to define the vitamin E type made it impossible to draw a meaningful conclusion. I asked the researcher if he realized how much damage this highly quoted article had done to vitamin credibility. If there has been anything like a retraction, I have yet to see it.

Illness is Not Caused by Drug Deficiency

If you've made it this far in reading this article you have discerned that I'm sympathetic to vitamin arguments. I think most diseases are some form of malnutrition. Taking the position that nutrition is the foundation to disease doesn't make medicine any simpler. You still have to figure out who has what and why. There are many disease states that are difficult to pin down using the "pharmaceutical solution to disease." A drug solution is a nice idea, in theory. It makes the assumption that the cause of a disease is so well understood that a man-made chemical commonly called 'medicine' is administered, very efficiently solving the health problem. The reality though, is medicine doesn't understand most health problems very well. A person with a heart rhythm disturbance is not low on digoxin. A child who is diagnosed with ADHD does not act that way because the child is low on Ritalin. By the same logic, a person with type II diabetes doesn't have a deficit of metformin. The flaw of medicine is the concept of managing (but not curing) a particular disease state. I'm hard pressed to name any disease state that mainstream medicine is in control of.

Voltaire allegedly said, "Doctors are men who pour drugs of which they know little, to cure diseases of which they know less, into human beings of whom they know nothing." Maybe he overstated the problem. Maybe he didn't.

1. Free full text paper at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1422648/pdf/20021200s00014p814.pdf
Also: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1422648/?tool=pubmed
2. http://www.ncbi.nlm.nih.gov/pubmed/2777040 and http://www.ncbi.nlm.nih.gov/pubmed/1697548
3. http://www.ncbi.nlm.nih.gov/pubmed/21509344 and http://www.ncbi.nlm.nih.gov/pubmed/21731913
4. http://www.fda.gov/Safety/MedWatch/SafetyInformation/
5. http://www.nejm.org/doi/full/10.1056/NEJMsa070502#t=articleResults
6. Media example:
http://seniorjournal.com/NEWS/Nutrition-Vitamins/2008/8-02-29-VitaminEMay.htm .
OMNS' discussion at: http://orthomolecular.org/resources/omns/v04n18.shtml
7. Original article at:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2258445/?tool=pubmed or http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2258445/pdf/AJRCCM1775524.pdf

Nutritional Medicine is Orthomolecular Medicine
Orthomolecular medicine uses safe, effective nutritional therapy to fight illness. For more information: http://www.orthomolecular.org

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The peer-reviewed Orthomolecular Medicine News Service is a non-profit and non-commercial informational resource.

Editorial Review Board:
Ian Brighthope, M.D. (Australia)
Ralph K. Campbell, M.D. (USA)
Carolyn Dean, M.D., N.D. (Canada)
Damien Downing, M.D. (United Kingdom)
Michael Ellis, M.D. (Australia)
Martin P. Gallagher, M.D., D.C. (USA)
Michael Gonzalez, D.Sc., Ph.D. (Puerto Rico)
William B. Grant, Ph.D. (USA)
Steve Hickey, Ph.D. (United Kingdom)
James A. Jackson, Ph.D. (USA)
Michael Janson, M.D. (USA)
Robert E. Jenkins, D.C. (USA)
Bo H. Jonsson, M.D., Ph.D. (Sweden)
Thomas Levy, M.D., J.D. (USA)
Jorge R. Miranda-Massari, Pharm.D. (Puerto Rico)
Karin Munsterhjelm-Ahumada, M.D. (Finland)
Erik Paterson, M.D. (Canada)
W. Todd Penberthy, Ph.D. (USA)
Gert E. Schuitemaker, Ph.D. (Netherlands)
Robert G. Smith, Ph.D. (USA)
Jagan Nathan Vamanan, M.D. (India)
Andrew W. Saul, Ph.D. (USA), Editor and contact person. Email: omns@orthomolecular.org
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Sunday, January 29, 2012

Words to live by........

Researchers identify factors linked to menopause onset

Good morning from sunny but chilly NC! Check out this article from USAToday ----- researchers have confirmed a genetic link to the age at which a woman enters menopause. It has long been said that one way to know when you will enter menopause is to ask your mother when she entered hers, and this research seems to bear that out.

It's not an absolute, and for many women, their mothers had hysterectomies at an early age so that she doesn't know at what age she would have entered menopause naturally. This "ask your mother" issue was a topic of discussion a couple years back amongst my friends ---- 7 of us, ranging in age from about 43 to 69 were having lunch, and amongst the group, only one woman still had her uterus, and she was the oldest member of the group!

Saturday, January 28, 2012

How books, puzzles may help ward off Alzheimer's

The husband of one of my friends is dealing with frontal temporal dementia (and he is only in his mid 60's), so quite naturally I am very aware and concerned about my own cognitive function. This article from MSNBC.com piqued my interest, it discusses how keeping the brain busy and active with puzzles and books over a lifetime may help ward off Alzheimer's Disease. I love to read, and I enjoy sudoku puzzles so I am happy that two of my interests may also be helping me stay healthy.

Hanging out with your friends is another way to stay healthy and active, and that's what I plan to do today (and actually did yesterday too, so I'm staying in tip top shape!) ------ have a great weekend, everyone!

Thursday, January 26, 2012

Pomegranate Seed Oil For Menopause No Better Than Placebo

Prescription strength progesterone cured my hot flashes in less than 3 days, so I have never tried pomegranate seed oil, but I know it's been touted as a non hormonal way of revlieving hot flashes. Check out this article from Medical News Today, a small study done in Vienna shows that the pomegranate seed oil pills were about as effective as placebos in alleviating the number of hot flashes per day. Most women tell me that the non hormonal remedies they have tried for hot flashes and/or night sweats simply don't work, and some have paid out a lot of money in vitamins and remedies that have little or no effect.

Sunday, January 22, 2012

Friday, January 20, 2012

Budgeting Your Energy in Menopause

I remember a time, pre hormonal balance, that budgeting my energy was the only way I could get through a day. I remember thinking at the time that I did not know how the hell I would have gotten through peri/menopause if I had been trying to work full time (I am medically retired because of injuries in a car accident in 1992) and/or raise a family (I'm single).

The first month that I was on progesterone (Dr. Carr started me on one hormone at a time) that my energy level after the first 10 days or so was increased to the point that I so overdid it I put my back/pelvis/hip pain over the moon----my pain level was so increased I was almost hysterical. My pain managment doctor was wonderful and understanding, but made it clear to me that I would have to gradually increase my activity and exercise program so that I could manage my pain level. I learned a lot that first year, and now most of the time I balance my energy with my pain level (I still overdo sometimes, but that's ok, I just schedule myself lightly the next day or two to let my pain level settle back down). I still get kind of frustrated sometimes because I know I could go farther, faster, longer if my back/pelvis/hip didn't hurt so much, but most of the time I can remember how far I have come in the last 5 years.

The tips in today's article from The Huffington Post.com are not new but always worth a reminder: Make yourself a priority, don't be afraid to seek support, and for goodness sake, stop beating yourself up so much (I still need to work on this one!) Regarding the taking care of yourself tip: exercise. Really. And I never thought I would be one to adocate that everyone get out there and get moving, but it really, truly does make a difference----it increases my energy level, reduces stress (I would never, ever have made it through the bullying situation I found myself in last summer/fall without my workouts to help burn off some of the adrenaline surging through me), and keeps the joints flexible. Long term, I know it's what helped cure my osteopenia (along with testosterone and Vitamin D optimization). Both my pain management doctor and Dr. Carr are amazed at the progress I have been able to make physically from my workouts.

Have a great weekend, everyone! Rainy and cloudy here in NC all weekend, tomorrow I am going to take a beading class (I love making beaded jewelry, among my other hobbies) and Sunday I plan to snuggle in the house, catch up on little projects and read some hormone articles to include in the blog!

Monday, January 16, 2012

What Your Doctor May Not Tell You About Osteoporosis and Bioidentical Natural Progesterone

If you are not already a reader of the blog Bioidentical Hormone Health-----you should be. Today's article on bone health is spot on ----- I couldn't have said it better myself. I'm running off a copy of it to take to the gym tomorrow, the ladies in my exercise class smugly tell me how they are taking care of their bones with osteoporosis drugs---and they are the same ones who lecture me about how their doctor's tell them that "a hormone is a hormone". I try not to even react anymore (my primal urge is to bite them). I cannot overemphasize the importance of bone health----it's what is going to help us stay active, independent and mobile as we grow older. My own mother fell about two years before her death and broke several bones in her upper arm, and she just gave up, she refused to walk much after that because she was afraid of falling, and it led to her being bedridden and very, very depressed and unhappy. I do not plan to follow that path.

Physician Resource

The nice folks over at Shmirshky.com have a Doctor Directory that is comprised of recommendations from readers of their blog. My own doctor is listed among them......this is another resource if you are seeking a doctor for menopausal care.

Sunday, January 15, 2012

Saturday, January 14, 2012

Thursday, January 12, 2012

Compounding Pharmacies

Hi everyone, I wanted you to know I have not forgotten my promise to list some of the compounding pharmacies that you so generously shared with me last month after my debaucle with Fireside Compounding Pharmacy in CA. I'm going to work on getting the list together and posting it over the weekend---my Internet has been screwy for over a week, and my back has been giving me fits, so sitting at the computer is really difficult right now. I'm hoping to get an IPad soon so that I can post and browse articles from a more comfortable position. Enjoy the rest of your day!

Wednesday, January 11, 2012

Yes, we are!

I love NPR on Saturdays, I listen to Car Guys, Wait Wait Don't Tell Me, and Says You (in bits and pieces while I am out running errands). I had a huge treat on Sunday, my friend Linda got tickets for a taping of Says You (two shows) and invited me along for the day. To tell you I was thrilled would be an understatement! Anyway, one of the categories was defining "modernisms" and one of the words was "quintastic". It stumped both teams until several clues were given. The definition? Quintastic means being over 50 and fantastic. Yep, I know I am and I bet you are too! Long live the Quintastics------and does that mean when we turn 60 we turn into Sextastics? (wink)

Low Levels of Vitamin D May Be Linked to Depression

The link between Vitamin D deficiency and depression is not really new, but now that the Mayo Clinic is linking the two, perhaps it will be taken a little more seriously. Check out this article from WebMD. Also, please note that the RDA (recommended daily allowance) for Vitamin D listed in the article is below what many doctors are now recommending (I take 5000 IUs daily and in in the winter, I alternate days of 5000 and 10,000 IUs just to keep my levels optimized).

I used to live in the Northeast, where in the winter we wouldn't see the sun for a week or more at a time. Seasonal Affective Disorder (SAD) is very common in the winter time, short days, people aren't outdoors to even feel the effect of the sun on the spirit (we are on day three of gray, gloomy weather here in NC, I just want to stay inside and knit!) Even when the sun is out in the winter, if you live in the northern two thirds of the country, the sun is not strong enough to benefit your vitamin D levels from about mid October to late March. Be sure to check with your doctor, and if you have not had a Vitamin D test, insist on one at your next visit. Almost every person I know who has had the test found they were deficient in Vitamin D.

Off to knit (no, just kidding, I am in the house for the rest of the day, but I have many little things I need to catch up on around here!)-----sunny or cloudy, enjoy the rest of your day!

Wisdom From 'The Wisdom of Menopause'

I have ready Dr. Northrup's book The Wisdom of Menopause, and I'll just say that it's interesting. Here is an excerpt (actually, several very short exerpts) from the book in this article on The Huffington Post.com. A couple of quick points:

I actually am more creative post menopausal, but I attribute it to being bioidentically hormonally balanced. Between all the medications I was taking and the lack of hormones, before BHRT I was definitely dealing with cognitive impairment, and it very much adversely affected my creativity (and since I am by nature a very creative person, it was devastating). Once I got balanced, I was able to discontinue 7 medications, including the Ritalin I had taken for years for ADD. I'm still ADD to be sure, but I am able to (mostly) manage the symptoms pretty well. I make a lot of lists, keep myself to a routine, and try not to fly off the wall over little things.

My bone health was absolutely improved with testosterone therapy, regular weight training (I do light weights at home, weight machines at the gym) and Vitamin D3 optimization. I'm huge on this---a lady at the gym last week told me her son told her that women should never do weights. I am to be congratulated for not screaming bloody murder right in the middle of the gym. I took a deep breath, smiled, and politely explained to her that weight training is absolutely crucial for bone health.

Dr. Northrup's view on breast health? Ummmmm. I really just can't wrap my head around that one (OMG, get your mammograms!)

Monday, January 2, 2012