Friday, December 23, 2005

Ibuprofen and Stevens Johnson Syndrome

Drug Recall Help Center entry.
Toxic epidermal necrolysis is part of the same life-threatening disease as Stevens Johnson Syndrome. Virtually all-toxic epidermal necrolysis cases are the outcome of drug reactions. Resembling severe burn injuries all over the body, toxic epidermal necrolysis is distinguished by a blistering and peeling of the top layer of skin and is fatal in up to one-third of cases. Within three days, the development of the painful disease can quickly occur, requiring hospitalization typically in a burn unit.
If the toxic epidermal necrolysis is the result of a medication, the patient is immediately taken off of the drug. In February 2005, a group of doctors and families called on federal regulators to warn the public that products containing ibuprofen can cause Stevens Johnson Syndrome, and patients continuing to take the drug without realizing it might be stemming from a medication reaction can chance developing toxic epidermal necrolysis.
The lobbyist said they just wanted warnings on ibuprofen products to highlight the risk of the syndromes and to urge consumers to immediately discontinue the medication if a rash develops, not to ban the drugs. Since hardly any U.S. physicians and almost no consumers are alert of the risk of toxic epidermal necrolysis and the need to discontinue ibuprofen intake immediately should a rash develop, petitioners consider a few sentences on drug boxes would be a valuable addition.
In Europe, labels include a warning that the medication should be stopped if a rash appears after starting to consume it, but the similar warning does not exist in the U.S. Children's Motrin also does not list among the potential dangers Stevens Johnson Syndrome or toxic epidermal necrolysis, however it was included in warnings when it was sold as a prescription medicine.

Thinking about sticking to acetaminophen. This entry is from "Another Stupid Science Blog":
Acetaminophen poisoning is now the leading cause of liver failure in the United States, and nearly half of those poisonings are the result of accidental overdosing. Accidental overdosing occured in two main ways: exceeding the recommended daily dosage, or taking 2 drugs that both contained acetaminophen. Overdosing occured at dosages as low as 2.5 times the daily recommended dosage over the course of 3 days.

Although people who knowingly take more than the recommended daily dosage are certainly asking for trouble, the real tragedy are those who take the recommended daily dosage of several medicines, not knowing that many of them contain acetaminophen

Sunday, December 18, 2005

Neuroleptic studies "A Huge Trick"

Spinning the Doctors by Rob Waters in the May/June issue of Mother Jones.
The studies these claims were based on were conducted with mentally ill patients who were, to start with, on old generation antipsychotics, usually Haldol. To begin the study, all the patients were abruptly taken off their meds. The placebo group went through Haldol withdrawal, a process known to trigger side effects. The others got Risperdal.

"It’s a huge trick," claims David Cohen, a professor of social work at Miami’s Florida International University, who has written widely on psychiatric medication. "In the group yanked off Haldol and left with nothing, the extrapyramidal symptoms worsen. Of course they do. They’ve just been yanked off Haldol and their brains are going haywire!"

In fact, many patients on Risperdal in Janssen-sponsored studies did experience EPS—just not at a greater rate than those withdrawn from Haldol.

Doug Arbesfeld, a spokesman for Janssen Pharmaceutica, said there was nothing misleading about the ads for Risperdal. Few schizophrenic patients available for trials are not already on medications, he noted. "Anyone who understands how these studies are constructed would understand that."

In fact, researchers at McMaster University in Ontario did test patients not previously treated with antipsychotics and found that 59 percent on Risperdal developed Parkinsonism, compared to 52 percent on Haldol.

Monday, December 12, 2005

PBS Frontline - didn't make the broadcast

Frontline Dangerous Prescriptions notebook reports on additional problems with hypertension drugs.
About 50 million Americans have hypertension (commonly known as high blood pressure) -- and an estimated 30 million need some sort of medical treatment to bring their problem under control. Patients who fail to lower their blood pressure face increased risk of heart attacks, strokes and diabetes -- so the treatment of hypertension has become one of the largest markets for drugs in America and everywhere else in the developed world.
By some estimates, there are as many as 180 different prescription medications used in the United States to treat hypertension. Almost every major drug company has at least one product for lowering blood pressure, and doctors are generally happy to have these choices. But having so many choices does create a problem. Some drugs are bound to be more effective than others -- so doctors urgently want to know what's best.
Unfortunately, pharmaceutical companies rarely conduct clinical trials that fairly and objectively compare other companies' drugs against their own. And the FDA doesn't conduct such trials either, because the agency is not in the business of doing medical research -- only reviewing the results submitted by pharmaceutical companies.
With Americans spending $16 billion a year on blood pressure medicines, and no objective information to show which ones were most effective at reducing the problems caused by high blood pressure, about 10 years ago the National Heart Lung and Blood Institute (a division of the National Institutes of Health) started a long-term clinical trial that would honestly and fairly compare the effectiveness of the leading types of blood pressure medicines. The study, called ALLHAT (short for Anti-Hypertensive and Lipid-Lowering treatment to prevent Heart Attack Trial) enrolled over 42,000 Americans, lasted for some eight years, and cost over $140 million.....
While all the drugs helped lower patients' blood pressure to about the same degree, according to the ALLHAT results patients on Norvasc -- an expensive and highly-advertised product -- were 38 percent more likely to develop heart failure than patients on the cheap, tried-and-true diuretics. And patients on Lisinopril (also more expensive than diuretics, and just coming off patent) were 15 percent more likely to develop strokes, 19 percent more likely to develop heart failure, and 11 percent more like to have angina than patients on diuretics. So, as a first-line treatment, the cheapest, oldest and least-promoted drug was significantly better at preventing the serious problems that can arise from having high blood pressure.
If you eliminated all the ACE inhibitors and calcium antagonists [calcium channel blockers] for the first-line treatment of hypertension," says Furberg, and if patients were put on diuretics, "we would avert maybe 60,000 events per year -- 60,000 heart failures or strokes. These are devastating complications. So, if you want to know what has happened over the past five years, we'll you can multiply by five. So we're talking about a large number of people who unnecessarily have suffered these events because we didn't have the knowledge we have today.

After I read this, I asked several people if they took diuretics and they did - but they were also on additional medications.

Ten years for acceptance of bacteria/stomach ulcer connection

Barry Marshall, a gutsy gulp changes medical science
Watching patients suffer drove Marshall nuts. He believed a simple cure was at hand: antibiotics. So one July day in 1984, he drank the germ, later named Helicobacter pylori. He quickly developed flulike symptoms. On the 14th day, a colleague examined his stomach lining and found the telltale inflammation that accompanies most ulcers. Marshall's immune system soon fought off the infection.

The medical community resisted. "People didn't know what to do with him, coming out and saying, 'Look, you guys are all bloody wrong,'" says Walter Pe terson, a University of Texas professor of medicine. Pharmaceutical firms loathed his idea. They had begun profiting from acid blockers–costly pills that could control ulcers. Now this outback upstart proposed a one-time course of antibiotics to cure most cases for $35.

Notice the ten year lag between discovery and implementation - and this when the suggested cure could do no harm.

Research Outside the Box

This chart from Science Made Stupid was meant as a joke, but it might just be too true. Does the idea die if it cannot get funding? How many times have you heard the irritating cliche, "think outside the box." Actually, in medical research, to think differently is academic suicide. Linus Pauling, who received TWO Nobel Prizes, one for peace and one for chemistry, was shunned by the scientific world when he advocated the use of Vitamin C for improving health - from the prevention of colds to the arrest of cancer. See Mother Earth Interview that details his struggle. If a Nobel Prize winner cannot get funding for research, how would an average scientist with a novel idea that challenged accepted beliefs fare?

Liver damage from common pain relievers

Another Stupid Science Blog has an entry about the dangers of combining over the counter medicines and causing liver damage.
Acetaminophen poisoning is now the leading cause of liver failure in the United States, and nearly half of those poisonings are the result of accidental overdosing. Accidental overdosing occured in two main ways: exceeding the recommended daily dosage, or taking 2 drugs that both contained acetaminophen. Overdosing occured at dosages as low as 2.5 times the daily recommended dosage over the course of 3 days.

Saturday, December 10, 2005

Florida youths kill homeless man for fun

Roberts, a frail 53-year-old man, was pummeled repeatedly with fists and kicks, and beaten with a stick, because the teenagers were bored, according to an investigative report. His bloodied body, left in the woods for several days, became a trophy as the teenagers brought others to see it, according to reports..,0,7864508.story?coll=orl-news-headlines-volusia