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Drug Interactions, Polypharmacy, and Science-Based Medicine

As I write this, the American news cycle is firmly focused on the issue of drug harms. It’s in the headlines not because of the thousands of cases of drug toxicity, hospitalizations, and even deaths that are documented each year, but because of the untimely death of singer Whitney Houston. While the cause of Houston’s death has not yet been identified,prescription drugs and alcohol are suspected to have played a role. If that’s the case, she’ll join a long list of celebrities whose deaths have been attributed to the abuse of prescription drugs. Over at Natural News, Mike Adams has already added her name to the list of “celebrities killed by Big Pharma“. He elaborated on drug-related deaths back in 2009 when actor Brittany Murphy died, deeming her death to be due to “Acute Pharmaceutical Toxicity“:

As you already guessed, there’s a fatal flaw in this pharmaceutical approach to sick care: Pharmaceuticals have never been tested in combination with other drugs. So all the so-called “gold standard science” is absolutely worthless at knowing what might happen when half a dozen pharmaceutical drugs are combined in a patient’s body. Brittany Murphy may have been on as many as TEN drugs!

Despite the fact that no combination testing has ever been done on pharmaceuticals, they are regularly prescribed in combination. Obviously, this creates a whole new realm of unknown risk based on the way multiple drugs might chemically interact in the human body.

The more pharmaceuticals you take, the more dangerous they become. While one pharmaceutical chemical may at first seem harmless (even though just one drug can actually kill you), when you start adding a second, third, fourth and fifth prescription on top of that, you’re dealing with Acute Pharmaceutical Toxicity (APT) that’s never even been tested in clinical trials.

Pharmacists are trained to help people avoid the most toxic two-drug combinations, but they rarely have any real knowledge about what happens when you combine three, four, five or more drugs. No one does. The science has simply never been done on that question. It’s no wonder: With all the possible combinations and permutations of pharmaceutical toxicity, it would take literally trillions of clinical trials to test them all.

Adams’ ignorance of medicine is obvious here. Combinations of drugs are studied in clinical trials all the time. You can start with the HIV treatments, move on to cancer drugs, and then chronic illnesses to see studies examining two, three and more in combination. But if a particular combination hasn’t been studied, are we still in the realm of science-based medicine? Alternative health proponents, sensitive to the lack of evidence supporting their preferred treatments, see drug combinations as just one example ofSBM hypocrisy. We’re told that “only 10–35% of medical practice is based on randomized controlled trials” as a justification for unproven or disproven treatment strategies.While this particular statistic has been repeatedly examined and debunked, and the risks of polypharmacy have been discussed at SBM, a science-based approach to combining drugs, even in situations when they haven’t been directly studied in clinical trials, hasn’t gotten as much attention.

It’s important to acknowledge that adverse reactions from prescription drugs are a major cause of harms and death. In 2008 poisonings caused more deaths than car accidents, and many of these poisonings were from prescription, not illegal, drugs. It’s been estimated that adverse reactions may cause 2-6% of hospital admissions, and that proportion may be even higher in specific age groups. Each case of drug-related harm has its own set of contributors, which may include health professional culpability, a lack of proper education, and patient factors (including situations of deliberate abuse). The tragedy is not just their absolute numbers, but the fact that many of these events are both predictable and avoidable — particularly those that result from combining prescription drugs, or mixing prescription drugs and alcohol. As Harriet Hall has noted before, it’s misleading to say that combining drugs can’t be evidence-based. How different drugs interact when combined in the body isn’t a scientific black box: An understanding of drug kinetics and of molecular biology allows us to predict with fair accuracy how drugs will behave when combined. So while we cannot anticipate all idiosyncratic reactions to drugs, there already exists the knowledge and tools to be doing a much better job preventing drug-related harms.

There are two main types of drug interactions:

Pharmodynamic interactions change the effect of a drug, without changing the amount of drug in the body. The celebrity overdose is a common example: combining multiple drugs that can depress and impair the central nervous system can lead to significant sedation and even death. These outcomes are not a surprise — they are a direct extension of their pharmacologic action. We can use pharmacodynamic interactions in more positive ways, too: Different types of antihypertensives work in different ways, so a combination of drugs may be effective in lowering blood pressure when raising the dose of a single drug is ineffective or causes unwanted side effects. But not in all cases. Combining drugs like ACE-inhibitors with potassium-sparing diuretics may lower blood pressure, but both drugs also elevate potassium levels, sometimes to life-threatening levels. Another example of pharmacodynamics is the treatment of pain with a narcotic such as codeine, plus an anti-inflammatory,such as naproxen. Both provide pain relief, albeit by different mechanisms of action.

Pharmacokinetic interactions are the result of one drug affecting another drug’s action by modifying its concentration at the site of action. This can be accomplished in four different ways:

1. A change in drug absorption

Unless it’s injected, a drug needs to be absorbed (usually from our gastrointestinal tract). Modifying the environment (say, reducing stomach acidity with a proton pump inhibitor like Prilosec) can modify how extensively some drugs are absorbed, if that absorption is dependent on an acidic environment. Or we can influence absorption by slowing down or speeding up the motility of your gastrointestinal tract: Change transit time, and you can change the extent of absorption. Or kill off some bacteria in your colon antibiotics, and it may reduce the circulation of drugs that are secreted in the bile and then reabsorbed. It doesn’t have to be the stomach, either. Drugs administered via the skin can have their absorption affected by solvents like DMSO.

Cellular pumps allow drugs and other chemicals to cross otherwise impermeable barriers. P-glycoprotein is a cellular pump located in the intestine, kidney, liver and blood-brain and blood-testes barrier. Loperamide (Imodium) is an anti-diarrheal that is structurally similar to narcotics, but lacks the usual narcotic effects on the brain, because p-glycoprotein blocks it from crossing the blood-brain barrier. When the function of one drug depends p-glycoprotein, and another drug modifies its action, unpredictable effects can results.

2. A change in drug distribution

Drug molecules don’t just float along in the bloodstream — they may hitch a ride on proteins, binding to them and effectively decreasing the amount available for activity at the site of action, or in the liver, when the drugs will be transformed (and eliminated). The impact of one drug on the protein binding of another can modify a drug’s action. If one drug displaces another from its protein binding, this can raise the effective or “free” levels in the blood, potentially causing a toxic effect.

3. A change in drug metabolism

Drug metabolism is the process that convert drugs (and other chemicals) into molecules that can more easily be excreted from the body, usually by way of the kidneys. These transformations are catalyzed by enzymes, and some drugs act to inhibit or induce enzyme action. In particular, a group of enzymes called cytochrome P450, or CYP enzymes, are the main metabolic pathway for many drug products. While there are dozens of different CYP enzymes, only a handful act on drugs. Consequently, if we know a specific drug is metabolized by, inhibits, or induces a particular CYP enzyme, it becomes easier to predict the possible effects on other drugs — without the need for direct evidence to verify the interaction.

Many drugs are well absorbed from the gastrointestinal tract, yet fail to appear in high levels in the blood circulation. It’s the liver at work, causing what’s called the “first pass” effect — metabolizing drugs as they first pass through the liver, before they circulate in the body. Inhibition of certain enzymes, particularly CYP3A4, can dramatically suppress this first pass effect, potentially changing usual doses into overdoses.

4. A change in drug elimination

Drugs can induce elimination of other drugs, reducing peak levels and duration of effect, possibly to an extent that efficacy is compromised. Or they can inhibit elimination, raising peak levels and the duration of effect, possibly to toxic levels.

Drug-Food Interactions

We tend to separate drug-drug interactions from drug-food interactions, but from a biochemical perspective, it doesn’t matter: foods are just combinations of chemicals, some of which may interact with drugs. And the mechanisms for these are the same:

  • pharmacodynamic effects: alcohol can increase the sedating effects of narcotics, antihistamines, and sedatives like benzodiazepines
  • absorption issues: calcium and iron can reduce drug absorption, while some drugs are absorbed more extensively in the presence of food.
  • drug kinetic issues: vitamin-K containing foods can antagonize the effects of warfarin; tyramine-containing foods combined with the (now rarely used) monoamineoxidase (MAO) inhibitors can cause a massive increase in blood pressure and even stroke. Grapefruit juice has been identified as a significant cause of drug interactions, through inhibition of CYP enzymes.

Drug-Herb Interaction

Herbal products can be a nightmare from a drug interaction perspective. In general, herbs raise the level of therapeutic uncertainty and risk, compared to drug-drug interactions. Compared to the relative straightforward data on drugs with known pharmacokinetics and predictable interactions, herbs can contain many different chemicals, of which the “active” ingredient(s) may not even be known. Combine the lack of standardization, and the possibility of poor quality control standards, and you’ll see most pharmacists wince when you ask about drug-herb interactions: the unknowns make combining herbs and drugs potentially risky, especially in situations where the drugs have a narrow “therapeutic index“, or when the stakes are high, such as cancer chemotherapy.

While we don’t have good estimates of their true prevalence, we know that some herbs are demonstrably problematic: St. John’s Wort (Hypericum perforatum) (SJW) can cause significant drug-drug interactions, including HIV drugs and transplant therapies. There are multiple cases of transpanted organ rejection linked to initiation of SJW. Why? SJW is a powerful inducer of CYP3A4 enzyme, which increases the metabolism of immunosuppressants, decreasing their effects.

What’s most frustrating about drug-herb interactions is that the natural products industry seems determined to keep consumers in the dark about the potential harms, as Mother Jones outlined this week, in a column entitled What the Supplement Industry Isn’t Telling You About St. John’s Wort:

The real problem here lies in transparency to consumers—a problem that goes directly back to the supplement’s manufacturers. In a 2008 study published in BMC Complementary and Alternative Medicine that tested 74 different SJW brands, less than a quarter of the product labels identified possible interactions with antidepressants. Even more disturbing was that only 8 percent identified possible interactions with birth control.

Many groups, like the Center for Science in the Public Interest, have tried to push the FDA to standardize SJW labels to properly reflect possible dangers. But since supplement makers are not required by law to warn consumer about health risks associated with their products, it hasn’t been easy. “These companies fight warning labels like the dickens, and whether they intend it or not, that affirms the belief that natural products are unequivocally good for you,” says Stephen Gardner, litigation director at CSPI.

And that’s the issue. It’s not that drugs are inherently harmful, and herbs are wonderful and safe panaceas. Any product, whether it’s a herb or a synthetic drug, has the potential to harm, and to interact negatively. And unless the potential for interactions is well understood, we need to approach the combination of herbs and drugs with caution. Part of the solution is ensuring that health professionals and consumers alike are asking the right questions about their safety and efficacy.

Pharmacogenomics

One of the most interesting areas in drug interactions and drug safety is our evolving knowledge of pharmacogenomics: how genetic factors can influence drug behavior. The vision for pharmacogenomics is to maximize efficacy and to avoid adverse drug reactions. The reality is that we’re not there yet, but the science is progressing. For example, the dosing of warfarin (Coumadin), a drug associated with a significant bleeding risk, can be modified to minimize toxicity based in part on testing for the genes CYP2C9 and VKORC1. While it doesn’t eliminate the dosing uncertainty, and the clinical usefulness of testing remains limited, it’s a promising sign of what may become a more predictable way of selecting and dosing drugs. Over time, our accuracy at drug selection and dosing may become much more personalized than it is today.

Where do we go from here?

Harms associated from combining prescription drugs neither validates alternative medicine, nor invalidates science-based medicine. Celebrity or otherwise, many of the harms attributed to prescription drugs are predictable and avoidable. Every treatment decision boils down to an individual evaluation of risk versus benefit, and we can combine therapies with a great degree of confidence based on our understanding of how they will (or will not) interact. Drug-related injuries and toxicity are a real issues, one that medical systems could be doing a much better job of addressing. But when it comes to understanding how these harms are occurring, and preventing them, it’s not just the drugs we need to look at: we already have the information, technology, and capacity to significantly reduce the occurrence of drug-related harms.

Posted in: Herbs & Supplements, Science and Medicine, Science and the Media

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44 thoughts on “Drug Interactions, Polypharmacy, and Science-Based Medicine

  1. Harriet Hall says:

    I can’t think of a single celebrity whose death was due to appropriate prescription and use of pharmaceuticals. In every celebrity death I’ve heard of, they either took more than the prescribed dose, talked their physicians into prescribing inappropriately, or obtained multiple prescriptions from different providers. In the study I reviewed at http://www.sciencebasedmedicine.org/index.php/reducing-the-risk-of-adverse-drug-events/comment-page-1/ most adverse drug events even from single drugs were due to overdose.

  2. davea0511 says:

    “Drug-related injuries and toxicity are a real issues, one that medical systems could be doing a much better job of addressing”

    Well said, and having established that fact then we must ask the one question you failed to ask: “What will medical practitioners do DIFFERENTLY to reduce this problem?” If “we already have the information, technology, and capacity to significantly reduce the occurrence of drug-related harms” then what do you propose? A bigger stronger “medical system”?

    To be truthful I don’t know what the exact answer to that question is, but I don’t think centralizing and increasing the power of a failed system is how a business would go about solving one of their internal problems. It takes some innovative thinking and creative solutions. It seems to me, if we investigate these incidents, there are normally family members who are not surprised the overdose happened … that they were expecting it … and I think a clue lies there somehow as in THE PEOPLE WHO ARE GENERALLY IN THE KNOW (family members) AND COULD ANTICIPATE IT WERE POWERLESS TO DO ANYTHING ABOUT IT.

    That’s what needs to be fixed, and if anything it seems the “medical system” is ever more determined to take even more power away from those people, and give it to those who perceive patients as their craft whereby they get ahead in life. Strengthen that system and things will only get worse.

  3. davea0511 says:

    As an addendum to my prior comment when I said “those who perceive patients as their craft whereby they get ahead in life” I was *NOT* referring to medical practitioners, but rather referring to “the system” which I consider to be hospital administrative systems, insurance companies, pharmaceutical and biomedical companies that operate on capitalistic principles, and such. Again, I was not referring to medical practitioners, whom I’ve always considered to be some of the best people with the most noble aspirations that I know, and whom I also consider to be burdened down and subjected by the current “medical system”.

    Doctors are not the system, but an essential part of the solution, however their hands are tied by the sustem (and in fact manipulated often by the system in ways of which many of them seem to not be aware).

  4. crazyred says:

    SJW has also been linked to decreasing the efficacy of OCPs, in addition to the other interactions already known. Why this drug remains OTC is beyond me.

  5. CarolM says:

    Sorta related, but in the last month I’ve been told to take big doses of Omega 3 by both my optometrist and opthamologist, and then a second opthamologist sold me a 3 mos supply of AREDS vitamins, which would require a 25,000 IU dose of Vitamin A every day. The first opthamologist said I needed to take 4 g of Omega 3 every day, or it would have no effect at all. This all in the interests of helping dry eye syndrome and slowing down some apparent signs of macular degeneration.

    I did look up the AREDS article here at SBM and it just doesn’t seem like a the slam dunk these docs seem to believe. And of course I won’t know the results of the AREDS treatment for years.

    What is going on in opthamology, anyway? These dosages just seem unsafe to me.

  6. LovleAnjel says:

    @ CarolM,

    I was also prescribed O-3s for dry eye by my optometrist, but he told me to follow the directions on the bottle (OTC brand name). I’m not sure if upping the dose would make a difference, most of my pain has been alleviated.

    Vitamin A is fat-soluble, so excess will build up in your body to toxic levels. According to the Institute of Medicine, the upper limit for daily dosing is 10,000 IUs. You should cut back.

    You should look for another set of eye doctors. They should not be selling you vitamins.

  7. LovleAnjel says:

    @davea0511

    We need to keep in mind that the patients also have agency – the family members are not surprised by an overdose because the patient is abusing drugs. Drug abusers will game the system – find different doctors and not tell them about other doctors/prescriptions, purchase the drugs on the street, lie, get their friends to get pills for them by falsifying symptoms, ect. The families are powerless because they cannot control the behavior of the abuser. I’m not sure that is a failure of the “medical system”.

  8. mousethatroared says:

    Harriet Hall -”I can’t think of a single celebrity whose death was due to appropriate prescription and use of pharmaceuticals. In every celebrity death I’ve heard of, they either took more than the prescribed dose, talked their physicians into prescribing inappropriately, or obtained multiple prescriptions from different providers.”

    Just to be a devils advocate. Michael Jackson died from drugs prescribed by his doctor. His doctor was convicted of involuntary man slaughter. He administering sedatives usually only used in the hospital as a home sleep aid.

    http://www.nytimes.com/2011/11/30/us/michael-jacksons-doctor-sentenced-to-four-years.html

    Although, perhaps MJ would fall under the “talked doctor into prescribing inappropriately” category. I tend to hold the doctor responsible there, regardless.

    But, I do hold bad doctoring responsible, not big pharma or conventional medicine…Micheal Jackson’s treatment seemed anything but conventional.

    -formerly M in M

  9. Chris says:

    The medical group that our family doctor is part of, along with a hospital system they partner with, have created a patient database. This is to assure that all of the prescriptions and information can be shared so there is no overlap.

    It kind of works. Last September the information from my son’s emergency department visit was available to both the family doctor and his cardiologist. Though sometimes, a renewal of the prescription by the ED was mucked up because it was a different form of his regular medication.

    Though that only works if a patient stays in the same system. My son has been referred to the university medical system, which has its own database. Fortunately, I have been informed that the records that were transferred were complete, and the two systems are communicating with each other*.

    * Specialist cardiologist from university did answer family doctor’s question about my son taking Imitrex for his migraine (last one mimicked a stroke), and the answer was “no.”

  10. lilady says:

    Great blog and, anytime you can take a swipe at Mike Adams whose ghoulish list of celebrities killed by *Big Pharma* strikes a blow against Adams’ brand of pseudoscience.

    I take notice of the ghoul’s list of celebrities and it appears that Adams thinks that Michael Jackson died from “an injection of Demerol”:

    “The county coroner stated that Jackson died from the combination of drugs in his body, with the most significant drugs being the anesthetic propofol and the anxiolytic lorazepam. Less significant drugs found in Jackson’s body were midazolam, diazepam, lidocaine and ephedrine.” (Source-Wikipedia)

  11. Marky says:

    Being famous can probably lead to stress and anxity when your always supposed to perform at your best etc, and many do probably seek help from they’re doctor. Its also probably harder to say no to a famous person.

    Im sure most celebrities easily can get a hold of most illegal substances as well and combine them with prescription drugs.

    Is prescribing of Xanax in the Usa? In my country its mostly reserved for severe panicattacks where other treatment has failed. I see very few prescriptions and 9/10 is sadly fake.

    Why Keith Richards is still alive is anybodys guess…..

  12. Lytrigian says:

    @mousethatroared — The thing that bugged me about the whole MJ/Conrad Murray thing is that Dr. Murray hadn’t done anything that was any different in kind from what many celebrity’s doctors apparently do for them. Only, it was very different in degree, and in this case turned out badly. I wonder if he would have been prosecuted at all had the decedent (I refuse to call him a “victim”) not been MJ. Strange that no one talked about that. Sued, perhaps, but you’d expect that in any event.

  13. Quill says:

    No matter a person’s outlook or beliefs, it makes sense to have all available information actually available. Big Supplement’s expensive campaign against labels containing possibly vital information is antithetical to reason but certainly makes sense from a marketing perspective.

    Or does it? For instance, wouldn’t it “upmarket” and bring St. John’s Wort to the pharma level if it had to be packaged with a detailed consumer information pamphlet of the kind that comes with a valium prescription? Seems it would but then again the great myth of naturalness would probably fair poorly when contrasted with full disclosure.

  14. Ed Whitney says:

    Naturalness?

    Hey, don’t you people even know that oral contraceptives cause prostate cancer?

    http://merrimack.patch.com/articles/merrimack-rep-claims-the-pill-has-been-linked-to-prostate-cancer

    Rep. Notter mentions a Dr. Bernstein, but she meant Dr. Brownstein, a “natural” MD who told her about the link at http://www.newsmaxhealth.com/dr_brownstein/Prostate_Cancer_The_Pill/2012/02/06/432113.html
    Luckily, if you get prostate cancer from the Pill, Dr. Brownstein can make your cancer melt away naturally. So there.

    http://www.ncbi.nlm.nih.gov/pubmed/22102643
    has the ecological study that started the fuss.

  15. ConspicuousCarl says:

    davea0511 on 16 Feb 2012 at 12:25 pm
    I don’t think centralizing and increasing the power of a failed system is how a business would go about solving one of their internal problems.
    [....]
    THE PEOPLE WHO ARE GENERALLY IN THE KNOW (family members) AND COULD ANTICIPATE IT WERE POWERLESS TO DO ANYTHING ABOUT IT.

    So what then? Give more power to the family members who failed to do anything? I thought that wasn’t your angle.

    it seems the “medical system” is ever more determined to take even more power away from those people, and give it to those who perceive patients as their craft whereby they get ahead in life. Strengthen that system and things will only get worse.

    What exactly do you mean by the “system”? Exactly who is taking power away from families, and how? I know you don’t mean doctors, but you remain vague about who exactly you are talking about. You really need to be a lot more clear on all of this.

    Scott Gavura could have been clearer about his desired solution, but you are making strong statements about unidentified entities.

  16. mousethatroared says:

    Lytrigianon ,The thing that bugged me about the whole MJ/Conrad Murray thing is that Dr. Murray hadn’t done anything that was any different in kind from what many celebrity’s doctors apparently do for them. Only, it was very different in degree, and in this case turned out badly.”

    From the NYTimes “Dr. Murray told investigators that he had administered an intravenous drip of 50 milligrams of propofol, a powerful anesthetic, to Mr. Jackson nightly for six weeks before the singer’s death to help him sleep. Dr. Murray also administered lorazepam, an anti-anxiety drug that can be addictive, and midazolam, a muscle relaxant, to treat Mr. Jackson’s insomnia.”

    Also, after finding MJ in his room, not breathing, but with a pulse, the doctor waited (preforming CPR on the bed) for a half hour before running down to get security to call for help… even though he had a cellphone.

    Yup, it’s a wonder that it turned out badly.

  17. sarah007 says:

    David said: “Despite the fact that no combination testing has ever been done on pharmaceuticals, they are regularly prescribed in combination. Obviously, this creates a whole new realm of unknown risk based on the way multiple drugs might chemically interact in the human body.”

    Isn’t this the kind of quackery you are trying to stamp out?

  18. sarah007 says:

    lilady said: ““The county coroner stated that Jackson died from the combination of drugs in his body, with the most significant drugs being the anesthetic propofol and the anxiolytic lorazepam. Less significant drugs found in Jackson’s body were midazolam, diazepam, lidocaine and ephedrine.” (Source-Wikipedia)”

    So most of what killed him was made by drug companies, prescribed by a doctor. That’s the point you are avoiding and it is not just one isolated case. When someone dies that is doing something non pharmaceutical you go bonkers. There is more than one person on a cocktail of drugs, legally prescribed slowly dying right now.

    David said:“Despite the fact that no combination testing has ever been done on pharmaceuticals, they are regularly prescribed in combination. Obviously, this creates a whole new realm of unknown risk based on the way multiple drugs might chemically interact in the human body.”

    So what exactly is so clever, intellegent and right about this proper doctor crap in these situations?

  19. mousethatroared says:

    @sarah007 – I don’t see a David in this thread or article. Who are you quoting from?

  20. WilliamLawrenceUtridge says:

    I’m curious Sarah, are you this vehement about advocating for gun control? Since your apparent take seems to be “any drug that may cause harm should be banned”. Your comments about doctors seems to be analogous to saying “people don’t kill people, guns do”.

    Drugs have a known risk-benefit and safety profile that is clearly and prominently stated – witness any commercial on TV for a drug that closes with “this drug may cause…” followed by a lengthy list of adverse effects. The reason people get annoyed about non-drug chemicals used as drugs (such as vitamins and herbs) is that they are portrayed as risk-free and effective. Neither is the case. Drugs can cause acute toxicity that can be lethal, as well as associations with increased risks of cancers over the long term. Herbs are mostly unknowns since they are not studied before being marketed and sold. You’re getting an unknown dose of a compound with unknown effects.

    Nobody here says drugs are safe and risk-free. But they do have an extensive vetting mechanism that includes formal safety and efficacy testing. Most non-drugs that are promoted for their drug-type effects (and used as substitutes for medications) don’t have such a mechanism. Patients could be getting something actively dangerous, worthless, or having potentially serious interactions.

  21. Chris says:

    mousethatroared, you will notice that Sarah is quoting a quote by Mike Adams and thinking it is part of the actual article, one she thinks is written by a “David.” This is indicative of her level of literacy.

  22. mousethatroared says:

    Thanks Chris – I wasn’t sure if was genuine confusion or if Sarah007 had intentionally meant to suggest that Scott Guvara and David (Gorski?) were the same person. But because it’s a Mike Adams quote, that doesn’t work out either. It’s difficult trying to follow her. I’m not sure why I tried.

  23. Purenoiz says:

    @mousethatroared,

    I believe sarah007 is in fact a young teenager. In another post “she” resorted to name calling and was particularly proud of herself for calling people geeks. To see that she lacks critical reading skills, along with critical thinking skills is not a surprise. I doubt she read the article and only see’s what the comments have to say.

  24. Narad says:

    I believe sarah007 is in fact a young teenager. In another post “she” resorted to name calling and was particularly proud of herself for calling people geeks.

    Teenagers aren’t generally into Natural Hygiene, which the coy obnoxiousness seems to fit very well.

  25. Narad says:

    Ah, failed close-blockquote immediately above.

  26. lilady says:

    The Troll has infested all the blogs on this site. It is best to just ignore her…there is obviously some sort of emotional problem and a disconnect from reality.

    I agree with Dr. Hall that the recent deaths of celebrities from prescription drugs, are due to “friends” (or hired staff) getting multiple prescriptions of sedatives/opiates for the star. There is also an underground supply route…for the right amount of money, these types of drugs can be purchased from “dealers”.

    In the case of Michael Jackson, Dr. Conrad procured large supplies of an IV anesthetic which is never legitimately used outside of an operating suite.

    To me what is more devastating for the loved ones who are left behind, is the use of a celebrities death for Adams’ own agenda of promoting his “brand” of pseudoscience. Sad.

  27. mousethatroared says:

    lilady-I’m not sure if this is still the possible, but about 8 years ago, when a family member had two almost fatal overdoses of oxycotin mixed with alcohol, we found out she had gotten the oxycontin from an online company (I believe outside of the U.S.) that had a doctor writing scripts after “patients” filing out a brief online “examination” form.

    It’s so frustrating.

  28. lilady says:

    @ mousethatroared: Do you mean websites like this?

    http://opioids.com/offshorepharmacy/index.html

    Just in case a “user” may not want to access any of those online drug stores, there are always local “pill mills”…that seem to open as fast as…or faster than…the DEA can shut them down:

    http://www.medscape.com/viewarticle/748811

  29. mj and whitney died because of two things: each had their psychological, not medical, problems (insecurity, sleep, addiction, on-the-road lifestyle, stress of having the expectation of producing reliably desirable artistry for a capricious public, stress of so many people depending upon them for livelihood, inability to recognize and stand up to bad peer influences, etc.), and each had found medical providers who were willing to conceptualize the problem as not psychological but medical, and so apply a medical, not psychological, remedy.

  30. birth control pills cause prostate cancer? does a condom provide protection?

  31. JPZ says:

    @davea0511

    Please do not give ConspicousCarl’s comment much weight. He has emitted more than his share of vitriol and bile for what he calls “sCAMers” here, and the [b]so-called editors[/b], moderators and various folk have only embraced his unscientific, hateful and implausible views. His hate seems to come from one poor child whose parents insisted on an unscientific remedy for their child – honestly, it would be nice if our system would allow him to punch them in the face for such idiocy, but it does not. So he seeths in his own juices of hate in response.

    @Scott

    “Herbal products can be a nightmare from a drug interaction perspective. In general, herbs raise the level of therapeutic uncertainty and risk, compared to drug-drug interactions. Compared to the relative straightforward data on drugs with known pharmacokinetics and predictable interactions, herbs can contain many different chemicals, of which the “active” ingredient(s) may not even be known. Combine the lack of standardization, and the possibility of poor quality control standards, and you’ll see most pharmacists wince when you ask about drug-herb interactions: the unknowns make combining herbs and drugs potentially risky, especially in situations where the drugs have a narrow “therapeutic index“, or when the stakes are high, such as cancer chemotherapy.”

    Please address drug-food interactions (http://en.wikipedia.org/wiki/Grapefruit_drug_interactions) because they are, in fact, perhaps moreso, more likely to present drug-reality challenges to physicians and pharmacists. Oh wait, you didn’t respond to scientifically valid viewpoints that previously I have presented here. Shall we run through the enzymes and metabolism systems so that you can prove my cautions and corrections are illegitimate? This will be a fun game – go get your textbook.

  32. JPZ says:

    I guess he doesn’t have a textbook – much as I suspected. Let me ask you a straight question, Scott (if in fact you can handle one), if peanuts counteract a specific cancer therapy, how would you know it except in post-market surveillance (you know the same way you get ‘actual’ facts about dietary supplements)? The phase III clinical trials for a new drug have one primary outcome and as few as possible secondary outcomes to avoid putting the drug approval dossier at risk. I know this because I have run these trials – have you? Phase III trials do a great job of looking at other acute and chronic disease interactions, but environmental and dietary variables are generally ignored – well, much in the SBM vein of ingnoring data. Sorry to pull that whole “experience” thing on you. What color is your vest as a pharmacist?

    *To the casual observer, gosh it is entertaining when the “s”BM folks go hog wild on homeopaths and reiki folks. I mean, using dynamite to fish is really quite the show. Observe what happens when facts intrude on their “skeptic bias.”*

    Gotta love this comment, “Adams’ ignorance of medicine is obvious here” from Scott. If I started a comment here with, “Scott’s ignorance of…” I would hope someone would hold me to my facts more than the editors have held Scott to that standard here So, Scott sez (they, the editors, become more deaf when I quote them with a “sez”), “The tragedy is not just their absolute numbers, but the fact that many of these events are both predictable and avoidable — particularly those that result from combining prescription drugs, or mixing prescription drugs and alcohol.” Aaaand, we need to keep in mind that clinical trials only detect new drug-old drug interactions when the patient frequency of use exceeds the minimum detectable difference in outcomes of the clinical trial sample size (surprised Scott? Oh wait, you never said if had actually run a clinical trial). As Scott points out but does not elaborate upon, one can hypothesize that two drugs will interact in a specific manner based on mechanism, but, until you test that hypothesis, well you might want to consider what direction you are shouting relative to the wind.

    So, he will argue that he covered drug-food interactions. But he neglected to mention that he is comparing apples to interstellar phenomenon. Scott sez (just let that bit of irritation sink in to the editors), “Compared to the relative straightforward data on drugs with known pharmacokinetics and predictable interactions, herbs can contain many different chemicals, of which the “active” ingredient(s) may not even be known” Wow, just wow. So food interactions with drugs that were only discovered several years after the class of drugs was approved should be considered… what? Equally horrible as herbs? Have you defaced the Florida Grapefruit Board website lately? And “relatively straightforward” is complete hogwash, the interaction between two orphan drugs is incredibly well know, right Scotty?

    I guess I need to start crossposting this scientifically-sound criticism to other websites that enjoy “s”BM criticism. If the koolaid swallowers called editors here can provide facts (not opinions) to counter my POV, you might be surprised how strongly I will support a more fact-based opinion.

  33. JPZ says:

    Yeah, they are going to dismiss me as rude. Oh wait, their allied commentators don’t get dismissed for being rude about things “s”BM hates. Dang, it is a pity that dissenters are not held to the same standard.

  34. JPZ says:

    LOL, so much for expecting a scientifically-valid response here. It is funny, the editors and the unrestrained pit bulls among their contributors go hog wild when someone throws out an unsupportable position on homeopathy or reiki. If the poor soul cites a study roundly discredited by this website and others, then these folks close in like sharks smelling blood in the water. Yes, sometimes they draw their “s”CAMer prey out with innocent questions, but once the juggular is exposed – chomp.

    Oddly enough, they seem to flee if their familiar scapegoats do not line up for a beating. Point-by-point, data based refutation of their all too familiar statements is met with denial and obfuscation – not science.

    If I didn’t have a valid case, wouldn’t they and their pit bulls attack as they have so often? Perhaps there is no blood in the water…

  35. weing says:

    Does anyone have any idea what JPZ is on about?

  36. Chris says:

    Um, having a conversation with himself? Perhaps with some fun supplements?

  37. JPZ says:

    @weing and Chris

    I dissent. I provide facts, and I contest the foregone conclusions of “s”BM editors and contributors here. I welcome facts from other contributors. Unlike any editor here, I will change my mind when confronted with better facts. Here, I have provided facts (which oddly enough the “s”BM folks have not challenged). My only request is for us to discuss facts and evidence without dismissal due to subject matter. If you can’t handle truth, shut down this “s”BM site.

    If you can only see dissenters as “sCAMers,” then perhaps you need to question your own views and this site.

  38. JPZ says:

    Chatty, chatty, chatty – more science!

  39. JPZ says:

    Well, I suppose I can reveal this now. Can any of the physicians here care to explain why guaifenesin should be prescribed (Robitussin for the typical doc who can’t remember to write a script for the generic not the name brand). Is this a placebo for a cough? Have you looked at the data? If you are not an internist or family medicine doctor, then realize you should shut up since I have asked for the opinion of folk who have actually recommend this dross. Remind me why pre-1938 drugs are OK, but pre-1994 supplements are the work of the devil?

    I honestly don’t get your hate on dietary supplements (or tolerance of on your blog) if you are not willing to examine the data.

  40. Scott says:

    They are perfectly willing to examine the data. For supplements, it’s just not there (at best). For cough suppressants, it’s ALSO not there. To quote Dr. Novella,

    Over the counter (OTC) cough suppressants simply do not work and are not safe in children. If you have a serious cough, the kind that can cause injury, you need prescription medication (basically narcotics, like codeine). Also, in most cases using a cough suppressant makes no sense, especially in combination with an expectorant. You want to cough up the mucus and phlegm. If your cough is caused by a sore throat, take an NSAID. If it’s post nasal drip, treat the congestion as above. And if it’s severe, see your doctor. But don’t bother with OTC cough suppressants.

    http://www.sciencebasedmedicine.org/index.php/treating-the-common-cold/

    And Scott G. has also weighed in:

    Despite a long history of reasonably safe use, there’s no evidence that traditional cough and cold products have any effectiveness in children. Mild side effects are not uncommon, and fatal side effects are exceptionally rare, but possible. Given that colds are generally mild and resolve on their own, and that no product has ever been demonstrated to have a meaningful effect on the duration of a cold, over-the-counter products, “natural” or not, are unnecessary for children.

    http://www.sciencebasedmedicine.org/index.php/think-of-the-children/

    What a waste of straw.

  41. JPZ says:

    Sorry Scott G., you fell into the trap. Didn’t mean to disrespect your kool-aid…

    They can bitch and moan about perfectly legal OTC cough (not) surpressants. But these kind and benevolent products are OTC, and, by the grace of the skeptic gods, supposedly held to a higher standard than those damned dietary supplements. Shall we look up morphine next? Any of the other pre-1938 drugs?

    My point is that laws change. Crap drugs, OTC and supplements get approved via grandfather clauses for political expediency. The vast majority of dietary supplement ingredients are pre-1994 grandfathered. To say that dietary supplement ingredients are “unregulated” is like saying all of the other FDA-regulated but grandfathered drugs,etc. are unregulated. You might be surprised how long that list of drugs looks like. Check it out on fda.gov, I doubt folks here would respect truth when it opposes their belief.

  42. WilliamLawrenceUtridge says:

    Lalalalalalalalalalalalapayattentiontome

    No.

  43. JPZ says:

    @WLU

    Nope, science. You got learned in science didn’t you? Maybe not. You mistake a person speaking loudly about unscientific reasoning for one wanting attention. I welcome other skeptics of skeptics to chime in, but this is not a place that can accept self-reflection.

    And, the problem is that you, Conspicuous Carl and others can say any foul and unscientific sewage you want without censure from the “so called” editors. So, no matter how much truth I provide, you can proxy as much unscientific garbage as you like.

    As always, I challenge anyone here to go fact to fact about dietary supplements or functional foods (surprised that they are different?) with me.

  44. Scott says:

    You were the first person to say dietary supplement ingredients are “unregulated.” That’s just as much a strawman as your false point about cough suppressants – as demonstrated by the referenced posts, those are being held to the same standard here.

    You have made no point other than some meaningless semantics, straw men, and the implication that if something was done once, it’s necessarily appropriate to do the same thing in a different context.

Comments are closed.