July 1st, 2007 by Dr. Val Jones in News
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There’s a new trend in the pharmaceutical industry: repurposing old drugs for new indications and/or combining current drugs to create brand new effects. Recent studies suggest that two drugs (Lyrica and Neurontin) approved for the treatment of neuropathic (nerve) pain may also be helpful for improving sleep quality. And since disordered sleep is also at the root of conditions like fibromyalgia, there seems to be reason for enthusiasm. Another study suggests that Wellbutrin (an anti-depressant often used as a smoking cessation aid) could be useful for enhancing libido. Again, some cause for celebration – quit smoking AND improve your sex life with one pill? Not bad.
The New York Times describes the new trend in drug combination research – robots combine random drugs to see if together they have stronger effects on tissue cultures than they do alone. Sounds like low-brow trial and error, but companies such as CombinatoRx are betting that this approach will turn up potential therapeutic benefits at a faster rate (and at much lower costs) than the old-fashioned process of original drug research and development.
This should be handled with a healthy dose of skepticism – is combining nexium (a stomach acid reducer) and naproxen (pain medicine that can harm the stomach lining) anything more than a commercial gimmick? What about the chance finding that anticoagulants enhance the effects of inflammation-reducing steroids? Perhaps that is indeed relevant and helpful?
It’s clear that testing drug combinations has the potential to create a financial windfall for pharmaceutical companies – so the FDA will need to make sure that these new combo drugs offer real benefits over taking them separately.
Still, if you asked me where I’d rather put my research dollars – testing unusual drug combinations in Petri dishes or analyzing whether or not water has memory (a foundational principle of homeopathy), I think you know where I’d place my bet.
Go ahead and shuffle and re-deal, Big Pharma. Maybe you and the FDA will uncover something useful after all? We’ll be watching with interest and a critical eye.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
June 27th, 2007 by Dr. Val Jones in News, Quackery Exposed
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Well, hooray for the FDA. On August 24th a new rule will be phased in, requiring all supplement manufacturers to demonstrate that their products contain the ingredients listed on their labels (nothing more, nothing less). This rule will help to reduce contamination issues (some supplements have been found to contain dangerous levels of lead, bacteria, and other contaminants) and false advertising (some supplements don’t contain as much of an ingredient as the label claims).
This is really good news, and better late than never. Although some manufacturers were already conforming to this rule (kudos to them), this will require compliance for the rest of the companies out there who have been misleading the public about the contents of their supplements.
Some say that this rule doesn’t go far enough to ensure the safety and efficacy of the contents of the supplements, and that these bio-active ingredients should undergo the same degree of testing as pharmaceutical products. Unfortunately, studying all the supplements for efficacy would be an enormous and extremely expensive task that is totally cost-prohibitive. At this point, the best we’ve got is NCCAM, and they are slowly grinding their way through a long list of supplements that are purported to be useful for the treatment of various conditions. They are systematically reviewing them to see if indeed they produce the desired effect, without any undesired effects.
And so at this point, let the buyer beware – supplements may or may not be as helpful as the manufacturer claims, and they may not be as side-effect free as they suggest either. But soon you’ll at least be able to know that they don’t contain toxic chemicals, heavy metals, or dangerous bacteria – and that’s a giant step in the right direction for public safety.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
June 20th, 2007 by Dr. Val Jones in Expert Interviews
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There has been a lot of buzz about the new diet pill,
Alli (Orlistat). Gastro Girl and Dr. Val
decided to interview the incoming president of the American College
of Gastroenterology, Dr. Brian Fennerty, about the weight loss drug. He had lots of interesting things to say –
check out these 6 podcast links:
1. Who is a good candidate for Alli?
Answer
2. What should patients know about Alli?
Answer
3. What about oily stool?
Is that a worrisome side effect?
Answer
4. What about people with IBS?
Can they take Alli?
Answer
5. Is there a link between Alli and colon cancer?
Answer
6. What’s the bottom line about Alli?
Answer
Would you like to see more podcasts with experts on this blog? Let me know!
P.S. Want to see what another expert is saying about Alli? Check out James O. Hill, PhD’s blog post.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
June 14th, 2007 by Dr. Val Jones in Health Tips
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Every once in a while a friend or family member is in a bind and asks me if I can prescribe them some medication. When people have a case of painful otitis externa (external ear infection), some tinea corporis (ringworm), or just need an allergy medicine refill, for example, and can’t get an appointment to see their doctor for weeks, I generally feel badly and offer to prescribe them something to tide them over. I know it’s not right to prescribe medications to folks who aren’t technically your patients, but it just seems worse to watch them suffer with a time-sensitive illness that has a simple cure.
Today I had to look up all the various and sundry treatments for ringworm. According to my Pharmacopoeia (and eMedicine.com) pretty much any antifungal cream on the market is a possible treatment for it… so how is a doc to choose the best therapy? Is it trial and error? Is it pick the cheapest medicine on the list and cross your fingers?
There are times when many different medicines are appropriate treatment options, and the best choice requires a bit of guess work mixed with past experience. Since I can’t find any literature suggesting that one topical treatment is more effective than another, I just chose a common, inexpensive cream. Sometimes medical decision making has its gray areas… Wouldn’t it be nice if everything had one clear answer?
Oh, and if you do have ringworm, keep in mind that 1) you can catch it from your dog – and yeah, Fido could catch it from you 2) you are contagious to others 3) it’s easy to treat with pretty much any anti-fungal cream or lotion (apply twice a day for 2 weeks or so) 4) if you can’t get to see your doctor, using over the counter Monistat may do the trick in a pinch. If your skin is not responding to the cream – better get checked out to make sure it really is a fungal infection and not something else.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
May 23rd, 2007 by Dr. Val Jones in News
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I was struck by two different news stories today – one in the New York Times, and the other in the Washington Post. Although the topics were different, the underlying theme was unified: drug companies (particularly Glaxo Smith Kline?) are coming clean with research data and marketing messages. Sure, it might have taken a law suit by Eliot Spitzer to shine a light on the common practice of witholding negative research information from scientists… and it also may have taken a costly failure of an over-hyped diet pill by a competitor drug company to cause GSK to take the honest marketing track with Alli… But I like this new honesty, however we got to it.
Did you know that drug companies spend billions of dollars to research the safety and effectiveness of their drugs, but then are under no obligation to share what they learn with the general scientific community? No, they share what they want to – generally the studies that show the largest effect or the greatest safety profile. But now, physicians have been given access to the raw data collected in all the trials (showing benefit, no benefit, or harm) conducted by GSK. And they’re having a field day! A new study published in the New England Journal of Medicine is based on an analysis of GSK’s research, where they have found that Avandia (a popular diabetes drug) may put people at higher risk for heart attacks and heart related death.
Now here’s the devil in the details (as Dr. Charles rightly points out): the potential harm has been blown way out of proportion – the media has been citing “a 43% increase in heart attacks/myocardial infarctions and a 64%
increase in death from cardiovascular causes” when another way of stating what the authors found is that 86/14,371 patients or 0.598% of the patients taking Avandia had a heart attack, while 72/11,634 or 0.619% of people
not taking Avandia also had a heart attack. Gee… which sound bite seems more scary?
Honestly, I feel worried for the general public who are now (with the new full disclosure of drug company data) sure to be victims of an onslaught of media hype around all sorts of small differences found in research studies. Believe me, it’s important to sift through all this data to look for early signs of potential drug related health risks – but I think we should be careful before we terrify our patients with scary statistics.
Maybe in the midst of all this new honesty – we can have medical bloggers like Dr. Charles and the Revolution Health team help patients get to the bottom of things without having to have a PhD in biostatistics. We need a voice of reason to translate research data for public consumption. I’ll do my part – but since there are ~6000 research studies published per day in this world… I need some back up. Any takers?This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
