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HuckleB's Journal
HuckleB's Journal
December 22, 2011

What’s All That Other Stuff In My Medicine?


"If you read enough supplement advertisements, like I do, you’ll often see the purity of a product is cited as one of its merits. It’s usually some phrase like:

Contains no binders! No fillers! No colours! No excipients! No starch! No gluten! No coatings! No flow agents!

It’s a point of pride for supplement manufacturers to advertise that their product contains nothing but the labelled ingredient. And that’s also seen as an important benefit to many that purchase supplements. The perception from many consumers (based on my personal experience) seems to be that products are inferior if they contain non-drug ingredients. By this measure, drug products are problematic. Pharmaceuticals all contain an array of binders, coatings, supplements and fillers. Even (gasp) artificial ingredients and sweeteners! And they’re often, though not always, disclosed on the package label.

But rather than being a negative feature, these supplementary, non-medicinal ingredients play a critical role in ensuring that drug products are of consistent and reproducible quality. Without them, we’d have products that are potentially unstable, we’d be unclear if they were actually being absorbed, and we wouldn’t know if they actually delivered any active ingredients into the body. In short, we’d be in the same situation we’re currently in with many herbal remedies and other types of supplements.

Standard pharmaceutical products are evaluated in both clinical trials (to measure efficacy) but also more basic tests – such as whether a drug that is ingested is actually absorbed into the bloodstream. A promising drug won’t work if it doesn’t reach the desired site of action. And to do that, we use a variety of tools and processes to ensure that a drug is reliably and predictably absorbed when we use it, whether by ingesting it, rubbing it on our skin, or injecting it. Excipients can be described as any components of a drug product that are not the “API”, the active pharmaceutical ingredient. Excipients serve to keep the API stable, help its absorption, and simplify the manufacturing process.They help ensure that products are consistent – batch to batch and bottle to bottle. Excipients also help improve consumer acceptance and usage.



An interesting read on something that pops up in conversation around here, now and then.

December 21, 2011

Does Coenzyme Q10 Relieve Statin-Induced Muscle Pain?




Muscle pain during statin treatment is a common problem encountered by patients, and a frequent question posted to pharmacists. The documented benefits of statins on morbidity and mortality suggest that all evidence-based efforts should be made to keep patients on therapy.

Consider this: in moderate to high risk heart patients, for every 1 million patients treated with a statin, 15 cases of the severe adverse effect rhabdomyolysis might occur. However, 30,000 cardiovascular deaths or non-fatal myocardial infarctions would be avoided. That is one case of rhabdomyolysis for every 2000 severe cardiovascular events avoided.[17] In light of this risk- benefit relationship, it’s critical that muscle pain be evaluated by a physicians before statin therapy is discontinued, because the benefits outweigh the risks of treatment.

Unfortunately, there’s little high-quality, persuasive evidence to support the use of CoQ10. This initial data is promising, but larger, better trials are required before using this supplement can be considered to be supported by good science. In light of the risk-benefit ratio, however, in cases where discontinuation of statin therapy is being contemplated, a trial of CoQ10 may be reasonable."


A fairly thorough summary of the issue, at least at the time it was published. Just FYI, since this topic comes up frequently on the Health forum.

December 19, 2011

PLOS Blogs Book of the Year: Thinking Person’s Guide to Autism


"A sea-change is happening in the world of autism. Just a few years ago, the loudest voices in media coverage of the issue were those of Jenny McCarthy’s “warrior moms,” defending Andrew Wakefield’s now-discredited claim that the combined measles-mumps-rubella vaccine causes autism, while spending hard-earned income on the latest cure for their “vaccine-injured” kids — which could allegedly be found in megadoses of vitamins, chelation therapy to remove heavy metals like mercury from the body, elaborate elimination diets, home hyperbaric chambers and saunas, and untested gray-market drugs.

It’s not hard to understand what motivated these parents: Intense love and concern for their children, along with healthy skepticism of corrupt multinational corporations and government agencies that have proven themselves fully capable of covering up crimes against humanity that resulted in the injury and death of thousands. The mothers and fathers of kids on the spectrum have excellent reasons to distrust the medical establishment — notably its unquestioning acceptance of Bruno Bettelheim’s “refrigerator mother” theory in the 1950s, which cruelly blamed parents for their kids’ developmental disorders, adding shame and stigma to the challenges of raising an autistic child.


The book doesn’t make light of the diligent work required to make the world a more comfortable, supportive, and joyful place for atypically developing kids, while helping them cope with the stresses and sensory challenges that are an inevitable part of life on the spectrum. But it also makes clear that one of the toughest things to deal with as a parent is the pervasive view of autism as a tragedy. The deeply networked science-and-tech-literate parents who put the book together have happy children who are respected and treasured for being who they are, rather than pitied as unwitting victims of a Big Pharma conspiracy. (That was cherubic Leo Rosa rocking the iPad in a clip played at Steve Jobs’ last keynote).


One of the most progressive aspects of the Thinking Person’s Guide is that it includes a section of essays written by autistic people themselves, which gives it an intimate, insiders’ view of a way of being that is all too often depicted as an impenetrable enigma (represented by the ubiquitous puzzle-piece iconography employed by many fundraising organizations, which many self-advocates have come to detest). Their accounts indicate the pressing need to debunk stereotypes of autistics as either amazing savants or automatons who lack empathy, and to create neurodiversity-friendly workplaces — needs that are not addressed by the usual star-studded “autism awareness” campaigns that raise millions of dollars a year to scan genomes and hunt for new drug targets.



This is now on my "must read" list. I'll post about it again, once I've had a chance to dig into it.
December 17, 2011

When Dietary Supplements Are Used As Medicines



The FDA regulates foods and has been instrumental in improving the safety of our food supply. It regulates prescription and over-the-counter medications, requiring evidence of effectiveness and safety before marketing. Surveys have shown that most people falsely assume these protections extend to everything on the shelves including diet supplements, but they don’t.


DSHEA is based on a fiction. It prohibits claims that diet supplements prevent or treat any disease and only allows structure/function claims alleging that they “support” health in various ways. DSHEA is a stealth weapon that allows the sale of unproven medicines just as long as you pretend they are not medicines. It allows the sale of products that are not intended to prevent or treat disease so people can buy them with the intent of preventing or treating diseases. People don’t buy St. John’s wort (SJW) to correct a deficiency of SJW in their diet or in their bloodstream; they don’t buy it to “support” brain function; they buy it to treat depression. People don’t buy glucosamine to “support joint health” but to treat their arthritis pain. People don’t buy saw palmetto to “support prostate health” or correct a saw palmetto deficiency, but to relieve symptoms of benign prostatic hyperplasia or to prevent prostate cancer. The FDA’s “Quack Miranda warnings” are routinely ignored even by those few who actually read the fine print.


What are the chances that a diet supplement picked at random will turn out to be safe and effective when proper studies are done? Not high. Promising drugs that pharmaceutical companies submit to clinical trials only have about a 5 percent chance of making it to the market. A few years ago, I went through all the entries in the Natural Medicines Comprehensive Database and tabulated their effectiveness ratings. Only 5 percent were rated “effective” and almost all of those were vitamins, minerals, and medicines that are also available as prescription or over-the-counter products approved by the FDA.

There are many products on the diet supplement market that combine multiple ingredients in a kitchen-sink mixture that has no rationale and has not undergone any testing. Maybe the ingredients act synergistically; maybe they interfere with each other. How would we know? Taking such products is a crap-shoot and is like being a guinea pig in an uncontrolled experiment. Many supplement mixtures are sold by multilevel marketing programs and improve health only to the extent that they improve the health of the promoters’ wallets.



A concise piece in regard to the problems with a lack of regulation of the supplement industry.

December 14, 2011

The Chicago Tribune Digs In To The Wasted Money Spent Via NCCAM

Federal center pays good money for suspect medicine

Troubled study at heart of therapy debate

Study's doctors have had their share of troubles

Energy healing sparks debate


I'm mildly shocked to see this in such a MSM publication.

Note: Orac did a piece on this series, as well.

December 13, 2011

Federal Center (NCCAM) Pays Good Money For Suspect "Medicine"

Feds dole out millions of dollars for questionable studies on treatments ranging from energy healing to acupuncture

"Thanks to a $374,000 taxpayer-funded grant, we now know that inhaling lemon and lavender scents doesn't do a lot for our ability to heal a wound. With $666,000 in federal research money, scientists examined whether distant prayer could heal AIDS. It could not.

The National Center for Complementary and Alternative Medicine also helped pay scientists to study whether squirting brewed coffee into someone's intestines can help treat pancreatic cancer (a $406,000 grant) and whether massage makes people with advanced cancer feel better ($1.25 million). The coffee enemas did not help. The massage did.

NCCAM also has invested in studies of various forms of energy healing, including one based on the ideas of a self-described "healer, clairvoyant and medicine woman" who says her children inspired her to learn to read auras. The cost for that was $104,000.

A small, little-known branch of the National Institutes of Health, NCCAM was launched a dozen years ago to study alternative treatments used by the public but not accepted by mainstream medicine. Since its birth, the center has spent $1.4 billion, most of it on research.



It's a long piece, so the excerpt is just the first four paragraphs. There was no good way to summarize it. Still, in an era where research dollars for health care science are scarce. This needs attention, IMO.

December 13, 2011

Vitamin D and Multiple Sclerosis


"This is an interesting science story – the fairly recent discovery that there is a potential link between low Vitamin D levels and the risk of multiple sclerosis (MS). It is a good example of how the process of science works to incorporate new ideas.


So far we have only observational studies of the role of vitamin D in MS. It has been observed for many decades that higher latitude correlates with higher risk of developing MS. Recent, however, it has been suggested that the biological factor at work may be vitamin D levels, and reduced sun exposure leads to lower vitamin D level. Observational studies have now supported this hypothesis.


A new study, however, looked for mutations in the CYP27B1 gene, which is involved in vitamin D metabolism. If a person inherits two copies of the abnormal gene variant they will develop rickets – a disease of severely low vitamin D. If they have just one copy of the abnormal variant, and one healthy variant, then they will have low vitamin D levels but not severe enough to develop rickets.


The story of vitamin D and MS is a good illustration of how science is supposed to work. A new hypothesis was introduced, which made some sense, and so investigators did preliminary research (observational studies) showing that there was a potential correlation. As the evidence grew, scientific interest grew, and researchers started to look at the question from multiple angles.



It's very difficult to summarize this piece in four paragraphs, and my cuts may only serve to confuse the issue. I highly recommend a full read of the article. It is a wonderful explanation of how science works, and how it moves forward.

December 9, 2011

‘Blowfish’ for Hangovers: Cure or Red Herring? (No, The FDA Did Not "Approve" It)

This product seems to be giving us a little insight into science/health reporting, as I suspect that most articles on this product are simply regurgitating company press releases. But I admit that I haven't spent the time to find the company press releases.



The FDA did not immediately return ABC News’ requests for a comment. Contrary to recent headlines, the agency did not approve the drug. Because the over-the-counter formula combines drugs that are already approved, it didn’t have to. It does, however, regulate the manufacturing process and the drug’s packaging.

“Like all drug packaging, it has a lot of warnings for people with certain conditions,” said Haysom, describing the health risks of aspirin – a blood-thinner – for people with bleeding conditions. “And pregnant women should not take it, but hopefully they don’t need to be taking it!”

A hangover is a collection of symptoms that emerge when alcohol’s intoxicating effects start to wear off. Research on hangover treatments is scarce, but alcohol is thought to trigger an inflammatory response – a process blocked by non-steroidal anti-inflammatory drugs like aspirin. The inflammatory response is similar to the body’s defense against flu, and is linked to lethargy – an energy lull boosted by caffeine. Finally, the chemicals produced by the body to break alcohol down are hard on the stomach – collateral damage tempered by an antacid.

But it’s unclear whether Blowfish, which contains acetylsalicylic acid and citric acid — both of which could mitigate some of its stomach-soothing effects — is better than the age-old hangover remedy: Aspirin and a cup of coffee.



IMO, it all seems like a lot of hype over another unnecessary, and rather expensive, product.

December 8, 2011

Depression, Heart Disease May Be Linked By Stress Recovery Time


"Studies of late have found associations between depression and heart disease.

Those who suffer from a mood disorder, for instance, may be twice as likely to have a heart attack compared to individuals who are not depressed, according to recent data.

But the relationship between depression and heart disease has been poorly understood.

A new study may help to clarify the link, suggesting that depressed people also suffer from a dysfunctional biological stress system. In it, researchers found depressed individuals have a slower recovery time after exercise compared to those who are non-depressed.



Just FYI. I found it to be very interesting.

December 6, 2011

Researchers Compile Surprising List Of Most Risky Drugs For Older Americans


"Some medications are well known for being risky, especially for older people. Certain antihistamines, barbiturates, muscle relaxants—take too much of them, or take them with certain other medications, and you can wind up in serious trouble (and possibly in the back of ambulance).

But researchers from the federal Centers for Disease Control and Prevention (CDC) and Emory University reported in this week’s New England Journal of Medicine that those high-risk medications are not the ones that most commonly put older Americans (ages 65 and older) in the hospital.

Warfarin is #1
Instead, they found that warfarin is the most common culprit. Warfarin (the brand-name version is called Coumadin) reduces the blood’s tendency to clot. Many older people take it to lower their risk of getting a stroke.

After warfarin, different types of insulin taken by people with diabetes were the second most common cause of medication-related emergency hospitalization in this study, followed by oral antiplatelet drugs (aspirin and clopidogrel, sold as Plavix, are the main ones) and then the oral hypoglycemic drugs (glyburide and glipizide, for example) that people with type 2 diabetes take to manage their blood sugar levels.



Interesting research.

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