ethics · narrative medicine · news · pharm

Finally, the Well blog, that bastion of doctor-bashing, has a pro-allopathic medicine article.

As with all posts on Well, the comments are where the real money’s at.  People share their encounters with physicians that are (usually) related to the topic at hand. Usually these are negative, because complaining is more fun than being supportive.  (I know. I complain a lot.)

Today’s are negative as well, but for once they are pointing out the problems with the quackery of alternative medicine.  Not all alternative medicine is crap (e.g. acupuncture for relief of nausea during chemo, which one of the comments mentions), but as people point out, but when you start to say that you can move energy spheres around, and don’t back it up with a study — I’m sorry, you’ve lost me.  There’s not a lot of difference between a GNC herbalist store and the patent medicines that peddlers sold at the beginning of the 20th century.

The article itself talks about the problem with celebrity endorsement of alternative medicine. For sure, celebrities are very visible, and people are sheep (including myself; I pretty much want to beEmma Thompson when I grow up) but taking a single person’s anecdotal experience over the recommendation of someone who has studied a subject for 15 years seems … idiotic. I would be like me telling someone that I won the lottery by framing the card upside down and dancing a jig — so you should too!

Emma Thompson approves of my plan to take over her life

(I probably just pissed some people off by implying that alternative medicine is doohickey. But here’s the thing: medications and procedures proposed by Western medicine have to be carefully studied to see if they are safe and effective. This process often takes years, especially to study long-term effects. Alternative medicine people, bring me your evidence. Then we’ll talk.)

Actually, I’m just glad — especially after the disability studies talk — to see that there’s still support for the type of medicine I’m learning: evidence-based, pro-patient, let’s-not-kill-people medicine.

neuro · news · pharm

A pill for MS

First off, thanks to Chenoa, Lila, and MedZag for the kind words on the last post. It’s good to know that other people care about this stuff too.  I’ll keep you all updated in how the year goes.

Fingolimod
This is fingolimod; ain't it a beaut? (Image from Wikipedia)

In happier news, the FDA approved fingolimod in the treatment of multiple sclerosis! Up till now, MS treatment has been all intramuscular or intravenous. So this is an exciting step forward, to have an oral medication.  What’s more, a trial published in the New England Journal in February showed that fingolimod was actually superior to interferon in one-year follow-up. (PDF link; you’ll need Acrobat Reader and possibly a subscription to the NEJM.)

I had a patient with a new diagnosis of MS during my neurology sub-internship. (She had likely been living with the disease and its aftereffects for decades, but had never been diagnosed.) She was very squirrely around needles — we actually had to LP her under fluoroscopy because she couldn’t keep still.  My attending, resident, and I discussed her long-term medication plan, and I decided on weekly interferon as the best compromise between injections and relapses.  But I kind of want to track her down and say, “Look! We can do something to help you!”

Yes, yes, there may be long-term side effects.  In the trial, the high-dose of fingolimod was associated with two fatal infections, both herpesvirus.  This new treatment is not a panacea, and it may well turn out to be the new Tysabri, another highly-anticipated MS drug that led to progressive multifocal leukoencephalopathy. (I had a patient with that, too. It was ugly.)

But for now, at least, a very tentative thumbs-up to Novartis.

(Disclaimer: I don’t work for Novartis, and I don’t think I own their stock, but I’m not a medical professional yet either. This is not intended to be medical advice. Please don’t go to your neurologist and demand fingolimod; or if you do, at least have a better citation than “some med student blog on the internet.”)

MS-3 · pharm · psychiatry

Trade names

I realized sometime in the wee hours of the morning that Thorazine is chlorpromazine but thioridazine is Mellaril. Ha!

And don’t get me started on clonidine vs. Klonopin (clonazepam) vs. clozapine.

This is why psychopharmacology confuses me. Not to mention that whole “we’re not totally sure how this works but we’re prescribing it anyway.” (Though M. had a decent explanation of the delayed onset of SSRIs, involving neural networks, so I’m mollified. For now.)

MS-2 · pharm · Step 1

Spawn of Pfizer/Merck/Whoever

I usually just go to the grocery store and buy everything in sight, but with the recent monetary crunch (thank you, Step 1, for costing a veritable pound of flesh!) I figured I’d better just make a list.

I am going to be the only person at Fairway with a shopping list headed Metaglip (glipizide and metformin HCl tablets).  Which is quite appropriate, as the only reason I’m going to the store at all is to buy ingredients for red velvet cupcakes for tonight.

Happy Valentine’s Day!  Avoid the metabolic syndrome, if you can!