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“Pharmageddon” by Charles Medawar

Posted by shutah on January 29, 2011

Taken from

Pharmageddon has been defined as, “the prospect of a world in which medicines and medicine produce more ill-health than health, and when medical progress does more harm than good”. We see the need to investigate and explore that risk and to identify the factors and features that describe it.

Pharmageddon embraces the arguments of Ivan Illich (1976) but extends his focus. He warned of the risks of medicalisation, the generally dehumanising and damaging effects of professional interventions: “the medical establishment has become a major threat to health“. Beyond direct drug injury (clinical iatrogenesis), he was concerned about the ill-effects of medicine on culture and community, “the paralysis of healthy responses to suffering, impairment and death” that resulted from “the expropriation of health“.

But since Illich wrote, the whole shape of medicine has changed – both the knowledge base and its applications – and the pharmaceutical industry has come to dominate the medical establishment and the thrust and ethos of drug research, regulation, prescribing, availability and use.

The values of the market increasingly count. Now the leading companies, ‘the Pharmas’, have the driving influence on lifestyle, well-being and health outcomes. Their interests and investments have a major impact on the nature and availability of drug treatments, and on the essence and conduct of medicine, worldwide.

The surge towards globalisation since the 1990s has placed the pharmaceutical industry where it is today. The Pharmas are now centred in the USA – which represents half the global market – and mainly reflect American health values and ways of doing things. The Pharmas are also major instruments of US foreign policy, and their interests are well defended as such.

Pharmageddon stands for the lament that the state of world health represents a colossal waste of what medicine and medicines could accomplish, by structurally harnessing all the talent, energy and commitment that is there. Increasingly this is not happening, which is neither morally defensible, nor in the best interests of our future. It is damaging to the climate of health, the oxygen of community and the core of personal well-being.

Pharmageddon is marked by the contrast between over-medication and drug deprivation; it also implies a strong causal link between the two. Under-medication in poorer communities, and over-medication in richer ones, are connected as closely as obesity and malnutrition, like two sides of the same coin.

Intensive drug marketing and excessive drug consumption has produced an industry whose capacity to innovate and provide is compromised, and whose viability seems increasingly to depend on systematic exaggeration of drug benefits and suppression of evidence of risks and harm. In place of transparency, the industry has now largely taken into its own hands the role of providing information to the public and professionals, filling the air with messages about health priorities, expectations and needs. The net result is a drug supply system that starves national health and sustains global health deprivation.

Outside the major drug markets, populations suffer and die because drugs they need are completely unaffordable, because trade rules block access, and/or for lack of relevant innovation. Elsewhere, the obsession with drug treatment, health observance and disease awareness, is producing nothing like the desired effects. The USA exemplifies this trend: it is beset by diseases of affluence, most obviously by obesity, with diabetes and related complications. But in spite, and no doubt also because, of all the treatment options, fewer than one in twenty citizens manages to maintain a normal weight, eat a nutritious diet, take adequate exercise and not smoke.

For all this, the notion of Pharmageddon may still seem almost inconceivable – as did the risk and threat of Climate Change, just a few years ago. It is natural to deny risks when the misery in prospect results from so much good intent and great talent, and from the enjoyment of huge benefits, valued freedoms and countless goods. And because medicines are especially precious goods, the idea of Pharmageddon offends personal and vested interests alike.

Parallels seem to exist between health and environmental catastrophe. The issues compare to the relationship between a car journey and Climate Change: they are inextricably linked, but not remotely connected in scale or relevance in the average driver’s mind. Just as Climate Change seems inconceivable as a journey outcome, so most personal experience of medicines flatly contradicts the notion of Pharmageddon.

As clinical practitioners, or individual consumers with access to medicines, most people have seen, felt, witnessed and/or imagined their sometimes miraculous effects and results. But, to pursue the analogy, the risk of Pharmageddon is to do with the way in which all drug travel changes the climate of health, even when so many individual drug journeys seem vital or worthwhile.

Both because and in spite of all the benefits of good medicine, it seems crucial to consider whether, collectively, we are rapidly losing sight and sense of health. Increasingly it seems we are. At least we need to challenge the dominant fallacy that drugs more and more resemble magic bullets and offer ever better solutions for the main trials of life.

At the same time, we need to accept that Pharmageddon is not simply the product of malevolence, but the natural outcome of something like a ‘conspiracy of goodwill’ – a universe driven by self interest, but dominated by a complex of corporate bodies all competing to survive. If Pharmageddon seems to beckon, it is in spite of what everyone wants, not because of it.

That also applies to the Pharmas. All might be well if their products matched promise and met genuine health needs. In fact, the Pharmas are panicked by this huge shortfall and become more predatory, gluttonous, devious and oppressive, to try to compensate for it. Health outcomes drift further and further away from mainstream thinking; excessive promotion, data suppression and falsification, secrecy, bribery, fraud and deep conflicts of interest are increasingly revealed.

The consequences go far beyond the drug disasters that make the headline news.Pharmageddon implies that we have now arrived at a tipping point where leading companies devote their main energies to marketing lifestyle products, rather than on finding ways of meeting real medical needs. The brave new world in prospect is one in which commercial imperatives trump health priorities, when Pharmas and followers systematically change our understanding and experience of what it means to be human, flattening the distinctions between cultures, degrading the clinical arsenal, and developing vast numbers of drugs, most not needed and all purporting to be best. The net result is not only therapeutic disappointment, but also crushing pressures that no public health system could ever survive.

Many people have concerns about many different flaws in the present system of pharmaceutical medicine, but what do they all add up to? Our starting point is simply that the word, Pharmageddon, may mean something important and deserves to exist, if only as a description of forest rather than trees.

The etymology seems to fit. Pharmageddon conveys the idea of a battle between health and ill-health, right and wrong and for better or worse. It also challenges the tendency to take for granted that progress in pharmaceutical medicine leads naturally to better health. Armageddon was “the great symbolic battlefield of the Apocalypse, scene of the final struggle between good and evil”. Apocalypse (APOKALYPSIS) literally means the lifting of the veil, “a term applied to the disclosure to certain privileged persons of something hidden from the mass of humankind…” (Wikipedia, 2007).

The time has come to lift the veil: the broader significance of the risks must be explored and revealed. If Pharmageddon is part of any future reality, we all need to know.



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Nurses Drug Handbook 2010

Posted by shutah on January 28, 2011

Pages 775 and 777

Take a look at this, read it, digest it and then tell me this medication does anyone any good whatsoever!!

Nurses Drug Handbook 2010



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NICE updates six year old guidance on chronic anxiety

Posted by shutah on January 28, 2011

26th January 2011

Guidance on managing generalised anxiety disorder (GAD) in adults is being updated for the first time since 2004.

GAD is a common condition with chronic, excessive worry about a number of different events associated with heightened tension. It can vary in its severity and complexity for each person. The National Institute for Health and Clinical Excellence (NICE) says it is important to consider how each patient should be treated individually.

In a statement, Christine Carson, Programme Director for the Centre for Clinical Practice at NICE, says: “Since NICE published guidance on the condition in December 2004, new evidence has emerged about how to manage GAD in adults. Therefore this particular section of the guideline was prioritised for updating. The new recommendations include health professionals considering a diagnosis of GAD in patients presenting with anxiety or significant worry, and in those frequently attending primary care who have a chronic physical health problem, or do not have a physical health problem but are seeking re-assurance about somatic symptoms or are repeatedly worrying about a range of different issues.”

Updated recommendations include:

  • Recognition and communication of the diagnosis of GAD should occur as early as possible to help people understand the disorder and start effective treatment promptly
  • People with GAD, whose symptoms do not improve with education and active monitoring, should be offered one or more of the following as a first-line intervention, guided by the person’s preference: individual non-facilitated self-help, individual guided self-help or psycho-educational groups
  • Patients should not be offered an antipsychotic for the treatment of GAD in primary care
  • People with GAD with marked functional impairment or those whose symptoms have not adequately responded to low-intensity psychological interventions such as pure self-help, guided self-help and psycho-educational groups should be offered an individual high-intensity psychological intervention or a pharmacological intervention

An under-recognised condition

Dr Tim Kendall, Director of the National Collaborating Centre for Mental Health, Medical Director and Consultant Psychiatrist, Sheffield Health and Social Care NHS Foundation Trust says: “Generalised anxiety disorder is a very common but under-recognised condition characterised by endless worrying, which results in substantial disability for many sufferers, affecting their capacity to work and to live fulfilled and meaningful lives. Many develop secondary disorders, such as panic and depression, and it’s much more common in people with chronic physical ill-health.”

He continued, “People with GAD will be able to choose from a range of self help interventions, including two psychological treatments and some antidepressants. The guideline emphasises choice and patient preference, and is much clearer that there are some old treatments that just don’t work. This is a really excellent and new piece of work produced with some of our top national clinical experts and really committed service users.”


Reacting to the new guidance, Catherine O’Neill, Services Manager at Anxiety UK tells us by email: “GAD is a particularly difficult disorder to live with as it is constantly on the sufferer’s mind, providing no respite for the sufferer. Anxiety UK is pleased that NICE has revised their guidance on GAD so people can be diagnosed more quickly and receive the help they need.”

She explained, “Anxiety UK knows that currently GAD sufferers often do not receive a formal diagnosis for many years and are often misdiagnosed, leading to a prolonged period of uncertainty. It is hoped that focusing on early detection will reduce this.

“We also approve NICE’s recognition of the importance of self-help in treating GAD. Peer support is extremely beneficial, not least because it reduces the social isolation that many sufferers experience, and our members’ feedback shows that self-help can be vital in managing GAD long term. Anxiety UK is pleased to see more robust guidance overall with an emphasis on patient choice at the centre.”


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Troops can’t heal what they can’t feel !!!

Posted by shutah on January 27, 2011

Troops can’t heal what they can’t feel

Paxil, Zoloft, Fluoxetine, Sertaline ……

Each medication comes with warnings but no one seems to be paying attention to them anymore than they paid attention to the fact that most of these medications include instructions that a doctor monitor the patients. In other words, sending them back into combat on these medications offering warnings against driving or operating machinery is not a good idea considering they are doing a lot more than just driving.

PTSD is a wound but it is a wound causing emotional pain. They need to be able to feel something so they can heal it.




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Ready? Get Set … GO!!!! Deja vu strikes again!!!

Posted by shutah on January 26, 2011

Reps Hired for Viibyd Launch ……..

Now that Clinical Data has an FDA approval in hand, it’s gearing up to grab a piece of the $12 billion antidepressant market. The company is hiring sales reps and rolling out a marketing campaign to support its new drug Viibryd, hailed as the first SSRI without troublesome sexual side effects. Viibryd will face some entrenched competition, including branded drugs such as Cymbalta and Lexapro, as well as a slew of generics.

As Medical Marketing & Media reports, Clinical Data started early this year with a print campaign designed to prepare the ground for a launch. Advertorials pointed out side effects of existing antidepressants and suggested that patients might need another, better-tolerated alternative. Meanwhile, a New York ad agency is working on branding, and others are preparing to target payers and physicians.

Clinical Data CEO Drew Fromkin told MM&M that he’s aiming to have 150 reps ready to go for a second-quarter launch. They’ll target psychiatrists first, then aim to expand into primary care. Marketing materials will focus on Viibryd’s differences from existing meds. The drug will be touted as the “first and only” antidepressant to combine an SSRI and a serotonin 1a receptor partial agonist in one molecule, Fromkin said.

Of course, Viibryd’s side-effect profile will see the spotlight, too. “We have a very safe drug here, and the adverse events are very different than you see in other [depression] drugs,” Fromkin said. And although the CEO didn’t mention it specifically, you can bet that marketing will get around to talking about the data on sexual side effects, which didn’t crop up in Viibryd patients more often than they did in those taking placebo.

Sorry, what was that???

Fromkin said that, while no head-to-head studies have been conducted to compare Viibryd with other drugs on the market, “at the macro level, we have a very safe drug here, and the adverse events are very different than you see in other [depression] drugs.” Specifically, Viibryd “doesn’t have any issues with respect to cardiac or liver function issues, blood pressure and other vitals,” said Fromkin. “You don’t see that with our drug.”

Ah, so there ARE adverse effects, they’re just “VERY DIFFERENT THAN YOU SEE IN OTHER [DEPRESSION] DRUGS!!

Oh, well, that’s alright then!!!!


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