Street's Health Discussion. Volume 1 Issue 1

[Street Pharmacist]

Originally Posted by Mean Mr. Mustard

I am reading your post and I am coming up with questions on the fly - you mention how "anti-bacterial washes" is leading to an increase in antibiotic resistant organisms. I have never heard of the two being connected - do you have any recommendations for journal articles that would link the two? Does it have to do with people being exposed to fewer bacterium, which results in a less honed immune system, which then results in more rampant infections and the body being unable to fight off the infections as they arise?

I actually love it when people wash their hands with an alcohol based hand wash, especially in a health care setting, and even in the community because with the rise in community based care it really is unknown who in the community does have a compromised immune system. MRSA is absolutely everywhere regardless - and I shudder to think what is on a Safeway carts handles.

I'm more talking about "anti-bacterial" soaps and the like that contain things like triclosan and such things. Alcohol and bleach are antiseptic and not linked to resistance to my knowledge. I will look for the study. I believe it was specifically about triclosan. We must stop being so worried about normal transient bacteria imo, though that's a harder position to back up factually

[Street Pharmacist]

Originally Posted by puckluck2

And it happens all the time.

No, no it doesn't.

[puckluck2]

Originally Posted by Mean Mr. Mustard

Where did you get your medical license from?

You don't need a medical license to listen to a doctor tell you from their own mouth that it happens.

But you're a nurse and not a doctor so drug companies don't approach you so not shocking you don't know it happens.

[Street Pharmacist]

Originally Posted by puckluck2

http://ethicalnag.org/2012/08/13/big-pharma-persuasion/

McGill University’s Dr. Ashley Wazana in Montréal reviewed 29 studies on doctors’ prescribing behaviour in the U.S., Canada, Holland, New Zealand, and Australia.

In his review, Dr. Wazana noted how a number of other persuasive marketing tools in use by drug companies impacted their targets in the medical profession:

free samples, honoraria, and research grants led doctors to be significantly more likely to prescribe that drug;
freebies also led doctors to request the drug for formularies (hospitals’ official lists of drugs that can be prescribed there);
hearing a drug sales rep deliver a presentation led doctors to recommend “inappropriate treatment” more often than other doctors, including treatment that cost more and was more invasive;

medical residents who heard drug reps speak at lunch rounds were more likely to have inaccurate information about drugs on the market;
doctors who “occasionally” attended Pharma-sponsored meals were 2-3 times more likely than other doctors to request that the sponsor’s drug be added to a hospital formulary;

doctors who “often” ate these meals were 14 times more likely to do so;

85% of doctors said they had some interaction with drug reps, with an average of three to four encounters a month;

86% of doctors accepted free drug samples, and half got research grants

two out of five doctors attended company-sponsored meals, and a similar proportion accepted funding for travel or lodging to attend company-hosted conferences

None of that supposes they receive incentives from prescribing certain drugs. What it means is they are more likely to be misinformed by said drug companies. Your mistrust is misplaced.

[HELPNEEDED]

Totally off topic, but I must ask:

Is there any way, if I had a perscription, to get a 5% Spironolactone cream made?

Thanks man!

[puckluck2]

Originally Posted by Street Pharmacist

None of that supposes they receive incentives from prescribing certain drugs. What it means is they are more likely to be misinformed by said drug companies. Your mistrust is misplaced.

Why do you suppose doctors accept free drug samples? And why have studies shown that free drug samples leads to that drug being prescribed more?

Drug companies aren't offering free samples out of the goodness of their hearts. Anyways this thread has been de-railed enough maybe I'll start a new thread.

[HELPNEEDED]

Originally Posted by puckluck2

Why do you suppose doctors accept free drug samples? And why have studies shown that free drug samples leads to that drug being prescribed more?

Drug companies aren't offering free samples out of the goodness of their hearts. Anyways this thread has been de-railed enough maybe I'll start a new thread.

Free samples are offered inorder to allow doctors to judge their effectivness.

[Ashartus]

Originally Posted by Flabbibulin

Street pharmacist, dont mean to change topics entirely, but hope you dont mind me asking a different topic question as my doc recently brought this up with me. what is your opinion on the huge emphasis over the last few years on vitamin D supplementation? Is this just the latest medical industry hype, or are vitamin D levels really as important as they say? From what I can tell, everyone in Canada will be low on vitamin D in winter months, and it seems to be nearly impossible to get to those ideal levels through food and sunshine alone?

Vitamin D is a pretty active area of research and different experts will tell you different things about how much you need. Excessive vitamin D can be harmful, but deficiency is more likely here. Most agencies don't recommend more than 4000 IU, though real toxicity isn't seen until much higher than that. Personally I take a vitamin D supplement in the winter but don't worry about it in the summer when I'm spending more time outside in the sun.

[Mean Mr. Mustard]

Originally Posted by puckluck2

Why do you suppose doctors accept free drug samples? And why have studies shown that free drug samples leads to that drug being prescribed more?

Drug companies aren't offering free samples out of the goodness of their hearts. Anyways this thread has been de-railed enough maybe I'll start a new thread.

Drug companies offer free samples so that the doctors will be aware of their brands and prescribe more of that product relative to the competition, this is particularly the case with new drugs for which generic options are unavailable due to patent laws. It is just a way of getting the name of the drug and its application into the realm of awareness for the physician.

That is different than the pharmaceuticals offering monetary incentives for prescribing a certain type of drug as you insinuated.

[Street Pharmacist]

Originally Posted by puckluck2

Why do you suppose doctors accept free drug samples? And why have studies shown that free drug samples leads to that drug being prescribed more?

Drug companies aren't offering free samples out of the goodness of their hearts. Anyways this thread has been de-railed enough maybe I'll start a new thread.

Agreed. You are insinuating doctors receive incentives for prescribing them. They are given those to hopefully get the doctor to prescribe their drug. Ethically there is a huge difference.

[Street Pharmacist]

Originally Posted by HELPNEEDED

Totally off topic, but I must ask:

Is there any way, if I had a perscription, to get a 5% Spironolactone cream made?

Thanks man!

Look for a compounding pharmacy. I am in BC, so I don't know of any in Calgary, though I'm sure there are many

[undercoverbrother]

Originally Posted by puckluck2

http://ethicalnag.org/2012/08/13/big-pharma-persuasion/

McGill University’s Dr. Ashley Wazana in Montréal reviewed 29 studies on doctors’ prescribing behaviour in the U.S., Canada, Holland, New Zealand, and Australia.

In his review, Dr. Wazana noted how a number of other persuasive marketing tools in use by drug companies impacted their targets in the medical profession:

free samples, honoraria, and research grants led doctors to be significantly more likely to prescribe that drug;
freebies also led doctors to request the drug for formularies (hospitals’ official lists of drugs that can be prescribed there);
hearing a drug sales rep deliver a presentation led doctors to recommend “inappropriate treatment” more often than other doctors, including treatment that cost more and was more invasive;

medical residents who heard drug reps speak at lunch rounds were more likely to have inaccurate information about drugs on the market;
doctors who “occasionally” attended Pharma-sponsored meals were 2-3 times more likely than other doctors to request that the sponsor’s drug be added to a hospital formulary;

doctors who “often” ate these meals were 14 times more likely to do so;

85% of doctors said they had some interaction with drug reps, with an average of three to four encounters a month;

86% of doctors accepted free drug samples, and half got research grants

two out of five doctors attended company-sponsored meals, and a similar proportion accepted funding for travel or lodging to attend company-hosted conferences

Marketing Ethics for the Easily Swayed.

[undercoverbrother]

Originally Posted by HELPNEEDED

Totally off topic, but I must ask:

Is there any way, if I had a perscription, to get a 5% Spironolactone cream made?

Thanks man!

Maybe Kenron across from the Foothills.

[HELPNEEDED]

Do you believe the spiro cream could work to stop/slow/reverse MPB like finasteride?

[Street Pharmacist]

More related to the topic, here are some ways the drug companies can misinform prescribers.

Abbott did a talk about antibiotic resistance in respiratory illness. The talk focused on how their main competitor azithromycin increased resistance much more rapidly than Biaxin, which was theirs. Also, they discussed how Biaxin's coverage covered the bacteria that cause Sinus infections much better than azithromycin.

What they missed talking about was the fact that acute sinus infections are rarely bacterial, and as such should not be treated with antibiotics at all.

[Mean Mr. Mustard]

Originally Posted by Street Pharmacist

I'm more talking about "anti-bacterial" soaps and the like that contain things like triclosan and such things. Alcohol and bleach are antiseptic and not linked to resistance to my knowledge. I will look for the study. I believe it was specifically about triclosan. We must stop being so worried about normal transient bacteria imo, though that's a harder position to back up factually

Okay thanks, I agree on everything that you said, particularly in a home setting I am not concerned about bacteria because they help us a lot more than they hurt, particularly with regards to digestion and the healthy flora that exists on and in everyone. I really think it has only been in the past 10 years where we have a culture of cleanliness that is based on the belief that all bacteria are evil and out to kill us and our children, when in fact that isn't the case. The vast majority of bacteria want nothing more to do than to reproduce.

The one thing I didn't read in your post was when people half-ass the prescription and stop taking it when they start to feel better.

Also for the females on the board and peoples significant others, when you first notice symptoms of a UTI don't run to the doctor, go to the tap and drink water (unless you are on fluid restrictions or have a history of a kidney injury). A large portion of the time UTIs can be treated by drinking water and pushing fluids.

[photon]

I haven't read it yet but Bad Pharma by Ben Goldcare seems like an interesting book, he's got the chops to be objective and isn't pro-alternative or anti-doctor, he's definitely pro-science based medicine, just seems to go into how the whole health care industry has evolved into what it is.

[Azure]

The companies that make antibiotics for livestock are quite happy with bacteria becoming resistant to antibiotics, considering they can come up with a new 'medicine' and charge $4 a shot to use it, versus the $2 a shot the last one cost.

Draxxin is a great example of this. At the time it came out it was a miracle worker in the line of preventive disease control, but it also cost around $700 per bottle.

Products like Nuflor were MUCH cheaper, but not as effective.

There are a few others on the market that I can't remember the name of that were around $40 per bottle, but not as effective either.

Problem is, crowding 200 head of 900lb animals into a pen designed for 20 animals of the same size, and they are bound to get sick. So feedlot owners are forced to use the antibiotics, because treating afterwards isn't as cost effective.

The whole system is screwed, but I guess if you want a $.99 quarter pounder within 5 min of ordering, this is what it takes.

[Minnie]

Originally Posted by Mean Mr. Mustard

Also for the females on the board and peoples significant others, when you first notice symptoms of a UTI don't run to the doctor, go to the tap and drink water (unless you are on fluid restrictions or have a history of a kidney injury). A large portion of the time UTIs can be treated by drinking water and pushing fluids.

*nods* Exactly what we have done here forever. The only time we've done antbx for a UTI in the last 15 years was when the kid was really little and had a specific medical issue which was causing the multiple/continual UTIs.

[Azure]

Originally Posted by Flabbibulin

Street pharmacist, dont mean to change topics entirely, but hope you dont mind me asking a different topic question as my doc recently brought this up with me. what is your opinion on the huge emphasis over the last few years on vitamin D supplementation? Is this just the latest medical industry hype, or are vitamin D levels really as important as they say? From what I can tell, everyone in Canada will be low on vitamin D in winter months, and it seems to be nearly impossible to get to those ideal levels through food and sunshine alone?

There are numerous studies showing that people in North America are all low in Vitamin D levels.

Vitamin D is obviously important, although like all vitamins, it probably effects everyone differently.

I supplement with anywhere from 5,000IU to 10,000IU per day, and according to my blood tests, my Vitamin D levels are perfect.

And I've been doing that for 4 years now.