What Your Doctors Don’t Know About the Drugs They Prescribe

I’m a big fan of Ben “Bad Science” Goldacre. This new TED talk by him highlights a huge problem. A “cancer at the core of evidence based medicine”, as Goldacre puts it. We don’t really know if the drugs we use work. We just believe that we know.

Goldacre has just published a book on the subject, called Bad Pharma. You can read the foreword on his blog. I ordered a copy right away.

13 comments

  1. eddie watts
    scary stuff, but not surprising really.
  2. High reprint orders in medical journals and pharmaceutical industry funding
    Here is a free full text paper in which Ben Goldacre was a co author.

    You may also enjoy.
    Ben Goldacre keynote Strata Conference London 2012

    I think we should also insist that all medical research conducted with public funds or using data collected from publicly funded hospitals/universities is made available free online six months from journal publication.

  3. He was also on You and Yours today
    Talking about the way pharmaceutical companies influence prescribing practice and make huge donations to Charities purporting to help patients with particular diseases lobby for expensive medications.
  4. Mommy
    ...and this is why (no offense, Doc) I don't believe in doctors, drugs, the medical community or pharmaceutical companies. And people call ME crazy.
  5. Bad Science is a wonderful book - very informative and highly entertaining too. After I read it, I gave copies of it as gifts to a couple of other people. Also, it really encouraged me to scrutinise my own actions as a researcher.

    I'm sure I'll read Bad Pharma too, but in some ways I'm not really looking forward to it all that much. I've never been a very enthusiastic patient, but the more I find out about medicine, the less I like it.

  6. I can't imagine how a doctor can be expected to know all the medications he's apt to prescribe, though a working knowledge of the basics is expected. My approach is to avoid taking any medications if possible, that way I don't have to worry. That's why I got on HFLC, to prevent diabetes and the drug storm that brings with it.

    http://www.sugaraholics.com
    http://highfatlowcarbrecipes.wordpress.com

  7. Barbara
    I think the most important thing he pointed out is that most of the "big" modern diseases have been researched and drugs developed to assist in their cure or at least management. And now we must invent new diseases/syndromes so we can sell more drug "tweaks" to keep the whole circus going.

    Even for us who are interested in what we eat for health, we must be aware of how food has become the new "medicine" and how we are being manipulated into thinking of food as the new drug.

  8. Alan
    Unfortunately for me and too many others I did not know how little most MDs know about the drugs they prescribe nor did I know of the potential debilitating risks of antibiotics called fluoroquinolones (FQs, eg. ciprofloxacin, levofloxacin, moxifloxacin, etc; the full scientific names have "flox" or "ox" in them). FQs are very commonly prescribed. I took 2-3 rounds of cipro in my life, without apparent trouble, and then I got hit by both cipro and levaquin. I did not have any bacteria in my urine and yet my MD prescribed them one after another, and I took them... until I realized that they damaged me. I have been studying this topic for 2.5 years and everything that Ben Goldacre says is what I have found (bogus drug trials, many ignorant MDs, toothless FDA, and ongoing toxicity, disability, and death). The Ted clip is tame compared to my sense of the reality, and compared to Ben's first chapter-- which is excellent.

    FQs can induce permanent fibromyalgia-like pain and weakness, diabetes, ripped tendons, CNS excitotoxicity, seizures, low energy, neuropathy, IBS, clostridium difficile, wheel-chair-bound 20 year-olds, etc.....Much of this damage can be delayed (this delayed reaction, weeks, months, is written in many of the package inserts!).

    There has been FQ coverage in NYTs, Huffington Post, Forbes, PBS in the last year. This is helpful but not nearly enough. I am going to buy Bad Pharma. My stack of similar books is growing as are my stacks of scientific papers. We need excellent blogs like this with educated readers. I hope that some of Ben's solutions are helpful.

    Below I listed a few valuable scientific papers regarding FQs that you might be interested in reading or knowing about? I gave brief summary information.

    Abdel-Saher et al. (2012) Involvement of glutamate, oxidative stresss and inducible nitric oxide synthase in the convulsant activity of ciprofloxacin in mice. European Journal of Pharmacology. 685:30-37.

    Cipro induced seizures in a dose-dependent fashion. The brain tissues had increased glutamate and elevated oxidative stress. Note that many chronic neurological diseases include chronic high levels of glutamate and oxidative stress. See Blaylock's book Excitotoxicity and Pall's NO/ONOO hypothesis.

    Hall et al. (2011) Musculoskeletal complications of fluoroquinolones: guidelines and precautions for usage in the athletic population. PM & R The Journal of injury, function, and rehabilitation. 3:132-142.

    These three Mayo MDs recommend that FQs be used as a last resort in athletes; when one of the three MDs was asked on the phone if that meant everyone, he said yes.

    Cohen JS (2001) Peripheral Neuropathy associated with fluoroquinolones. The Annals of Pharmacotherapy 35:1-7

    Ten years ago, Cohen described the severity and persistence of FQ damage–which includes nerve damage–in a sample of ~50 people.

    Leone R et al. (2003) Adverse drug reactions related to the use of fluoroquinolone antimicrobials: an analysis of spontaneous reports and fluorquinolone consumption data from three Italian regions. Drug Safety 26:109-120

    Leone et al. examined FQs side by side in comparison to other antibiotics in a large Italian sample. FQs were far more dangerous than alternative antibiotics (significantly so, and the damage was in multiple body systems).

    Lawrence JW et al. (1993) 4-Quinolones cause a selective loss of mitochondrial DNA from mouse L1210 Leukemia cells. Journal of Cellular Biochemsitry. 51:165-174.

    Nearly 20 years ago Lawrence et al. demonstrated that FQs deplete and mutate mammalian mitochondrial DNA. The FDA does not check for this damage in their drug approvals. I called one of the authors and found that the funding dried up for this line of research.

    Pharmageddon is real and it is very important to share information that can save our health and lives.

    I find that eating LCHF completely helps stabilize my blood sugar; it seems to reduce my pain; and it may increase my energy. I believe that LCHF is neuroprotective (there is a scientific literature on this, you probably know this.).

    Thank you Doc for your excellent blog.

    Best,
    Alan

  9. Margaretrc
    @Alan, Now you've got me worried. I recently took a 10 day regimen (10 pills, one a day) of levofloxacin. I'm done with the series, but am worried about the delayed effects you describe. I really had no choice about taking the medicine--I was in a bind. Guess I'll be checking out the info. you've provided. Thanks.

    Thanks for this, Doc. I love Ben Goldacre. I already have his Bad Science and have ordered Bad Pharma. I've also read other books of a similar vein and it scares the heck out of me. That's why I follow an LCHF WOE and stay away from meds as much as possible.

  10. Alan
    Margaretrc, hopefully you will be fine. But these permanent side effects are horrific so use this information; remember that there are alternative choices for antibiotics. Here is a pertinent quote from the NYTimes article:

    "In an interview, Mahyar Etminan, a pharmacological epidemiologist at the University of British Columbia, said the drugs were overused “by lazy doctors who are trying to kill a fly with an automatic weapon.”
    http://well.blogs.nytimes.com/2012/09/10/popular-antibiotics-may-carr...

    Oh and by the way, the ONLY delayed reaction language in the package inserts is about tendon issues and diarrhea. These warnings are on all the FQ labels. The problem is that there are NO warnings about delayed neurological issues on any FQ label. If you have an adverse reaction and it is delayed then it is too late to call your MD. Even when I called my MD twice he did not recognize my side effects while I took the FQs; my MD had no clue how to fix me either once I told him that I had numerous symptoms while I was taking FQs (there is no known treatment shockingly....).

    Perhaps I should have included this blood sugar reference as well given that a LCHF lifestyle is very helpful to keep your blood sugar homeostasis in the face of FQ-induced carb-intolerance (or other causes):
    Aspinall SL et al. (2009) Severe dysglycemia with the fluoroquinolones: a class effect? Clinical Infectious diseases. 49:402-408
    http://www.ncbi.nlm.nih.gov/pubmed/19545207

  11. Alan
    I am almost half-way through Bad Science. I like most of it, but there are some things that I don't fancy.

    For example,

    Ben says on page 111:

    "If I were writing a lifestyle book, it would have the same advice on every page, and you'd know it all already. Eat lots of fruit and vegetables, and live your whole life in every way as well as you can: exercise regularly as part of your daily routine, avoid obesity, don't drink too much, don't smoke, and don't get distracted from the real, basic, simple causes of ill health."

    Where is the protein and fat? Is Ben vegetarian? How can some people avoid obesity on fruit? How can some people maintain glucose homeostasis without fat and protein?

    I think Ben should read Taubes and Bernstein as well as many scientific publications (start with the references here on dietdoctor).

  12. Lomac
    There are a lot of very intelligent people here so I wish to ask your opinion. Is anyone familiar with mark human md? He is a pro- lifestyle medicine doctor. I liked his book the blood sugar solution. However he supplements as part of a healing of the mitochondria (for those whose quiz results in impaired metabolism, which is likely everyone who would choose to read the book). These include l carnitine, high dose coenzyme q10 (109mg), resveratrol, alpha lipoic acid. I am not sure that these are proven at all. However my instinct is 'why not'.

    Is there a limit?! Are we going crazy with non pharma lifestyle supplements, because pharma is clearly demonized, but these are not. I want to know should I be as wary of supplements as I am of prescription meds?! Any insights?

  13. john
    I am 81 years old Navy Vet and have been treated for type 2 for over 35 years. My first treatment was one Pill and a life style change. My doctor didn't get all up tight when my Sugar was 850 , cholesterol 900 and Triglycerides 2700. He just explained that if I didn't change my life style I would die and gave me one pill Micronizes as that's about all there was then. Then in 1997 doctor put me on Metformin and as high as 3500 mg with Glucotrol, Took that for years up to two years ago when I went on Just Lantus 30 units a day and Metformin 500mg twice a day.
    I never had a blood sugar under 134 all those years and just two years ago had Angina attacks and then had By Pass surgery.
    I decided that after all those years of Metformin I don't want it any more, so I quit and just take Lantus. I have fired several doctors as all they know are Base lines and Aic for which there is evidence that isn't always accurate.
    I find that most doctors today don't have a clue how to treat the persons on the systems. Drug companies are going full bore on pushing drugs and got doctors in there grip.
    Doctors have there patients scared to death with the Base lines and AIC . Have no idea what Hypoglycemic is like, I am as I said 81 served in two wars, been exposed to every cancer chemical and Type of radiation known to man and have type 2, and yet here I am still not blind or lose of legs and or not on dialysis,
    I just quit Metformin as Its been in my body way too long, My aic is 9 and most the time my fasting sugar is around 100 to 174, My doctor acts like I will die tomorrow if I don't get my sugar down. I told him at 81 of course every day is a crap shoot but I wont live by drugs or fear , Only how I feel. Common sense will work also.
    Note to doctors,,, Read the Forums and Blogs of people with the disease and Keep in Touch with John Hopkins, Harvard Medical and the Mayo Clinic Like I do, and not dam drug Companies.

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