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Doctor's Consultation  by Dr. Iain Corness

 

November 17, 2018 - November 23, 2018

Are you really “normal”?

Amateur psychologists are plentiful. Every pub has its own resident psychologist. I am sure you have met more than one.

One of the biggest problems, from the medical doctor’s viewpoint, is the current surfeit of “fifty baht psychologists.” Everybody these days feels as if they are entitled to voice their opinion as to the psychological “wholeness” of everyone else. Never mind all the amateur psych’s, there are bookshelves now crammed with paperbacks of psychological advice for every problem the world could ever have. Unfortunately, most of them should only be used for holding doors open or throwing at predatory puppies.

You see, what many forget is that experiencing the whole range of human emotions is part of our “normal” lives. Anger, hurt, elation, depression, sadness, grief, despair, dejection, rejection, joy, excitement or desolation are all very normal human emotions. If you take these away, what are you left with? You are left with a “zombie” - an unfeeling being that is unable to express real emotion.

Now why is this a problem to us doctors? It becomes a problem because people begin to believe that somehow it is “wrong” to feel sad when, for example, one of life’s calamities strikes. Instead of working through the grief or despair, the patient is encouraged by family and friends to go and see the doctor and ask for some Prozac, or this month’s “wonder drug.” In this country, with powerful medications being available over the counter without prescription, this poses an even greater threat to normal reactions and normal recoveries.

I repeat, there is nothing wrong with showing normal emotions. Goodness me, even my cat lets me know when it is displeased with something I have done (generally given it some cat food it doesn’t particularly like) and it expresses true emotion. It does not need a magic tablet. It will get over it.

And so it is with people too. The reason for the depression, or elation, eventually becomes accepted by your emotional self and the middle of the road “normalcy” returns. You don’t need a magic tablet either (though I might draw the line at eating cat food.)

Now, of course, there can be pathological forms of emotional disturbance too. Deep dark lingering depression, without any real basis for it, is a pathological condition, but depression over financial woes, personal loss or the passing of a loved one is “normal”. This type of emotional problem only requires treatment (and I didn’t say “tablets”) when the person involved finds they are unable to come out over the top of it after a reasonable period of time. Many times the only treatment necessary is a friendly ear to allow the person to talk through their “normal” emotional responses.

Unfortunately, many societies look upon anything to do with emotions as displaying weakness. The old “big boys don’t cry” theme again. Just look at the way you grew up with parents who would say, “You’re OK. It’ll be better in the morning.” No sympathetic words as that would make you a ‘softie’.

No, sadness and happiness are part of our normal make-up and indeed part of our lives. Accept it and move on to the next day. No magic tablets required.


November 10, 2018 - November 16, 2018

The other side of the coin

Last week I had a bit of a tilt at Big Pharma and some of the underhand ways of influencing the medical profession. This week I would like to look at the other side of the coin and highlight things you should be aware of.

The first and most obvious is the PI, short for Patient Information sheet. This slip is inside the box of genuine medications. The concept is that by having an educated patient, that person will use the new found knowledge to take the medication wisely. Well, that was the initial reason. Sorry, it didn’t work.

Now here comes the other side of the coin. The becoming better informed patient reads the list of side effects and feels that the medication is far too dangerous to take, so leaves the packet in the bathroom cupboard, thus slowing down the rate of recovery.

Now let’s look at some of the dangerous side effects. Did you know that one of the side effects of salt is DEATH. Good old salt that you can buy from your local 7-Eleven. Yes one on every street corner and it can sell you death pills. Makes no difference that you have to eat something like 240 grams and that is a lot of salt on the chips. In fact, that’s more salt than chip. That gets us back to the absolutely true statement that dosage alone determines poisoning (Paracelsus 500 years ago).

What the PI also does not say is what percentage of patients actually show any side effect at all. This can be less than 1 percent, but the governmental watchdog insists that the printed warning must be there. I am not in favor of the PI. Your doctor should explain the medication he is prescribing and the likelihood of side effect problems.

You can see the difficulty. Not everyone metabolizes chemicals the same way. And here is another interesting fact, when testing chemicals for toxicity, the chemical is compared to one called a placebo, which is a supposedly inert chemical. Yet that inert chemical can also produce symptoms on the testing! How can this be?

The answer is in Subjective findings and Objective findings. Subjective means you are recording the person’s thoughts and feelings which can alter, while Objective means you are measuring something and the results can be repeated.

Sorry to make something so confusing, but that’s how it is. Without placebo (no matter how inaccurate) you have nothing to compare against. And the manufacturer sticks it into his PI. And incidentally covering his posterior if anyone tries to sue.

Now there is yet another side to the coin – counterfeiting. We live in a fake world these days. Fake news and fake drugs. The price of medicines is always a contentious subject – and not just in Thailand. In Australia “brand name” drugs are more expensive than “copy” (generic) drugs. However, there is a good reason for the brand name being more expensive than the generic. The pharmaceutical companies spend millions of dollars to develop, test and get licensing for new drugs, costs not borne by the makers of the generics, after the patents expire. But some manufacturers do not wait for the patents to expire and the ‘copy’ drug hits the market and will also be cheaper.

In Thailand, many drugs can be bought over the counter (OTC), which may or may not be a good thing. Self-diagnosis and self-prescribing can be dangerous. That is why I believe that doctors should be prescribing, and pharmacists should be checking and dispensing. If some drugs are only available through pharmacies world-wide, on the prescription of a doctor, is it safe to just buy OTC, without any doctor’s advice? Obviously not!

Through the middle of this pharmaceutical minefield goes the unsuspecting patient, where the only yardstick is price. And it is the wrong yardstick. Believe me when I say, be guided by your doctor, buy only genuine medications from our pharmacy which you can trust.


November 3, 2018 - November 9, 2018

Wonder Cures!

Big Pharma has developed so many wonder cures, there will soon be nothing left to cure.  If that were only the case.

However, every week the pharmaceutical world manages to get itself banner headings across the globe, with headlines such as “Arthritis pill beats Viagra as best seller.”  Certainly attention grabbing.  All they have to do is to send out press releases with ‘cancer’ or ED (Erectile Dysfunction) in the subject line and the story will get a run.

For example, I must admit that my first thought was that somehow this new arthritis cure-all was able to give Willy the Wonder Wand a new lease of life as a sort of pleasant side effect.  However, this was not the case as I found by reading further.  The new wonder cure is purely for pain relief from arthritis.  Reading further down the story it appeared that this new drug was supposed to fix the aches without drilling holes in your stomach the way the more usual arthritis drugs do.

Even further reading showed that the manufacturer claimed that the new wonder cure “MAY (my capitals) cause fewer ulcers than other drugs” although the American Food and Drug Administration still required the manufacturer to put the same warnings about stomach ulcers on this new drug as they have to with the other older drugs for pain relief.

All of a sudden, this newspaper article did not look as informative as it did before.  Even the reference to Viagra was somewhat suspect, especially when the writer said, “A significant amount of usage of Viagra was recreational and after a while the users got over the novelty of it.”  This quotation was attributed to a Jack Lamberton, an analyst from a securities firm and apparently a part-time comedian.  Who is he trying to kid?  Recreational?  Were all these 80 year old men supposed to use Viagra for PROcreational purposes?  Come on!

Looking at this article a little bit further, and as a medico I began to feel more and more that I was being manipulated by the drug companies.  This has become an increasing ploy of the pharmaceutical industry of late.  Produce a demand in the general public and the doctors have to go along to write prescriptions to fill an apparent need.  Meanwhile the drug company profits go through the roof.

The correct way to introduce any new drug is to fully test it, put the reports of the tests into the medical journals (not the popular press) and have their reps detail the doctors so that the medical profession can decide how and when this medication should be used.  When the demand is coming from the patient, this is not the best way for either the patient or the profession.

I tend to look back at the other “wonder drugs” that the drug companies have released in this way.  Take Prozac for example. The newspapers were running articles on this drug before it appeared in the legitimate medical press.  Again this produced a demand (and expectation) in the general public before it was proven to work in clinical practice.  Do not get me wrong - it is not a bad drug, but it is not the panacea for all depressive ills.

No, I tend to be very skeptical of these breakthroughs that the patients tell me about, rather than the other way around.  There are no real wonder cures, I’m afraid.  Even Viagra has had more than a few drawbacks - especially when used for “recreational purposes” and thank you Jack Lamberton!

Of course the other trick to give these articles some legitimacy is the quotation from some specialist in the field.  However, read further down and you find that the specialist was in the employ of the drug company.  Or even more sneaky, the testing was being bankrolled by Big Pharma.  With new drugs having the potential to make billions for the parent company, no wonder they want the medical profession to prescribe it.

Your protection against this?  Stick with ethical practitioners prescribing ethical medications from ethical pharmacies.  Patients sometimes complain at the cost of meds from my hospital.  That’s the price of getting the real thing.



HEADLINES [click on headline to view story]

Are you really “normal”?

The other side of the coin

Wonder Cures!