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
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
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
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
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
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
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
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.