Brand Name versus Generic Drugs. Are You in Danger of Clueless Doctors?

Posted on July 18, 2014 by Angela A Stanton, Ph.D.

It seems to me that most everyone hates high drug prices (me too) so everyone heads toward generic the moment it is available. But we are facing problems with that. We all know that many of the generic drugs are manufactured in places without US standards and though the FDA and pharmaceuticals swear that they are safe and equivalent, there have been exceptions to that and lawsuits followed.

However, here I want to evaluate if doctors and the FDA understand chemical structure and if they are looking at that to see if the generic is a true equivalent to a brand name in active ingredients.

This blog is about the danger of your doctors not understanding the chemical structure of the medicines they prescribe, so cannot catch if there is a difference between a generic or a brand name.  They do not (cannot) compare if the chemicals will be able to do the same in the generic as in the brand name in your body. Surely we know that we can fool our bodies and eat rubber thinking it is sugar. If it is sweet and looks like sugar, we will think we eat sugar but we may still die at the end of the day from eating a chemically different food from what we thought we ate.

This is definitely true in the case of food–just look at the history of several artificial sweeteners. So what about generic drugs? Do they have the same chemical structure as the brand name? And most importantly should they? What is a generic versus a brand name? That is what I want to discuss and want to guide you through one particular drug that I bumped into and nearly got killed by.

The brand name of the drug in question here is Singulair and unless you fall into the 1% of asthmatics for whom this is a life saver, you probably have never heard of it. Think of it as an environmental protection against asthma. I have asthma and I happen to be in this 1% so the chemical structure is important to me and it should be important to my doctor. It is important to note that many more asthmatics take Singulair than they need to. To test if you need it, stop taking it for a couple of days. If your asthma does not change (provided your environment does not change) you are in the 99% who do not need this medicine.

The generic name of a drug represents the name of the key ingredient(s) in the drug–by law. So for example, Advil is Ibuprofen since that is the key ingredient in both. There are generics for many drugs but of course brand name drugs have patent block for 20 years so until then, companies who manufacture generics do what is called “backward engineering.” Backward engineering takes the drug, looks at the patent information that contains just enough information to know what the end product looks like. They then chemically untangle and try to rebuild to have similar behavior in the generic drug to the brand name with the same active ingredients–also by law.

NTI (narrow therapeutic index) drugs can be tricky because the blood concentrations you need to achieve a therapeutic dose and the concentrations that will cause harm are very close together. Small changes in concentrations can lead to ineffective or toxic responses. Medications for seizures, heart arrhythmias, thyroid hormone, warfarin (blood thinner), and lithium are all NTIs. (source)

Not being equal to a brand name is fine as long as the name of the generic reflects the difference. Most do. Take Singulair. The main ingredient in the brand name is Montelukast Sodium. Generic medications providing the same are all called Montelukast Sodium and they come dime a dozen. But someone up or down in the food chain of drugs decided that oh.. sodium is not important… and dropped it and came out with a generic called Montelukast.

Montelukast is not Montelukast Sodium, as the name depicts. In fact, the generic manufacturers honestly state that by showing even the chemical differences–mind you this is already against the law. The law clearly states that the active ingredients in a generic must match that of the brand name 100% and only the inactive ingredients can be different (source).

Here is the chemical name and the look of the chemical chain of Montelukast Sodium, i.e. Singulair:

Singulair - Montelukast Sodium

Singulair – Montelukast Sodium

As you can see on the top right it has Na+ at the end–Na+ is sodium ion that will ensure it will attach to the proper receptors in the body. It is positively charged so it seeks out a negatively charged ion, in this case you see COO– there. This combination is important in the metabolism of the brand name drug–or generic drugs with the same chemical signature.

Now let us look at Montelukast, which is pretending to be generic for Singulair:

Montelukast

Montelukast

It is not listed but the molecular weight is 582 so way less than Montelukast Sodium that is 608.18.

Note how cleverly, wherever you see this chemical chain, it is always up-side-down – relative to how the Montelucast Sodium chemical chain is drawn. Why may that be? Could it be to deliberately take the eye off of the importance that instead of COO–Na+ we now have HO and O ? Plus many other changes!

To bring the point home easier, I transposed Montelukast’s chemical chain drawing into the same direction as Montelukast Sodium so you can see some of the differences better. It is not only the missing sodium. Here is what the two look like when they are side by side. Molenkulast Sodium (Singular) on top and Molenkulast on the bottom:

Montelukast Sodium versus Molenkulast

Montelukast Sodium versus Molenkulast

Oopsy! We have a big problem here! Not only is the sodium missing but also the chemical chain is broken in a different place in a different way and Molenkulast Sodium has H2C whereas Molenkulast has CH3 instead and an HO appears in that triangle in a different place. These have important indications in the human body! Perhaps the best way to put this is imitation crab versus the real crab: it may look like it and may even taste like it but the chemistry of the imitation crab is nothing like the chemistry of the real thing.

AMENDMENT on 8-26-2016: Since 2 doctors have commented below stating that the two molecules are identical (doctors Steve and Angela Grant), I would like to clarify in the article itself that the two molecules are completely different–my responses are written in the comments but to make it clearer, I add them here as well.

Dr. Steve suggested that the two molecules are the same because 1) the human body is always full of sodium so if the molecule needs a sodium it will pick it up and 2) as the molecule rotates in real life, taken in another view or angle the two are the same. So let me address his concerns since he is wrong on both accounts.

  1. Yes indeed, the body is always full of sodium. And as Dr. Steve correctly points out, in the body everything breaks down into ionic form and so he suggests–based on the molecule being able to pick up sodium from the body–that the sodium we have in the body is not already tied down by something else. That is chemically impossible since sodium (Na+) is an ion and as such, it will do everything possible to become a complete molecule and grab anything that has a negative ionic charge since sodium ion is positive (missing an electron). Exception to this are the ionic channels (all of our cells have many) in which case the function of the ions is to remain ionic and generate electricity taking advantage of the ionic charge differences. Sodium is unstable as ion and most certainly cannot await the arrival of a medicine. All sodium ions are already tied down in the body doing some tasks–or are to remain ions to conduct electricity. Most sodium is used as part of our electrolyte and as such it is used by our body to maintain hydration and to clear toxins out of the body.
  2. Furthermore, what Dr. Steve suggests assumes that a molecule–such as Montelukast–can pick up ions. A molecule is a stable form and it resists any changes to its structure. Thus as it disintegrates in the body into ionic components, it will perhaps pick up whatever else it can but at that point it is no longer Montalukast but its different ions, none of which necessarily will attract a sodium ion. In medicine, assumptions made are often dangerous guesses.
  3. Montelukast’s chemical formula is C35H36ClNO3S with molecular weight of 586.184 whereas Montelukast Sodium’s chemical formula is C35H35CINNaO3S with molecular weight of 608.18. As chemical equations, the rotation of the molecule no longer matters since it is a mathematical equation in which the left side of the equation must be the same as the right side.  So let’s put them side by side and you decide: C35H36ClNO3S  ?=? C35H35CINNaO3S  Are they the same molecules? Not even close. 

Dr. Angela Grant first suggested that since the body has “a lot Salt in the form of NaCl [sodium chloride]. I imagine Montelukast will pick up the Na+ regardless because of [its] strong affinity and our organs bathe in a pool rich with NaCl and other ionic compounds”.

  1. I provided answers to this in my response to Steve in point 1 above but this comment also assumes that NaCl remains NaCl in the body, in molecular form that is. NaCl is pure salt molecule that is stable and does not have the propensity to break up into ions unless it is forced to do so. The assumption that NaCl remains NaCl in our body ignores the metabolic chemical changes of anything that enters our body–though apparently this doctor was a chemistry major and is also a medical doctor. I wonder if NaCl stays as is, how on earth do we generate voltage that requires positive and negative ions on the two sides of all cellular membranes? Without NaCl breaking up into Na+  and Cl– to generate action potential, we have no cellular voltage at all. Action potential is when Na+ moves into the cell as Cl– remains on the outside of the membrane. Resting potential is when the positively charged potassium ions K+ flow into the cells as Na+ leave. Without ionic movement there is no life. Thus making the assumption that molecules don’t break up into ions is not understanding biochemistry and human physiology.
  2. Dr. Angela Grant also took the ingredient list of Singulair and Montelukast: “Each 10-mg film-coated SINGULAIR tablet contains 10.4 mg montelukast sodium, which is equivalent to 10 mg of montelukast...”  lol… not sure on what planet is 10.4 mg of something equivalent to 10 mg of something but not on planet earth, as far as I can tell, that is an F- in math.
  3. However, she also states that we all are different and respond to medications differently and thus what may seriously affect my health may not affect yours. Totally true. However, when it comes to a medicine that is a standardized formula, there is no such allowance that a generic drug having a different active ingredient from the brand name is permissible because some people are different.

End of Amendment

Now you would think that a head doctor at a very famous and prestigious medical institution would check for such chemical differences before prescribing Montelukast instead of Montelukast Sodium to an asthmatic, whose ability to breathe may, in fact, be compromised by the generic drug!

Do you think they did? No. Why did they not check? Because of 3 reasons that I can think of:

  1. If you visit the Wikipedia and look for Singulair, you will get Montelukast and though I had a big fight with them, they refuse to see its significance since they say that on the FDA website the two, meaning Montelukast and Montelukast Sodium are the same–but that is actually not true.
  2. It is cheaper to produce Montelukast than Montelukast Sodium and thus medical facilities will pay less.
  3. I noted earlier that only 1% of the asthmatics benefit from the drug. Many get it who do not benefit. So for them it makes no difference if it is Montelukast or Montelukast Sodium since neither would work anyway. Thus there is no way to check, except in those rare cases, like mine, where it matters, if the generic as Montelukast works equivalently to the brand name that is Montelukast Sodium. This muddies the importance of getting the correct chemical formula!

Thus the answer is clear; those of us for whom the real stuff would work end up getting the fake stuff that will get us sick. This is not unique; it happens all the time to others as well. What makes it unique is that this time I was able to identify the difference and rest assured they will not get away with it without either changing to the real stuff or making the news as the bad guys. One of the two will happen! Their choice!

This is also a warning for you all out there who read this post! Our medical system has deteriorated to the point where we as patients must be better knowledgeable about our illnesses than our doctors are! It is time for us (you too!) to start taking a giant magnifying glass to all medications we take and compare ingredients and look at chemical charts. You don’t need to know what the chemical stuff means; you just need to see if they look alike!

I would love to hear your thoughts!

Angela

Amendment – July 22, 2014:

I would like to add to this article some important information. Today I called Merk, the pharmaceutical company that manufactures Singulair. They confirmed that indeed, Montelukast is not equivalent to Montelukast Sodium and the active ingredient in Singulair is indeed Montelukast Sodium.

I recommended they check the postings on Wikipedia on Montelukast and also on the NIH website (I linked here only one article but there are many  more) because these articles are incorrect and wrongly represent Merk’s great product Singulair, which is Montelukast Sodium. It also gets people like me sick, since Montelukast does not have the necessary ingredient of Montelukast Sodium–in other words, Montelukast Sodium is one molecule. It is not equivalent for me to take Montelukast and a pinch of salt. Nope.

I thought I update you since now the assault on all fronts of the wrong information is on and my medical company better provide me with the correct drug!

I was also given the brand name medicine by my medical provider, resolving my problem.

Angela

End of amendment.

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Salt, Government, Doctors and People!

Posted on July 15, 2014 by Angela A Stanton, Ph.D.

Let there be people and make them salt free to have them happy heart! YES!! Beautiful and dead. Makeup anyone? This will be a fiery post so buckle your seat belt!

By some medical professionals in the media–who shall remain nameless since we all know whom we are talking about–salt has become the black sheep of our nation–as well as other nations since they copy us. Salt is said to be bad for us. Reduce salt! Eat salt substitutes! For healthy and happy heart stop eating salt!

Guess what? Without salt your heart will not work, your brain will not work, your lungs will not work. You actually will be dead. You may have a gorgeous heart when they open your cadaver and they can frame it! But not eating salt will kill you. Furthermore, you may have a perfectly healthy heart that you may destroy by not eating enough salt!

Remember when you were born? No? You have heard of the amniotic fluid filled sac that bursts as the baby is born right? Well it is not water. Nope. It is salt water and some other minerals. Have you tasted your blood lately? Hopefully not but if you will, it is salt water that is red with some other stuff in it. Our bodies are made up of 70% water it is said; no, our body is actually 70% salty water with other minerals that form electrolytes.

If you end up in the ER, the transparent liquid they pump into your blood via IV is not water; it is either saline (salt water) or electrolytes (salt, potassium, water, magnesium, and some other elements). So when I hear the statement on TV “salt is bad” for us, I would like to yell and tell everyone that

NO! It is too much salt that is bad for us!

What is too much salt? If you have developed hypertension (high blood pressure), that means you may have eaten too much salt relative to water and potassium (may have since it can also be genetic). You can prevent a non-genetic hypertension by eating balanced ratio of salt with water and potassium. You may even revert non-genetic hypertension by eating the right amount of salt with the right amount of water and the right amount of potassium!

Please! Enough of this no salt nonsense! We now have mothers who feed no salt to their developing children as young as age 3, who then end up with underdeveloped brain, migraine, or worse! Why do we need salt? Salt creates a voltage differential between inside and outside of the brain cells to allow the sodium-potassium pumps to work. No salt, not enough voltage, no pumping, no cell alive. Is that what we want?

So stop this nonsense of not eating salt! Eat salt! And if you already have migraines or want to know more why we need salt, read my book Fighting the Migraine Epidemic (digital) (paperback).

Contact me if you have any questions.

Angela

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We Know We Are Doing Bad Medicine… But…. Said the Doctor…

Posted on July 9, 2014 by Angela A Stanton, Ph.D.

There is a summary write-up of a discussion between doctors on MedScape. This is not an article (or video since it contains the video of three doctors’ discussion in addition to the transcript) for public viewing; one must be a published scientific article author to be able to view the original. In case you do have an article in the NIH database and have access, the link is provided. I do have access so I summarize here what the discussion is about for those who do not have access and, as before, I need to ask you to sit down before you read it. Some parts of the article are shocking.

The debate title is “The Pros and Cons of Patient Satisfaction Measures” and it is a Primary Care debate between three doctors: Bradley P. Fox, M.D., William R. Sonnenberg, M.D., and  Charles P Vega M.D. The discussion is dated July 8, 2014.

Apparently Dr. Sonnenberg made the suggestion that “patient satisfaction” should be used “as guide for physician evaluations and payment.” He presented a paper in the Keynote Physician, which is a paper of small circulation so he thought nothing of the ensuing consequence. Then later he gave a lecture in San Diego on Brochiolitis (children’s lung infection) and suggested that doctors “need to pin downs diagnosis” in patients because otherwise “parents will be taking their children to emergency wards or urgent care centers, where they will be given the obligatory prescription for azithromycin (common antibiotic), which seems to make everyone happy.”

This created what you may call chaos in the conference as ER doctors ran after Dr. Sonnenberg after his talk telling him that “Look, we know that what we are doing is wrong, that this is bad medicine. But our performance is judged largely by 2 parameters. First, do we get the patient door to door in 45 minutes? Second, do we keep the patient satisfied?”

Wow! WOW! and WOW!

They know that they are practicing bad medicine! They know and admit it! Plus they also admit that medicine is all about money because they need to get the patient out the door–in case you don’t know, there is a time limit set by each emergency room for what it considers to be acceptable to pass before they must admit the patient to the hospital. Thus getting patients to not be admitted is goal number one over and above patient health! Goal number two is to make sure patients leave with a smile, even if they were given the wrong treatment.

What happened to ethics? To the Hippocratic Oath that states “Do No Harm!”?

The discussion continues about how administrators are leading what doctors do. There is really nothing new about this since we all know and have always known that doctors can only do what the administrators, who are not doctors, let them do. This not only leads to bad medicine but also can have dangerous consequences, as our recent discovery of superbugs suggests. Superbugs do not respond to any known antibiotics. The reason for these superbugs is precisely the over-prescription of antibiotics for cases where it is not only not needed but may actually cause harm. If doctors are judged by patient satisfaction and they are not happy, according to what these three doctors are talking about, the patients did not receive antibiotic treatment!

Thus we have a multitude of problems here, not the least of which is patient education–or lack thereof.

The three doctors go on discussing how increased patient satisfaction is actually associated with higher patient mortality rates–which would be understandable based on the antibiotics argument but not on any other measure. They also discuss the importance of patient satisfaction for “patient adherence” meaning that we stick with our doctors.

It nearly seems to me that three used-car sales reps are talking here! Is this real?

They continue: “Right now, the effect of patient satisfaction on income is about 3% of a primary care physician’s salary and 2% of a specialist’s salary. This is not a major chunk of a physician’s salary, or anywhere close.”

This is a very interesting discussion. Pretty soon I will feel like a bag of peanuts for sale. How much of my health really maters to doctors?

The discussion continues: “Physicians are generally a very competitive lot, and if you look at a survey and see that you are in the lower 10% or 20% of a given metric, you will try to do things to increase it.” The discussion does not detail how far doctors are willing to go to achieve to be in higher than the lower 20% of a given metric and it is not clear what the “metric” in this sentence refers to but whatever I try to refer to in terms of what physicians are for, it sounds bad, except in one case, in which patient health is a metric.

Unfortunately the questions of metric with respect to patient health has not come up anywhere in this discussion.

But there is another angle to being watched and judged by administrators. Dr. Sonnenberg said

Once I was dinged for something I believe is distinctly unfair. Years ago, a patient had an x-ray in the emergency ward; I received the result 3 days later. I called the patient promptly when the x-ray showed up on my desk. The patient yelled and screamed and gave me a bad report, and I ended up getting certified for 1 year instead of 2 years. It did not matter that what I did was logical, proper, and the best anyone could have done. They did not care; they saw the and dinged me for it anyway.

Thus even when a doctor does the right thing, the administrators’ rules are above and beyond what a doctor may seem to be the right action–even if that is the right action for the patient.

Dr. Fox was the only one who suggested the kind of measurement that included the terms “real-time or medically sensitive approach” for being included in a metric of deciding the quality of a physician.  A “medically sensitive approach” is still not “did we get the person healthy” approach but better than “was the patient out the door in 45 minutes?” for sure.

But then here is a not-so-funny statement for you:

One humorous anecdote I heard was that to get rid of the outliers, make sure you put down an abuse diagnosis in the coding. If you put down an abuse diagnosis — alcohol or drug abuse — those statistics are automatically excluded by Press Ganey. I have heard that this is a way to game the system…. (Dr. Sonnenberg.)

So the system is being gamed in medicine. Again, nothing new, only a confirmation of what we all already knew only it is odd to hear it from the mouth of a doctor. Isn’t it?

I am ashamed that I read this discussion but glad that I did as well for it proves what we all know: medicine today is in shambles because of incompetent administrators who look only at profits. There is nothing wrong with looking for profits if appropriate care is provided. But getting profits based on how fast the patient is kicked out of the office is not a profit center for a physician!

I am looking forward to your thoughts!

Angela

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Symptom or Cause? Why Can’t They Get It Right?

Posted on July 7, 2014 by Angela A Stanton, Ph.D.

I cannot help but laugh when I see television commercials of medicines. Forget that they have longer warnings of how it may hurt or kill you than the benefit they may give you–in fact if you did not look at the television during the commercial but only listened, you would swear to never take another medication in your life. But I am now laughing on something else as well.

Every time I watch my weekly favorite show (60-Minutes), a commercial pops up for Crohn’s disease and Colitis with a guy interviewing for a job wondering if he can get through the interview, the meeting, the flight, etc. Then the advertisement goes something like this: “What if you could find out that the underlying cause of your disease is inflammation… ” something like that–this is not verbatim since I don’t know the exact words and even if I did, it is not important. The meaning is important.

The “underlying cause is inflammation”? Really? On which planet is inflammation a cause? On planet Earth it is a symptom that has a cause on its own. Thus treating inflammation does not treat the underlying cause but treats another symptom that causes the original symptom you feel. So you have to live with a decision of which symptom you prefer to have.

But what is the cause of the inflammation?

The truth is that we may never find out what the cause of the inflammation is for a few reasons: First, pharmaceuticals are not looking for the cause of an illness but the treatment of the symptoms. We are in an era of symptom treatment and not illness cure or cause finding. There are several reasons for this. One of them is that treating symptoms makes money and keeps you sick. The second reason is that finding the cause means you will be cured and then you won’t need to take medicines anymore. That leads to long unemployment lines in both pharmaceuticals and among doctors. It is in no one’s interest to cure you. You can see that by how they treat the new drug for Hepatitis C, which provides a cure but no medical establishments wants to pay for it! They would rather not cure you and keep you sick so they can continue treating your symptoms.

The third reason why there is no cure is that no one knows how to find it since by the time you have symptoms, often times the causing pathogen or agent or problem is long gone. It is a detective work that would have to be starting early; perhaps it needs to be genetic research to find the cause and prevent it from becoming an illness.

We understand that we do not yet have the science to solve all problems but please, do not fool the public! The public tends to believe the industry since “they know what they are talking about.” Ha! No they don’t!

I would love to hear from you! Angela

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Medication: Brand Name then Brand Name and then Brand Name again!

Posted on July 5, 2014 by Angela A Stanton, Ph.D.

You are probably familiar with the patent length of new drugs but in case you are not, it is 20 years. What happens when the patent expires? You think you know the answer since you see so many generics and most medical providers will only pay for generics. Even if brand name medications are covered, chances are you are out of pocket with a bigger deductible. This is what you find–particularly for older medicines–but not for those that are not so old. Why not? I hope you are sitting… if not, take a seat please!

Do you read The Economist? If not, you should. Lately, toward the end of the magazine, there are several science sections from which you can learn the latest of what is truly the driving force behind our scientific and medical status. I found the link to the article I am about to discuss, so feel free to read it. In case you have the have the paper edition; it is on page 72 in the June 21st 2014 issue. This is an amazing and very shot one-page article.

The article sums up what happens to brand name drugs after the 20-year patent and exclusivity expires. I was shocked to read the choices these pharmaceuticals make and the most interesting part is that it is all legal. When I got my doctorate, because my field is medical experimenting on human volunteers, I had to spend a couple of years studying law, specifically human rights and everything relating to patents. In fact I have a rather fiery article poking fun of one particular case that happened in the 1970 where a doctor practiced experimenting without consent, made a ton of money by selling his unauthorized collection of blood from the patient and patented it, something that exists in nature–completely against all patent laws. Although I gave a link to the book, the title of my article is not visible: Patenting Lives. Chapter 5: Forfeited Consent: Body Parts in Eminent Domain.

This particular book is out of print now for the 3rd or 4th time since it is used as a text book but is available in Kindle–mind you it is still very expensive, so forget it. But I just wanted to show you that I am familiar with the subject and have the right to poke fun again; this time over the pharmaceutical companies who get away with murder and with the patent office yet again!

So here is what is happening in short: normally patent expires in 20 years, so this means the end of being the only company selling the drug. Using the patent information, other companies can identify precisely what is in the drug and re-create it as a generic, selling it for a fraction of the cost. This means the death of the brand name of course, something Big Pharma cannot allow to happen. So they have created some options for themselves that are “legal.” And I place quotes around the word “legal” because the law states that something can only be patented if it is genuinely something new both in design and function. If one of the two does not hold, the item cannot be patented.

Yet Big Pharma found a way around this and just before the patent of a drug would expire, they create another version of the same drug with modifying something (probably a non-essential additive) and market it again as new, apply for a patent and they get it! Yet the drug is essentially the same and it certainly has the exact same function else it could not be prescribed for the same illness. Thus we have a broken patent office system that does not see past its nose–or perhaps there is some political interest involved.

Another alternative is they buy off potential generic manufacturers trying to sell generic–meaning they pay other companies who would manufacture the generic in order to not manufacture and sell generic. Although this costs money, they still earn more money then if they had let the generic drugs come to the stores. According to The Economist, in 2012 alone there were 40 such deals that cost the Big Pharma “only” 3.5 Billion but of course they earned $8.1 Billion, so the payout was pocket change.

A third trick by Big Pharma is to nudge customers (doctors in this case) toward other drugs that behave similarly. I now understand why my mother’s doctor kept on switching her from her Simvastatin cholesterol drug that worked perfectly well, was generic, and saved her liver, to Lipitor all the time, which is not nearly as effective, destroys the liver, and costs a lot more. Every time we went for a refill, Lipitor was waiting for her and every time I had to fight the doctor to re-prescribe Simvastatin. Shame on that doctor!

In conclusion: keep your eyes and ears open! Do not let your doctor change your medications without good explanation and reason and without getting your consent! They must get your consent for every drug they give you. Changes behind your back indicate some kind of ugly monster you do not want to get involved with. As for the Big Pharma, the only way to get rid of them is by simply not getting sick. Do the best to your body to keep it fit and healthy and then who cares what they do?

Questions? Contact me.

Angela

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Vacation Over – Medical Reality Hits Again!

Posted on June 28, 2014 by Angela A Stanton, Ph.D.

It was great being on vacation for a month. Luckily all was beautiful and I wish I lived there (I was in Scandinavia). But I live in the US. As most of you probably already know, I have several Facebook groups where I keep in touch with over 1000 members discussing medical issues, migraines, etc. I received a private message yesterday from a friend and to conceal his/her identity, I will not use name and use “she” for generic though the person need not have been a female.

I have discussions like this all the time with frustrated people whom the medical system fails. The number of these people is growing as is my anger toward the medical and pharmaceutical industry. There are stigmas out there that are not only unwarranted but are harmful.  The medical oath Do No Harm does not seem to stand anymore. Personal bias has taken over and the patients are helpless. I am hoping to change that–or at least start a change that others can catch up on and follow to solve the problem.

So here is a classic case that happens more often than not. This particular patient has various illnesses, one of which is migraine. Unfortunately there is a huge stigma among many doctors that migraine is 1) just a headache with a crying and non-pain tolerant person and 2) it is a mental case. Now we have a 3rd variation: a migraineur is a druggist. This is new to me! It is also sad and shameful that doctors today have so little understanding and are not updating their knowledge at all. I wrote a book on migraines and posted several articles on its blog. There is one that lists the symptoms of a headache versus a migraine. Read it to see what a migraine is (particularly if you are a doctor!) before you make judgments in the future. This list is not my fiction of imagination but from Mayo Clinic and other medical sources.

So let me return to my discussion with this migraineur yesterday. She had a migraine for a week and it was getting worse–I call this a runaway migraine. She asked if she should go to emergency room (ER) and I suggested to go; in fact I would have gone after the 3rd day, which is what I used to do while I still had migraines. I no longer do–and you too can prevent them if you read my book Fighting the Migraine Epidemic but my process is not medicinal and so it is not an instant solution.

So this person (not sure if she already has read my book or not) contacted me and told me what happened at the ER. Here is what was written (edited):

“The ER doctor said, ‘I understand you are a migraine patient and for that reason alone I will tell you upfront that you will NOT be receiving ANY form of a narcotic. You will NOT receive any muscle relaxers or anxiety reducing medications. You will be given IV fluids and a steroid plus Imitrex and Benadryl.’ I said I do not want Imitrex because it makes me very sick. They said I was being a bit irrational… The doctor said that she refused to give me anything that a medicine seeker would want. Excuse me… I waited a week to come in! I didn’t jump for drugs! When I disagreed with the Imitrex the doctor said I was being difficult. I was so out of it, they were pushing meds in my IV before I could ask what they were giving me. The steroid made me burn and tingle all over. I felt like I was on fire! It went away after a long 10 minutes though… I asked why I was getting Benadryl. The doctor’s response was: “It is a part of MY protocol.” Well, excuse me, but I have had migraine issues for years Missy. I can tell you more about my response to meds and my body more than you ever could.”

So let us discuss this “doctor” and I put doctor in quotes because in my opinion this is not a doctor but a quack. Why? For several reasons; let me list them here one by one:

  1. A migraine sufferer is not a druggist
  2. There are no “cures” for migraine. Imitrex is a serotonin drug that was originally created for depression and even for patients of depression it only works 30% of the time. New science suggests that inflammation may be involved with some depression patients but not all. Imitrex is the most off-prescribed drug in the US today. By off-prescribed I am talking about it being created for something other than it is being prescribed for.
  3. Benadryl? Really? For migraine? Did this doctor believe that a migraine is an allergy? This doctor should be fired for 2 reasons: 1) Benadryl is an allergy medication given only for allergies and some doctors take it as an ‘innocent” sleeping pill since it does wipe you out. It is “innocent” because it does something else that doctors forget about, which is my point 2) it plays with the water management of the body and dehydrates. Thus if you take a Benadryl, you will end up as a shriveled up dry person unless you replenish. Migraine–read my book–is partly caused by dehydration so giving Benadryl is a double trouble for the pain of migraine! It will make the pain stronger rather than weaker!
  4. Steroid IV for a migraine! Oh my god! Where did this doctor get her degree from? Steroid’s first side effect is a headache. Thus giving steroid for migraine can increase the pain rather than decrease. Secondly, steroid is extremely bad for the body! As you read, the patient felt a burning for 10 minutes all through her body! That tells you that it caused damage in the body rather than any benefit. Steroid also has other harmful effects–many in fact. I even know of people who nearly died from steroid. It is a dangerous drug and is definitely not for migraines!
  5. The only thing this doctor did right is giving an IV to the patient. Nothing else.

Note that this is not an isolated case. Doctors all over the US (and perhaps the world) are using migraine patients as guinea pigs to test various drugs on yet none, and I mean NONE works! Why? Every single medication is aimed at pain relief but in the case of migraines, where the pain is coming from and why has not officially been identified (or if it has it has not been released to the public). In fact cures for migraines will not be forthcoming at all. Why not?

Today we have a medication by one of the pharmaceutical companies that has created a near 100% cure for Hepatitis C for patients with genotype I (mostly US). The medication costs a lot of money because once the patient is cured, there is no more need to get more medications. Thus the pharmaceutical company must calculate into its cost versus profit calculation the amount of money that will be lost by not having repeat customers! So what is the medical community doing? Refusing to allow the medication through to sick patients.

Conclusion 1: the medical industry does not want you to be cured! They want you to remain sick. Having a sick population guarantees jobs for the future!

Conclusion 2: patients need to self-identify what is wrong with them and try all methods without the medical industry first and go to medical care when all else fails.

This obviously does not work for everything: if you need your appendix taken out or have cancer, yes, you will need to face the inevitable of being used by the medical industry and its dirty politics. But if you have other illnesses, like migraine, for example, read my book
Fighting The Migraine Epidemic: How To Treat and Prevent Migraines Without Medicines – An Insider’s View
by Angela A. Stanton, Ph.D. either in Kindle  (under $4) or in paperback  (under $20) edition. It will let you treat yourself without doctors.

New book on Clueless Doctors will be forthcoming not only with stories like this but also explanation and examination of the medical system as a whole and a very big section on self-diagnosis that will give you a head start to at least visit the last doctor. I will also show you how I found the doctors I am willing to deal with and how you can do that too!

Contact me for questions,

Angela

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Fighting For Human Rights In United States: A Losing Battle in Healthcare

Posted on June 6, 2014 by Angela A Stanton, Ph.D.

This gallery contains 6 photos.

An amazing story and explanations with lots of comments on medical corruptions.

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SSRI Danger for Migraine and Depression Sufferers

Posted on June 5, 2014 by Angela A Stanton, Ph.D.

This particular blog article has been written up before on my blog where my book is being displayed and sold with autograph but since so few people understand how SSRIs work, what they do and why, I decided to copy paste the information.

The function of SSRI (Selective Serotonin Reuptake Inhibitors), how they work and what they do.

Although the book mentions little about SSRIs (or medications in general), many migraine sufferers end up taking them for life without even knowing what they are. For my biggest surprise, many doctors (including Psychiatrists) have no clue what is actually inhibited and how. In this short paper I would like to call attention to what SSRIs do and why you need to avoid taking them.

In this picture you can see my little sketch of just two brain cells (neurons) communicating via neurotransmitters. One, the yellow on top, has an opening from which many red dots are flowing out. Those are neurotransmitters and for the sake of the argument, let them be serotonin.

The neuron below in green has no such release but as you can see has a blue gate I call “reuptake gates”, as does the yellow neuron above. To understand the function of the gates, think of a bathtub. It has a leaking opening on the top so that if you fill the tub with too much water, the extra flows out into the drainage. This outflow prevents the bathroom from overflowing with water.

The function of the reuptake gates is exactly that: they measure how much serotonin is already flowing between the neurons in the layer separating them. When this layer is full, the reuptake inhibitors send a message to the neuron to stop making more serotonin since there is enough.

The little pink triangles are what I called “Reuptake Plugs.” These plugs are the reuptake inhibitors. In effect they plug up the hole on the tub so any additional water that comes into the full tub, continues to flow and floods the bathroom. When such reuptake inhibitors are used, they plug up the ability of the neuron to feel that it has enough serotonin already made and it continues to manufacture serotonin until it is released from this task—which in the case of taking SSRIs is never.

Thus those who take SSRIs stand a very high chance of an overflow of serotonin in the brain, which can cause very serious harm called by various names: serotonin syndrome (official name), serotonin toxicity, toxidrome (toxic levels of any kind of drug), etc.

WARNING

Unfortunately, as real as this disease is, few doctors actually accept it as a viable condition. Though the NIH (National Institute of Health) actually has a very strong paper on this subject still most doctors refuse to acknowledge its existence and even if they do acknowledge, they do not recognize it or diagnose it when it happens.

The many drug overdoses of famous actors and singers I guess were not yet enough to make toxidrome into a serious condition enough to pay attention. I suppose more people must die before the consequence of these drugs is taken more seriously. As for serotonin overdose, since serotonin medications are so often prescribed, their ability to cause harm is higher than that of say heroin but because pharmaceutical companies make a lot of money selling them and perhaps the doctors are given the wrong information and/or have ulterior motives, the use of SSRI continues for things it was clearly not intended to be used for.

Year after year hospitals report delirium as a condition in which people die. Delirium is not an illness but a symptom–and in some cases it may be a symptom of a drug overdose, prescribed drug or otherwise, including serotonin. Drug overdoses are simple to detect by a blood test but for some reason many hospitals refuse to test overdoses of legally prescribed medications, such as serotonin! SSRIs are probably among the top prescribed drugs in the US today and the doctors who prescribe them have no way of testing if the patient actually needs it or if it is already prescribed, if the dose given is too high or low. It is not a difficult test; a simple blood test can test for serotonin levels since serotonin has functions everywhere in the body, including digestion and the movement of the intestines that pass the food on. The higher the level of serotonin, the faster the food passes through, leaving many migraine sufferers with IBS (irritable bowel syndrome) and other digestion issues.

SSRIs are the most common medications prescribed today for depression, migraines, ADD, ADHD and they go under a variety of brand names that you can find at Wikipedia. Yet serotonin has not conclusively been shown to work for any of these. There have been many studies where the numbers were statistically derived in such a way that the benefits appear significant but let me ask you this: Would you take a medication for an infection of your toe that may end up jeopardizing the health of your digestive system? Would you take a medication for a pain in your head that can make you want to commit suicide?

Indeed! Serotonin drugs’ most frequent side effects are suicidal thoughts and irritability. 

SSRI anyone?

And there is more to say! The brain is a very adaptive organ as you read it in the book. This adaptability has been very advantageous throughout our evolution but when it comes to drugs that are introduced externally, the adaptation of the brain takes on another meaning. If serotonin is produced by neurons in the brain, that is their task: produce serotonin. They may have other neurotransmitters to produce–many neurons in the brain have multiple functions. Thus if you start taking serotonin in the form of medication, the brain will quickly stop making its serotonin and reassign those neurons to some other task. This is optimization of your brain since resources are limited. The problem happens when you want to stop taking serotonin medication. You now face what is called “withdrawal” even though you were not a drug abuser or an alcoholic. The withdrawal is identical. Your brain needs to relearn how to make serotonin.

Some changes in the brain are temporary and you can in a short time reset the brain to its original functions; some changes are nearly permanent and your recovery is greatly limited if it exists at all. Serotonin falls into this second category. That means that once you started to take serotonin medications–any serotonin medication, need not be SSRIs, your brain may no longer be able to re-learn how to make serotonin ever again–this is likely age dependent as well. A younger brain is more adaptable bidirectionally whereas an older one in decline will adapt to serotonin replacement fast but not to stopping the extra serotonin. It may never be able to go without.

So should you accept an SSRI from a doctor when he/she offers it? My personal take on it is absolutely no.

Foods that boost serotonin levels

Are there foods containing serotonin that you can eat? You bet there are. Visit this wiki site to find out what foods you can eat if you feel depressed and perhaps are low in serotonin.

Are there people who are clinically depressed who may need serotonin medicines? I am sure there are. I saw many on television: they spend all day in bed, cry, want to be alone, etc. Has it ever been asked WHY those people have depression? Nope. Would it be better to find out why than to drug them up? Yep; you bet!

Think twice before you accept any medications or supplements–and remember that herbs are medications we know nothing about! Most drugs today at one point were herbs and then the drug companies started to mass produce them, test  them, and legalized them. At that point an herb becomes a medicine. But all medicines were herbs! Do not forget that!

Stay healthy!

 

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Serotonin and Migraines: a Second Take

Posted on June 2, 2014 by Angela A Stanton, Ph.D.

It seems that today the words “migraine” and “serotonin” are synonymous. Have a migraine? Take a serotonin pill; some type of tryptan. It is interesting to note that serotonin has very little to do with migraines even though the entire medical industry and researchers are using serotonin for migraines. So you may ask: if it is not for migraines, why are they used? Why do they think there is any connection if there is none? And what is the reason the first person ever thought about giving serotonin for migraine the first place.

So let me take each question one by one and provide a short explanation to each so you don’t think you are in my university lecture.

  1. If serotonin is not for migraines, why are they used? Good question. So far the only reason I heard from doctors is that “it seems to work for some even though it was not made for it.” Great. It was not made for it… so what was it made for? Depression. Does it work for depression? About 30% of the cases yes but 70% no.  Why are they still used if for the majority it is not working for either migraines or depression? The reason is that there are no other medications that can make you sleepy and comfortable enough as well as serotonin does, and when you are sleepy and comfortable, you may forget you have pain.  The image I inserted here is taken from Wikipedia that explains what serotonin is good for and what it does (look for the red).
    Serotonin and Dopamine brain circuitry

    Serotonin and Dopamine brain circuitry

    As you can see, serotonin is responsible for mood, memory processing, sleep, and cognition. Of these sleep and mood are serotonin’s main functions in the brain. Serotonin is not something our body can create on its own without help. It can be released by eating foods like turkey or spending time on the sun. In both cases you will feel sleepy. Sleepiness tells you that your brain released serotonin. I do not see any “pain killer” or “for migraine treatment” listed under the roles of serotonin listed in the brain. Do you?

  2. Why do scientists and doctors think there is any connection between serotonin and migraine if there is none? This is a bit more complicated to answer so bear with me. Since serotonin needs to be released in small quantities by the brain, if for any reason it is not released, one will get restless, moody, cannot sleep, etc., but will not necessarily hurt. Give that person a dose of serotonin and she will feel great. This is one reason why it works in the case of depression for 30% of the people afflicted with that disease: their depression is caused by not being able to manufacture serotonin–but note that people in depression usually do not have migraines albeit people who have migraines can feel depressed. Being depressed versus having clinical depression are not the same though. The second part of this question is why can’t some people manufacture serotonin? And this is where we connect back to migraines. In order for the neurons to manufacture serotonin, conditions for such manufacturing must be met. If the brain is not providing the proper conditions–be it a tumor, a cyst, head trauma, or simply a chemical imbalance such that the neurons are not able to generate enough electricity to make serotonin and release them–the brain goes without serotonin. If this is the case, taking serotonin medications will fill the brain with serotonin. However, once that serotonin is used up the emptiness will return, since the brain is still not able to make serotonin. The brain needs to have all its abilities to make serotonin and all other neurotransmitters.

3. So why did the first person ever thought of giving a serotonin pill to a person with               migraine? I suppose for the same reason many medicines are prescribed “off label,”             which is in fact how doctors can unofficially test with untold patient volunteer guinea             pigs if a drug will work for something other than officially indicated. There really was no       reason for it at all. It was just a guess.

So why does the brain actually hurt in a migraine? If the brain is not able to function, it complains. In the case of depression, because it is serotonin that is often what is believed to be missing, the brain does not hurt and in 30% of the cases when serotonin is provided, the depression improves–however serotonin is not necessarily the choice for treatment of depression since Norepinephrine hormones seem to be more related. But in case of migraines, the brain is not missing serotonin but neurotransmitters that do not work. The brain has a very cohesive network of neurons. Each neuron can have thousands of connections with other neurons–holding hand so does speak. When a particular region of neurons is not working, the connecting neurons try to wake the “sleeping” neurons up by sending electrical signals to it. If that does not work, the active neurons send pain signal to neurons whose job is to receive such pain signals and pass the pain over to you the owner of the head. Thus in the case of migraines, the pain we feel is the pain the neurons send to pain receiving neurons.

The brain manufactures dozens of neurotransmitters or neuro-peptides. Some neurons manufacture more than one neurotransmitters. The brain assumes that all neurons work and so if it finds a region that does not work, it will signal you, the migraine sufferer, that something is out of order. Yes, you can take a pain killer and perhaps get rid of the pain for some length of time but that does not solve the underlying problem of why you had the pain and the non-functioning neurons the first place.

Let me explain one additional very critical information. 90-95% of the serotonin is not manufactured in the brain and is not used by the brain at all. Serotonin is a hormone of digestion and as such it is manufactured by the gut for the use of the gut to assist in the passing of food via the movement of the food being pushed through. 90-95%! That means that if you take a serotonin medication for migraine pain in the head, 90-95% of that drug will affect your digestion and only 5-10% your brain–and on top of it, it may not work for you at all. This can cause serious complications for migraine sufferers. Most migraine sufferers end up with IBS (Irritable Bowel Syndrome) as a result of taking tryptans. Those who have developed IBS before migraine, may in fact have a reason to suspect a serotonin imbalance of the body and they may benefit from regulating their IBS by taking serotonin.

For reasons clearly understood (by me) based on what serotonin drugs do, not one of the people who contacted me so far about migraines as a result of my migraine treatment book was without IBS (the book is available both in e-book and also in paperback everywhere but here I link you to amazon paperback). All whom I talked to are/were taking some type of tryptan medication to reduce their migraine pains. Of the many hundreds who by now have contacted me, I so far only found one person for whom a serotonin drug actually reduced the migraine pain and no one else and she had IBS before migraines.

So before you pop that next tryptan pill for your migraine, evaluate if the risks of having IBS as a result of taking a drug that can cause it is worth taking. It may not be. There are alternatives, such as proper brain chemical management, the details of which you will find in my book. I do not endorse any supplements, vitamins, or medications in my book. I endorse paying attention to your body, understanding what it needs and why and eat accordingly. When it comes to applying my recommended chemical balancing of the brain for proper voltage generation, there are no more triggers, be it weather, food, pressure, heat, or anything.

Please feel free to ask any questions!

Angela

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Why Do Tryptans Sometimes Work & Other Times Don’t for Migraines?

Posted on May 30, 2014 by Angela A Stanton, Ph.D.

I am starting to realize that perhaps not everyone understands why tryptans work for some people sometimes but not all the time and why they don’t work for others at all ever. So here I try to give you an explanation so you can relate to it and not be puzzled.

There are 2 reasons and I present this in 3 cases why tryptans (or serotonin enhancing drugs) do or do not work. But first, you must understand that the job of brain cells (or neurons) is to manufacture neurotransmitters–such as serotonin, dopamine, etc. Some brain cells only make one neurotransmitter and others make more–in research labs at Berkeley when I once visited, I have seen neurons making up to 3 different types of neurotransmitters. One of those may be serotonin but the others are not.

The reason why tryptans are typically used for migraines–as well as for depression–is because it is assumed that you have not enough serotonin and if you have more, it will make you feel better. 

It will, if and only if the neurotransmitters that are in trouble and not working are of the kind that make serotonin and they are not producing it for whatever reason. But if the neurons not working are of the kind that normally manufacture some other neurotransmitter and they are not manufacturing it now, then you are not in need for serotonin replacement.  Thus if then you get serotonin for your migraine, it will not work–you have enough serotonin.

Case 1)

The tryptan drugs sometimes work and other times don’t work is because sometimes it is the serotonin making neurons that don’t have enough energy to make serotonin, in which case serotonin replacement saves the day.

Case 2)

The tryptan is not working even though other times it often has worked. This means that this time the neurons that are idle are not serotonin making neurons. You still get the same migraine but something else is missing and not serotonin.

Case 3)

If you never find tryptans working for you it is because you never happen to have those neurons down that make serotonin.

This complicates a lot of things for doctors who are searching for the cause of the pain rather than the cause of the problem to start with. Most drugs–including Calcitonin gene-related peptide receptor antagonists for migraine–are after pain and not cause. This explains why only 30% of the people are helped with tryptan and also with Calcitonin gene-related peptide receptor antagonists and not all. Don’t misunderstand, 30% is a huge percent, particularly if you happen to be in that 30% but remember that it is still just a band-aid and the migraine initiating factors remain, only now you don’t feel them.

What that means is that if you have migraines that you do not feel, you may still progress to strokes, seizures and hemiplegic migraine state since the migraine cause was not stopped and parts of your brain are still not functioning. Thus you will potentially develop more serious conditions later since the underlying condition is not treated.

I hope this helps in understanding the many treatments available today–including botox, electric devices, etc. They do not cure only act as pain killers. To date, the only research that is purely for the cause of migraines is found in the book Fighting the Migraine Epidemic. The link here is only to one site, the author’s site, but it is widely available everywhere, including in very inexpensive e-book format for around $3.50 depending on where you buy it. If you want to understand the cause and treat the cause rather than just the pain, and if you want to prevent migraine, read that book.

Let me know if you have any questions.

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