Healthsifter by mary desmond pinkowish, since 2003

Doctors to the Stars: A Pain

Do you ever wonder about the other side of stories like those about Michael Jackson, Heath Ledger, Anna Nicole Smith? If so, read the column by Dr. Kent Sepkowitz in today's Slate. Here's an excerpt detailing his brush with celebrity patients. He goes on to describe how easily docs get sucked into the celeb cycle.

So now are we awaiting the news on poor Michael. His version of Dr. Nick, a physician named Conrad Murray, had, by report, been a member of the retinue for just a few months. Murray's entry into the news was characterized by his apparent attempt to exit the news; he is said to have high-tailed it from the scene of the dead or dying Michael even as police and others descended on the house. His exact contribution to the death will be revealed in the weeks, months, and probably years ahead but is likely to resemble that of his predecessor Dr. Feelgoods—whose pen and syringes and customer-is-always-right attitude ended up creating a corpse where once an icon stood.

In a strange way, I actually stand in awe of these guys. I have taken care of a few celebs in my career, and for me it was an awful experience. If you fuck it up, you're toast. Once I took care of a very important person, a person you have heard of and are very interested in, someone you would be shocked to know had the problem—asthma—that I treated him for. Well, almost treated him for. His complaints and his recollection of near death last time he had the identical symptoms so unnerved me that I asked a colleague to assume his care.

A Vote to Ban Vicodin, Percocet; Lower Doses for Acetaminophen

A panel convened by the FDA yesterday voted to recommend banning the prescription pain killers Vicodin and Percocet because of concerns about liver toxicity when these drugs are taken with acetaminophen, the active ingredient in many over-the-counter pain and cold products. Then panel also recommended that the maximum daily dose of acetamophen be reduced. Here's part of the story from Physician's First Watch:

The FDA does not have to heed the advice of its expert panels, but it frequently does, according to the New York Times. If the FDA follows the panel's recommendation, seven other prescription drugs combining acetaminophen and narcotics could also be banned.

In addition, the panel voted to reduce the maximum daily dose of acetaminophen to less than 4000 mg and the maximum dose in over-the-counter formulations to 325 mg (down from 500 mg).

According to the Washington Post, 124 million prescriptions for Vicodin or its generic equivalents were written in the U.S. last year.  The New York Times also covers this story today and closes with some good advice:

Consumers need to be better educated about the risks of popular medicines, most panel members agreed.“If you keep track of what you’re taking, none of this is an issue for you,” Dr. Jan Engle, a panel member and head of the Department of Pharmacy Practice at the University of Illinois in Chicago, said in an interview after the meeting.

Find more on acetaminophen from the FDA here.

Drug-Induced Celebrity Deaths: Isn't There a Better Way to Learn These Lessons?

Drugs.com says that Michael Jackson's death drove a huge increase (really huge) in Internet queries about the drug Demerol (meperidine hydrochloride), which has been implicated in his death (pending the rest of the toxicology reports). Similar spikes of interest about drugs like Xanax (alprazolam), Valium (diazepam), OxyContin (oxycodone), Ativan (lorazepam), and Restoril (temazepam) followed the deaths of Heath Ledger and Anna Nicole Smith, according to Drugs.com. Here's an excerpt from that article:

Drugs.com reported a massive 20,900% increase (yes, you read that correctly – twenty thousand, nine hundred percent) in interest for information on the prescription medication Demerol – allegedly prescribed for the legendary entertainer Michael Jackson. More than 135,000 page views were logged on the Drugs.com web site by people researching Demerol this past Friday – the single biggest spike in daily interest for a medication since the similarly tragic and untimely death of Heath Ledger.

Demerol (meperidine) is a narcotic pain relieving medication. It works by dulling the pain perception center in the brain. Interest in the medication exploded from around 650 page views per day on average to 135,164 page views on Friday, June 26.

So some people may now know more about the dangers of these meds. Will lives be saved? Who's actually doing the reading?

Autism and Vaccines: Autism One Conference, Chicago

AMEDnews reports evenhandedly on the Autism One conference, which was held in Chicago over the Memorial Day weekend.One of the featured speakers was Dr. Andrew Wakefield, the British physician whose 1998 paper in The Lancet claimed an association between autism and the measles, mumps, and rubella (MMR) vaccine and autism in 12 kids. But this is what's happened since then, quoting from AMEDNews:

"Every so often, a small study such as the one conducted by Dr. Wakefield comes along to buttress that belief. In this case, the momentum has held, even though 10 of the 13 authors on the 1998 paper published a statement inThe Lancet in 2004 retracting the original interpretation that their data indicated a causal link between MMR and autism, and Dr. Wakefield faces significant professional scrutiny."

That is, Dr. Wakefield is in danger of losing his license to practice. In June, the UK health authorities declared that measles is now endemic in that country and confirmed a recent measles-related death. In the US, measles rates are at their highest since 2001. It's more than spots: encephalitis and pneumonia are just two possible complications.

Damage done.

The Faces of Meth

Whoa.
From the Faces of Meth Program
And the FOXNews story.

More...

National Institute on Drug Abuse (NIDA)

Office of National Drug Control Policy

US Health and Human Services Tips for Teens

Parents. The Anti-Drug

DEA

Is Your Child Using Meth?

Performance-Enhancing Drugs for Intellectuals

William Saletan writes in Slate about performance-enhancing drugs for high achieving academic types.  It turns out that the scientific journal Nature polled its readers about their use of

• Ritalin (aka methylphenidate), which enhances concentration even in people without ADHD
• Provigil (modafinil), which lets you work long hours without needing to sleep
• Various beta-blockers, which are usually used to treat high blood pressure and other cardiac disorders but also decrease anxiety without the wooziness and fatigue that tranqs (Valium, Librium) can bring on.

About 1400 readers took the poll. Here are some of the findings, quoting from Slate:

"The number of people who said they'd used these drugs for enhancement was 50 percent higher than the number who said they'd used them for therapy. Eighty-six percent of the admitted self-enhancers said they'd done it to improve concentration; 31 percent thought their pill of choice improved memory. Nearly two-thirds said they had colleagues who used the same drugs."

The original report from Nature is here, and it's worth reading and looking at the graphics. Will professors whisper about the next Nobel laureate in physics the way that most of us whisper about Roger Clemens?

Prescription Drug Abuse in Young Adults, College Students

Accidental drug overdose deaths are five times higher than they were during the 70s and twice as high as during the cocaine-fueled early 90s according to a column in today's Wall Street Journal. Booze and pot still reign on college campuses, but more students are turning away from Ritalin and other drugs that were popular several years ago and moving toward some real bad boys--Percocet, OxyContin, and Vicodin. And they're often getting these out of mom and dad's medicine cabinet--or via internet pharmacies. The users probably don't understand the profoundly addictive nature of these medications. Check out this site for teens, which has Spanish info too. These Rx drugs are close cousins of heroin--do people not know this? NPR did a good report on kids and OxyContin a few years ago.