Drug addict

Although it is essential that drug companies make a profit, there are occasions when they go a bit too far, and there are two main ways they do this. One way is to change the formulation of the product shortly before the patent expires and generics are released -for example, Tritace (ramipril) capsules were discontinued by the manufacturer and tablets introduced a few months before the patent expired, hoping that doctors would not switch back to the capsules once the generic was available. Another way is to refine the manufacturing process slightly so that only one isomer of the drug is produced - for example omeprazole and esomeprazole, and cetirizine and levocetirizine. In the vast majority of cases, there is no clinical difference. A more contentious point is the development of 'me too' drugs. So MSD develop simvastatin (Zocor), then Pfizer look at it, alter a bit of it to produce atorvastatin (Lipitor), and save themselves time and money in development. However, there are often clinical differences between drugs in the same class - atorvastatin has a longer half life than simvastatin and is more effective at reducing cholesterol levels than simvastatin is.

Clobetasol is indeed a glucocorticosteroid, as are most of the steroids used medically. Clobetasol is effective in treating eczema flare ups, though you only need to use a small amount. Definitely not recommended to use steroids to promote hair growth, unless you want your skin to thin etc. If your house mate is worried about hair loss, he can try minoxidil (Regaine, available from pharmacies), or if that doesn't work his doctor could prescribe finasteride 1mg tabs (Propecia) on a private prescription (and will cost around £25-£30 per month).

The classification of Cannabis as a schedule 1 drug is ridiculous, but it is also arguable that schedule 1 should be scrapped althogether (if schedule 1 means "no medicinal use"). To say that a drug has no medicinal use is short sighted and narrow minded, and makes life very difficult if someone wants to do further research if evidence comes to light that it may have a medicinal use. I recently read an article about magic mushrooms being used to treat cluster headaches, which are frequently unresponsive to currently available medication. However, because hallucinogens are schedule 1, it will be difficult to investigate this further. Why not redifine schecule 1 along the lines of "drugs which are not currently used medicinally"?

Hyponatremia is pretty uncommon, and is usually caused by excessive water intake. High sodium intake causes the kidneys to excrete less water, which over time causes hypertension. It is difficult to reduce the amount of sodium in the diet because so much of it is used in processed foods, hence diuretics ("water tablets") are used to increase excretion of sodium.

I'm not new, but am back from an enforced extended break, during which I worked my fingers to the bone in the lab on a project and revised like hell for my finals (and then celebrated when it was all over). But it all paid off - I got a first,have got a job lined up and have lots of options open. And I have my life back now, which is good.

Amoxil in the UK is yellow and has a banana flavour. As for the generics, it depends who has made it.

Blike and badchad, I did mean to reply sooner, but my stupid internet connection wasn't working. I just want to make a couple of quick points. Firstly, knowledge of medicines is not just pharmacology, the pharmacokinetics are also important, as is the formulation of the product. Pharmacists are the only people who have this knowledge. In the UK, pharmacists routinely go on ward rounds with the medics and intervene to prevent inappropriate prescribing. Very few hospital pharmacists in the UK spend all their time in the dispensary. I have met one pharmacist who has lost his access to his hospitals pharmacy system, because he doesn't use it, but cannot cope if he doesn't have access to the pathology system. He also used to be in the position of having to write prescriptions out for TPN, and then getting a doctor to sign it - does that make sense to anyone? Blike, prescribing an adult dose for a child is not a 'stupid mistake', it is a fundamental error which could hve fatal consequences and should not occur. Badchad, one of the difficulties in the UK has been the medical profession holding tightly onto its responsibilties and not wanting to let anyone else take new roles on. Medics always oppose new developments. One example of this was the decision to make emergency hormonal contraception available direct from pharmacies without a prescription. in 1992, 27% approved, by 2004 this was up to 60%.(http://www.pharmj.com/ContentsPages/Contents20041204.html'>http://www.pharmj.com/ContentsPages/Contents20041204.html p819.) Pharmacists want to take on more responsibility, but are having to fight every step of the way with the medical profession. I do look at JAMA, NEJM, the Lancet and the BMJ when I have time, but I wonder how many medics, or medical students look at pharmacy journals, such as http://www.pharmj.com

http://www.the-shipman-inquiry.org.uk/images/fifthreport/chapter/Fifth_Report_Covering_Letter.pdf the whole of the fifth report of the Shipman inquiry is here if you want to read it: http://www.the-shipman-inquiry.org.uk/5r_page.asp I think this supports my assertion that the GMC is an old boys club and refutes Aardvark's position that the GMC operates as a kangaroo court, though the GMC is being forced to change (http://www.gmc-uk.org).

To apply to do pharmacy in the UK, you need to have A-level chemistry, and two other subjects. Normally these two others are taken from biology, physics and maths. It used to be that the grades needed to do pharmacy were lower than for medicine (I managed to get in with BCC), but the requirements are tougher now, particularly in the top schools of pharmacy. The pharmacy course in the UK is four years, and leads to a MPharm degree. After graduating you have to undertake at least one years training in a pharmacy (community or hospital), and pass an exam (the pass mark is 70% and you only have three attempts), before you are a pharmacist and have the magic initals 'MRPharmS' after your name. The degree course is intensive, though not as intensive as medicine, and it was quite normal for me to have 25-30 hours of lectures and practicals a week - the fourth year is different as that is when the research project is done. Pharmacists should prescribe drugs, because, quite frankly, they are the experts on medicines. There is absolutely no way a doctor can know as much about medicines as a pharmacist does, because doctors have to have a broader knowledge. To say that pharmacists should just dispense is insulting and a waste of a five year specialised education. Doctors frequently make mistakes, but they are not always what people think of as 'mistakes'. Not giving someone the optimum standard of care is a mistake as well, for example not giving a patient a statin for secondary prevention of MI. These types of errors can be picked up in hospitals where pharmacists have access to patient notes. However in the community this is not always possible. The standard of care could be better if doctors diagnosed diseases and pharmacists prescribed.

roflmao! or at least I hope that was a joke.

and I got that too

I wear glasses pretty much all the time. The only time I wear contacts is when I play rugby, but they they tend to keep getting knocked out. Contacts are too much hassle to put in in the morning when you're in a rush, and you can do some damage if you try to take them out after you've been drinking, as I found out...

I went to the NME Awards Tour gig at the Birmingham Academy last week, and the Killers were pretty damn good. 'Somebody told me' and 'Mr. Brightside' were the best songs of the night, but IMHO the Killers were the worst band on the night. The other bands playing were Kaiser Chiefs, Bloc Party, and the Futureheads, and they were all bloody fantastic. You can hear some of the gig by going to http://www.bbc.co.uk/radio1/listen, and then clicking on the 'listen again' thing and going to the Lamacq live show for 24th January. Or you can check out: http://www.blocparty.com http://www.kaiserchiefs.co.uk http://www.thefutureheads.com

It's more disgusting to not use a technique which could lead to great advances in medicine. Why don't you ask people with, for example, Parkinson's disease or insulin dependent diabetes what there views are? I also agree with JaKiri: the views of my parents on this are irrelevant to me.

Absolutely true. I've dispensed doses of morphine that would easily kill someone if they hadn't built up a tolerance. In paliative care, there is no maximum dose for morphine or diamorphine (heroin). Figures would be nice, thanks. And type of crime would be interesting - is it theft or assault? My feeling is that it would be theft, in order to pay for the next dose. But then of course, different drugs have different effects. How many crimes are committed under the influence of nicotine (is it even possible)? But look at alcohol. One thing I have learned at uni is stay the hell away from Broad Street at chucking out time! Yet how many people advocate prohibition of alcohol? When the former operational head of Scotland Yard's Drug Squad argues for drug legalisation, I tend to listen carefully to his arguements. His stance, in a nutshell, is: http://eddie.gn.apc.org Drug laws, at least in the UK and I expect elsewhere, are actually horrendously complex. There are two ways of classifying a drug. The one most people know about is by the Misuse of Drugs Act, which is based on potential harm - heroin is class A, amphetamines are class B and cannabis is class C. There are also the Misuse of Drugs Regulations, where drugs are classified according to medical use. Schedule 1 drugs are not used in medicine (LSD, cannabis [?]), Sch. 2 is the opiates and stimulants, Sch. 3 is barbiturates and 'minor stimulants', Sch. 4 is benzodiazepines and anabolic steroids, while Sch. 5 is negligible risk or low strength. This can lead to what can appear to be conflicting situations. Cannabis is class C, but is Sch. 1 (I don't think it's been moved yet.) Morphine is more confusing. It's class A, but depending on the strength of the preparation, it can be either Sch. 2 or Sch. 5 (pharmacists have to keep invoices, but not records of supplies.) At a low enough strength (0.02-0.04% depending on form), it can be purchased over the counter at pharmacies.

Type A blood has type A antigens on the red bllod cells and anti-B antibodies in the plasma. Type B has anti-A antigens. Type AB has both A & B antigens, but no anti-A or anti-B antibodies. Type O has no antigens, but has anti-A and anti-B antibodies. Type A RBCs would aglutinate with type B or type O plasma. Type B RBCs would aglutinate with type A or type O plasma. Type AB RBCs would aglutinate with any other blood type plasma, while type O RBCs would not algutinate with any type plasma (hence type O being called the universal donor.) So, you would need to separate the blood into RBCs and plasma and then see what happens when you start adding things together.

The gastrointestinal tract is generally taken to mean the tube in the body from the mouth to the anus. Stomach pH is between pH 1 and pH 3.5 in the fasted state. The pH of the small intestine is between pH 5 and pH 7, increasing along the small intestine. The pH of the mid-distal duodenum, the part of the GIT immediately after the stomach, is pH 4.9 in the fasted state. Passage of material from the stomach to the duodenum is controlled by the pyloric sphincter. Presumably release of stomach contents into the duodenum would initially cause a reduction in the pH, but this would quickly be corrected by increased bicorbonate secretion from the Brunner's glands. Not very much lives in the stomach, though lactobacillus and candida (a yeast) are part of the normal flora. In terms of pathogens, Helicobacter pylori lives in the stomach and causes ulcers. The normal flora of the small intestine includes E.coli, lactobacillus and enterococcus, while for the large intestine (the colon) it includes E.coli, enterobacter and klebsiella. For more information on normal GIT flora, see http://www.vacadsci.org/PUB/micro17.pdf http://textbookofbacteriology.net/normalflora.html

I support legalisation of drugs, both on philosophical and pragmatic grounds. Mill's principle of liberty argues that the only reason a person should be stopped from doing something is to prevent harm to others, and that 'over himself, over his own body and mind, the individual is sovereign', leading to the conclusion that drugs should not be illegal. There are several pragmatic reasons to support legalisation of drugs. A large proportion of crime is committed by drug addicts. This also leads to a large proportion of the prison population being made up of drug users. These people should not be placed in prison, the failings of which are clear to see, they should be treated for their addiction. The profit being made by organised criminals from drugs are staggering - £34,000 on a kilo of cocaine. With profits like this, it is not suprising that the 'war on drugs' has been such a spectacular failure. And think how much governments would make from taxation on legal sales of drugs. The final, and to me the most persuasive arguement, is that legalisation would make drug use far, far safer than at present. The quality of the product would be assured (the standards for medical supplies of morphine, heroin and cocaine are just as stringent as other medicines) and paraphenalia would be easily obtained. Though needle exchange schemes are becoming more widespread in the UK, they are not that common and water for injections is still a prescription only medicine. How would drugs be supplied if they were to be legalised? Arguements have been made for supply via pharmacies, but I doubt this would happen. Pharmacies do not sell alcohol or tobacco. Pharmacists provide healthcare and promote health. Selling drugs would clearly be at odds with this, and would bring the profession into disrepute. If (when?) drugs are legalised, they should be sold in the same way as alcohol is, but with tougher enforcement of regulations and harsher punishement for breaking the regulations. Now to address some of the objections raised. Yes, legalisation would probably lead to an increase in drug use, but obviously there would also be a strong, honest education programme. Gilded: if people didn't turn up to work then they would be disciplined, just as you or I would if we went out on the piss and didn't go to work the next day. OnlySinan: could you explain why you think legalisation would promote crime? My view is that it would reduce crime as people could obtain there drug from a reputable source and providing the price was reasonable dealers wouldn't be able to undercut it and make profits like they do now. Drugs obviously aren't good for you, but then tobacco and alcohol are both legal. Both of these are psychoactive substances, are addictive and can kill you. Alcohol also directly causes a lot of violence. Do those that think drugs should remain illegal think that tobacco and alcohol should be made illegal? Some sources: http://observer.guardian.co.uk/uk_news/story/0,,1386115,00.html http://observer.guardian.co.uk/review/story/0,,1385987,00.html

Molecular Biology of the Cell (Alberts et al), and some other biomedical books can be searched here: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books&itool=toolbar

I've got access to Science Direct. If anyone wants papers PM me and I'll see what I can do.

from the article: All you've got at present is the nurse's word against the employer's word, but it should be straightforward to test the defibrillator, as long as it's not gone missing... There should surely be procedures in the hospital for bringing attention to equipment thought to be faulty. Removing it and placing it in front of the manager's office is probably not the way to go.

Pain is a very subjective experience and pain thresholds vary from person to person, and within an individual. I once broke one of my metacarpals in the first minute of a rugby match and still played the whole game. When I went to hospital in the evening the doctors were proding it around I there was a whole gaggle of students playing with it and they were amazed that I was sitting there and letting them do it. YT: maybe endorphins are short acting and so would enable you to escape from danger even if you were injured.

I'm British as well, so here are my answers if you want them: 1. Age: 22 2. Gender: male 4. natural hair colour: blonde/reddish (depends on time of year - gets redder in the winter) 5. natural eye colour: blue-green 6. do you dye your hair: no 7. do you have coloured contacts: no 8. heritage: one of my grandparents is Irish, I know one of my great-grandparents was Scottish, and if you go back enough there's some French in my family (the theory is that they came over to Britain during the salt tax. If anyone has read 'The Count of Monte Cristo' my family's name is mentioned in Ch. 24, 'Smugglers', though the spelling is a bit different now the pronouncitation is the same.)

Hotzone is a pretty decent book, though as Ophi said it is a bit sensationalised. A couple of other good books are 'The Coming Plague' by Laurie Garrett (1994 so a bit old now, but has information about a whole host of diseases including ebola, lassa fever, toxic shock syndrome and AIDS, and ha s ahuge bibliography), and 'Level 4: Virus Hunters of the CDC' by J. McCormick & S. Fisher-Hoch, which is a bit more recent than Garrett (1996).

Well, the week from hell is over and everything turned out ok in the end My stance, which I think you agree on going from your posts, is that medicine has a scientific base. I am not, and would not, argue that the practice of medicine is a scientific discipline. Most people will have had experiences of good and bad doctors, and good doctors are normally described as having a good bedside manner, that indefineable and unteachable combination of charm, humour and communication skills. The other factor in medicine is that most of the time you can only go on what the patient tells you. Intelligent questioning can provide some useful insights. This causes problems because although we might know the biochemical basis of the illness it is not always possible to measure the markers in a patient. If we look at depression as an example, it is thought to be caused by low levels of monoamines (i.e. serotonin, noradrenaline), but measuring levels of these in patients is difficult as to assess CNS levels you would have to take CSF samples, which is not something GPs can (or want to) do, but trials have shown that agents which increase levels of monoamines are effective in depression. This argument is true for many conditions and doctors have to make a diagnosis based on symptoms the patient (or their carer) describe to them and the parameters that can be measured. Patients also have a tendency to not take the medication they are prescribed properly, making evaluation of their condition more difficult. Increased diagnosis of conditions can also reflect increased awareness of conditions, or changes in the guidelines for conditions. Diagnosis rates can shoot up simply because GPs are more aware of a condition (I'm particularly thinking of CNS conditions here.) I've not had time to look for stats about different rates of myringotomy, tonsilectomy or appendictomy in the UK, though I have thought of a reason the rates could be different in different aussie states. If different states in Australia have different laws, this could explain the difference. If the law surrounding medical negligence is different in different states in Australia, doctors in states may decide to err on the side of caution to prevent legal action by patients in the future. So what is the science underpining the practice of medicine? From what I know (and the school of pharmacy I'm at doesn't collaborate with the nearby medical school), medicine is based on anatomy, physiology, pathology and pharmacology (though you could make an arguement for doctors passing prescribing over to pharmacists, but that maybe is a topic for another thread), obviously the exact content will depend on the specialities of the university. It is likely that some alternative therapies will be accepted into the mainstream, particularly those involving herbal medicines. Taxol is a fairly recent example of a drug obtained from natural sources. One of the main advantages of conventional medical practice is the fact that you know the medication you recieve adheres to certain standards (also an argument for liberlaisation of drug laws). Some herbal products have been withdrawn from the UK market, most notably kava kava due to hepatotoxicity, and there have been cases of skin creams being alduterated with corticosteroids. Standardisation of active ingredients is also an issue. I'm know the healthcare system in Australia is different to that in the UK, where most people have their treatment funded by the government. My argument is certainly biased by the system we have in the UK. If the government is funding the cost of treatment then the standard of evidence needed for the NHS to fund a treatment may be higher than that in countries where the patient pays most, if not all of the cost. One of the key parts of my undergraduate pharmacy education, and I'm sure it's the same for all health care professionals, has been to enable us to discriminate between those cases we can treat and those that need to be referred on to someone else. Does this happen with alternative therapists? Another point regards regulation. There is a distinct lack of regulation for alternative therapists. Often they do not even need to register with anyone, and so cannot be disciplined. Regarding Dr. Holt, there's not enough infomation on that site really, though I have read about use of porphyrin (a photosensitiser) and light, so it seems plausible (though some of the links on that page are, quite frankly, barmy). One final thought: one man's rat poison is another man's life saver.