4 Commonly Prescribed Drugs That May Not Be Safe
They are so common no one thinks twice about them: drug ads that tell you about a disease you might have and a pill that could treat it. Just "ask your doctor," they say, if the pill is right for you.
Until 1997, such direct-to-consumer (DTC) ads did not exist because without a doctor’s recommendation, how could people know if the medication was appropriate or safe? The only thing people knew about drugs and drug risks was from ads they peeked at in medical journals at the doctor's office.
But after the ads started in 1997, the allergy pill Claritin became a household word, along with Xenical, Meridia, Propecia, Paxil, Prozac, Vioxx, Viagra, Singulair, Nasonex, Allegra, Flonase and, of course, Lipitor—and Big Pharma became a Wall Street darling.
Now the American Medical Association (AMA) is taking a second look at DTC advertising. In November 2015, doctors at the AMA's Interim Meeting sought a policy to address one of its biggest problems: the growing proliferation of ads "driving demand for expensive treatments despite the clinical effectiveness of less costly alternatives." Billions are spent advertising expensive new drugs that are not clearly better than existing ones, the AMA said. The Kaiser Family Foundation agreed and said exorbitantly priced drugs—like $1,000-a-pill hepatitis C drugs and recently approved PCSK9-inhibiting cholesterol drugs—are the "public’s top health care priority." The new cholesterol drug will cost an estimated $14,000 a year.
Looting tax dollars and raising health premiums is only one result of DTC advertising. To sell drugs, the ads raise awareness of conditions people never worried about before and probably don't have. Some conditions are so rare the ads appear to be selling the disease itself. How many people, for example, suffer from "Non-24," a condition that mostly affects blind people yet is currently advertised on TV? How many people suffer from "exocrine pancreatic insufficiency" and need to ask their doctor about their "poop" as other ads currently suggest?
Nor are the drugs even clearly safe. Many of the aggressively advertised drugs have risks that have surfaced after their ad campaigns expire (Others like Vioxx, Bextra, Baycol, Trovan, Meridia, Seldane, Hismanal and Darvon were removed from the market altogether).
Here are some heavily advertised drugs that are not necessarily safe.
1. GERD Meds
Few had heard of the condition gastroesophageal reflux disease before DTC advertising. While a small percentage of the population may have GERD, the condition is widely believed to have been pushed to sell proton pump inhibitors (PPI) like Nexium. In many cases "GERD" is really heartburn and can be treated with Tums or Rolaids, critics said.
GERD has made a lot of money. The "Purple Pill," Nexium, made almost $5 billion in the U.S. in one year and the class of PPIs made $13.6 billion, translating into 119 million prescriptions. But safety questions have followed.
In 2012, the U.S. Food and Drug Administration (FDA) warned that PPIs are linked to Clostridium Difficile or C. Dif, a sometimes deadly intestinal infection that is becoming increasingly drug resistant. In 2013, medical literature linked PPIs to fractures, calcium and magnesium deficiencies, community-acquired pneumonia and vitamin B-12 deficiencies. Other research suggests PPIs might cause blood vessels to constrict and cardiovascular risks and this month, research said PPIs may be linked to increased risk for chronic kidney disease.
If DTC advertising was the medium that made Big Pharma a Wall Street darling, statins like Lipitor were the drug class. In 2005 statins earned $18.7 billion in the U.S. and Pfizer’s Lipitor became the best-selling drug in the world.
Patients loved statins because they could ignore diet and exercise advice and still, apparently, reduce heart attack risks; their body would "forgive" the bacon cheeseburger. But not all medical voices agreed. Some wondered why the nation spent approximately $20 billion a year on cholesterol-lowering drugs instead of effective, less dangerous and less expensive lifestyle and diet changes. Others questioned the value of statins themselves.
High cholesterol, which statins treat, is a "relatively weak risk factor for developing atherosclerosis," Barbara Roberts, an associate clinical professor of medicine at the Alpert Medical School of Brown University told me. "Big Pharma has consistently exaggerated the benefits of statins and some physicians used scare tactics so that patients are afraid that if they go off the statins, they will have a heart attack." Though many doctors have "swallowed the Kool-Aid," Dr. Roberts, author of The Truth about Statins, said, "diabetes and smoking are far more potent when it comes to increasing risk."
In 2012, the FDA floated new risks to the entire statin class, adding warnings to their labels about memory impairment, diabetes, liver injury and muscle damage. Memory problems had always been suspected with statins, but after Lipitor's patent ran out, they were confirmed.
Statins were given a big boost by Paul Ridker of Brigham and Women's Hospital in Boston, who presented the results of a study on the statin Crestor, funded by its manufacturer AstraZeneca, in 2009. Even though Ridker was co-inventor of a related patent and stood to profit from sales and study authors listed 131 financial ties to Big Pharma, the media were wowed. Headlines screamed “AstraZeneca's Crestor cuts death, heart attack" and "Crestor study seen changing preventive treatment!" Ka-ching.
But doctors posting online comments in the New England Journal of Medicine were not convinced, especially since the study was stopped early because, AstraZeneca said, of its clearly positive results. "It is well established that RCTs [randomized controlled trials] stopped early overestimate benefits significantly," wrote a physician from Rochester, Minnesota. "It is shocking that this trial was terminated 50 percent through, based on a small absolute benefit, with real questions about long-term risk," a poster from LSU Law Center, read.
During Crestor-mania, few remembered that the FDA's own David Graham had named the drug among the top five most dangerous in Capitol Hill testimony. Public Citizen, the national watchdog group, had petitioned for the drug’s withdrawal and research in the journal Circulation found Crestor "was significantly more likely to be associated with the composite end point of rhabdomyolysis, proteinuria, nephropathy or renal failure" than related drugs.
Vytorin was heavily advertised as treating both genetic and dietary sources of cholesterol and combined the statin drug Zocor with the anti-hyperlipidemic drug Zetia. The problem was, it was marketed before a study confirmed its effectiveness and when the study was published, it found Vytorin had no effect on the buildup of plaque in the arteries. Oops.
Like other expensive and popular drugs, the issue wasn't just that Vytorin did not work any better than a much cheaper drug. Its makers, Merck and Schering-Plough, also admitted "theoretical" safety concerns about liver damage. In 2014, American Journal of Cardiology authors reported an unexpected increase in cancer incidence and mortality in subjects possibly linked to ezetimibe, one of the Vytorin ingredients.
Vytorin demonstrates well the AMA's current concerns about profiteering. The state of New York paid $21 million for Vytorin in two years out of its Medicaid dollars—a likely worthless drug. "Drug companies are on notice that concealing critical information about life-saving prescription drugs, profiting at the expense of patients' health and wasting taxpayer dollars, is simply unacceptable," then New York Attorney Andrew Cuomo, now governor, said.
Vytorin was such a scam, Sen. Chuck Grassley (R-Iowa) asked the General Accounting Office to investigate why the FDA would approve a drug to reduce artery-clogging plaque that didn't reduce artery-clogging plaque. Former Congressmen Bart Stupak (D-MI) and John Dingell (D-MI) asked why Schering-Plough Executive VP Carrie Smith Cox unloaded $28 million in stock when she knew the study failed before the public did.
"Many consumers may not have taken Vytorin had they been aware of the study results," Rep. Stupak said during hearings. He might have added "had they not seen DTC advertising."
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By Matthew J. Landry and Heather Eicher-Miller
When university presidents were surveyed in spring of 2020 about what they felt were the most pressing concerns of COVID-19, college students going hungry didn't rank very high.
Why It Matters<p>This is not just a matter of growling stomachs. This is a straight-up education and health issue.</p><p>When students don't really know if they'll be able to get enough to eat, it can lead to a series of problems that make it harder to stay in school. For instance, it can affect <a href="https://doi.org/10.1177%2F1359105318783028" target="_blank">academic performance</a> and <a href="https://doi.org/10.1186/s12889-019-6943-6" target="_blank" rel="noopener noreferrer">sleep quality</a>. It can also lead to <a href="https://doi.org/10.1177/1359105318783028" target="_blank" rel="noopener noreferrer">poor mental and physical health</a> outcomes for college students.</p><p>Food insecurity can also result in disrupted eating patterns if there is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6627945/" target="_blank" rel="noopener noreferrer">not enough food or the variety</a> or <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-019-6943-6" target="_blank" rel="noopener noreferrer">quality of what someone eats</a> is low.</p>
Campus Food Pantries<p>Previous strategies by <a href="https://www.gao.gov/assets/700/696254.pdf" target="_blank">colleges and universities</a> to fight hunger in their student bodies have varied widely. They include campus food pantries, emergency cash assistance and nutrition education through noncredit classes or workshopse.</p><p>These strategies were put to the test during the spring 2020 semester, when nearly <a href="https://hope4college.com/wp-content/uploads/2020/06/Hopecenter_RealCollegeDuringthePandemic.pdf" target="_blank">three in five students</a> said they had trouble meeting their own basic needs during the pandemic.</p><p>College food pantries saw <a href="https://www.utrgv.edu/newsroom/2020/05/01-utrgv-student-food-pantry-seeing-recent-increase-in-demand-during-covid-19.htm" target="_blank" rel="noopener noreferrer">big increases</a> in demand. Others said they <a href="https://www.theprospectordaily.com/2020/09/22/uteps-food-pantry-is-running-out-of-food/" target="_blank" rel="noopener noreferrer">were getting less donated food</a>. This made it even harder to meet the rising food needs of students.</p><p>Campus food pantries largely rely on local or regional food banks, which have been dealing with <a href="https://www.indystar.com/story/news/local/2020/10/04/indiana-food-banks-call-more-food-stamps-meet-publics-need/3523683001/" target="_blank" rel="noopener noreferrer">greater demand</a> than they are able to meet during the pandemic.</p><p>The many students who are attending college remotely will, of course, have less access to campus resources like food pantries.</p>
Federal Help<p>Other potential ways to get more food are government programs like the <a href="https://www.fns.usda.gov/snap/recipient/eligibility" target="_blank">Supplemental Nutrition Assistance Program</a>, known as SNAP. Yet the majority of able-bodied students are not eligible. Long-standing restrictions, like the <a href="https://www.fns.usda.gov/snap/students" target="_blank">college SNAP rule</a>, prevent full-time students from receiving these benefits.</p><p>Such regulatory hurdles were created under the assumption that most students can rely on their parents to get enough to eat. However, college students have vastly different levels of financial support. Some students can rely on their parents for everything and others cannot rely on their parents for anything.</p><p>Decreased reliance on parental financial support is <a href="https://ir.library.louisville.edu/jsfa/vol47/iss3/5/" target="_blank">especially common</a> for first-generation students and students of color, who now make up <a href="https://1xfsu31b52d33idlp13twtos-wpengine.netdna-ssl.com/wp-content/uploads/2019/02/Race-and-Ethnicity-in-Higher-Education.pdf" target="_blank" rel="noopener noreferrer">45% of enrolled college students</a>.</p><p>Under normal circumstances, many college students might rely on part-time jobs to pay for their food.</p>
Short-Term Solutions<p>Universities and colleges can make it a priority to ensure students are aware of all available campus resources and services. They can also potentially help students apply for federal assistance benefits.</p><p>Campus food pantries are not a fully effective and efficacious solution for the scale of college food insecurity, but they can be a good interim solution to increase access to food for students.</p><p>Campuses without food pantries can start one, making use of resources the <a href="https://cufba.org/resources/" target="_blank">College and University Food Bank Alliance</a> provides. Schools with food pantries can try to get them to <a href="https://www.swipehunger.org/5campuspantry/" target="_blank" rel="noopener noreferrer">reach more students</a>.</p><p>Universities and colleges can also lean on one another for support. The <a href="http://wp.auburn.edu/endchildhungeral/alabama-campus-coalition-for-basic-needs/" target="_blank" rel="noopener noreferrer">Alabama Campus Coalition for Basic Needs</a> is a great example of this. It brings together 10 universities across the state of Alabama collectively working to address student food insecurity.</p>
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Plain Naturals is making waves in the CBD space with a new product line for retail customers looking for high potency CBD products at industry-low prices.
Is More CBD Really Better?<img lazy-loadable="true" src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDU2ODQyNC9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYzMzYxMDMzN30.6B08i5QYW_Iq5bUf3qtm8oK8o6FKsRUZ74gdakgJ_TY/img.jpg?width=980" id="0ef5b" class="rm-shortcode" data-rm-shortcode-id="bac86abf3ce246742b18b0dc4052f4dd" data-rm-shortcode-name="rebelmouse-image" />
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The Truth About CBD Product Potency<img lazy-loadable="true" src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDU2ODMyNC9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYyNDc2NTg1N30.OAm3iOTO_pKZLXi7KdJ7n0DGOFMdOmIYuG4ArGooFC4/img.jpg?width=980" id="d657c" class="rm-shortcode" data-rm-shortcode-id="ee016a81b29caa699b9185b64ce345d6" data-rm-shortcode-name="rebelmouse-image" />
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By Dr. Kate Raynes-Goldie
Of all the plastic we've ever produced, only 9% has been recycled. So what happened to all that plastic you've put in the recycling bin over the years?
Triangle of Mistruths<p>The myth created around plastic recycling has been one of simplicity. We look for the familiar triangle arrows, then pop the waste in the recycling bin so it can be reused.</p><p>But the true purpose of those triangles has been misunderstood by the general public ever since their invention in the 1980s.</p><p>These triangles were actually created by the plastics industry and, according to a report provided to them in July 1993, <a href="https://www.npr.org/transcripts/912150085" target="_blank">were creating "unrealistic expectations"</a> about what could be recycled. But they decided to keep using the codes.</p><p>Which is why many people still believe that these triangular symbols (also known as a <a href="https://sustainablepackaging.org/101-resin-identification-codes/" target="_blank" rel="noopener noreferrer">resin identifier code</a> or RIC) means something is recyclable.</p><p>But according to the American Society for Testing and Materials International (ASTM) – which controls the RIC system – the numbered triangles "<a href="https://www.astm.org/Standards/D7611.htm" target="_blank" rel="noopener noreferrer">are not recycle codes</a>." In fact, they weren't created for the general public at all. They were made for the post-consumer plastic industry.</p><p>In other words, the symbols make it easier to sort the different types of plastics, some of which cannot be recycled – <a href="https://www.ecobin.com.au/understand-recycling-codes/" target="_blank" rel="noopener noreferrer">depending on the recycling facility</a>.</p><p>"Unfortunately, just placing your plastic into the recycling bin doesn't mean it will get recycled," says Lara Camilla Pinho. She is an architect and lecturer at the UWA School of Design who is researching novel uses of plastic waste.</p><p>"The recycling system is complicated and often dictated by market demand. Not all plastic is recyclable. We cannot recycle plastic bags or straws for example."</p>
Behind the Scenes<p>So, what makes recycling plastics so difficult?</p><p>"Essentially, there are two types of plastics – thermoplastics and thermosets. While thermoplastics can be re-melted and re-molded, thermosets contain cross-linked polymers that cannot be separated meaning they cannot be recycled," says Lara.</p><p>"Even thermoplastics have a limit to the amount of times we can recycle them, as each time they are recycled they downgrade in quality."</p><p>Even when plastics are recyclable, it is <a href="https://www.theguardian.com/environment/2019/oct/13/war-on-plastic-waste-faces-setback-as-cost-of-recycled-material-soars" target="_blank">often more costly</a> than simply making new plastics.</p>
Sugar, Seaweed and Mushrooms<p>If the conventional recycling system isn't working, what else can we do with all the plastic we've created?</p><p>Lara is looking for ways to add value to recycled plastics such as using it in the design and development of architectural products. She hopes to use these architectural products to help underserved communities that are disproportionately affected by plastic waste.</p><p>In addition to recycling, we also need to find ways to reduce our use of virgin petroleum-based plastics.</p><p>Bioplastic is one such product that has been getting a lot of hype over the last few years. And although they're better than petroleum-based plastics, bioplastics also come with their own <a href="https://phys.org/news/2017-12-truth-bioplastics.html" target="_blank">set of challenges</a>.</p><p>"There are already a lot of bio-based alternatives to plastic, such as bagasse – a byproduct of sugar cane processing," says Lara.</p><p><a href="https://blogs.scientificamerican.com/observations/the-mycelium-revolution-is-upon-us/" target="_blank" rel="noopener noreferrer">Mycelium</a>, a type of fungi we most often associate with mushrooms, are also providing an interesting plastic alternative.</p><p>"In the field of architecture, mycelium is starting to be used as an alternative to plastic insulation, but also as compostable packaging and bricks," says Lara.</p><p>"The bricks take around five days to make and are strong, durable, water resistant and compostable at the end of their use."</p><p><a href="https://www.arup.com/news-and-events/hyfi-reinvents-the-brick" target="_blank" rel="noopener noreferrer">Hy-Fi Tower</a>, created by <a href="http://www.thelivingnewyork.com/living_about.html" target="_blank" rel="noopener noreferrer">The Living</a>, is an example of a building made from these bricks.</p><p>And finally, there's seaweed.</p><p>"[Seaweed is] cheap and can reproduce itself quickly without fertilizers. In architecture, there is use for seaweed as an alternative to plastic insulation but also as cladding," says Lara.</p>
More Money, More Problems<p>While all these alternatives are great, the main cause of our plastic dilemma is not scientific or technological, but economic.</p><p>As long as it remains <a href="https://engineering.mit.edu/engage/ask-an-engineer/why-is-it-cheaper-to-make-new-plastic-bottles-than-to-recycle-old-ones/" target="_blank">cheaper to create new plastics</a> from fossil fuels rather than from bioplastics or from recycling, we're going to be stuck with plastic garbage islands floating in our oceans.</p><p>The true cost to our health and our environment has yet to be included in the equation. But once it is, maybe that is when the real shift will happen.</p>
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