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Introduction

You might think that there are a lot of pharmaceutical drugs available, last estimate around 250,000 but the type of drug, prescribed for specific conditions like hypertension, diabetes, heart disease have been duplicated many times.  I would hazard a guess that since there are 10 major pharmaceutical companies, they each have a drug, or multiple drugs for hypertension, diabetes, heart disease. These are called ‘Me Too’ drugs.


Me Too/Me-Again Drugs

‘Me Too’ drugs simply confuse medicine and prescribing physicians, although I daresay the real ‘drug pushers know their product and are even familiar with the possible different side effects even if they are prescribed for the same health condition.  Now you might argue that multiple drug ‘copy cats’ stimulate competition and therefore drive prices down and saving health care services money, but is this really the case.  Ben Goldacre in the book ‘Bad Pharma’ informs us of an economic analysis on drugs that FDA consider having no benefit over existing options are made available at the same price. For example an OTC drug called ‘Cimetidine’ (A drug you probably know as ‘Tagamet’ is a histamine H2 receptor antagonist that inhibits stomach acid production for ulcer healing and heartburn) made by GSK. In the same class of drugs there is Ranitidine (Zantac) made by GSK, Nizatidine (Axid) made by Eli Lilly and Famotidine (Pepcid) marketed by Merck. Zantac was more expensive than Tagamet and both drug prices kept rising despite the introduction of Axid and Pepcid.

Then there is the ‘Me again’ drugs such as Omeprazole (Brand names : Prilosec, Losec, Zegerid or it is also referred to as the Purple Pill) which was making $5 billion /year for Astrazeneca and it was coming to its patent end, so to avoid the onslaught of generic drug makers making copies and robbing the pioneer drug maker of even more profits it relaunched the same drug but with a twist.  Chemical molecules can exist in ‘right’ and ‘left’ forms which is called Enantiomers (a Greek derivative meaning opposite part) or optimal isomers. The diagram below displays the chemical structure of lactic acid which happens to be stereoisomer or enantiomers with a left and right hand isomer (same part).  In terms of drug manufacture a mixed (racemic mixture= equal amounts of left and right handed) enantiomers of a chiral (geometric property) molecule, but only only 1 side has the mechanism of action while the other is almost inactive but can produce side effects.  On the other hand drugs can be produced with either a right side or a left side active but not both so these are ‘enantiopure’ to enhance their pharmacological efficacy and in some cases eliminate some side effects and the dosage can be lower. This is the case with the drug Eszopiclone (brand : Lunesta) marketed by Sunovion it is a hypnotic agent used for insomnia and is enantiopure, whereas its mixture counterpart is Zopiclone which you need 2mg of to achieve the same therapeutic effects as 1 mg of eszopiclone. However, the enantiopure version of a drug tends to be far more expensive (yes you need less but not to warrant the extortionate differential in price) and in theory less side effects.

Fluoxetine (Prozac) is an  Enantiomer and the right handed version has a longer half-life (stays in the body longer) which only needs to be taken once /week as opposed to once/day, however one of its side effects is QT-Prolongation or in French Torsades de pointes ( which for some reason conventional medicine like to use, to make them sound educated or maybe it’s like the word Deja-vu, anyway it means ‘twisting of the points). This means if you look at the harmonic wavelength (what’s called a Sinusoid)  of the heart on an ECG it would be very irregular like in heart arrhythmia and could raise the risk of sudden death..ok I get the picture I can take a stronger prozac version..and only take it once a week but it heightens your risk of sudden death..You can’t make this stuff up..Johnnie Mcenroe again..you cannot be serious !!!!. There are many drugs that heighten the risk of QT-Prolongation for example:  Clarithromycin (Anti-infectives), Domperidone (Anti-emetics- prevents nausea and vomiting), Chlorpromazine (Antipsychotics), Methadone (Opioid analgesics or moderate pain killer), Terfenadine (antihistamine).  Here is the website if you want a full list:

                               

https://crediblemeds.org/

The drug Omeprazole for heartburn as mentioned above, Astrazeneca in 2001 launched Esomeprazole which is the right sided enantiopure version of the  mixed version Omeprazole at a price 10 times more than Omeprazole, and by all accounts there is very little difference between both drugs. There are many examples of chemically chiral molecules or enantiomers (Mirror images but not superimposable) which include natural amino acids that tend to be left handed and sugars. Enzymes are chiral where one side may bind to a receptor which the other side does not.  In foods Carvone which is a terpenoid (organic compound produced by plants) chemical found in seed oils such as Caraway, spearmint and Dill.  Spearmint contains the L-enantiomer of carvone and Caraway seeds contain the R-enantiomer of carvone but both plants differ in taste and smell. Similar, left and right hand versions of drugs although contain the same chemical substances they react slightly different within the body.

In tragic cases as in the Thalidomide story where a drug was sold in a number of countries between 1957 -1961  to combat morning sickness for pregnant women but the drug maimed thousands of new born babies (only 50% of known 10,000 cases survived), who had Phocomelia (limb malformation), eye deformity, alimentary and urinary tract deformities, blindness and deafness. This particular poison..this really is a deadly poison is another example of a enantiomers which was originally sold as a mix where one enantiomer provided the desirable sedative effects, while the other caused the birth defects.  If only they had tested this drug properly they could have made it with just one enantiomer which would have made it safe providing of course they chose the correct side.  

Look on drugs.com..this drug is still available and is being used to promote immune system response to help slow tumor growth in multiple myeloma (bone marrow cancer),….oh and also to prevent skin lesions caused by Leprosy.  Leprosy…really, this is not the middle ages, I know Leprosy still exists in parts of India…. and stimulating the immune system for multiple myeloma..how is that possible if you are taking chemotherapy, and if not you need to tone down the immune system.  This is a blood cancer like leukemia, Hodgkin’s disease, lymphoma, myeloma, and the last thing you want to do is to activate the immune system because the parasympathetic immune system is strong anyway. Generally in the blood cancers phagocyte cells that line the smaller blood vessels tend to filter out life-saving pancreatic enzymes and as a result nests of leukemia or lymphoma cells can thrive unabated in the marrow and in the spleen protected from enzymatic attack.  

These conditions are parasympathetic immune cancers as opposed to sympathetic hard tumor cancers.  The immune system is weak in the sympathetics so they are largely protected from the blood cancers but of course more susceptible to the hard tumor cancers like lung, pancreas etc, so in these cases it would be advisable to beef up the immune system providing some protection.  There will be a future article on cancer drugs but for now the tactical science to treat cancer is erroneous and of course the drug design is completely ineffective because the intended target is wrong.  Cancerous tissue are your own tissue, so they possess the same intelligence as your own healthy tissue, but for one thing…… healthy tissue manufacture certain membrane proteins like analogues such as alpha-1 antitrypsin that are protected from marauding, circulating pancreatic enzymes, but cancer tissue does not contain these particular membranes so they can be destroyed permanently.


Medicare/Medicaid

I must say there was  one person in this whole medical machinery who is not afraid to speak out on the huge money wastage that goes on day after day. Most of the world’s health care systems are cleaning out government coffers forcing cut backs because of lack of funds, yet senatorial representatives are allowing themselves to be manipulated by drug maker lobbyists and allowing the same companies to hemorrhage money from state coffers using over priced medication.  Tom Scully, administrator of the Centers for Medicare and Medicaid (CMS) the nation’s largest health insurer appeared in 2002 that was not afraid to speak out, but was there anybody listening, yes because Astrazeneca complained to congress and he was told to shut up.  

Tom Scully had some incredible career references, White house adviser to Bush senior, and CEO of the Federation of American Health systems and he refers to CMS as a ‘Dumb price Fixer’, for example he referred to the way CMS pays oncologists for approx $6 billion worth of prescription drugs outside of hospitals. He knows that reimbursement for these cancer drugs represent 25% over-payment for the  so called acquisition price.  From the previous paragraph Esomeprazole was purposely left off the reimbursable drug list because of its high price tag. Scully publicly said that any physician prescribing Nexium (brand name for Esomeprazole) should be ashamed of himself. His remark of dumb price fixer refers to blind reimbursement for everything despite the quality and workmanship that goes into say hip replacement surgery’ if you are the best or the worst doctor they all get paid.  Fixed price for all leads to no measurement of quality, no consumer information or price sensitivity, and artificially high prices. Alas he resigned in Dec 2003 to become a lobbyist for the pharmaceutical industry.

Has the US partly become a society of junkies, just recently some medicare beneficiaries are prescribed opioids by 10 or more physicians or filling prescriptions for 1000 pills /month.  In Washington DC one patient filled prescriptions for 2,330 pills of Oxycodone, Hydromorphone, and morphine in one month prescribed by one physician. In Illinois one patient received 73 prescriptions for opioid drugs from 11 physicians and then filled them at 20 different pharmacies (some prescriptions were filled at multiple pharmacies on the same day).

As reported by the Office of the Inspector General in 2015 the number of opioid deaths exceeded 33,000 and about half from prescription opioids.  This is obvious abuse (..yer think so….) where the patients are ‘doctor shopping’.  Don’t these people realize that this poison damages. Morphine use damages the lungs.  Professional sports players have committed suicide from over use of Oxycodone.  This is going to put the illegal drug dealers out of business…lol.  A total of 89,843 medicare beneficiaries were divided into 2 categories, 69,563 received extreme amounts of opioids and 22,308 were doctor shopping. One patient in New York received 62 opioid prescriptions during the year (more than once /week) for Fentanyl or Oxycodone pain medications (this equated to over 3,130mg/day for a year). All but one of these opioids were prescribed by ONE PHYSICIAN …you see these people are self governed and can do whatever and they don’t even get a parking ticket,  If you want to know more:

https://oig.hhs.gov/oei/reports/oei-02-17-00250.pdf


And here is a great quote by Count Lev Nikolayevich Tolstoy, a great man from the evil empire as Ronald Reagan once said about the Soviet Union..that’s a laugh what did I say about pointing fingers..3 fingers are pointing back at you:

No disease suffered by a live man can be known, for every living person has his own peculiarities and always has his own peculiar, personal, novel, complicated disease, unknown to medicine — not a disease of the lungs, liver, skin, heart, nerves, and so on mentioned in medical books, but a disease consisting of one of the innumerable combinations of the maladies of those organs.

This simple thought could not occur to the doctors (as it cannot occur to a wizard that he is unable to work his charms) because the business of their lives was to cure, and they received money for it and had spent the best years of their lives on that business. But above all that thought was kept out of their minds by the fact that they saw they were really useful […]

Their usefulness did not depend on making the patient swallow substances for the most part harmful (the harm was scarcely perceptible because they were given in small doses) but they were useful, necessary, and indispensable because they satisfied a mental need of the invalid and those who loved her — and that is why there are, and always will be, pseudo-healers, wise women, homoeopaths, and allopaths. They satisfied that eternal human need for hope of relief, for sympathy, and that something should be done, which is felt by those who are suffering.”

Leo Tolstoy


References/Acknowledgments:

  1. Bad Pharma book Ben Goldacre    
  2. The drug price controversy nobody notices Jonathan Cohn  2016 NCBI
  3. The Medicare world from both sides Interview by Uwe Reinhardt Tom Scully
  4. Deadly Medicines and Organized crime Book Peter Gotzsche 2013
  5. Chirality,Carvone, Enantiomer, Racemic, Zopliclone, Eszopiclone, Cimetidine, Omeprazole Wikipedia
  6. Extreme use of Painkillers and Doctor shopping plague Medicare Charles Ornstein July 2017 ProPublica
  7. Opioids in Medicare Part D Concerns about extreme us & questionable prescribing  Office of Inspector General
  8. Health quotes Goodreads website

 

 

Author: Eric Malouin

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