Before You Take That Pill » Women’s health

Dear Doctor, Cipro and Levaquin Might Make Your Tendons Snap Off

Doug Bremner — Sun, 05 Feb 2012 22:35:14 +0000

That’s a translation into person speak from a letter I got a couple of years ago from Bayer Healthcare Pharmaceuticals that started out with “Dear Healthcare Professional” and went on to their new “black box warning” for their antibiotic drugs Avelox (moxifloxacin hydrochloride) and Cipro (ciprofloxacin). Here is their warning:

Fluoroquinolones, including Avelox/Cipro, are associated with an increased risk of tendinitis and tendon rupture in all ages. This risk is further increased in older patients usually over 60 years of age, in patients taking corticosteroid drugs, and in patients with kidney, heart or lung transplants.

Well it’s about time. I wrote about this nasty habit of cipro to snap tendons and mess up joints in my book Before You Take that Pill: Why the Drug Industry May Be Bad For Your Health because at the time Cipro was the most poorly rated drug on askthepatient.com. I hate to say I told you so, but, I did tell you so. It’s just too bad that it took the manufacturers a couple of years to get the word out. I wish people in the healthcare industry would read these websites, which patients go to only out of desperation.

Unfortunately, 81% of the time this toxic drug, Cipro is prescribed inappropriately, and 32% of women get this drug inappropriately for new onset urinary tract infections, when the preferred first drug is Septra.

Another drup in the same class as Cipro is Levaquin, which is the third most discussed drug on medications.com, just behind my other two faves, Yasmin (the birth control pill that might make you nuts) and Singulair (asthma drug with similar problems). Levaquin and like drugs also seems to drive people nuts, which reinforces my conclusion that when it comes to drug companies, if they don’t kill you they might drive you crazy.

So let’s all sing “I need a drug that won’t drive me crazy” to the tune of I need a lover that won’t drive me crazy,” by John Cougar Mellencamp.

[update from the previous post of Feb 15, 2009]

Testosterone (podcast)

Doug Bremner — Thu, 17 Nov 2011 17:44:35 +0000

Podcast Powered By Podbean

Low testosterone in men, women’s hormones, strippers, libido, and health consequences of sex hormones.

Listen to more podcasts at www.dougbremner.podbean.com. Subscribe to my podcast feed here.

New Podcast on Testosterone and Related Topics

Doug Bremner — Wed, 26 Oct 2011 20:41:06 +0000

I just started making podcasts and my first one is here on low testosterone, strippers and birth control pills, cads and dads, and various assorted rambling topics.

Are Birth Control Pills Safe?

Doug Bremner — Sun, 04 Sep 2011 21:19:46 +0000

After their introduction in the 1960s, it was noticed that women on OCPs were developing blood clots in their legs and having heart attacks and strokes at higher rates. Newer generations of OCPs came with reduced doses of hormones, which lessened the risks.

So at this point in OCP history, how safe and effective are these pills? For non-smoking women age 15-30, there is no increase in death rate for a comparable form of contraception, the IUD. Because of the health risks of pregnancy, the death rate amongst women from age 15-34 who are on the pill is actually lower than for women who do not use any form of birth control.

OCPs can be unsafe in older women smokers. They should not be used in women with a history of blood clots, untreated high blood pressure, breast or uterine cancer, migraine headaches with focal neurological symptoms, known pregnancy, liver or cardiac disease. The same side effects women experienced with early pills are still a problem for some women taking modern versions: headaches, nausea, bloating, breast tenderness, and weight gain. Your OCP should have low estradiol (less than 50 µg) to decrease the risk of blood clotting.

For young, non-smoking women without hypertension or diabetes the health benefits balance the health risks of OCPs. For these women there is no increased risk of heart attack or stroke. There is a 28% increased risk of blood clot in the leg, but since this is rare the risk than any one particular woman will get one from an OCP is still very rare. For smokers there is an increased risk with OCPs that gets worse with age. For instance, the risk of death is 1 in 200,000 per year in non-smoking women under the age of 35. However risk increases with age and smoking to 1 in 700 per year for smokers over age 35.

The risk of cervical cancer doubles after 10 years of oral contraceptive therapy in women with a history of human papilloma virus infection (HPV). It is not clear if the risk is from the OCP or the increased risk of being infected with HPV for women on OCPs who may not use barrier protection. However since the risk of getting cervical cancer is .008% in any given year a doubling of risk means increasing your risk by another .008% per year. OCPs increase the risk of liver cancer. Liver cancer, however, is rare. OCPs increase the risk of breast cancer by 10-20%.

In women of childbearing age breast cancer is rare, and any increased risk and goes away after OCPs are stopped. In addition the types of breast cancers that develop in women on OCPs are more easily treatable; therefore the overall risk from breast cancer is not increased. OCPs reduce the risks of ovarian and uterine (endometrial) cancers. OCPs reduce the risk of anemia, through reduction of iron loss in menses, pelvic inflammatory disease, and osteoporosis (since estrogen promotes the laying down of calcium in the bones).

Women who take the pill have identical fertility rates after going off the pill compared to women who never took the pill. OCPs are safe for teenage girls to use, with the exception of Depo-Provera.

Use an OCP with low doses of estradiol.

Sperm Might Be Good For You?

Doug Bremner — Wed, 13 Apr 2011 17:02:24 +0000

Just when I thought there was nothing fun to write about in the field of academic medicine an email surfaced expressing outrage about an editorial in the February 2011 edition of Surgery News. Youcan access the pdf here but don’t expect to find the article because it has been replaced by a comment that it was pulled because of concerns expressed from members of the American College of Surgeons. What is all the fuss about? As you can read here in the version that is travelling around the internet, Lazar Greenfield MD wrote about the beneficial effects of sperm as part of a larger editorial that had something to do with sexuality in different animal species (I’m not really sure what the point of the article was, however). Anyway the fuss was over a study he cited that showed that college women who didn’t use condoms were less depressed and had better cognitive performance than women who did. The conclusion was that there might be something beneficial in the sperm that was transmitted to the women through their vaginal canals. This was described by some as “insulting and outrageous” and “not the right kind of message to be sending to women” with calls that he should resign as president elect of the ACS.

Personally I am not sure what all the fuss is about. I have heard about this study before, and maybe the people who are outraged should take up their complaints with the study authors. I don’t think we should suppress discussion of science because of political beliefs. But maybe I am missing something.

Bring Back Those Loving Feelings… With a Pill, Of Course

Doug Bremner — Thu, 17 Jun 2010 20:31:22 +0000

Last year I wrote here about the Aphrodite study, which was of a testosterone patch for the ladies, that would let them have one more orgasm a month, as long as you weren’t perturbed by the possibility of growing a beard. Apparently the FDA wasn’t impressed with that either, as they didn’t approve. Steve Nissen, MD, who was on that FDA committee, didn’t comment on the latest pill to come along for the ladies, even though it, too, has the dubious value of adding one more “sexually rewarding event” per month.

The hype these spin mesiters of the pharmaceutical world are trying to spin is related to what is described in the DSM as hypoactive sexual desire disorder (HSDD). And they are rolling out a big media campaign to try and generate interest in this “under-diagnosed condition”. The new wonder drug, Flibanserin (an alternative to the headache lie is suggested by this name, perhaps?), a 5-HT1A receptor agonist and 5-HT2A receptor antagonist, is being rolled out by Boehringer Ingelheim as a new treatment for HSDD. They’ve got pitch people in the front organization Society for Women’s Health Research, including Dr. Laura Berman and Lisa Rinna (below), a sopa opera star who claims she isn’t horny enough. and wants to take a crack at that pill.

I bet her partner doesn't fart too much

Lisa’s trick was taking an, um… pole dancing class. At least it isn’t drug related. I guess she feels that those fat slobs somewhere East of Hollywood need the pharmaceutical solution, though.

Maybe the ladies aren’t getting turned on by their fells cuz they fart too much, or have gotten fat, or don’t take out the garbage, or say denigrating things and don’t make them feel valued.

Maybe they should make a pill for the husbands.

In any cause this is disease mongering with the goal of making profits, if I’ve ever seen it before.

Fresh Guidance for Pregnant Women on Antidepressants, Indeed.

Doug Bremner — Tue, 23 Feb 2010 03:05:02 +0000

In August of 2009 ABC News did a story on antidepressant use in pregnant women, with one of the sections entitled “Fresh Guidance on Antidepressant Use in Women”. Fresh guidance, indeed. The only thing fresh about it was that a number of the academic psychiatrists who had been receiving large sums of money to serve on various “Women’s Health” consulting boards related to mental health paid for by the pharmaceutical industry, who were also being paid to fan out across the country and give lectures designed to convince psychiatrists to give SSRIs to pregnant and lactating women, were being quoted in the article as stating that antidepressants were safe to give in pregnant and lactating women. That was, in fact, far from the truth. It has been known for quite some time that SSRIs can induce cardiac defects, increase the risk of miscarriage, and cause other problems like Primary Pulmonary Hypertension (PPH). The drugs cross the placental barrier, for Christ’s sake. Would you take a drug that messes with the brain’s serotonin receptors in your unborn baby, willingly? Hopefully not! Why not just use crack cocaine?

Amy Philo, a mom who developed severe psychiatric symptoms as a result of being given Zoloft in the post-partum period, was contacted by ABC News about their story, but she was never put on the air. Instead, ABC went with a mom who took antidepressants during pregnancy.

Amy Philo and son

See Amy Amy Philo Speaks Out on the Mother\’s Act.

Since 80% of the efficacy of antidepressants is purely placebo effect, the much vaunted effects of the mainstream academic psychiatry establisment to get all pregnant women with depressive symptoms on an SSRI, which held the risk of injury or death to their in utero babies, something they would have to live with for the rest of their lives, in exchange for a 4% or so bump over placebo on a depression rating, all of the ranting and raving of mainstream psychiatry over the tragedy of the depressed mom, and this bullshit about how she won’t connect with her baby when it is born, seems a bit overblown, no? The true risks of SSRIs to pregnant and lactating mothers and their babies are now becoming known, thanks to excellent journalist reporting by people like Evelyn Pringle. Hopefully it can save some lives. And babies.

Men on Women and a Woman on Men

Doug Bremner — Mon, 04 Jan 2010 19:08:33 +0000

The title of the book in question was originally Men ON Women but as author Barbara Silkstone got into interviewing over 500 men on their opinions about women, sex, and relationships, the men relaxed in her one on one chats and became emotionally naked with her, hence she changed the title to 527 Naked Men and One Woman: Adventures of a Love Investigator, which you can buy here.

Barbara Silkstone

I found the book fascinating (as a psychiatrist) for the wide range of nuttiness found in the men’s attitudes about love and sex, which seemed to boil down to either I am looking for my life partner and that one wasn’t it, or she just stayed at home with the kids and had no goals and I want a woman with goals, and on and on. Men shared their confusion about what they thought they wanted and how unhappy they were when they actually got it.

I recently interviewed the author through email and here are some snippets:

DOUG: How did you come up with the idea of the book?

BARBARA: I was just coming off of a second divorce and felt like I was taken financially by my ex. I was sure he had a hidden agenda. I have a lot of really great guy friends and I thought there must be some guys out there who marry for true love and don’t just worry about the money. I started with a list of eight guys willing to be interviewed about their relationships. When the word got out that there was a woman who wanted to hear about their thoughts on relationships and wasn’t judgmental, the word spread through the guy-network and then around the country. I traveled for six years just listening to men. Can you imagine?

DOUG: Was there anything that surprised you about the interviews?

BARBARA: Some of the men’s attitudes about relationships were a lot worse than I had expected. It got pretty hard to listen to after a while. It took a toll on me emotionally. There were many days went I spent the mornings with men who were having mulitiple affairs and justified them and then afternoons with single men who were helping married women cheat and those single guys had all sorts of justifications. Few of the men ever used the word love.

DOUG: Was there a certain answer that ran through all the interviews?

BARBARA: I would ask the men if they would be willing to die for the woman they claimed they loved. Only 14 men out of the 527 said yes and yet half the men were married. Their response was usually…’You’re not gonna use my name, right? Then, ‘Of course I wouldn’t lay down my life for my wife. She has no goals. I still have things to do with my life.’

It got me wondering whatever happened to those romantic guys from days of old who marched off to defend their women folk? How did we lose them? Where did they go?

DOUG: I was surprised at how many men looked at relationships from primarily a self centered perspective, or that worried about things like not getting bogged down with a ‘stay at home mom’. And yet they were so unhappy.

BARBARA: Yes it is pretty remarkable. I started out with a plan to interview 1000 men in one year. But after six long years and a couple of melt-downs I had to stop at 527 guys. I had no more emotional strenght left – and I’m a pretty storng lady.

DOUG: Has this affected your own view of dating?

BARBARA: I haven’t dated since I finished the last interview. I’m a perfect example of biting off more than you are trained to digest. Since I finished the interviews. I became THE WOMAN WHO KNEW TOO MUCH. What I did was an excellent job of biting off more than I could chew. I had no way to put all this knowlege into prospective. I am my own collateral damage.

DOUG: What are you working on now?

BARBARA: I’ve just completed a novel titled THE SECRET WORLD OF ALICE IN WONDERLAND, AGE 42 AND THREE-QUARTERS. I discovered that we all live in some version of Lewis Carroll’s reality. If we can just learn to laugh at ourselves we’ll survive and get a few giggles along the way. My Alice has some crazy quirks – she suffers from Alice in Wonderland Syndrome and nibbles on little pink pills to keep her cool. She’s dying to live in England and almost does. Gangsters pursue her and she runs into the arms of a charming British conman. It’s a bit like A Fish Called Wanda.

DOUG: Barbara has agreed to hang around and answer questions about love and relationships on the comment section. Thanks for agreeing to being interviewed!

BARBARA: Thanks for having me!

Pharmawars. Episode 1, the Mommies Strike Back!

Doug Bremner — Sat, 18 Jul 2009 14:53:03 +0000

from @pharmawars

Mommy Wars: John Grohol is Blocking My Comments from His Website So I Am Commenting Here

Doug Bremner — Thu, 16 Jul 2009 01:39:06 +0000

I posted a comment on John Grohols web site at 4 pm Atlanta time when there were 32 comments; now there are over 50 and he hasn’t approved mine so I am going to write from here (currently 9:11 pm local time). All I can say is thank god for the internet which finally will spell the end of censorship by large entities. I am not sure what he had an issue with but assuming there was not a glitch maybe he didn’t like the fact that I said that many of these so-called patient advocacy groups receive funding from pharmaceutical companies and with their emphasis on screening and identification of cases are a bonanza for drug companies increasing their market share. It is not only for post-partum depression (PPD) but for other disorders and I know because I have been there but I don’t want to throw rocks at any particular organization.

Moving on to the comments under John Grohol’s psychcentral post on my original post and followup on Motherhood is not a Medical Illness (I know I am paranoid but having my website hacked into and comments disabled right after I made this post seems like an eery coincidence), relating to his (what I consider) impugning me that I have an agenda, am against use of psychotropic meds, or am trying to sell my book, I have the following response: 1) I don’t know what agenda he thinks he has; 2) I am not against psychotropic meds, in fact prescribe them, I only believe that people have the right to be informed and to decide for themselves the risks and benefits and not get railroaded into things by the government (i.e. mass screening as with the Mother’s Act), doctors, or other entities; 3) my book sells for one cent (yes!) on amazon, and as authors like Gina Pera (who setting aside for the moment some of her strident commentary on the topics at hand, which I don’t always agree with necessarily, wrote a very nice book on ADHD, thank you very much) can attest, you get all of your payment in advance, and unless you get on the best seller list (which I am not) you never get payments related to how much it actually sells. And the amount authors get pales in comparison to the tens or hundreds of thousands that psychiatrists get consulting or being on speakers bureaus for pharmaceutical companies. We don’t write books to make money, we do it because we are passionate about our topics. There’s a difference.

Moving on to the specific issues, Grohol stated that I cherry-picked a single paper to pick a fight with him about whether there were more risk factors for PPD than merely a prior history of depression or anxiety. He, somewhat condescendingly IMHO, described me as a “prestigious researcher” (thanks for the compliment, John), implying that I hadn’t done due diligence. Or maybe shut up and sit down, go back to the lab, etc. Well, he made a series of statements about so-called risk factors for PPD and I went after the few that looked most relevant. The risk factor of substance abuse turned out to be women who were actively abusing cocaine or drinking a six pack a day while pregnant, which can cause harm to the fetus. I originally said they should get a slap up side the head rather than worrying about PPD screening, and I took it down cuz it wasn’t politically correct (violence against women and all) but I think I am gonna put it back there. As for “abuse” most of those were men who abused their pregnant wives, which is another story altogether. The studies of childhood abuse didn’t show an association for the most part after controlling for depressive symptomatology. We can argue the details, but I guess the point is that I think he is making statements and then giving a string of references and getting up on a bully pulpit about science and not expecting a rebuttal cuz noone will read them. So far, no good.

Again, NO to the MOTHER’S ACT.