Head lice are a big problem, affecting 6 to 12 million people in the US every year. Head lice are becoming endemic amongst our children. Unfortunately the pharmacological treatments for head lice are not that great. Malathion (Ovide) is an organophosphate that kills lice by inhibiting the cholinesterase enzyme.

Malathion works well for lice, unfortunately it has the side effect of being highly flammable, so little children should stay away from fires, to keep their heads from catching on fire. 

The most commonly used prescribed medication for these problems is lindane (Kwell). Doctors apparently have not figured out yet that it doesn’t work and has been associated with some potential safety concerns. Efficacy of lindane has been decreasing over the past few decades to lindane due to the emergence of treatment resistant lice. Lindane has limited efficacy, killing only 17% of lice after a 3 hour period, and none after 10 minutes, the recommended time of exposure.

In other words, take Lindane as directed, and it will do NOTHING!

The news about the stop smoking drug Chantix (varenicline) just keeps getting worse. When my sister emailed a while back and said she was thinking of taking the drug to get off the weed, I said make sure you have your suicide hotline number handy. A recent report in JAMA shows an alarming number of suicides and suicide attempts on Chantix, much larger than you would normally expect.

Last year I was sitting in my car dealership waiting to get service on my car and working on my laptop while the television was droning on in front of me. I mean this was one of the rare times when I watch TV without the benefit of Tivo to pause the commercials or otherwise avoid them. And it was like one prescription medication ad after another! They were only punctuated by an ad for a device for diabetics to check their blood sugar at home. All I can say is they better get Ronald McDonald (”Don’t forget to feed the waste baskets…”) back on TV so that they can keep those diabetics rolling in to buy their blood glucose testers (not to mention their Avandia and Actos).

Anyhoo one of the ads that caught my eye was of a woman who droned on about how she needed a cigarette to wake up, one in the car, one at 10 am… Boy I know that drill. I kicked the habit by writing a book that advocated diet, exercise and lifestyle changes over prescription medications for health (works every time! No relapses!).

But enough of my narcissism, back to the “My Time to Quit” campaign by the makers of the anti-smoking drug Chantix, which was gleefully playing across the screen at my auto dealership and interfering with my ability to concentrate on more important things like write a book chapter that noone would ever read.

This drug affects the frontal lobe of the brain, which regulates emotion, and has been associated with depression, psychosis, and suicidality. It made headlines when a famous country music singer from Texas who was on the drug accosted a neighbor in an apparently psychotic state of mind and was shot dead.

Thanks Texas home invasion gun laws!

What’s really annoying is that the clinical trials of Chantix excluded people with mental disorders, but smoking is increased in this population, and these people are obviously at increased risk of suicidality. In spite of this the spokespersons for Chantix say it is fine for people with depression and other mental disorders to go ahead and take Chantix.

When I think of Chantix, in spite of the PR campaign to the contrairy, rather than thinking,

Time To Quit!

The image that comes to mind is of (Governor) Arnold Schwartenagger about to finally eliminate a robot in one of the terminator movies when he says…

Time to die!

I have the best method to quit smoking. DIE!

Oh well, maybe I’ll start humming along with the “life saving drugs” theme song one of these days.

Hat tip to Philip Dawdy.

“Congress did not intend FDA oversight to be the exclusive means of ensuring drug safety and effectiveness” – Justice John Paul Stevens

More bad news about bisphosphonate drugs for osteoporosis, which were bad enough to have readers write in about cases of erosive esophagitis and an incredible case of physician writing a case report (Jennifer Schneider MD, also a reader of this blog) about her own femoral fracture caused by getting out of her seat on a train while on alendronate. Well it looks like the medical community is starting to catch on as evidenced by a commentary in JAMA this week by Bridget Kuehn called “Long Term Risks of Bisphosphonates Probed” in which she highlights recent reports of increased risk of femoral fracture, atrial fibrillation, and esophageal cancer in women treated with bisphosphonate drugs like Fosamax and Boniva for osteoporosis, and points to the increasing awareness that treatment for longer than five years with these drugs probably worsens health outcomes. A recent study by Lane et al in 2009 showed that amongst a series of patients 37% of patients with subtrochanteric and femoral shaft fractures were on Fosamax (alendronate) compared to 11% of patients with hip or femoral neck fractures, indicating that long term treatment with this drug was associated with a specific type of fracture. As I have previously written about, these drugs turn off bone turnover and after five years make bones more brittle, not less. She also cited a letter to the New England Journal of Medicine by Diane Wysowski PhD of the FDA (old aquaintance from the Accutane wars) documenting 23 cases of esophageal cancer, with 8 deaths, in patients on bisphosphonates.
A terrible outcome of bisphosphonates of course is osteonecrosis of the jaw, which used to be called “Phossy jaw” cuz it was seen in match factory workers (the phosphorus in the matches got into the bone and turned off bone turnover), a condition so terrible it drove match factory workers to suicide. Nowadays we call it “Fossy jaw” in honor of our old friend, Fosamax (“Ladies Don’t Get Sucked Into the Bone Mineral Density Testing Rat Maze”).

That’s a translation into person speak from a letter I got today 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 over a year ago in my book 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.

[originally posted November 8, 2008]

[updated Feb 15, 2009]

See site of a patient suffering from long term effects of Levaquin “Death by Levaquin.”