Disagree on PEG - very often pushed by pediatricians starting from 6 months on when the drug itself is not allowed for anyone under 17 and for longer than a week. Yet here they are pushing it. Not even getting into the aggressive behaviors caused by PEG. No thanks for me or my family.
Surprising that a chronic drug would end up in there. As we continue to obsess on treating congenital chronic illness and refusing death in old age, our society will become more and more intolerable, because the ratio of diseased to healthy will just become morally, pragmatically, and financially unbearable.
Pretty good list, nice work. A few quibbles with your rationales:
--Insulin for type 2 diabetes probably does more harm than good, as it makes patients fatter and sicker. Their blood sugar could more effectively/safely be controlled through therapeutic carb restriction and other lifestyle changes.
--In many cases, using a non-drowsy antihistamine is better than using diphenhydramine. No need for the drowsiness or other cognitive effects. (But I understand you chose it partially because it's available for injection...).
--The usefulness of epinephrine in cardiac arrest is somewhat questionable.
--I'm glad you didn't include statins or SSRIs. That would have been a bit silly.
--You may have a gonorrhea epidemic on your hands. (Well, not literally...)
I don't know if I would change anything on the list, those were just some of the thoughts that struck me as I read through your explanations.
I beg to differ from your well considered list on 2 points:
(1) Since I was born before 1950, I was a vulnerable, at risk individual before any of your top 20 meds were available at the local pharmacy. Nonetheless I survived.
(2) I am very disappointed that no immunizations are on your list. In terms of lives saved, or years of life saved, these vaccinations singularly or in toto are blockbusters.
Before levothyroxine was introduced in 1955, doctors prescribed patients thyroid replacement made from the thyroid gland of animals. And most patients were very satisfied with their treatment. Today endocrinologists discourage the use of glandular and push levothyroxine. The problem is that your body needs T4 and T3 and levothyroxine is only T4. I felt horrible on only levothyroxine for years after RAI for Graves. Finally found a doc to put me on Armour thyroid and I felt so much better. I'm not the only one. Stop the Thyroid Madness website has been trying to educate people about this for years. Also, check out book and website by pharmacists Isabella Wentz. Our medical system really has a long way to go and they could start by aurally listening to patients rather than companies pushing their products.
Everyone realizes that the profit motive has long since replaced the altruisitic motive in virtually all of the healthcare industry, and unfortunately, profit seems to be winning more and more.
For example, thyroid medications have for decades been blithely recommended for lifelong consumption by most patients. Yet many studies have shown that they are of limited use, particularly in the elderly, and also carry serious risks. Here's a link to an old NYT piece which gives a glimpse of what I mean.
Dr. Prasad is well-known for his study of medical reversals and his dedication to evidence-based medicine. I would respectfully submit that ALL frequently prescribed medications, particularly those where the evidence is old, should be regularly reassessed for risks, benefits, and appropriateness for use in different patient segments (e.g. elderly, those with comorbities such as kidney or heart disease, etc.).
Prime candidates for such in-depth reassessment would be long-term use of thyroid medications, anticoagulants, and antidepressants, but I'm sure there are many other meds that also need such scrutiny.
That's the kind of list I'd like to see Dr. Prasad and his colleagues provide.
The clinical idea of Levothyroxine is that most patients are efficient at converting T4 to T3, when in reality, a fairly large percentage of people are genetically poor at that conversion.
This explains why some people get poor symptom relief with Levothyroxine compared to Armour Thyroid.
Also: not sure how I feel about quetiapine as your choice of antipsychotic.
Quetiapine doesn't block any D2 <400mg, and lower doses get you other receptors e.g. 25mg of quetiapine is simply an H1 blocker, 100mg gets you H1, a2, 5HT_2a blockade but still no D2.
Disagree on PEG - very often pushed by pediatricians starting from 6 months on when the drug itself is not allowed for anyone under 17 and for longer than a week. Yet here they are pushing it. Not even getting into the aggressive behaviors caused by PEG. No thanks for me or my family.
Fascinating list. I learned a great deal, thank you.
What happened to ivermectin (1987) ? What about quinine (1820) or another anti-malarial? Valproate (1962)?
Surprising that a chronic drug would end up in there. As we continue to obsess on treating congenital chronic illness and refusing death in old age, our society will become more and more intolerable, because the ratio of diseased to healthy will just become morally, pragmatically, and financially unbearable.
Pretty good list, nice work. A few quibbles with your rationales:
--Insulin for type 2 diabetes probably does more harm than good, as it makes patients fatter and sicker. Their blood sugar could more effectively/safely be controlled through therapeutic carb restriction and other lifestyle changes.
--In many cases, using a non-drowsy antihistamine is better than using diphenhydramine. No need for the drowsiness or other cognitive effects. (But I understand you chose it partially because it's available for injection...).
--The usefulness of epinephrine in cardiac arrest is somewhat questionable.
--I'm glad you didn't include statins or SSRIs. That would have been a bit silly.
--You may have a gonorrhea epidemic on your hands. (Well, not literally...)
I don't know if I would change anything on the list, those were just some of the thoughts that struck me as I read through your explanations.
My disagreements would be at the edges. Well done.
Compelling list, despite the notable omission of the Nobel Prize–winning ivermectin:
• “Letter to Alex Berenson on World Ivermectin Day” (https://margaretannaalice.substack.com/p/letter-to-alex-berenson-on-world)
• “Letter to a Scientifically-Minded Friend” (https://margaretannaalice.substack.com/p/letter-to-a-scientifically-minded)
Compelling list, despite the notable omission of the Nobel Prize–winning ivermectin:
• “Letter to Alex Berenson on World Ivermectin Day” (https://margaretannaalice.substack.com/p/letter-to-alex-berenson-on-world)
• “Letter to a Scientifically-Minded Friend” (https://margaretannaalice.substack.com/p/letter-to-a-scientifically-minded)
Compelling list, despite the notable omission of the Nobel Prize–winning ivermectin:
• “Letter to Alex Berenson on World Ivermectin Day” (https://margaretannaalice.substack.com/p/letter-to-alex-berenson-on-world)
• “Letter to a Scientifically-Minded Friend” (https://margaretannaalice.substack.com/p/letter-to-a-scientifically-minded)
Compelling list, despite the notable omission of the Nobel Prize–winning ivermectin:
• “Letter to Alex Berenson on World Ivermectin Day” (https://margaretannaalice.substack.com/p/letter-to-alex-berenson-on-world)
• “Letter to a Scientifically-Minded Friend” (https://margaretannaalice.substack.com/p/letter-to-a-scientifically-minded)
Compelling list, despite the notable omission of the Nobel Prize–winning ivermectin:
• “Letter to Alex Berenson on World Ivermectin Day” (https://margaretannaalice.substack.com/p/letter-to-alex-berenson-on-world)
• “Letter to a Scientifically-Minded Friend” (https://margaretannaalice.substack.com/p/letter-to-a-scientifically-minded)
UBC representing!!! 💪🏻
I beg to differ from your well considered list on 2 points:
(1) Since I was born before 1950, I was a vulnerable, at risk individual before any of your top 20 meds were available at the local pharmacy. Nonetheless I survived.
(2) I am very disappointed that no immunizations are on your list. In terms of lives saved, or years of life saved, these vaccinations singularly or in toto are blockbusters.
I would opt for lithium rather than quetiapine due to its nasty adverse effects like metabolic issues
Before levothyroxine was introduced in 1955, doctors prescribed patients thyroid replacement made from the thyroid gland of animals. And most patients were very satisfied with their treatment. Today endocrinologists discourage the use of glandular and push levothyroxine. The problem is that your body needs T4 and T3 and levothyroxine is only T4. I felt horrible on only levothyroxine for years after RAI for Graves. Finally found a doc to put me on Armour thyroid and I felt so much better. I'm not the only one. Stop the Thyroid Madness website has been trying to educate people about this for years. Also, check out book and website by pharmacists Isabella Wentz. Our medical system really has a long way to go and they could start by aurally listening to patients rather than companies pushing their products.
Very good comment, thanks.
Everyone realizes that the profit motive has long since replaced the altruisitic motive in virtually all of the healthcare industry, and unfortunately, profit seems to be winning more and more.
For example, thyroid medications have for decades been blithely recommended for lifelong consumption by most patients. Yet many studies have shown that they are of limited use, particularly in the elderly, and also carry serious risks. Here's a link to an old NYT piece which gives a glimpse of what I mean.
https://www.nytimes.com/2017/04/21/health/could-be-the-thyroid-could-be-ennui-either-way-the-drug-isnt-helping.html
Dr. Prasad is well-known for his study of medical reversals and his dedication to evidence-based medicine. I would respectfully submit that ALL frequently prescribed medications, particularly those where the evidence is old, should be regularly reassessed for risks, benefits, and appropriateness for use in different patient segments (e.g. elderly, those with comorbities such as kidney or heart disease, etc.).
Prime candidates for such in-depth reassessment would be long-term use of thyroid medications, anticoagulants, and antidepressants, but I'm sure there are many other meds that also need such scrutiny.
That's the kind of list I'd like to see Dr. Prasad and his colleagues provide.
The clinical idea of Levothyroxine is that most patients are efficient at converting T4 to T3, when in reality, a fairly large percentage of people are genetically poor at that conversion.
This explains why some people get poor symptom relief with Levothyroxine compared to Armour Thyroid.
Here’s a few studies showing this:
https://eje.bioscientifica.com/downloadpdf/journals/eje/171/3/R123.pdf?pdfJsInlineViewToken=570820738&inlineView=true
https://clinicaltrials.gov/ct2/show/NCT01801033
https://www.researchgate.net/publication/5357133_A_Common_Variation_in_Deiodinase_1_Gene_DIO1_Is_Associated_with_the_Relative_Levels_of_Free_Thyroxine_and_Triiodothyronine
Also: not sure how I feel about quetiapine as your choice of antipsychotic.
Quetiapine doesn't block any D2 <400mg, and lower doses get you other receptors e.g. 25mg of quetiapine is simply an H1 blocker, 100mg gets you H1, a2, 5HT_2a blockade but still no D2.
Why not haloperidol?