Tag Archives: carnitine

SPECIALIST NATURAL MEDICINE CLINIC 2015

SPECIALIST NON-XRAY PAIN, BONE, BREAST, BRAIN,  HEART, CHEST, GENITOURINARY, HORMONE RISK SCREENING  @ NATURAL MEDICINE CLINIC

for appointments for consultations,   or non-xray procedures by registered practitioners :  Sure Touch breast prescreening on  Saturday mornings next on  7 February 2015  by Sister Zeneath Ismail – cash R650 (then R450 if followup scan desired within 3 months);   -QUS  ultrasound quantitative bone density  cash R450 -tariff item 3612-  anytime;  Unlike radiologists’  and thermography reports (which describe only  the imaging finding), the rates quoted include relevant breast or bone consultation and management planning  by specialist nurse & physician.

IF BOOKED TOGETHER, (not necessarily the same morning) then combined breast and bone screening is R1000.

OTHER SERIOUS health problems ARE DEALT WITH BY CONSULTATION DURING THE WEEK (OR ON A DIFFERENT SATURDAY MORN) : heart- ECG,  fatigue, HRT, sexual health, hypertension, depression, memory/dementia, lung & lungfunction, anaemia-haematology; kidney/bladder/pelvic, hormone-endocrine, depression, osteoporosis, sleep, diabetes, thyroid, adrenal; cramp; skin,  infection including STDs & HIV/AIDs, stroke, epilepsy-neurology, dizziness, heartburn/digestive/liver,  neuropathy,  sexual health, menopause, HRT, genitourinary; immune problems, or arthritis relief;

Thermography no-touch infrared screening  for suspicious  cancer /inflammatory  changes:  by Radiographer Melinda-next 23 March 2015.   R900 breasts; R1100  head and  upper;  or lower body & pelvis;  R1300 whole body.

Bookings/queries contact Evelyn/ Reyhana / Val at  the Natural Medicine Clinic, 1st Floor no 15, Grove Medical Bldg, opp ABSA (parking ABSA Parkade )  near Warwick/Cavendish  Square Claremont Cape Town RSA, ph +27216831465 or a/h +2783 4385248 or reyhanadaya@yahoo.com  .

For the disabled – by arrangement  drive  up the ramp  to the Clinic door on the Grove Bldg 1st floor  parking deck.

Under CMS Council for Med Schemes Reg 10(6), open Medical schemes eg hospital plans  have to pay from their own funds (not members’ savings) for appropriate outpatient consultation (tariff item 0191) for  PMBs ie major conditions eg  cancer,   depression, neck/spinal problems, serious heart, lung, other disease., etc. Breast and osteoporosis concerns are generally part of menopause consultations N95.9   (if not already eg breast cancer code C50) and thus are often billable  med scheme benefits. The menopause billable item only applies if you are 45yrs upwards, unless you have had total hysterectomy.

On patients’ requests, appropriate invoice can be prepared and submitted to your scheme for refund of your due benefits. Some schemes eg hospital plans  falsely deny due benefits until reported to their regulator  CMS. For medical plans where the billable tariff benefit rate is higher than the breast screening fee paid, the med plan rate 0191  will be charged eg R790 by the contracted  specialist,  and refundable by Discovery to the member. some basic schemes eg Keycare, Bonitas require preauthorization, or referral by their contracted GP  .

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CHRONIC ILLNESS- MANAGED ANTIAGING & GENERAL PRACTICE CLINIC SOUTH AFRICA

update 6 April 2015

In Claremont  Cape Town

A  Specialist Family Internist Clinic offers consultations by appointment especially for managing (and ideally preventing)  the major chronic degenerative diseases of aging  and  maintaining physical, mental (and why not sexual?) vigour to a ripe and healthy old age; as well as preventing and managing acute disease at all ages.

The clinic (a specialist physician and a nutritionalist)  offers all-system evaluation and if available, natural  (as well as essential prescription orthrodox) prevention/treatment including metabolic – weight-endocrine-diabetes; heart-lung -kidney; hypertension; neurological-pain; joint & muscle; abdominal, immune system ie infection, cancer and auto-immune  support;  genito-urinary, & sexual problems;

and appropriate screening – ECG, non-xray ( no-touch thermography- eg thermomammogram;   SureTouch tactile) mammograms, non-xray (ie  ultrasound) BMD ie  bone fracture risk measurement, body composition, and appropriate hormone profiling/replacement.

Phone during office hours for appointment: for Claremont office  ph 021-6717415  or 6831465 (or 083-6299160) – at Grove Medical Bldg 1st floor no 15 (opp ABSA Bank Parkade c/o Grove Ave Pearce Rd)  , or neil.burman@gmail.com ;  or consultation by telephone/Skype or email .

by appointment only:        OFFICE HOURSby appt: ph office:  9am-5pm weekdays, 9am-1pm Saturdays.  AFTER  HOURS up to 9pm any day generally at office: –  email doctor   neil.burman@gmail.com  or ph 6am to 9pm  0836299160. EMERGENCIES  cannot be dealt with- acute emergencies and trauma, bleeding cases  must go to any  Emergency Unit .

Billing according to means ie specialist professional rates:  eg as a preferred provider for Discovery Health-  consultation procedure  0190; for needy patients, what the medical scheme pays  Detailed medical report and advice protocol provided at R300. Even Hospital Plans have to pay for outpatient consultation for scores of PMBs ie Prescribed Medical benefit conditions like Menopause.

 Needy patients desiring brief consultation can be seen by arrangement at GP rate.    Bone density scan  (covered by some medical schemes)  procedure 3612..  Non-xray mammograms are not yet covered by medical schemes codes: R650 for SureTouch including clinical consultation, R800 for thermomammogram.

UPDATES: HEALTHY LIVING

This  blog is irregularly updated   with the latest detailed pharmacological information on the ingredients of anti-aging preparations, the powder blend compositions, and mail-order/wholesale prices.

These are all detailed  on the page Product Details and Pricelists. but of course all the ingredients, as food supplements, can be ordered individually to US  or UK  or Japanese pharmacopoea standard anywhere from any reliable importer or manufacturer.

The prices listed are not updated weekly, they are a guide; and  dependent from day to day on imported costs which are mostly rising constantly .

For information email sales@healthspanlife.com (or contact 027836299160).

The public, as well as interested distributors/retailers, are invited to contact Healthspan Life!.

LISTING THE SCORES OF NATURAL WEIGHT-REDUCING INSULIN SENSITIZERS:

 neil.burman@gmail.com

 one of the great frauds of the corporate Prescription Drug Innovators- backed by their tools the FDA and the other Drug regulators, academics and political lobbyists they fund – is to omit to mention the natural nutrients that invariably do better than the patented prescription drugs they want mimicked.

Or they  hide behind the FDA smokescreen that natural products cannot be recommended until they have undergone far more rigorous trials than was required of modern designer drugs- which moderns rarely stand the test of time – efficacy, necessity and safety- with chronic use.

A classical example is the entries that one is led to on search for Insulin Sensitizers: eg – apart from metformin- many sites list only designer drugs eg the dangerous pioglitazone (Actos) or rosiglitazone (Avandia)- eg in Self-management of Diabetes  , and New Drugs for Type 2 Diabetes  and US Patent 6153632 – Method and composition for the treatment of diabetes ‘

 Wikipedia search leads to anti-diabetic drugs, where only biguanides and glitazones are listed under insulin sensitizers . – but there is a detailed listing and discussion of the dozens of alternatives natural insulin sensitizers.

FOODS THAT HURT: agents which slow metabolism, block insulin/ sensitivity or promote fat gain -adiposity: –

cooked fats; excess ie refined sugars eg sucrose (table sugar), glucose, fructose (eg fruit juice, cornstarch); NaCl; yam, cassava, celery-seed, rosemary ; betablockers, most antidepressants and major anxiolytics; cortisone; alcohol; HGH; synthetic sex hormones, aspartame; cholesterol-lowering drugs (statins lower testosterone, impair muscle, mood and liver- but no chronic trials show that they reduce insulin resistance or newdiabetes); most administered antidiabetic drugs (eg sulphonylureas, insulin/insulin mimetics eg gliptins) except metformin (& perhaps glimepiride). Sulphonylureas (relative to metformin) increase mortality by 43% & CVD mortality by 70% (DARTS 2006).

FOODS THAT HEAL: Combine fibre with the abundant metabolic stimulants that reduce insulin resistance, adiposity, appetite, calorie absorption, cell damage & lipidemia-

The VITAMINS – A, B2, B3, B5, B6, B7, B8, B9, B12, C, D, E, K;

The MINERALS – Ca, Mg, K, Zn, Cr, Se, Va, Zn;

The BIOLOGICALS fish oil, MCT, ribose; CoQ10; alpha-lipoic acid; arginine; 5HTP, carnitine; carnosine; n-acetyl cysteine, testosterone, estradiol; melatonin; inositol; GABA; taurine; thyroid;

the drug metformin derived from the plant galega biguanide ;and at least 66 other plants incl. aloe; sutherlandia; barley; basil; cinnamon, garlic, onion, cabbage, cucumber, spinach, nettle, white sweet potato,  gymnema, coleus, indigofera, fenugreek, curcumin, ginseng, olive leaf, dandelion, bilberry, kidneybean, stevia, psyllum, milk thistle, – see Pubmed on individual nutrients, and Hyperglycemic and Hypoglycemic Herbs .

Few of the above are commonly perceived staple foods; but they are easily combined – at modest dose and cost – in a twice daily food supplement regime. Since they combat all disease, there is hardly longer justification for using even the prescription drug metformin, let alone other (futile, risky) heavily marketed drugs- except that with rising demand, unless one grows one’s own foodstuffs, natural herbs and refined micronutrients especially in multiblends become far more expensive than prescription metformin. .

 In conclusion: what the Drug industry would dearly have us ignore is The Unitarian Hypothesis for the aetiology of diabetes mellitus. Morrison ea 2006 note that “over the years, insulin insufficiency will develop in most cases of even type 2 diabetes, with insulin therapy eventually required in order to achieve normoglycaemia. The Unitarian Hypothesis presents an overall cascade of biochemical and physiological interactions, a logic which embraces the points of entry of a variety of insults, all of which can lead to the clinical picture of hyperglycaemia and its attendant adverse outcomes.

The hypothesis buttresses the belief that nature – the genetic predisposition which directs potential antibody development; and nurture – the environmental influences such as stress, exercise, nutritional status (over- or under-), infective and toxic attack, can aggravate or initiate aspects of the cascade of reactions leading to hyperglycaemia. The causative agents functioning internally within the cascade are imputed to be free radicals, oxidizing molecular species and antibodies and the corollary to this overview concept would be that a situation that minimizes the genesis and accumulation of these three agents would minimize the development of diabetes mellitus.        

Currently the debate is rife about the use of free radical scavengers and antioxidants in the treatment and prevention of diabetes mellitus. The verdict is still out on this approach. Our research on rootcrops such as yams and cassava, staple foods in tropical countries, indicates the presence of cyanoglycosides such as linamarin, which on digestion yields cyanide radicals. These radicals are pancreatotoxic especially in the undernourished state. Dog models however, have shown that free radical scavengers such as riboflavin, Vitamin B2, is protective against this toxic damage. Further, scientific investigations have clearly demonstrated the role of antibody attack and have been able to ward off the appearance of type 1 diabetes mellitus in susceptible individuals, by the early use of immunosuppressive therapy such as cyclosporin.

Thus the Unitarian Hypothesis demonstrates how all types of clinical syndromes being described in diabetes mellitus are not necessarily variants of a specific illness but rather manifestations of a central process of membrane damage→antibody response→insulin inadequacy (quantitatively or qualitatively); and the future intervention in containing this disease may well lie in focusing on preservation of the integrity of the body’s cell membranes.”

SUPPLEMENTS AGAINST DISEASE/ AGING :

SUPPLEMENTS AGAINST DISEASE/ AGING :

Illness & early death are avoidable;

only aging isn’t..

Especially after age 30y, even with good diet & health, we need, but run out of, most essential micronutrients

some ~15 minerals esp CalMag,Zn,Se, Bo,Cr, I, Mn (Iron in kids & young women).

~15 vitamins esp C,D,B, K, bcarotene, E;

~25 of our own manufactured  Biological – FISH OIL; hormones (melatonin, 5HTP;HRT); enzymes, MSM, CoQ10, arginine, carnitine, ribose, cartilage, glycine, glutamine, lipoic/malic acids, flavinoids, cysteine, proline etc; &

AND Dozens of other biologicals-herbs/plants eg garlic; buchu; nettle; ginger,cinnamon, guai, galega, coleus, gymnema, stevia, milk thistle, cat’s claw huperzine A; borrie, aloe, sutherlandia, – both to improve learning & concentration- FISH OMEGA3 – at all ages- and to improve all systems,

and thus to help fight stress, pain- fatigue, pollution, toxins eg smoking/ sugar, heavy metals; infections, arthritis, anaemia, allergy, asthma, cancer, infertility, fattening, obesity- diabetes, memory loss, dermatitis, eczema, depression,colitis; anxiety, insomnia, hypertension, varicose-veins-piles, ulcers

and diseases of all organs- immune, heart-lung, liver, kidney, thyroid, bones, nerves,brain, etc.

Most patent prescription medicine/drugs are based on these listed evidence-based micronutritionals- but are often more risky, less effective. No patent designer drug does what these natural supplements do- lower all-cause mortality and diseases of aging by 36% to 50%, new diabetes by up to 80%.

ANABOLIZING THE FAINT-HEARTED WITH PHYSIOLOGICAL TESTOSTERONE REPLACEMENT

Some 2600 years after the first recorded therapeutic use of  human hormone replacement (in China), and about a century after the first modern hormone use, two new landmark trials with Nebido long-acting testosterone undecanoate DEPOT injection confirm testosterone’s  major  cardiovascular CVS Benefits:

an elegant trial by Guiseppe Rosano’s team at University Rome – Testosterone Benefit on Functional Exercise Capacity, Insulin Resistance, and Baroreflex Sensitivity in Elderly Patients With Chronic Heart Failure;

and Kevin Channer’s 12month trial in Sheffield UK Long term benefits of testosterone replacement therapy on angina threshold and atheroma in men . These confirm the heart-healing benefit of human testosterone replacement, as  we have seen for years in practice.

These findings are in striking contrast to solo estrogen supplement, which greatly improves vasodilation and thus perfusion and hypertension, but has no demonstrable benefit on general muscle or myocardial strength and mass, or arrhythmia; but increases fat mass including in muscle. (Our) metanalysis of all studies with oral estrogen +- progestin confirm   Aloia’s landmark 1995 study,  s that oral estrogen supplement  reduces lean mass (by perhaps 2kg/year)  but increases fat mass (by about 2.5kg/year), the net effect being steady weight gain of about 1/2 kg/year -which gynecologists dismiss as irrelevant, although it turns well women into dumplings- fatness frailty.

Microbiologist Dr Paul de Kruif (1890-1971) was perhaps the first to write the history of the developmental studies on testosterone The Male Hormone (1945) describing exciting clinical experience with it already before WW2 in the hands of medical scientists like Drs  Hammond, Werner  and Lalouche.

Einfeld details the first studies showing testosterone  benefit on CVD published in 1939. And Charbot ea from Paris have just confirmed what Gimeno ea first published from Univ California in 1963, that testosterone is a potent atrial antiarrhythmic drug -which partly explains why older women – normally with  serum testosterone, and testosterone:estrogen ratio only ~ 1:10th  of that of men-  are far more at risk of torsades arrhythmia and CVD in general than men.

William Masters and team had already in 1953 reported in the first RCT of human  bioidentical HRT the dramatic global benefits of injectible testosterone-estrogen even well after 70years of age  in already-institutionalized patients- as he called them, the Third Gender, those neutered by aging’s sexhormone waning.

then Tvedegard Moller & Einfeldt in Denmark ; & Jaffe in USA, reportedtestosterone’s  cardiovascular system CVS benefits .

Ullis Ptacek and Shackman’s thorough 1999  review shows that in USA testosterone only became reputable for study after publication of the landmark trials by Shalender Bhasin ea at UCLA  Drew medical school confirmed that testosterone is highly but safely anabolic on muscle in frail and aging men.

More obliquely, Chapman, Horowitz ea from Adelaide Australia  have just published a small study showing  dramatic benefit of  (oral) Testosterone and a nutritional supplement (475kcals, 9gms protein a day)  on reducing hospital admissions in undernourished older mean 77yrs  men mean BMI 19kg lean mass 43.4kg fat mass 12.8kg, and women mean BMI 18kg/sqm, lean mass 28kg, fat mass 15.8kg; thus the females especially were cachectic; combined supplements abolished hospital admissions over a year,  compared to 70% admission rate (only one patient had elective admissions, for separate hip replacement) without any supplements.It is common cause that such oral testosterone supplement gives very shortlived spikes in serum testosterone, thus does not raise the mean level.

DURATION CONFUSION IN THE ROME TRIAL?: the Rome paper by Caminiti, Rosano ea   perhaps  has a sub-editing typo:  It (the Tables)  clearly says they measured bloodlevels and cardiovascular response  at baseline and at 3 months after commencing testosterone undecanoate injection Nebido 1gm  at baseline and then the  6week shot.

but Nebido  1gm is generally given every 3 months (after the first 3 gms   each 6 weeks apart). This is because  it lasts for 3 months when given on a regular 3monthly basis.The definitive study by Schubert ea in Germany confirmed that the trough TT level over about 30months on 1gm Nebido 3monthly is about 16.3nmol/L – but a peak initially over the first 3weeks post injection to around 30nmol/L- ie rarely outside the physiological range of young men.

Hence the 4th shot would have been due 6months after the 1st shot.  As the Rome  abstract says, it is a 3monthly  administration long term.

So we await clarification that Caminiti & Rosano’s team  actually did the final measurements 3 months after the 3rd shot ie at 6 months ( 24 or 26weeks)? when trough  testosterone TT level  as they report was  predictably  up from ~8 to ~18 nmol/L. Why  would they have done measurements at 3 months (when they gave the 3rd shot) but not at the logical endpoint of 6 months? Otherwise their ‘after’ results would be after only 2gm Nebido over the first 3 months. More plausibly, their rsults are in fact as they say after 6months, after exposure to testosterone  for 6months.

WHAT IS “LONG TERM” IN A DRUG TRIAL? It is puzzling how the authors could call 3 months of replacement long term in their trial? Short term  in the context of human lifespan is surely up to a year (even at a mean of 70yrs age as in this cohort – average life expectancy is about 15years in a first world cohort); medium term would be up to perhaps 5years; and long term surely much beyond that. The only truly longterm RCT  ever done was the 20 year UKPDS.

But the FDA now routinely colludes with the marketing hype of drug companies to claim that even 3month trials are enough to register new designer drugs for chronic use- relying on experience, major adverse effects once the drug is in routine use to indicate if too many gullible patients are being poisoned or killed by the generally non-essential  wannabe new drug before they cancel it.

But it is common cause that serious injuries and degeneration eg of bone, muscle, brain etc can take 2 years or more to heal, before one can no longer expect much more recovery towards optimal function.  Even 6months is very early to expect optimal improvement, heart remodeling  on conservative dose anabolic  HRT equivalent to about 8mg TT a day imi or sc, since 1gm every quarter  has been determined to be an average optimal dose for Nebido, maintaining the blood TT at a minimum of about 16.3nmol/L. . But it depends on individual metabolism, habits, diet, smoking, alcohol and other estrogenic intake, antiandrogens and androgen receptors.

It is common cause that the magic formula for long cardiovascular life for men and women includes not just optimal diet and lifestyle but also  maintenance of  optimal bloodpressure,  and optimal levels by  supplementing  abundant vitamins B,C,D,K, some vitamins A and E,  the essential minerals especially calmag, zinc, iodine, iron, chromium, selenium, manganese, boron; and  the ”co-vitamin” human biologicals that deplete from early adulthood  in particular  EPA+DHA, CoQ10, carnitine, ribose,  arginine, carnosine, proline, and chondroglucosamine, and all our other hormones especially  gonadal, adrenal, thyroid, serotonin, GABA; and the plant prohormone metformin. in case of resistant overweight let alone obesity or diabetes.. A new study from Japan also shows that metformin protects from experimental heart failure.       Even modest boron supplement has potent benefit in reducing excretion of and doubling serum testosterone and estradiol levels in magnesium-repleted postmenopausal women.

But as endocrinologists, specialist physicians or family practitioners experience when interviewing an older patient , the likely answer the GP or specialist receives when enquiring about sex hormones – most patients will rebuff the query with “my gyne / urologist looks after that”.

This despite the fact that most gynecologists and urologists were trained primarily as surgeons and in reproductive organ problems and symptom relief ie short term – not in the pathophysiology of all the other internal diseases and prevention and care of the aging diseases, in which internists, geriatricians, general practitioners are trained and experienced after leaving  undergraduate medical school.

This is the appalling tragedy for the aging,  perpetuated by many cynical health professionals  and drug companies for whom only disease- not prevention- pays : that the most important supplements we  need for dynamic old age – human parenteral balanced sex hormones which deplete in 100% of women and over 50% of men- are dismissed except shortterm for the transient menopause symptoms, or for poor sexual function. .

Oral HT eg premarin, progestin is rightly condemned  much beyond 10 years or age 60yrs precisely because it is too risky (as confirmed by the  monumentally misguided but useful $billion  Women’s Health Initiative) or for sexual problems- which few health professionals are both trained and comfortable to address, and about which older people seldom complain precisely because they are already so impaired by the preventable major aging diseases – cardiovascular, metabolic, mood, mental, muskuloskeletal, malignant etc.

Studies showing the major benefits of testosterone on heart failure and ischemic heart disease of course do not discuss the pros and cons of enterohepatic versus the alternative (parenteral) route;  and to what extent the CVS benefits of TT are mediated by the  muscle-anabolic TT itself as opposed to by its daughter metabolite estrogen – with which no muscle anabolism, strengthening has been described except obviously in the uterus itself, and in promoting vascularization and endothelium. It is sad fact that estrogen alone promotes increasing adiposity while shrinking muscle mass, and dissolving collagen in eg the perineum. This causes the paradox that while estrogen strengthens brain, perfusion, skin, hair and  mucosa, it doubles the incidence and severity of stress urinary incontinence SUI, which SERMS in turn double again; with progestin perhaps halving the degree of SUI.

Only for women, at the behest of the drug industry and their non-human sex hormones, do doctors ignore the physiology, that androgens are the parents of estrogens, with the corollary that having dominance of the daughter- estrogen (whether by being overweight, or taking estrogen or progestin, or in the perimenopause)  suppresses levels and necessary anabolic benefits of androgen. They willfully ignore what is long proven, that estrogen dominance  has no direct benefit antidepressant benefit- if anything, while relieving menopause symptoms, it causes inner hostility- whereas maintaining testosterone balance relieves  depression in 2/3 of postmenopausal depression.

THE CRIMINAL RISKS OF ANY INTRAMUSCULAR INJECTION WHEN ALL THAT IS REQUIRED IS SHORT NEEDLE SUBCUTANEOUS ie SC. Finally, it is a risky and potentially dangerous myth that any routine injections must be  given intramuscularly imi. Unless there is a rare special indication for intramuscular (or intravenous) injection,  insulin   and Nebido and all “imi” injections should simply be given into a pinched fold subcutaneously sc ie under loose skin, ideally the upper outer buttock,  even preferable to the loose abdominal wall skin around which diabetics are advised to rotate insulin injections.

This  works as well sc  as imi –  but why advocate  the grave multiple – potentially paralysing or even fatal- risks of unwarranted  imi injection with a needle longer than about 10mm (the skin being  at most 2 – 3mm thick)  for which health practitioners regularly end up before a court martial when the monotonously predictable mishaps occur with the routine ~25mm long “imi” needle – intramuscular hematoma/abscess if not severe (sometimes permanent)  neuralgic pain or distal paralysis or gangrene from hitting a major nerve or artery, to pulmonary embolism from intravenous injection?

For this reason, a 25g needle usually suffices for most purposes, except  Nebido or eg Primogyn depot injection when a 23g needle is less tedious and slow since these are  suspended in a thicker oil vehicle ( than water-soluble insulin which easily goes through a 27 and even 29g needle). For usual eg depotestosterone cypionate or enanthate, or Mixogen/ Primodian Depot combinations, a 25g needle is ideal.

Imagine accidentally injecting 4ml of Nebido – oil- intravenously into an older male? This cannot happen with short 23g needle subcutaneous injection into the upper outer buttock – which is painless and causes at worst a transient bump.

when even imi Voltaren diclofenac can and does suddenly kill (and in retrospect there is never justification for it imi  since  it can always safely be taken by mouth or as suppository).;

and especially when we have for at least 60 years given subcutaneous pellets sc  eg testosterone up to 1000mg  to men and  in women up to 100mg testosterone with or without estradiol 25 to 100mg?

RESTRAINING UNNECESSARY RISING COSTS OF COMMON DRUG THERAPY AND CONFLICTS OF INTEREST:

The review published yesterday by Discovery Health  “Medicine expenditure up by 26% in private healthcare industry” based on the Mediscor Medicines Review resonates with this week’s editorial from JAMA on Resolving Unreported Conflicts of Interest. Apart from anticancer therapy (which affects relatively few patients but is very costly), by far the two top drug costs to the private  health system in RSA  are antihypertensive and hypolipidemic drugs.

But why are these two groups of drugs 1/6th of  local private medicines expenditure?

The reason is quite plainly vested interests- between prescribers, drug developers and retailers, for  well-known reasons:
1.  Modern western medicine  rarely attempts to address the pathogenesis  of disease – it takes too much effort by prescribers and patients to try to change diet and  lifestyle. And  the only “modern” drug that addresses the main causes of the common degenerative diseases – overweight, (pre) diabetes type 2, lipidemia, atheroma, thrombosis,  hypertension, cancer, arthritis, dementia – is the antioxidant, insulin-sensitising, energising,  nitric-oxide-promoter, antilipidemic, antithrombogenic, antihypertensive, anti-infertility, anti-PCOS,  appetite-and-weight-suppressive,  anticancer, and diabetes-preventing   plant-derived metformin. This is the only prescription drug  ever – with zero serious persisting adverse effects in appropriate dose –    that has been  shown (including in the only 20year randomized controlled trial ever) to actually reduce all  major morbidity and all-cause mortality by over one-third.

2. Only new ie under-patent drugs are $billion dollar –a-year rainchecks in a $trillion dollar industry where only disease pays (not prevention- which keeps patients out of hospitals & specialist centres  and off new drug) .

So the Disease Industry has correctly pinpointed overweight and hypertension as the two leading risk factors to bombard consumers with new drugs;

but  has created the  gigantic marketing ploy  that these common lifestyle-diet problems  need designer drugs: that
average mild to moderate hypertension must be treated by combinations of angiotensin-and adrenergic, and calcium-blockers – which  do not reduce all-cause morbidity and mortality.;
and  even average lipid levels  by statins and now even the futile  ezetimibe –which do not reduce all-cause morbidity and mortality;
and overweight-obesity  by patented drugs like Orlistat and Rimonabant –which do not reduce all-cause morbidity and mortality  ,
and type 2 diabetes by new sulphonylureas, glitazones and even more toxic and expensive injectables  like gliptins- –which do not reduce all-cause morbidity and mortality .

But  simple analysis of the hundreds of better-quality  published studies and trials (not those ghost-written in glossy journals  for drug companies to promote their products) shows that:

For average mild-to-moderate hypertension, no modern drugs (with many serious  adverse effects)   surpass for benefit  the triple and zero-side-effect  combination of lowdose reserpine plus lowdose coamiloretic- in RSA costing retail about R45 per 4 months ie about $2/month;

For average-risk overweight adults with or without lipidemia and diabetes, nothing surpasses the global benefits- major reduction in all-cause mortality and mortality- of  metformin started in low dose eg 250mg/day and increased  slowly to tolerance.
Obviously primary prevention  for everyone includes a few grams a day of the essentials that  deplete at all ages with longevity, the degrading food chain,  pollution and stress – the natural ~50  replacement supplements of  vitamins and minerals and the human biologicals EPA+DHA, CoQ10, arginince, carnitine, n-acetyl cysteine, alphalipoic acid, taurine, carnosine, MSM, chondroglucosamine, lutein, bioflavinoid,  choline, inositol, 5HTP, GABA, melatonin, plus key plant supplements eg ginkgo, milk thistle, galega, gymnema, coleus etc;

all of which can be simply taken as a powder blend in water twice a day with a teasp of cod liver oil or a fish oil capsule;
at a global retail cost of as little as R100/$12 a month ( plus  in older people, appropriate physiological  human sex hormones).

So while there is some- but relatively little-  competition between generics, the major saving in both cost, risks and prevention is between therapeutic equivalents eg lowdose coamilozide+reserpine, metformin, and other safe effective  supplements – which are all that are needed for prevention and most treatment of all the major degenerative diseases of aging including osteoporosis  (which agents  Industry and their funded lobbyists- researchers, academics, regulators  try persistently to denigrate if not actively suppress)-  vs other newer- and heavily marketed  classes of antihypertensives, appetite ,  lipidemia and osteoarthritis-osteoporosis  suppressants.

This issue of promoting evidence-based best  therapeutic equivalents is indeed blowing against the wind, the tsunami of $billion dollar adspend by Big Business to promote their designer labels. But all countries- while  run by ruthless politician big business looking after their own interests – do pay some lip service to restraining the normative  monopolistic and price-fixing racketeering that screws the man in the street- both in gross overpricing, and in massive tax evasion by big business, and in rigging of elections and tenders .

Our own Medical Schemes Council is in the process of open consultations about the revised necessary and approved drug lists for all diseases in the medical schemes industry. Hence urgent vigorous debate is urgently required – in all countries- before vested interests further strangle citizens’ choice of and access to both cheap old drugs to eg reverse the dropping of reserpine by bureaucrats in UK, Europe and state clinics here, and reverse the rising tide of suppression of the best prevention and treatment there is- the base of all modern medicines – minerals, vitamins and the numerous proven safe human and plant biologicals.

The trend by the FDA and EU and Big Business in RSA must be reversed, before they (in the interests of their own pockets filled with paybacks by Big Pharma) put all supplements totally on prescription by health professionals- the very people whose livelihood (including their shares in Big Pharma, med schemes and hospitals) depends on new quick-fix designer drugs which cure and prevent no chronic degenerative disease ie on avoiding effective doses and combinations of proven supplements.

As it is, the medical schemes in RSA are now compelled to pay for the services of witchdoctors (who admittedly probably kill far fewer people than do modern prescriptions and surgery for non-urgent conditions) yet these schemes- while insuring for profit people who persist in suicidal and homicidal smoking and alcohol and sexual behaviour-  flatly refuse to pay for the best prevention  there is – the supplements mentioned- because  they are neither promoted by Big Pharma nor on prescription.

Numerous references are available under many keywords on this website below.

ndb