Tag Archives: Wikipedia

part 2: WIKIPEDIA ERRORS IN SEX HORMONE ARTICLES

DOZENS OF MISTAKES IN WIKI MEDICAL ARTICLES:

SEX HORMONES:

In Endocrinology we learnt decades ago to use only human hormones in humans for endocrine ie hormone replacement, because of the problems of xenobiotics- animal (and plant) hormones eg:

1. risk of infection/ prion transmission;

2. risk of antibodies neutralizing their benefit;

3. they work on human hormone receptors- foreign hormones like equilins (and designer progestins) certainly bind to the respective sex hormone receptors, but they have some unwanted effects, and also block the intended human hormones from acting there.

4. the predominant hormone in premarin is estrone E1.  This hormone usually dominates by default post menopause- when women with low estradiol and often androgens suffer the multisystem degenerative aging diseases of hormone decline including breast cancers. Also, it is progestin and estrone dominance, not E2, which are most commonly associated with breast cancer.

5. For the above reasons, all hormone deficiencies that are treated by endocrinologists use only human hormones in physiological doses to produces blood levels in the healthy young range. Why are postmenopausal women denied the same right?

The Wiki Equilin entry says at present:

Equilin is one of the estrogens present in the mixture of estrogens isolated from horse urine and marketed as Premarin, the most commonly used form of estrogen for hormone replacement therapy in the United States of America. Estrone is the major estrogen in Premarin (about 50%) and equilin is present as about 25% of the total. “Estrone sulfate is usually the major form of estrogen in women.”. Equilin is not normally present in women” .

But under estrone wiki contradicts itself, it says “Estrone is the least abundant of the three hormones” in healthy young women ie less than estrone and estradiol. So it confirms the truth, that estrone is certainly not “the major form of estrogen in women”- at least not during the ~40years of menstruation. During the reproductive years, the blood estradiol averages about 20% higher than estrone.

XENOHORMONES: Why does wiki not even have an entry for xenohormone under xeno-, under premarin or under hormone replacement therapy? It states incorrectly under Estrogens that “nonsteroidal estrogens include synthetic estrogens known as xenoestrogens” – yet under Estinyl wiki states that estinyl was the first orally active synthetic steroidal estrogen. Wiki does say “ xenobiotic is a chemical which is found in an organism but which is not normally produced or expected to be present in it”. Obviously equilins ie premarin are xenobiotic hormones in humans. But under Estrogens it does say “In a study by the NIH, esterified estrogens were not proven to pose the same risks to health as conjugated equine estrogens.” And “The “first orally effective estrogen”, Emmenin, derived from the late-pregnancy urine of Canadian women, was introduced in 1930 by Collip and Ayerst Laboratories.”   Actually  Chinese physicians introduced them 2600years ago.

But at least Emmenin is human hormones. Equilins are xenohormones ie potent foreign hormones not found in humans. It is unclear why women should be treated with premarin – ie horse excreta. In Western medicine, humans are generally advised NOT to drink urine or extracts of urine.   Where does the FDA keep it’s brains and ethics about women? – does it consider them mares?

So why (except for Wyeth’s and the FDA’s economic benefit, and women’s detriment) does the FDA allow premarin, when it is mostly equilins and estrone, with negligible estradiol? At least oral estradiol – even in micronised oral microdose- is the most physiological human hormone.

Conventional Premarin  by mouth to control menopause symptoms produces combined estrogen levels  and effects  >10 times higher than those of healthy young women, which is surely why it is associated with both early promotion of subclinical breast cancer so that there is a spike of cancer in the first 2 years (such cancers have surely been present, growing slowly for at least a decade); and gradual increase in new breast cancers presenting after  about 12 years on premarin – all of which are apparently triggered initially by progestin/ progesterone (Horwitz 2008). . By definition, horse waste premarin is NOT a hormone replacement in humans- it would indeed be HRT for mares.

English is an explicit language. In humans, “Hormone” refers to dozens of different messenger chemicals- Wiki lists at least 60- which include testosterone, progesterone and the estrogens estrone, estradiol and estriol- but progestins and the many equilins are not listed.

Common daily misuse should not change the meaning of words.

So  HORMONE REPLACEMENT HRT in humans refers to physiological replacement of any available  missing hormone  by the same human hormone to the usual healthy functional level eg insulin by insulin to normal insulin and glucose levels, thyroid by thyroid, or cortisone by cortisone etc . Using a different hormone would be substitution. One cannot in practice replace a human heart  or kidney by anything but a human heart or kidney, nor human red blood cells by anything but compatible human red blood cells . One cannot effectively and safely replace insulin, growth hormone or most other hormones (including testosterone, estradiol and progesterone) by mouth- which is why percutaneous insulin has been available for >80years, and percutaneous sex hormones for >60years  (see eg Sex Endocrinology Handbook for the Profession: Schering Corporation, New Jersey  first edition 1944). And a human kidney transplant – not dialysis- is replacement of physiological kidney function.

We do not  use or need  the longterm risks of costly  synthetics eg bisphosphonates  to prevent and treat osteoporosis when the natural supplements- appropriate HRT, fish oil, minerals and vitamins safely abolish osteoporotic bone fractures – which bisphosphonates cannot do since they address only one of many  fracture risk factors . There is no evidence whatsoever to justify the wiki marketing hype that “bisphosphonates are the main pharmacological measures for treatment”, nor that  “newer drugs such as teriparatide and strontium ranelate” are anywhere as effective and safe in osteoporosis. In addition, none of these marketed drugs give the ~50% reduction in all premature aging disease and mortality that the full collation of natural supplements do.

HORMONE THERAPY HT refers to use of (usually megadoses ie) supraphysiological doses for treatment of some pathology eg highdose cortisone for allergy, asthma; premarin or estinyl for treatment of a bleeding problem or prostate cancer; or estinyl for contraception- suppression of normal physiology; or high-dose testosterone HT for the androgen resistance syndrome or female breast cancer, highdose thyroid for thyroid resistance syndrome.  Thus kidney dialysis uses synthetics, artificial therapy to purify the blood until a working transplant replaces the dead kidneys.

Thus metformin and the dozens of similar insulin sensitizers are prohormones for hormone therapy of metabolic syndrome and type 2 diabetes because they reduce insulin resistance, allowing insulin to work effectively at  normal insulin levels rather than the futile raised insulin levels found in insulin resistance or after sulphonylureas.

It is at least  thirty years since it was first observed that xenoestrogens and xenoprogesterones – especially by mouth- are not compatible with older women in that they cause common and serious adverse effects both short term and long term, whereas physiological doses  and blood levels of  appropriate balanced human hormones adjusted to tolerance do nothing but good.

While oral premarin alone in historical American doses  (and oral estradiol in Europe),  in appropriate use in young postmenopausal women (eg in the WHI), reduced all deaths and all major degenerative diseases by a third, these still increase the risk of thrombosis, gallstones and hypertension. And oral progestins block many of the benefits of estrogen and human progesterone, and promote breast cancer.

At present, apart from foodstuffs and plant extracts,  it seems that only one solitary animal ie non-human extract is indispensable for human therapy: chondroitin. Trials show that it is best combined with glucosamine (from cornstarch). Recent RCT for long enough shows that this combination not just reverses cartilage loss but (in not too advanced cases with bone grating on bone) actually restores cartilage so that normal function returns to previously crippled knees needing replacement. But unlike the xenoestrogens in premarin and EE, chondroitin is a natural  essential glycoprotein in all species including humans. We simply do not any longer harvest chondroitin or growth hormone from human corpses- only blood and organs for transplantation from highly selected donors, with exhaustive permission. (we also need extra free fatty acids- fish EPA and DHA- but technically these are not made by fish, they are made by marine algae).

Thus premarin and EE are unique in being the only xenohormones, xenobiotics from other species, that humans- women (rarely men)- are advised by doctors to take for “replacement”- when there has never been any evidence that they are as  effective and safe longterm as pure human estrogen  whether orally or parenterally.

It is difficult to find on Google a definition of esterified estrogen EE versus conjugated equine estrogen CEE. But the landmark 2004 article from Washington State and Leiden Universities gives the game away. It shows that Conjugated equine estrogen CEE (ie premarin) contain estrone sulfate approximately 53% and equilin sulfate about 25% (and dozens of other steroids in the remaining 22%). Esterified estrogen EE contains approximately 80% estrone sulfate and approximately 11% equilin sulfate; and in that trial, at equivalent medium to high doses, the CEE gave over double the risk of deep vein thrombosis VT; whereas (compared to controls), EE use did not increase VT.. .And under Estrogen, wiki states (without a reference) “In a study by the NIH, esterified estrogens were not proven to pose the same risks to health as conjugated equine estrogens.”

So it is unarguably clear from both 50 years of observation and trials that postmenopausal women are put in jeopardy whether they are denied appropriate  sex hormone replacement SHRT for almost the second half of their lives , or given the false comfort of “convenience” oral therapy especially with xenohormones such as premarin and progestin, or bisphosphonates. Men are not exposed to such bias at the behest of a giant USA manufacturer like Wyeth, and the USA government – the FDA – or the scientifically unverified change of mind of a leading gynaecologist like William Masters between 1953 and 1957). .

Men (and women) with biochemically and clinically proven (relative) hypoandrogenism are given the best endocrine  replacement ie testosterone through the skin. As with oral HT in women, androgens by mouth have been shown for decades to be either hazardous or ineffective, whereas testosterone through the skin to physiological  balanced youthful sex hormone  blood levels does nothing but good in men and women.

Wiki does not even have articles on androgen deficiency in men and women, merely mentioning the deficiency among many causes of sexual dysfunction. . But it is crucial to note that, irrespective of sexual complaints (which many patients are too inhibited to raise), relative androgen deficiency (in relation to available estrogenics) is common in most older people with chronic diseases, and worth trial of replacement.

Physiological correction of testosterone deficiency (from levels below the average of healthy robust sexually active young adults) into the upper range of healthy young adults often gives major improvement not just in sexual function, but also in reversing overweight- metabolic syndrome- obesity; depression; mood and mental problems; chronic fatigue and pain; osteoporosis and frailty; hypertension and cardiovascular disease; cancer, autoimmune diseases and infectivity; and anaemia.

The benefits of parenteral human  SHRT (as opposed to oral xenoHT) – including reduction in the mortality from cancer, cardiovascular, osteoporotic, autoimmune, mental and  mood diseases, and total mortality even on HRT after breast cancer- are set out in detail in a major 2008 review “Could transdermal estradiol + progesterone be a safer postmenopausal HRT” by a leading International Menopause Society team under Professor Andreas Genazzani.

By contrast, a 13year review of 67700 postmenopausal US women by the American cancer Society released 2 days ago showed an incidence of breast cancer of only 0.26% per year. The adjusted rate on estrogen+progestin (largely premarin + provera there) was increased by about 80% compared to non-users, mostly in the first 2 years as in the Womens’ Health Initiative. On premarin alone, in  average ie overweight to obese women , premarin alone associated with 50% more cancer only after >10years – as in Henderson’s study of 1982.

As discussed above after 60years of use of appropriate balanced non-oral human hormone replacement (estradiol, prodesterone, testosterone), the evidence is that if anything breast cancer and deaths from all causes are reduced.

So why use oral HT especially premarin and progestin for shortterm convenience,  when non-oral appropriate  (triple) HRT  gives minimal risk but major lifetime benefits?

And two centers (Harvard, and North Carolina) review fresh data that restoring low testosterone level to average level  with depot tesosterone injection in symptomatic men with androgen deficiency provides mulltisystemic benefits without increasing any risks including that of prostate cancer.

In conclusion, it is obvious that for researching health matters, the public is advised to use first the websites of international expert associations eg ISSAM- the International Society for Aging Males; IMS- the International Menopause Society; and Medline- Pubmed;

rather than those which are prone to commercial or academic local bias (by drug/ equipment companies and other local vested/ financial interests) like universities, patient support associations, the FDA/NIH, other National Health Services, private practice and craft groups, wikipedi or lay associations/ reports and advice.

Wikipedia health articles should be depended on only if they are certified by international consensus bodies like ISSAM and IMS, or if material facts are referenced to a verifiable expert source. Neither trials, reviews nor metanalyses are necessarily reliable evidence.

This review is not criticism of Wikipedia for providing an excellent open forum, it just highlights the potential biases in a forum which is not subject to oversight by an international panel of specialists in that field who do not individually  have vested interests or limited experience. And who doesn’t? The two criteria are in a sense mutually exclusive, since  the greater one’s  age and experience, the more biased, closed-minded, entrenched one may become.

Detailed referenced reviews the past year on each of these topics are published below.

ndburman mrcp(uk) gonadopause physician.

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WIKIPEDIA IS INVALUABLE, BUT BEWARE IMPORTANT BIAS IN IT’S CHRONIC DISEASE ARTICLES PART 1:

Wikipedia is now the top and invaluable reference source for the public.

Wikipedia entries are commendably frequently updated; but this does not mean that the entries are both up to date, objective and unbiased, since they are constantly being altered by conflicting outside editors.

We suggest amendments in  Wiki  health entries where appropriate as follows.

It will obviously have most effect if the recommendations to Wiki are based on consensus by the relevant international leaders- eg the International Society for Aging Males ISSAM, the International Menopause Society IMS, the International Pediatric Association, and so on; NOT by drug companies and their product promoters including individual disease associations (which by definition do not take a holistic multisystemic  view) or private and academic national groups whom/which drug companies sponsor/influence- including the problem of ghost writing! Many entries on Wiki appear to suffer from this problem of vested interests.

INTRODUCTION: EBM:

The Wiki article on EBM  Evidence-based_management ie  Evidence-Based Medicine hits the nail on the head. Medical diagnosis and treatment need to be evidence- based- but as the heretical pioneers Shaughnessy and Slawson stress, this must be POEM- patient-orientated evidence that matters. However, for the Drug Industry and their state arm  the USA FDA, the chronic major degenerative diseases are the biggest money-spinners since they arguably need lifelong drugs. Hence the Disease Industry  has invented epidemics of chronic diseases that were regarded as inevitable or self-induced until drug companies came up with designer drugs for each new  disease to medicalize – eg  epidemics of erectile dysfunction, mild to moderate hyperlipidemia, anxiety, mild-to-moderate depression, mild PMS and menopause syndromes, smoking, alcoholism,  and so on. Then  they and the FDA  generated trials and procedures  testing these patients with new “diseases”, and convinced the public that despite clinically insignificant benefits in trials often lasting well under a year, tested against only placebo,  the drugs could be registered  for chronic use even though there were long- proven natural remedies that did as well or better. They (their well-paid researchers, statisticians and often professional spin writers) then produce and pay for publication of  drug  trial reports claimed to be favourable, even though the evidence is weak or in fact adverse. . And the FDA is at least consistent- it still allows American chronic drugs to be thus launched with  only short trials, without head-to-head comparison against proven remedies – but blocks dubious foreign drugs like rimonabant..

Hence in our lifetime we have seen the rise and spectacular  fall – fatal for many patients- of many trumpeted medicines – of  stilbestrol, anabolic steroids, practolol, thalidomide, ticrynafen, barbiturates, antidepressants, fenformin, Vioxx, benzbromarone, troglitazone, cerivastatin, antiarrhythmics, phenfen, and antiplatelet drugs. And the Bush Administration recently forced through legislation immunizing the drug industry against claims for  damages from failed drugs! Mostly me-too drugs whose sole need and purpose was to create profit for industry for a few years before complications force their disappearance. This indeed is the FDA – Drug Industry’s  60  year commercial War Against Humanity (Elaine Feuer)  and compassion, Al Gore’s The Assault on Reason, Naomi Klein’s Disaster Capitalism, Ivan Illich’s Medical Nemesis.

The FDA-Disease Industry (and medical schemes)  then calls this sham  process  EBM, and denies the same recognition to long proven  optimal remedies  eg parenteral human HRT because there is no need, and no sponsor, to do long-term trials on natural remedies long-proven in clinical practice studies. The only “designer” drug – metformin- which is in fact a simple tagged plant extract-  that has ever been subjected to a 20 year trial  was effectively kept  off the USA market until the  trial was nearing completion in the mid-1990s – ie metformin in the UKPDS, which proved to be the only designer drug ever that almost  halves both all mortality and all chronic major degenerative diseases including type 2 diabetes. And still the FDA demanded a 10-000 patient one-year trial  – COSMIC- to prove the safety of metformin- after all, it was a Scottish invention and long-proven European drug, thus not to be trusted because it was not invented in USA. As if the Americans were not of recent European origin.

Similarly, the FDA (and the British)  embargoed/derided  lithium- the gold standard drug against bipolar disease- until 1970, forcing Mogens Schou to do an unethical double-blind withdrawal trial on stabilized patients to prove it’s efficacy – 100% of whom relapsed within 6 months on placebo, and restabilized back on Lithium. .

Hence all drug study and trial reports, especially for  registered drugs – however prestigious the journal and origin- have to be examined carefully to see if they were done without bias/spin to paint the new drug in a rosy light. The Womens’ Health Initiative most certainly was not unbiased despite the close to $1billion cost – it scandalously failed to test Wyeth’s two xenohormones against the gold standard, human estradiol and progesterone. Similarly, the statins for mild-to-moderate hypercholesterolemia  have never been tested head to head against the only drugs that reduce all-cause morbidity and mortality by 1/3 to 1/2- metformin, fish oil, appropriate balanced human hormone replacement, and a blend of effective safe doses of all the beneficial minerals, vitamins and biologicals including some herbs.

Similarly, the Viagra trials were fraudulent- they excluded men with frank hypogonadism (since Viagra will not work without testosterone priming). But Pfizer  and the FDA also colluded to refuse to disclose, publish the testosterone levels of men enrolled in the Viagra trials- when it has been known since the early 1980s that there is a dose-response correlation between erectile function up to a plateau above a serum testosterone of about 4.5ng/ml 16nmol/L -.1982 Salmimies ea. It turns out from other Viagra trials that the serum testosterone of trialists was around 13.5nmol/L.. So most of the men using Viagra/Cialis  did not/do not  need 2 Viagra tabs a week costing hundreds of dollars a month (as the NHS was conned into providing), but a conservative shot of depot testosterone perhaps 160mg every fortnight at a cost of below $5/month- with far more multisystem benefit, and none of the deadly risks (sudden death or stroke or blindness) of Viagra.

The Wiki article on erectile dysfunction dismisses testosterone deficiency as being a rarer cause of erectile dysfunction, but fails to mention the obvious, that partial androgen deficiency ie a serum testosterone below the mid-range -ie average- often responds to adequate depot injection trial of testosterone to elevate the blood level into the mid range of healthy young men (not just the range of elderly men, as is so often done).

Such is the power of fraudulent drug company deceit in collaboration with Regulators.

It is hollow hypocrisy that the UK has now introduced a regulator of alternative practitioners- but neither the USA, UK nor  other governments  have ordered their Medicines Regulators  to drastically restrict many of the scheduled drugs discussed below (and a few risky complementaries like black cohosh and kava) when there are far safer proven  alternatives. Manufacturers and Regulators themselves are certainly not going to do this- not when their  raison d’etre is well-paid screening and registering as many new drugs as possible, not policing old drugs.

PART 1: THERAPY OF COMMON MULTISYSTEMIC DEGENERATIVE DISEASES OF AGING:

1.1 Hypercholesterolemia and statins

1.2 Osteoporosis and Bisphosphonates

1.3 Hypertension and antihypertensives

1.4 Diabetes type 2, Obesity, metformin and other weight-reducing drugs.

1.5 Pain, arthritis and NSAIDs.

1.6 Fish Oil

1.7 MULTIPLE DESIGNER DRUG INTERACTIONS

PART 2: SEX HORMONES see next publication.

1.1 Under hypercholesterolemia wiki says “statins are the most commonly used and effective forms of medication for the treatment of high cholesterol”. But the wiki entries on statins, cardiovascular disease and hypercholesterolemia, and Pubmed, give no evidence to justify statins’ heavily marketed primary use in mild-to-moderate hypercholesterolemia and diabetes, no reference that shows they are as good and safe as the old proven combination of natural evidence-based remedies – vitamins, minerals and biologicals (including appropriate eg non-prescription fish oil, carnitine, CoQ10, arginine, ribose, carnosine,  galega officinalis- metformin, and appropriate sex hormone replacement).

It is metformin and appropriate HRT, not statins, that reduces both cardiovascular and all-cause deaths by at least a third, and meformin that halves the incidence of new diabetes when used preventatively in the adipose with insulin resistance etc. It is metformin, not statins, that merit marketing over the counter:  in sensible use imetformin is totally safe, unlike unregulated poisons like cigarettes, alcohol and  sugar.

None of the vast statin trials show that statins do any good other than lowering CVD risk by a third. So it is a blatant dangerous lie to state as Wiki does that “statins are the most effective medication for treatment of high cholesterol”- this claim certainly does not apply to the universal common mild to moderate hypercholesterolemia MMHC. Familial or secondary severe hypercholesterolemia justifying statins is generally rare; and  the indolent overweight/ diabetics with MMHC have enough problems with diabetic cardiovascular disease, neuromyopathy,  and osteoporosis without the added risk (fatigue; myalgia; hepatorenal; depressive; sexual; skin; respiratory impairment; and cancer associated with severe hypolipidemia) of statins, when metformin and the other antioxidant insulin-sensitizing supplements like appropriate HRT are safe and far more effective across the board – and do not deplete and antagonize  crucial and very expensive CoQ10 as statins do..

1.2 Under bisphosphonates, wiki says “In osteoporosis, alendronate and risedronate are the most popular first-line drugs. If these are ineffective or the patient develops digestive tract problems, intravenous pamidronate may be used. Alternatively, strontium ranelate or teriparatide are used for refractory disease, and the SERM raloxifene is occasionally administered in postmenopausal women instead of bisphosphonates”.

But popular does not mean most effective or safe. Wiki quotes no sources to prove that bisphosphonates- now with a notoriously long list of complications – or the designer drugs mentioned are anywhere near as good and safe for osteoporosis and all diseases of aging as the baker’s dozen of appropriate human HRT, vitamins and minerals. The popularity of bisphosphonates, premarin, statins and SERMs is obviously based simply on heavy marketing.

1.3 ANTIHYPERTENSIVES: the Wiki entries for hypertension, antihypertensives and reserpine are in total conflict – for the obvious main reason that the main entries are written by those sponsored by new-drug companies. On the other hand, Wiki says correctly under Reserpine: “it is one of the few antihypertensive medications that have been shown in randomized controlled trials to reduce mortality… In some countries reserpine is still available as part of combination drugs for the treatment of hypertension, in most cases they contain also a diuretic.”  see Pubmed  for at least a dozen such landmark studies.  It was confirmed as recently as the SHEP(1995) and ALLHAT (2007) trials that combinations containing reserpine are the best for resistant hypertension. And numerous trials up to the 1990s showed that lowdose reserpine plus a lowdose diuretic is as good as any more modern drug for mild-to-moderate hypertension. And trials show that lowdose thiazide diuretic plus a potassium-sparing diuretic eg amiloretic is better than a thiazide alone, and such combination was the only drug regime  associated with halving of dementia in the Cache County study.

It has been established for decades, and we see in hypertension practice every day, that the best results, with zero adverse effects, are with low dose of reserpine eg starting with ½ a reserpine tablet (ie 0.125mg/day) and half an amiloretic tablet (ie 27.5mg/day); usually reducing to ¼ of each tablet daily after a week. In many cases the dose can be reduced to 3 times a week because amiloretic has a gentle action over 24hours, but reserpine over weeks- so (unlike with modern drugs) forgetting the occasional dose does not matter. It’s cardioprotective, bone-protective and antianxiety benefits persist, with neutral effect or benefit on the metabolic and allergic and oedema  problems that abound with modern regimes.

But under Antihypertensives and Hypertension, this optimal regime is barely mentioned to be condemned – because it is old-fashioned, and the most effective therapy for mild to moderate hypertension. But it costs as little as $0.50 a month in eg South Africa, 1/300th of the price of an inferior designer combination like Prexum Plus. So it was removed from state codes in eg UK, Europe and South Africa precisely because it is too cheap and too good, it drastically reduces revenues from modern drugs. This despite the fact that this optimal combination has not been tested as first-line therapy against any modern drug- trials up to the 1990s showed that it was too good, so no drug company dare allow head-to-head trials again. And Regulators and involved politicians simply ignore these hard facts since their massive incomes depend on promoting modern, not old, drugs.

1.4 Antidiabetic and anti-obesity drugs: Wiki correctly says “Metformin is usually the first-line medication used for treatment of type-2 diabetes.” In practice, it is always the first line drug in a new type 2 diabetic since such patients invariably have excessive visceral girth and body fat if not rising BMI (above about 23kg/sqm except in a gymnast/athlete). But Wiki then perpetuates a disinformation myth: “Initial metformin dosing is 500 mg twice daily but can be increased up to 1000 mg twice daily”. This is nonsense, the reason why so many patients drop out of metformin trials and treatment, since perhaps half of us ( especially smaller people) are genetically slow metabolizers of metformin. . Metformin must simply be started at very low dose eg ¼ tablet (125mg/day), and adjusted upwards every day or two to tolerance- avoiding more than reduction in appetite and loosening of stools… with this simple approach, whether for diabetes control or, far more important, for obesity-diabetes and polycystic ovary syndrome prevention , the average tolerated dose is about 2.5 to 3gm a day in split dose (except with the new sustained release tablet). .

Wiki then says “metformin is also available in combination with other oral diabetic medications.”- but this is also dangerous marketing hype, such fixed combinations are to be avoided at all costs  since combination of metformin with any other antidiabetic drug both brings the disastrous risk of hypoglycemia, and neutralizes some of the benefits of  optimal dose metformin combined with optimised diet and lifestyle.  This is the heart of the reason not to delay metformin till diabetes- neurovascular- pancreatic disease is established, by when sometimes irreparable damage – glycation – is common, with irreversible eg kidney, nerve, eye or heart damage.

Wiki correctly states that the French drug  rimonabant was soon abandoned, and never released in the USA. And under Obesity Wiki indicates the adverse effects and lack of longterm safety-efficacy data that confirm why orlistat and sibutramine have no place in overweight-obesity-diabetes prevention and treatment when metformin is by far the best proven. .

1.5 NSAIDS NONSTEROIDAL ANTI-INFLAMMATORY DRUGS: The Wiki entry is pretty good except that it ignores the obvious – not only are these drugs poor analgesics, little better than the old paracetamol Tylenol, but they also have major risks- not just gastrointestinal bleeding but also heart and kidney failure, dermatoses and sudden death. Wiki discreetly omits to mention that there are many cheap proven old supplement NSAIDs  that in combination do better without risk (eg MSM methylsulphonomethane; vitamins (B3, B5, C, D); curcumin; cat’s claw, boswelia, bromelain, arnica, fish oil) than the problems of aspirin and the other myriad patent NSAIDS; and that, trauma aside, NSAIDS do nothing for the cause ie the underlying disease.

And there is no evidence whatsoever to support the for-profit rationale for promoting use of the NSAIDS- that they (even ibuprofen) are any better or safer short-term or long-term than judicious appropriate use of paracetamol+-codeine, or natural supplements eg judicious appropriate steroids- whether corticosteroid, secosteroid (vitamin D3) or sex steroid SHRT eg estrogen and testosterone. Detailed referenced reviews the past year on each of these topics are published below.

1.6 FISH OIL: Coyly, the only NSAID that Wiki lists under “other” is omega 3 – which actually reduces all major degenerative diseases and mortality by 20 to 50%…

But Wiki certainly gives full credit to the myriad health  benefits- and lack of adverse effects- of fish oil -EPA+DHA – in appropriate dose.

1.7 MULTIPLE DESIGNER DRUG INTERACTIONS: The older we are, the more likely we are to suffer from multiple chronic diseases, the more likely we are to be recommended different drugs for each disease- especially if we shop around consulting a doctor per disease. In particular, the use of multiple designer and synthetic drugs that interfere with normal metabolism is high risk- and becomes higher in older people who are prone to combined degenerative diseases like osteoporosis, muscle frailty, vascular disease, diabetes, anxiety, depression, arthritis and infections.

Eg there are on Pubmed since 1992 at least 6 reports on serious bisphosphonate – induced dermatoses, and 9 on statin dermatoses. . Statins are notorious for causing insidious myositis- especially with antibiotics; and there are reports of myositis-arthitis with bisphosphonates.   Statins can cause interstitial pneumonitis, fatigue and  weakness; bisphosphonates can contribute to lung problems via reflux, antihypertensive drugs via bronchial irritation. NSAIDs cause gastritis, oedema, hypertension, heart failure. the modern antidiabetics and antihypertensives  can aggravate heart failure. Yet doctors who advise against any HRT and other medicinal supplements frequently prescribe statin, bisphosphonate, NSAIDs, modern antidiabetics, antihypertensives  and periodic antibiotics together. This is criminal, since these drugs are mostly  unnecessary in either mild-to-moderate lipidemia, or osteoporosis, or arthritis, or hypertension, or  type 2 diabetes.

In conclusion, especially as specialists  (except for the old-fashioned increasingly rare general practitioner and the specialist in general internal medicine) tend to be increasingly specialized in one niche organ system or area of medicine ( but not in comprehensive and preventative care) , it is obvious that for serious illness, the patient is advised to study personally the latest illness advances  remedies and problems. But for researching health matters, the public is advised to use the websites of international multidisciplinary expert associations eg ISSAM- the International Society for Aging Males; IMS- the International Menopause Society; and  Medline- Pubmed;

rather than those which are prone to commercial or academic  bias (by local vested/ financial  eg drug/ equipment company/institutional interests) like Wikipedi,   universities, patient support associations,  the FDA/NIH, other National Health Services,  private practice  and craft groups,  or patient’s or lay associations’ reports and advice; especially the mass media which are especially open to marketing hype and sensationalism, and which with publication deadlines and bias to sensationalism, bad or lurid  news,  seldom succeed in tracking down objective unbiased expert opinions.Like Only Disease Pays, Only Bad News Pays.

And once disinformation is published, the media  (unlike Wikipedia) rarely bother to give equal time to  or opportunity for correction of misinformation- eg withdrawing bad information from websites. Which is not to say that old ideas should be deleted from the internet- they should just give the date of last update, and indicate if they are outdated.
Wikipedia health articles should be depended on only if they are certified by international multidisciplinary consensus bodies (of specialists and family practitioners)  like ISSAM and IMS.; or if material facts are referenced to a verifiable expert source. For the reasons stated, neither trials, reviews, metanalyses or “expert opinions” – even on Pubmed- are necessarily reliable evidence.

Detailed reviews of all these topics have been published the past year below on this column.

new from HealthSpanLife.com: OPTIMIZING THE ACCURACY OF WIKIPEDIA IN MEDICAL THERAPY OF THE COMMON MAJOR DEGENERATIVE DISEASES OF AGING:

Wikipedia has become the number one general reference source; and has tightened up considerably on accuracy and objectivity  the past two years, as far as one can judge for topics within one’s own in- depth knowledge. But then Wiki is only as good as the experts who bother to check & upgrade entries in their field.

 

For Bipolar Disorder Wiki indeed defies the Drug Industry and still lists the natural element lithium carbonate first  as the recommended drug for maintenance therapy, ahead of dozens of new competitors for that $multibillion market.. that’s a good precedent for a natural element  used  as a drug the past >150 years.,

 

For eg aspartame,Chronic Fatigue,  Hormone Replacement Therapy, Menopause; the Womens’ Health Initiative and andropause- androgen decline in aging males  the respective Wiki articles pretty accurately sum up the opposing views and evidence without apparent bias.

 

eg overweight  it sensibly  defines  as BMI above 25kg/sqm, and obesity above 30kg/sqm.  It notes that obesity is already the second leading cause of death in USA, reducing life expectancy by 20% in men and 5% in women-  the causes including the pervasive endocrine disruptors (estrogenic and insulin –desensitizing) – that saturate our homes, offices and food chain; and only 20%  of Americans successfully maintain longterm weightloss with diet and exercise.

    It notes under Biguanides that they were found in the 1920s to lower high blood sugar, but were then ignored due to the simultaneous commercial production of insulin.

 

But in the field of $trillion competitive drug marketting for the most common chronic diseases, Wikipedia articles still appears dominated by those with the biggest commercial interests ie the Disease Industry… 

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Under weightloss drugs it’s Obesity entry (updated to this month) lists only the antiobesity drugs recommended by the now-ancient 2005 (Am Coll Physicians) position paper: sibutramin, orlistat, diethylpropion, fluoxetine, bupropion, amphetamines- even though there are no even medium-term let alone longterm trials validating these for high benefit to risk ratio, they are all (now including rimonabant)  severely limited if not contraindicated by major adverse effects.

 

Metformin is dismissed in one line: “to treat diabetes..  Metformin may lead to mild weight loss in comparison to sulfonylureas and insulin..  in obese type 2 diabetics”. And the Wiki metformin entry does not even mention it’s overwhelming benefits in treating overweight- prediabetes and in reversing obesity in longterm use (up to 4 years reported so far in primary trials)- that we have been publicising for the past decade.

 

Similarly with another trillion-dollar industry – hypertension:

Under Reserpine, wikipedia correctly says “Reserpine is one of the few antihypertensive medications that has been shown in randomized controlled trials to reduce mortality..”

So WHY under the Wiki hypertension entry  treatment is “Reserpine listed as a second line choice by the JNC 7”? It has been common cause for some years now that so many mechanisms are at play in increasingly common “essential” hypertension, that once antihypertensive drug therapy becomes advisable, it is best to start with a combination that addresses as many of the causative mechanisms as possible for the lowest risks. The evidence, and daily experience, continue to grow that combined lowdose reserpine plus lowdose amiloride + thiazide amilothiazide (ie three drugs) is remarkably effective for the great majority of mild to moderate hypertension patients, at a (South African) retail cost of perhaps $6 a year, without any of the risks and costs of  all modern heavily marketed antihypertensive drugs (see wiki entries for each of these!. It is noteworthy that UK and EU authorities have removed reserpine from formularies – , as have the RSA state clinics and Hypertesion Society – without giving scientific reasons since there are none – but as in USA and most other countries, where reseprine is still available, experts agree that  the triple combination of these three is the best bedrock antihypertensive therapy there is.

 

Similarly, under analgesics  and non-steroidal antiinflammatories NSAIDS: because there is none, Wiki (like the Drug Industry) can quote no evidence to justify acetaminophen- paracetamol or any  other NSAIDs including aspirin as the drug of first choice for mild pain, since these drugs  are notorious for potentially lethal adverse effects. There are no trials to show  that, safety aside, NSAIDs are any better than many natural drugs available in simple combination orally and topically  eg fish oil, MSM, cat’s claw, arnica, boswellia, bromelain, capsaicin  etc, and proven by centuries of common and safe effective use..

 

On erectile dysfunction ED  Wiki  is even less reliable, stating incoherently (“last updated 30 December 2008”  that “It is rare, but some men receive hormones for their erection problem” . This appears either  to underestimate the percentage of ED cases around, or denigrate  the many in whom  testosterone deficiency plays an important role. The rule of medicine is, don’t be rigid about “normal ranges”- for especially the common hormone deficiencies, be aware of both hormone resistance and relative deficiency/ imbalance. And it ignores the fact that many using eg Viagra (which can occasionally kill, maim or blind) do not need Viagra, which trials show  does not work without enough testosterone around- and appropriate testosterone does vastly more global good.

   Wiki fails to point out the glaringly obvious that, having created a new common disease of Erectile Dysfunction, Pfizer has worked hard to cover up  the risk, and low need for, Viagra. Pfizer  flatly refused our request to disclose let alone publish the serum  testosterone mean and range  in the men who were enrolled in their vast Viagra trials-  they and FDA at first claimed privacy! Then when we invoked the freedom of information principle, they concocted a new blockade, that such info could only be made available on an institutional application…  but since institutions depend on Industry for research funding, a couple of local and USA institutions backed off submitting the formal applicatiion Pfizer and the FDA demanded. So whats new?.

 

As Wiki says, “Viagra  soon became a great success: annual sales of Viagra in the period 1999–2001 exceeded $1 billion.[citation needed]” ..but Wiki does disclose the many major complications that Viagra  can cause, although it does not mention  that Pfizer and the FDA summarily shut down the reporting of deaths on Viagra in about 2000/2001, by when reported sudden deaths (let alone strokes, heart attacks, blindness etc) on Viagra  had passed 1000. Pfzer blithely ignores the hard fact that appropriate use of testosterone replacement (let alone anabolic steroid abuse) has never been associated with increase in sudden death the past 70 years – quite the contrary since it suppresses class 3 arrhythmia- the opposite of Viagra .  And Wiki reports that even a diehard antagonist of anabolic steroid abuse at the FDA Dr Gary Wadler  admitted under interrogation that there is no evidence that anabolic steroids are “highly fatal”, when  in UK this year “anabolic steroids are classified as class C drugs for their illegal abuse potential, which puts them in the same class as benzodiazepines and canabis”- addictive drugs but vastly  safer than the addictive sugar, cigarettes and alcohol ) . http://en.wikipedia.org/wiki/Anabolic_steroid .

 

Probably most users of the internet include Wiki in any subject search, but Wiki should always be verified by primary sources if available, since a lot  of what Wiki publishes is simply opinion. We know only too well that a lot of belief in medicine is simply that- dogma unverified by either hard longterm  observational or trial data, Shaughnessy and Slawson’s gold standard “Patient Orientated Evidence that Matters”. www.annals.org/cgi/content/full/126/8/667

 

So we all owe it to Wiki to check topics in which we believe we are experts, and contribute to veracity with verifiable refereces where we can. For the Disease Industry and the inexhaustible media they fund for their benefit, ignorance (in patients let alone doctors) is bliss when it prevents the public- lay and health-  from seeing through marketing deceptions.

 

Best wishes for a better new year,