WEEKLY HEALTH BULLETIN July 3, 2009

MORE DRUGS IN THE NEWS YOU SHOULD KNOW ABOUT

TAMOXIFEN AND SSRI ANTI-DEPRESSANTS DON’T MIX

Tamoxifen is a drug that has been used for nearly thirty years to treat what is referred to as receptor positive breast cancer.  Receptor positive cancer simply means that the cancer cells have receptors to which estrogen can bind.  75% of all breast cancers are receptor positive.  Tamoxifen has been the subject of extensive research and is a mainstay of breast cancer treatment around the world.  It interferes with the binding of estrogen to these receptors and thus confers a protective effect.

It turns out that the SSRI antidepressants paroxetine (Paxil), fluoxetine (Prozac), and sertraline (Zoloft) all inhibit the liver enzymes that process Tamoxifen (the CYP2D6 enzymes).  This results in a reduction of active Tamoxifen and a loss of effect.  This means women on Tamoxifen have a higher risk of breast cancer recurrence when placed on any of the above anti-depressants.  About 30% of all women on Tamoxifen are put on SSRI antidepressants for hot flashes or depression.  Three other anti-depressants – citalopram (Celexa), escitalopram (Lexapro) and fluvoxamine (Luvox) do not pose this problem.

As an alternative to SSRIs one might consider basic nutritional mood support in the form of omega 3 fatty acids from fish oil (1000 to 2000 mg DHA plus EPA daily), vitamin D3 (2000 IUs daily) and a B complex multivitamin.  Omega 3s, vitamin D and the B vitamin folate all have well understood anti-cancer effects.

ARICEPT MAKES YOU FALL DOWN

Drugs commonly prescribed for Alzheimer’s Disease increase the risk of a slow heart rate and fainting as well as the resultant falls, hip fractures and pacemaker insertions.  The benefit of the pricey drugs is modest at best; it is indeed slim enough to have caused outrage among quite a few mainstream psychiatrists able to analyze the research themselves and who are not in some kind of financial relationship with the drug companies.  The use of these essentially useless drugs results in a multi-billion dollar expenditure in this country that would be better spent on caregiver support.  With a vanishingly low upside and significant harm potential, why do so many doctors insist on prescribing them?  Great Britain has deemed them a waste of money and stopped paying for their use.

The drugs in question are “cholinesterase inhibitors” Aricept, Exelon and Razadyne.  Looks to me like these widely used drugs are worse than nothing . . . at a truly astronomical cost.

MORE PROBLEMS WITH THE “LITTLE PURPLE PILL”

I previously wrote about a problem with acid-blocking proton pump inhibitors (PPIs). They boost the risk of pneumonia when used to prevent stress ulcers in hospital patients.  There is no evidence these drugs prevent stress ulcers in low risk patients, who constitute the majority of people who receive them.

It turns out their free use may account for as many as 33,000 unnecessary deaths a year from pneumonia in this country, a truly staggering toll.  PPIs include Prevacid, Prilosec, Protonix, Aciphex and Nexium, the infamous “little purple pill”.

These drugs cause other problems.  They increase the risk of something called Clostridium difficile diarrhea, a common problem, especially in patients who have been placed on antibiotics.  PPIs also interfere with nutrient absorption, which with long term use can result in deficiencies in zinc, magnesium and calcium.  It is probably for this reason that they are associated with increased risk of hip fractures and osteoporosis.  They also cause something called small bowel bacterial overgrowth (SBBO), which can interfere with normal digestion and irritate the immune system, increasing the risk of asthma and other allergic symptoms in susceptible individuals.

I hope the message is clear; these drugs are bad news when used regularly.  There few drugs used today that lead you on the path to so many other serious health problems.   Unfortunately, most conventionally trained doctors are ignorant of these ill effects – or choose to ignore them because they figure they won’t happen in their own patients.  They continue to hand these out like candy to their patients.

In future issues I will revisit safer, more accurate ways to think treat the variety of gastrointestinal complaints these money-making drugs get thrown at with such reckless abandon.

Alan Inglis MD
American Country Doctor