And more thought, if the proof is in the pudding, then the devil is in the details. Just as when a randomized controlled study demonstrates the benefit of some particular drug, we cannot automatically generalize those same results to another drug in the same family. So whether you believe in the benefits of chelation with regards to cardiovascular events, remember that this study was one of 30 weekly infusions plus an additional 10 infusions 2-8 weeks apart of a 500mL solution comprised of 3g of disodium EDTA, 7g ascorbate, B vitamins, electrolytes, procaine & heparin vs placebo. Another part of the arm randomized patients to either an oral mineral-vitamin vs an oral placebo. Thus was the 2x2 factorial study developed. My point is that we need to acknowledge that chelation therapy has many variations on a theme and this study was specifically on this regimen, not to be generalized to all chelation solutions.
Turns out it's allergy season around here, especially with all the olive trees blooming. Seems everyone is complaining of itchy watery eyes & runny stuffy nose, so we prescribe a lot of oral & ophthalmic antihistamines as well as intranasal steroids. But there's always someone who wants a course of oral steroids or a corticosteroid shot. It's the only thing that works for me, doc! I try to dissuade these patients of their request and point out (nicely) the folly of their shortsightedness. When used w/o oversight, the benefit of oral/injectable steroids is outweighed by their potential side effects, including but not limited to cataracts, diabetes, immunosuppression, osteoporosis & striae (stretch marks), etc.
What amazes me is that some of these patients still insist on getting their steroids. Well, as I mentioned yesterday, take the medication only if you need it and only if the hoped for benefits outweigh the potential risks. Personally, I'm not convinced that the short-term gains are worth the long-term risks but I guess I've never been beset by allergies like this patients, so I shouldn't force my views on them but rather just provide education.
Well, along those lines, a population-based nested case-control study was published yesterday in JAMA Internal Medicine, in which the authors concluded that oral glucocorticoid use is linked to an increased risk of acute pancreatitis. Of note, the participants were 40-84yo Swedes of whom 6,161 cases of initial acute pancreatitis were compared to 61,673 controls, each selected based upon similar age, gender, and calendar period. Greatest risk for this exquisitely painful condition occurred 4-14 days after starting glucocorticoid therapy. Recent use & former use did not increase risk, nor did stopping use.
So be careful what you wish for. That short course of corticosteroids might relieve your allergies but could also potentially bring about some rather painful consequences. Granted that's a big step to assume cause & effect, which this study was not designed to do, but the association was strong and the outcome poor. So why take that risk unless you feel it's absolutely necessary? Caveat emptor.
While I was doing the online equivalent of dumpster diving this weekend, I stumbled upon a number of tweets and questions surrounding the use of medications. On the one hand, many people write into any number of health care forums (I participate on www.healthtap.com) and ask about possible drug-drug interactions regarding their regimen. I find this a sad commentary as these questions should have been addressed by the physician at the time of prescription & re-addressed by the pharmacist at the time the medication was dispensed. Unfortunately, in this day and age, we don't have time to go into detail with our patients as accountable care organizations force us to become more efficient at data entry under the guise of providing better care.
As a result, there has been a backlash by patients who've lost their trust in their doctors aka healthcare providers. We're seen as pawns of Big Pharma, or worse, as salesmen pushing the latest medication on an unsuspecting population. Selective serotonin reuptake inhibitors are now being blamed for suicides and homicides. Yet, just two short decades ago, these very same SSRIs were considered a God-send as they were found to be useful in treating those with depression. And if you think about it, who's more likely to commit suicide? A depressed person or a non-depressed person? So blaming SSRIs for causing suicides is like blaming cars for killing others while the driver was under the influence.
If you're depressed such that counseling isn't enough, yet refuse to take any antidepressant out of fear that it might cause suicide/homicide, you just might commit some regrettable action even w/o taking said medication. Likewise, if you're now afraid of taking any antibiotic (healthy skepticism is a good thing), then your risk of dying from said infection is greater than if you didn't take the appropriate medication. So be sure not to rush your doctor for empiric antibiotics just a few days into a cough & runny nose (www.ChoosingWisely.org). And be sure s/he knows every medication & supplement that you're taking. Don't throw the baby out with the bath water.