An Apple A Day

This video talk is exceptional. You will find it interesting and surprising. The presentation style is very cool and the information is accurate, overlooked and extremely important.

Most of my patients are concerned about adverse effects of prescription medications. My own skeptical attitude on this and other issues underlies my approach to patient care, and has done so for as long as I have been practicing medicine.

Prescription medications can be life saving, but for many reasons, they can also cause problems. Most of the problems they cause are not so bad, but others are lethal. Some of their most devastating ill effects are quite unpredictable. Too often the medications do not work that well either, despite the incredible sums spent marketing them to all of us (doctors and patients) as simultaneously powerful and harmless. Using these medications is a trade-off between risk and benefit. None of them are “a sure thing”, and it is wise to carefully consider all options before choosing the prescription route.

Generally Americans are not as critical of prescription medications as we should be. Almost on a daily basis I see patients who are suffering the ill effects of some medication, and too often the connection between the medication and the patient’s distress is unrecognized. Sadly, it is not only the patients who are unaware. In fact, numerous patients have complained to me that another physician denied that the bad reaction they had been suffering was caused by the medication. Usually that adverse effect has been well-known, or at least well-documented in the medical literature, and it only takes a minute to look it up. Other times the particular adverse effect is rare and the physician’s adoration of prescription medication keeps him/her blind to the harm it is causing. Regardless of the reasons for this problem, a new study adds to the evidence affirming that those of us with this world view are right to be skeptical.

The study looked for a connection between a variety of medications and violent behavior. Twenty three drugs apparently made those using them more likely to commit acts of violence. Eleven of those 23 were antidepressant medications. Six were sedatives. Three were medications for ADHD.

It would make sense for these findings to be spurious. People with emotional problems are more likely to be violent at some point. We have seen a correlation between ADHD and violent behavior. However, like all reviewers I know of, in my opinion these findings are meaningful because of how the study was designed and the unpredictability of some of the results.

One surprise was that the worst drug was a drug used for smoking cessation varenicline (Chantix). Another surprise was that there was little if any increase in violent behavior linked to anti-seizure medication. Only one antipsychotic medication (ABILIFY - arpiprazole) was associated with increased risk of violence. The lack of a general association betwen antipsychotic medication and violent behavior is striking, as those are the patienst most likely to be violent in the first place. This nonassociation strengthens the contention that the other drugs are in fact causative.

In a side note - although ABILIFY was not strongly linked to violent behavior, I am concerned by how intense the marketing campaign supporting it has become. Magazine ads and TV commercials are pushing people to add ABILIFY to their antidepressant medication. At this point in time antipsychotic drugs like ABILIFY have become the most commonly prescribed drugs in America.

Medicine has an unfortunately well-established pattern of relying on drugs that we think are safe and effective, only to later determine that they are so bad that they are banned. Patients complain of bad reactions. The medical community at first disparages these concerns, especially if the ill effects of the medication are psychological. Early reports of PROZAC and other SSRI drugs leading to suicide, and the anti-malaria drug LARIAM causing anxiety, paranoia and psychosis were pooh-poohed by the medical profession. Those adverse effects are now well-recognized.

The bottom line is that you should be careful about using prescription medications. If you feel a medication is causing you harm, seek expert help, but honor your own sense. You know more about you than anyone. You are the resident expert in your own health care team.

Vitamin D has been all the rage for a few years. Ironically, despite the fact that everyone knows that our bodies create vitamin D in response to sunlight and most of us experience mood changes during the darker months, the high likelihood of a link had not been researched.

A study was just published correcting this blatant neglect and it was a very well designed interventional trial to boot. Over 900 elderly women and men were evaluated for evidence of depression and tested for their vitamin D blood level. They were followed for 6 years. At the end of the study women who had low vitamin D levels at the beginning of the study were twice as likely to develop depression. Low vitamin D males were 1.6 times as likely to become depressed.

Multiple Sclerosis has long been linked to vitamin D, with deficiency likely to make people susceptible and supplementation as an effective treatment. The association between vitamin D and MS is clearly important.

Other recent studies have confirmed links between vitamin D levels and various neurologic diseases, including Alzheimer’s. Sceptic that I am, some of those studies do not prove causation to me. I want to know that blood levels were low before the onset of any symptoms because people who are not well, especially if “not well” includes limitations to their mobility or thinking, will tend to go outside less than other people. Consequently they will have relatively lower vitamin D blood levels.

One recent study of Parkinson’s Disease and vitamin D does, fairly well at least, satisfy my skepticism. Finnish scientists analyzed blood of 3,000 individuals sampled between 1978 and 1980. After 30 years they found that individuals with the lowest levels of vitamin D were three times more likely to have developed Parkinson’s compared to those with the highest levels. As the number those developing Parkinson’s was small and the study was not one where vitamin D was given to healthy people to see whether Parkinson’s was prevented by the intervention with vitamin D, there are still some flaws but not enough to discount the findings. As we have often observed links between various environmental toxins and Parkinson’s and vitamin D helps our bodies clear such toxins, a causative connection is certainly possible. Also, as vitamin D has so very many biological effects, it is certainly possible that it might influence the rate of Parkinson’s and other neurologic disease by other means.

As is perfectly obvious at this point, everyone excepting a very few with a couple of rare disease, should make certain that she/he has good levels of vitamin D . In my opinion that means 50 ng/ml or above.