Thursday, 31 October 2013

What Zombies Don't Tell You

Today it is Hallowe'en. And in honour of one of the scariest, most horrific things to have happened today (the release of What The Doctors Don't Tell You's clearly illegal and highly dangerous Cancer Special), here is the fruits of my lunch hour's labour:

You're welcome, world.

Enjoy Hallowe'en.


Disclaimer: The advice given in this publication  is not intended to replace that of Randy. Before following any of the advice given, please check with him first.

PS: Randy is an obscure reference to the We're Alive podcast. If you're a Behemoth zombie, you're probably already riddled with tumours anyway.

PPS: Brains probably don't cure cancer. But then neither will any of the other nonsense that What The Doctors Don't Tell You are peddling. 

Is XLS-Medical Fat Binder worth its weight?

Oh Omega Pharma. Once again you provide me with some juicy blog fodder.

XLS-Medical Fat Binder has been on my radar for some time, but I haven't really gotten round to writing a blog post on it or taking a proper look at the evidence. However, prompted by a bit of real-life work I've just been doing, I've been doing some digging.

So what is it? Well, it contains something called litramine, which appears to be a cactus extract. It supposedly binds onto dietary fat and stops it being absorbed. Sounds suspiciously similar in action to orlistat, a licensed medicine. However, XLS- Medical Fat Binder is instead marketed as a medical device.

Here's what the company have to say on the matter:
"What is a medical device and how does it differ from traditional medicine? 
  • A medical device is designed to work on or inside the body - either temporarily or permanently. Its main aim is to prevent, diagnose, monitor or treat diseases. 
  • The key difference compared to traditional medicines is that medical devices work mechanically as opposed to pharmacologically. So it works alongside or with your body rather than affecting the chemistry of the human cells."
I think what they've missed out here is this: "If we sell this product as a medical device we just need to fill in a form and send it to the MHRA rather than actually having to bother proving that it works so YAY LETS JUST DO THAT!!." It would seem pretty bizarre that orlistat, which is also not absorbed from the GI tract and which also prevents absorption of fat from the diet is regulated as a medicine whereas this product isn't.

What of the evidence? Well, Omega Pharma once again provide us with a list of the most vague references ever seen, making it virtually impossible to find anything to back up the results they are shouting about. As references go, just writing: "In vivo, 2-armed, randomised, placebo-controlled, double-blind study, conducted in Germany, 2009" is, as someone so succinctly put it on Twitter, the equivalent of saying "This one time, at Band Camp...". These studies don't appear to be published in any peer-reviewed medical journals, so there is no way to verify the results from them. Oh dear.

Well, two can play that game.

Of course, not one to rely on the manufacturers alone, I performed a literature review to see if there was anything else out there. And there is: all of one study. And to be honest, the results are promising. Whilst there is a link to this bit of evidence on the XLS Medical website, its hidden away in the tiniest of tiny footnotes, which seems a bit odd really, given it seems to show that Litramine actually works. The trial appears well desgined (double-blind, randomized, placebo-controlled), and whilst not massive (n=123), it isn't as tiny as the usual sort of guff that can be purported as evidence. Patients who used Litramine lost an average of 3.8kg (+/- 1.8) compared to 1.4kg (+/- 2.6) in the placebo group (p<0.001), which actually seems rather encouraging.

Hang on though, let's not all jump for joy and throw away the salad leaves just yet. Patients in the trial had a hypocaloric diet plan and exercise regimes. The trial only lasted for 12 weeks, so is pretty short- term. and of course its still quite small, and the results would need to be replicated in further, larger, well-designed trials before we could know for sure.

And here's the big problem with it. the study medication is described as:

"Litramine IQP G-002AS is a natural fiber complex derived from Opuntia ficus-indica, enriched with additional soluble fiber from Acacia spp.IQPG-002AS is standardized for its lipophilic activity and has been shown to reduce the dietary fat absorption through GI fat binding." 
The study participants were given 500mg tablets three times a day. However I can't see anywhere on the XLS-Medical website that actually tells me how much litramine is in the tablets- it could be 5mg or 500mg. . So whether or not we can apply these promising results to XLS-Medical, we simply can't say.  
And wahoosa are these things are expensive. £39.99 for a months supply? That's six and a half hour's work at minimum wage.


Monday, 21 October 2013

Facebook, breasts, and why the combination of both annoys me.

"I like it on the living room floor!"

"I like it on the kitchen counter!"

Blah blah blah. These are the sorts of bawdy Facebook statuses that surface every year. They're then followed up with a message along the lines of "hey, let's not tell the MEN what we're doing, but according to this arbitrary nonsense below, put something attention seeking as your status update to help raise awareness of breast cancer".

There's always the inevitable guilt trip of "most of you wont bother with this, and you're all terrible, terrible, evil people who don't care about people with cancer and you will all go to hell"

These sorts of statuses/ messages have always bothererd me. The whole Carry On Breast Cancer vibe is just uncomfortable, for starters. They are infused with the same sort of superstitious, guilt-ridden nonsense as the old chain letters you used to get back in the late 80s. And people seem to go to great lengths to defend them, and any even remotely negative comments about them are batted straight back with an unthinking "why wouldn't you want to raise awareness of breast cancer? are you some sort of EVIL PERSON?!"  I have raised the point on my own Facebook and have also seen some friends take flack for daring to question these games.

There is a great piece of writing about exactly this subject that you can find about this subject here. You'll also find a piece from Skepchick here. However, there are a couple of other points that I want to raise in addition and to compliment the points raised in that piece, and some of the arguments used to defend the game that I have seen used on Facebook. These points are in no particular

How much awareness are these "games" raising? 
Given that the messages contain no information on the symptoms or how to check for breast cancer, or any links to good quality information sources, I'm not convinced that it is raising awareness. There have already been huge campaigns to raise awareness of breast cancer- people in the main already know that the disease exists. Therefore this campaign needs to add something specific to that: how best to check for signs of breast cancer, practical tips, or signposting to other good quality sources of information. Furthermore, actively excluding an entire gender or other large group of people from your awareness campaign seems like a very odd tactic indeed. The messages include how the "bra game" made it to the press- this appears to be the case, although not in the way the message would like to imply. But have any of the other campaigns that surface regularly made it to the press? I certainly haven't seen so.

Who has started these campaigns, and what charity etc are they raising money for? its not clear, and it would seem that no one knows who or why they originated. So what sort of awareness are they really raising?

Cold, hard cash
These games aren't asking for money to be donated to any particular charity. Yet, when it comes to cancer research, it is cold hard cash that makes the difference. There is a risk that people may feel that by taking part in the game, they have done their bit already in helping to raise awareness, which might discourage any further action. In actual fact, if you want to help, donate some money to a cancer research charity.Is there any evidence that this sort of bid to raise awareness translate into money being donated? No, of course there isn't, so we should all be focusing our efforts elsewhere.

Really people, are we that unimaginative that we require this arbitrary nonsense to put something titilling as a status? Do we so desperately want to feel a part of something that we will lower ourselves to this sort of bawdy crap? Can we really not think up any better innuendos to grab male attention as we appear to be so desperately doing here? These sorts of statuses sit on the same level of annoyance as the ones that are simply an unhappy face so that many people will reply with "what's up hun?" and the original poster will get lots of attention. If you want to be tacky and attention seeking, go right ahead, but do so with a bit of imagination and personality, not according to some formulaic crap involving handbags.


In 2010, breast cancer rates in men were approximately 1 per 100,000. Just imagine how emasculating, shocking, and devastating this diagnosis may be. The fact that bright pink is constantly associated with this disease can't help matters. That awareness campaigns like this one actively exclude men is frankly unforgivable. Campaigns that raise awareness of testicular or prostate cancer are often very inclusive of women (I'm thinking of the Movember campaign in particular, problematic as it may be for other reasons), despite the fact that for obvious reasons the likelihood of women getting these types of cancers is zero.

In addition, as a good friend of mine pointed out, it may be men who notice or feel changes in their partner's breasts before they do. Why would they therefore be excluded from any awareness campaign? It just doesnt make sense.

"Oh but its just a bit of a laugh isn't it?". I've seen this used as a defence for these games. No actually, no its not a bit of a laugh- its breast cancer, for crying out loud. Humour is undoubtedly a powerful tool in coping with such a diagnosis, but this is going to be different for everyone and needs to be treated as such. some people might find this funny whilst others might find it plain offensive. No Facebook chain message is going to be able to deal with the complexities of when and how to use humour in the face of a potentially devastating diagnosis.

So there is some thoughts to be going on with. I may or may not add to them as time goes on. In the meantime, if you'd like to do your bit, you could always donate a few pennies here. Meanwhile, for information on how to check your breasts, try this Breakthrough Breast Cancer page.


Thursday, 10 October 2013

So this one's for the friends

"So this one's for the friends
If not so for themselves
And this new life's directing us
Remind us in a town
You made us feel at home
We broke our backs on floors of stone
But I'd rather wake there any day
Than wake up here alone"
-The Chronicles of a Bohemian Teenager, Get Cape. Wear Cape. Fly

Today is World Mental Health Day. although this year the focus is on older people, I am in a nazel-gazing, emotional kind of a mood, and have found myself thinking a lot about my friends.

There are two aspects to this. Firstly, I know a lot of people with varying degrees of mental health problems. In fact, I would say that I probably know more people with some sort of mental health problem than those who don't. I find myself thinking of how much I wish I could change how they feel, draw out some of their pain or anxiety or depression for them and lighten their lives a little bit. I think of how wonderful and individual they are, and how amazingly brave and strong they are. The reasons for their problems are as diverse as they are- if there are reasons. I think of how badly they are treated by others, of the stereotypes that are applied to them, and want to shout from the rooftops about how wonderful all of these people are.

The other aspect is how my friends treat me. Its not big, sentimental gestures, nor is it anything to do with the length of time I have known someone. Its the bunch of flowers and bottle of wine that arrived in the post a few days after my marriage broke down. Its lending me an oil-filled radiator when the heating in my flat has broken and fixing my DVD player. Its letting me sit on the sofa in their house in silence because I don't feel like speaking but I don't want to be on my own. Its the rushing round to my flat to remove a spider because I'm too scared to do it myself. Its the constant sarcasm and good-natured banter at work. Its the tweeps who always cheer me up and check how I am when I am in a self-pitying mood, and the patient soothing of my drunken self via WhatsApp at 3am. Its the afternoons of laughter and the knowledge that, if I need to cry hysterically I could, and no one would think any worse of me. Its the quiet, unthinking hug when I am struggling to smile during someone's wedding, or the amazing poem written for my birthday.

These are the sort of things that I have built into my little emotional fortress. There are people out there who can't understand where I derive meaning from in life- I have no god, no children and no husband after all. But all of these little gestures, and all of these wonderful people form the basis of my meaning. Without them, I really don't know where I would be, but I'm pretty sure it would be an awfully dark place. This, for me, is the foundation of my humanism.

I don't tell my friends this kind of thing enough, but I'm so thankful and lucky to have them.


Monday, 7 October 2013

CBT session one

So last Friday I began a course of Cognitive Behavioural Therapy sessions, to help me deal with the social anxiety that I talked about in a previous blog post.

I don't really expect to learn anything new from the course, to be honest. I'm pretty good at accepting, rationalising and challenging myself to face my fears, but what I'm finding more and more lately is that I reach breaking point more easily. I've always been able to keep the anxiety in check and have always just thought that I am shy, but various things- the bout of psoriasis I had, being single again, stuff happening with my friends etc has meant that I've been much less able to control it of late. So much of my brain is taken up by being anxious that there is little left over for anything else. My organization skills, which were poor at best anyway, are completely shot, and even the most basic problems at work leave me feeling totally overwhelmed.

My friends are my world, and its hard for me to describe how much I love them and how much I love spending time with them. Since my divorce, when they rallied round and were totally amazing, I have made sure that they are the centre of everything I do. But this thing is getting in the way of that, and its making me miserable as a consequence.

The best way I can think to describe it is like an energy bar in a computer game, but instead of life force, mine is a social bar. It gradually decreases, then eventually I run out and require recharging. In more stressful situations (like going to parties or meetings where I know no-one, or-horror of all horrors- dating, for example) it runs out a lot quicker than if I am spending time with by best friends. The recharging usually involves lying on my sofa watching old episodes of Dexter and not talking to anyone, although lately I've noticed a much more scary emptiness creeping in, and I can find myself lying on my bed staring at the ceiling with no thoughts or feelings or emotions at all. These hours are terrifying and are something that has never really happened to me before. 

So, having seen my GP, I got referred onto this group CBT course. The irony of being on a group course for social anxiety has not escaped me, and of course I found myself worrying about all aspects of the course. How will I get the time off work? Will I find the place? (this sort of anxiety stems from a fear of looking stupid if I don't know where I'm going) Will I have to make awkward small talk with the other people on the course? Will they think that my reasons for going are stupid? What if I have to speak about my emotions to them? etc etc etc. One of my biggest worries is whether I was bad enough to justify being on the course. The fact that I have spent several days if not weeks worrying about whether I am anxious enough to justify it has also tickled my sense of irony.

Anyway, I managed to find the place, and staggered in red-faced, dry mouthed, sweaty and with my heart beating (irregularly) out of my chest. The other folk in the waiting room looked serene and at home. The course started late due to technical problems, which rather than giving me time to calm down made me even worse.

Once I was in there, I felt somewhat better. The initial session is all about the causes and symptoms of anxiety and how it can manifest in different people, so we didn't really cover any CBT techniques. I was very pleased to hear the trainers talking about the evidence base for CBT, and they explained the pros and cons and process of what we would be doing over the next few weeks. I was starting to feel quite settled. It was nothing I didn't know already, of course, but its always good to know that there are other people suffering from the same thing as you.

Then came the two slides on medication. The slides just covered some really general points which I agreed with, but one of the women there talked about how she didn't want to try any medication as she was so worried about side effects. The trainers said they knew very little about specific medicines, and she should speak to her GP or pharmacist. Well, I tried to keep my mouth shut, I really did, but I couldn't help myself. I thought about just trying to make out like I was someone who knew a bit about medicines, but I could tell that this woman was really worried. She was wanting to try an antidepressant, and thought it could benefit her in the short term, but she was really concerned that they could amplify her anxiety permanently. I wanted to help and reassure her, and before I knew it, I could hear myself saying "I'm a pharmacist..." I explained a bit about how the drugs work, what sort of side effects could happen, and what the sort of terms used to describe how common a side effect is actually mean. She, the other attendees, and the trainers all listened attentively and said how great it was to have it all explained in context rather than to just look at a really long list of scary words on a patient information leaflet.

I left feeling happy that I had shared some of my expertise, but sort of worried about the rest of the course. I fully expect next week to walk in and be asked various different questions about the medicines people are taking. You get used to this happening when you tell people that you're a pharmacist. The problem comes from the fact that now I feel like I need to be "on", and in professional mode, when what I actually sort of want is a place that I can switch off my forcefield and fall apart, so I can put myself back together in a more rational, calmer way.


Wednesday, 2 October 2013

Common Community Pharmacy Annoyances

It's funny how variable working in a community pharmacy can be. Nowadays, I locum here and there, and I tend to really enjoy it. I usually do evening shifts, so you have an hour or two of bedlam, followed by several hours of blissful calm and quiet, where you get to sort out all the outstanding things, do lots of other bits and pieces like checking owings, controlled drug stock levels, and cleaning. I usually also end up having bizarrely deep and meaningful conversations about life, love and philosophy with whoever I am working with. Usually when I leave a pharmacy it is as clean and tidy as possible, I've sorted out what I can, and have left notes for anything that I haven't been able to deal with fully.
I say all this because I lately did one of *those* locum shifts. The ones where it is constantly busy, no prescription is straightforward, the fax machine isn't working, and you seem to have to deal with every problem under the sun. On this particular locum shift, I think my colleagues and I encountered every single type of category of impolite customer possible in a 4 hour shift.
So, because the only way that we can cope with such things is to laugh about them, and because I fancy a self-indulgent rant, here is my compilation of the things in pharmacy that annoy me and that happened in that locum shift.
The Mythical Taxi
Some people do get a taxi to their local supermarket. I have done it myself. But it would appear that taxi companies must have an amazingly lucrative trade in ferrying people to and from pharmacies if the frequency of use of the phrase "Can you do it quickly please, I've got a taxi waiting" is anything to go by. These are not, as far as I am aware, magic words that will somehow warp the time-space continuum so that I am able to dispense and check a twenty item prescription in a mere matter of seconds. Whether or not you actually have a taxi waiting will simply mean that your prescription gets put in the queue in the same place it would have done anyway, and you will wait the same amount of time as you would have done anyway. Needless to say, I suspect that many of these taxis don't actually exist, but merely a tactic used by some people to attempt to "hurry their prescriptions along".
The Dry Chesty Cough
"What sort of a cough is it?" "Well, its a dry, chesty cough."
No, no it isn't. It's either dry or its chesty, its not both. And either way, there is little point buying anything for it given that there is no evidence that any cough medicines work.
The Evil Eyes
Glaring at me continuously for the entire time that I am dispensing your prescription will not in any way speed up my work, and in fact may have the opposite effect as I am more likely to lumber around in a sloth-like manner just to annoy.
"I Need To Be Somewhere"
At 6:05pm, a woman handed in her prescription of 4 items. At 6:07pm, having spent all of two minutes repeatedly sighing and tapping her feet, she asked to speak to the pharmacist. Off I went, leaving a prescription half-dispensed. She demanded to know how long her prescription was going to be (the one I left to go and speak to her), because she needed to be somewhere. I gave her an estimation, told her I was doing it now, then went off to complete it. She then asked to speak to me a further three times to find out how long it was going to be, each time meaning it would take a little longer. "But I need to be somewhere at 6:15!!" she told me each time. I handed her the prescription at 6:12pm, thanking her for her patience. She then proceeded to rant for several minutes about how long the prescription had taken and how it meant she was going to be late and she had to be somewhere at 6:15. She eventually stopped complaining at exactly 6.15, and I returned to the dispensary, whereupon I noticed out of the corner of my eye that she had taken the time to hang around to complain about how long it had taken her to get her prescription to some of her friends who she just happened to bump into in the shop. Goodness only knows what time she actually left.
Invading Privacy
If you have ever picked up a prescription from a pharmacy, you will have probably been asked to confirm your address. This is so that we can make sure that you actually get the correct prescription. This is not because we are evil assassins or because we want to sit in a bush outside your house and spy on you- we really don't- and you're address is written on the prescription so if we wanted to we could anyway. On this locum shift, however, we were accused of invading someone's privacy for asking for this information. "I don't need to give you that information!" he declared. The counter assistant advised him that this is a routine question to ensure that we give out the correct prescription. But this wasn't good enough, and he wanted to speak to someone in charge. Off I went into the breach. I told him that he could come into the consultation room to give us his address so no one could overhear, but this was "an inconvenience", apparently.
By this time, he was shouting and other people in the queue were staring at him.
Again, I advised that we routinely confirm the address to ensure that the correct prescription is given out.
He decided to prove that the prescription was his instead by giving out his name, date of birth, and by telling me every item that was on the script. Loudly. One of which was sildenafil (Viagra).
Magicking Up Medicine
Me: "I'm sorry, we don't have that item in stock. There is a manufacturing problem on it, so we can't get it from our suppliers"
Patient: "But I need it"
Me (in head): "Oh I see. Well if you can hold on a few minutes, I'll just nip round the back into our large pharmaceutical manufacturing factory, dig out the raw materials, and whip you up a batch right now then"
Me (in real-life): "I understand, but I'm really sorry, we can't get any in at the moment."
Patient: "But I need it."
Me: "Where is the nearest wall please, so that I can bash my head against it repeatedly?"
The Expert Customer
I'm advising a patient about how to manage their child's teething problems. Another customer waiting in the queue decides to chip in with "Those Nelsons Teetha sachets are really good." (Nelsons Teetha sachets are homeopathic, therefore contain nothing of use and have no pharmacological effect). From then on, I (and my many years of training and experience) might as well not exist, as nothing I say can steer the patient away from believing that Nelsons Teetha are simply THE best thing since sliced bread, and in her eyes I'm obviously a terrible pharmacist for not recommending them immediately.
Impatient Patient Questioning
You ask the patient all the usual questions. They're all answered with a loud sigh, vacant eyes, and a disinterested "yes" or "no" at all the bits that they think are right. I could be asking anything, and I'd get the same response. So sometimes, I like to mix it up a bit and throw in a question they're not expecting. If its something like Nytol or a codeine containing medicine, I'll ask "Do you take it regularly?" to which the response is usually a bored yes. In which case, I advise them that I can't sell them any, then swiftly duck for cover when they inevitably throw things at me.
A variant You ask the patient if they are taking any other medications, to which they sigh and say "no". It's only when they're about to hand over their money that they a) ask what would happen if they were taking medicines, then confess, or b) whip out an inhaler and proceed to take a couple of puffs right in front of you after they have just told you that they don't have asthma or COPD.
The patient can inexplicably only take one or two brands of generics for a product. You are, of course, expected to telepathically know this and dispense the right one, and woe betide anyone who doesn't. Now, I am entirely understanding of cases where a patient has specific requirements for one type of product- maybe an allergy to an excipient, say. But when there is not reason for it, and the patient is shouting at you for not giving them "the right medicine" despite them at no point telling you what "the right" one is, then I tend to feel a bit put out.
Mobile Misery
Now I am known for being attached to my mobile phone. However, one of the most annoying things when working in retail is having to deal with customers who refuse to hang up theirs whilst you are trying to have a conversation with them. Over a pharmacy counter, we often need to give detailed counselling, and of course we need to ask a lot of questions. I can't really do that if you are also listening to so-and-so discussing who was drunkest down the pub the other night. At this particular locum shift, I had to attempt to explain that there was an item owing on a prescription to a chap who was having just such a conversation. The icing on the cake was when he said to his phone-based friend "Hang on, I can't hear you, this stupid woman keeps talking about something and wont give me my prescription". Needless to say, despite me explaining the owing and handing him an owing slip, he returned a few minutes later demanding to know where the missing item was. This "stupid woman" then had to patiently and politely re-explain everything I had already told him.
How do I deal with situations like this? Politely, professionally, and with a smile on my face. I might have a bit of a rant and a laugh about it later in the back of the pharmacy, but outwardly in these situations I remain as calm as possible and attempt to be as helpful as I can. I've had many years of practice. The worst thing about this shift was that I was working with a new counter assistant and a newly qualified pharmacist, and I could see their morale slipping minute by minute. Their shoulders slumped, their smiles became more forced, and I found myself desperately trying to reassure them that this is just how some days go. Of course, we pharmacy types do make mistakes on occasion, and inconveniences do happen. I can understand that, when it comes to health, people can be scared and anxious, and that can come across as aggression. It is my firm belief, however, that a little bit of kindness and manners get you everywhere, and I am always much more likely to respond positively to calm and polite customers than those who default to outright rudeness, although I will do what I can to ensure that I help them all.