![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by AC75 on February 9, 2006, at 21:18:24
As someone who has taken Concerta for 3.5 years now -- and with a lot of trepidation as to its long-term effects -- I am thrilled that finally an FDA panel has shocked the system into what will surely be further study.
I have told every psych I met -- when they assure me these drugs are totally safe -- that I'm not convinced. Sure, stims have been around since the 1950s, but for most of that period they've been used on kids for some years at a time. The phenomena of adults like me being told that we can take stims till we're 70 is all new, and never been studied.
I KNOW my heart beats faster. I KNOW it feels a little irregular when I run. I KNOW it dehydrates me (by increasing frequency of urination). Every time, I've been told this is all "within the normal parameters."
Well, I'm glad someone blew a whistle that caught some attention. While I'm not looking to get off Concerta, I DO want a LOT more further study. After all, there are 3 million of us on this stuff!!
Posted by AC75 on February 9, 2006, at 21:20:00
In reply to FINALLY! Stimulants will be investigated, posted by AC75 on February 9, 2006, at 21:18:24
If you don't know what I'm talking about, go here:
Posted by Phillipa on February 9, 2006, at 21:41:39
In reply to Re: FINALLY! Stimulants will be investigated, posted by AC75 on February 9, 2006, at 21:20:00
That is alarming news!!!!! Fondly, Phillipa
Posted by alohashirt on February 9, 2006, at 23:09:15
In reply to FINALLY! Stimulants will be investigated, posted by AC75 on February 9, 2006, at 21:18:24
> As someone who has taken Concerta for 3.5 years now -- and with a lot of trepidation as to its long-term effects -- I am thrilled that finally an FDA panel has shocked the system into what will surely be further study.
>
> I have told every psych I met -- when they assure me these drugs are totally safe -- that I'm not convinced. Sure, stims have been around since the 1950s, but for most of that period they've been used on kids for some years at a time. The phenomena of adults like me being told that we can take stims till we're 70 is all new, and never been studied.
>
> I KNOW my heart beats faster. I KNOW it feels a little irregular when I run. I KNOW it dehydrates me (by increasing frequency of urination). Every time, I've been told this is all "within the normal parameters."
>
> Well, I'm glad someone blew a whistle that caught some attention. While I'm not looking to get off Concerta, I DO want a LOT more further study. After all, there are 3 million of us on this stuff!!The level of hysteria/fear around ADHD meds is not reality based. It's just another instance of the "drug paranoia" that had my mother and her peers terrified that LSD dealers were "hooking kids on drugs" by persuading them to lick stickers. Urban myths suceed because people enjoy being terrified.
Lets put this in perspective:
1. The stimulants are better researched than almost any class of medication.
2. "Totally safe" is a chimera and not the issue. Like everything, it's a numbers game. It is hard to estimate the likely fatality count attributable to ADHD but conceivable that it could be much higher than 7 in 3 million per annum. Remember that aspirin and aspirin like drugs kill 1000x as many people as are suspected die from stimulants!
3. If you take the FDA numbers and compare the to the AMA's stated leading causes of death in 2000 its clear that stimulants are safer than toxic f*rts from cabbage afficionados:tobacco 435,000 deaths; (18.1% of total US deaths),
poor diet and physical inactivity (400,000 deaths; 16.6%)
alcohol consumption (85,000 deaths; 3.5%).
microbial agents (75,000),
motor vehicle crashes (43,000),
firearms (29,000)
illicit use of drugs (17,000)
NSAIDs (ibuprofen, naproxen, aspirin) 7600
stimulants FDA suggest 6 or 7I'm not saying "stimulants are safe", but I do think the fear and hysteria make it hard to seriously clearly examine the issues and form a reality based view of the situation.
Posted by AC75 on February 9, 2006, at 23:34:11
In reply to A lot of hysteria about Re: FINALLY! Stimulants, posted by alohashirt on February 9, 2006, at 23:09:15
Absolutely! No dispute there. I'm conservative about my health and if I thought these meds were killers, I wouldn't be on them.
All I'm saying is that it feels often like doctors give us false assurances, depicting drugs (including the stims) as totally safe, risk-free, etc. I've heard this all the time. But I think as a society we're not seeking or getting robust health data. Since everyone is relying on the Ritalin-is-50-years-old logic, it seems there isn't the same push to investigate, investigate, investigate. I welcome anything that makes it happen.
Posted by James K on February 10, 2006, at 1:28:01
In reply to A lot of hysteria about Re: FINALLY! Stimulants, posted by alohashirt on February 9, 2006, at 23:09:15
What happens to cabbage eaters who smoke while drunk driving with a snickers in one hand and a gun in the other? Do they skew the stats for the rest of us?
I've been on drugs that were withdrawn. I'm completely fine. I don't agree with the approval process or the withdrawal process. I'm against it.
James K
Posted by Tom Twilight on February 10, 2006, at 3:54:32
In reply to Re: A lot of hysteria about Re: FINALLY! Stimulants » alohashirt, posted by James K on February 10, 2006, at 1:28:01
I think we should have an open debate on the safety of all psychiatric drugs, so in principal this seems like a good thing.
Having said that I have to points to make
Firstly as Alohashirt has said stimulants are relativly quite safe
Secondly stimulants in the UK are completely safe, because there never prescribed!
As my NHS Pdoc said "Stimulants are addictive and neurotoxic" (I wonder if he drink coffee...)
I'm just concerned that stimulants could be demonised in the US the way they have in the UK
Posted by Etienne78 on February 10, 2006, at 5:29:09
In reply to Be carefull-Is this cover for demonisation?, posted by Tom Twilight on February 10, 2006, at 3:54:32
10 Leading Causes of Death in the U.S.:
http://www.infoplease.com/ipa/A0005110.html
http://www.mydna.com/health/heart/essential_facts/top10mort.html
http://www.soyouwanna.com/site/toptens/accidents/accidentsFULL.htmlthought you would find these informative, as they differ somewhat from the other causes of death posted before.
basically as i have said before...we are all just guinea pigs for BIG pharmaceuticals...no better way to test a new drug than to unleash it on an eagerly sick population wishing on the promised panacea of happiness and calm. oh well... didn't expect much from the same white men that have butchered entire civilizations for the sake of gold.
have a nice day!
Posted by Etienne78 on February 10, 2006, at 5:34:11
In reply to Re: Be carefull-Is this cover for demonisation?, posted by Etienne78 on February 10, 2006, at 5:29:09
> 10 Leading Causes of Death in the U.S.:
>
> http://www.infoplease.com/ipa/A0005110.html
> http://www.mydna.com/health/heart/essential_facts/top10mort.html
> http://www.soyouwanna.com/site/toptens/accidents/accidentsFULL.html
>
> thought you would find these informative, as they differ somewhat from the other causes of death posted before.
>
> basically as i have said before...we are all just guinea pigs for BIG pharmaceuticals...no better way to test a new drug than to unleash it on an eagerly sick population wishing on the promised panacea of happiness and calm. oh well... didn't expect much from the same white men that have butchered entire civilizations for the sake of gold.
>
> have a nice day!
it's me again!!!!A link i thought would also be of interest to all...
http://www.health-care-reform.net/causedeath.htm
things keep getting better....
see you!
Posted by SLS on February 10, 2006, at 6:51:14
In reply to FINALLY! Stimulants will be investigated, posted by AC75 on February 9, 2006, at 21:18:24
http://www.rxlist.com/cgi/generic/methphen_ad.htm
- Scott
Posted by SLS on February 10, 2006, at 7:06:39
In reply to FINALLY! Stimulants will be investigated, posted by AC75 on February 9, 2006, at 21:18:24
So what's the plan?
What about every other drug out there with side effects?
Yankem' all?
How about asking your doctor why he didn't mention the side effects that you are concerned with? I think this is the question that might be most worth pursuing. Just have him read his own Physician's Desk Reference. It would be informative to learn what answer you receive.
- Scott
Posted by alohashirt on February 10, 2006, at 7:28:43
In reply to Re: Be carefull-Is this cover for demonisation?, posted by Etienne78 on February 10, 2006, at 5:29:09
There really isn't a substantive disagreement herehttp://jama.ama-assn.org/cgi/content/abstract/291/10/1238
The apparent difference is that the JAMA paper reports root causes rather than immediate cause. They are both working with teh same source data - just aggregating it in a way that highlights different information.
> 10 Leading Causes of Death in the U.S.:
>
> http://www.infoplease.com/ipa/A0005110.html
> http://www.mydna.com/health/heart/essential_facts/top10mort.html
> http://www.soyouwanna.com/site/toptens/accidents/accidentsFULL.html
>
> thought you would find these informative, as they differ somewhat from the other causes of death posted before.
>
> basically as i have said before...we are all just guinea pigs for BIG pharmaceuticals...no better way to test a new drug than to unleash it on an eagerly sick population wishing on the promised panacea of happiness and calm. oh well... didn't expect much from the same white men that have butchered entire civilizations for the sake of gold.
>
> have a nice day!
Posted by AC75 on February 10, 2006, at 10:47:20
In reply to FINALLY! Someone decides to read the label. » AC75, posted by SLS on February 10, 2006, at 7:06:39
Scott, I don't get the hostility in your tone. I don't even know how you read me as advocating such an extreme position. If you read the articles carefully, you'd discover the issue is one of LABELING and INVESTIGATION, not WITHDRAWING them from the public.
Um, YES -- the labels mention the risks. Whoop-dee-doo. They mention every possible little thing that could happen. How does that satisfy someone who wants to QUANTIFY the risks to the heart specifically?
Look: this was a kid's drug for decades. Then it got opened up to adults in a huge way (note the 90% increase in adult scrips in just the last 3-4 years). Now we have a new governing theory, that adults can take stims for decades on end. Your little list-of-symptoms is not going to help me decide whether I have a significantly increased risk of heart attack or stroke when I'm 50 or 60 because I took Concerta for 20 or 30 years straight (as other natural cardiovascular changes occur in the body, related to aging).
Coffee has been consumed for entire lifetimes for centuries. Methylphenidate has been used with younger populations (who are in any case at significantly less risk of heart disease) for only several years at a time. We've opened up a new front here, and all I'm saying is that we need new and better data. Who can disagree with that?
Posted by SLS on February 10, 2006, at 12:46:41
In reply to FINALLY! Stimulants will be investigated, posted by AC75 on February 9, 2006, at 21:18:24
Oops.
Sorry.
> > > Well, I'm glad someone blew a whistle that caught some attention.
I do apologize. Reading too quickly, I thought you had said "blew the whistle" rather than what you wrote, "blew a whistle". What a difference a single word can make.
I tend to agree with you. There is quite a bit of research available on these drugs as neuroscience has continued to investigate them through the years. What has not happened, though, is the use of longitudinal investigations to follow a cohort of children through their development into adults while taking ADHD medications to evaluate clinical efficacy versus adverse events. It is difficult to judge potential benefit versus unknown cost when trying to evaluate the appropriateness of bringing a drug through development and marketing it. It is a gamble of sorts, especially with drugs that have been out for such short periods of time. However, if we wait years and years to observe the long-term effects of drugs on rats as a condition for approval, no new drugs would become available to relieve suffering in the here and now.
Perhaps the COSTART program and Phase IV surveillance protocols should be encouraged more than they are right now. Even so, some of the most important life-saving drugs have some of the worst and potentially fatal side effects. It is appropriate that they be made available in the absence of alternatives. However, patient education seems to be largely ignored by a great many clinical practicioners, such that patients are not given the information necessary to grant a truly informed consent. Then, when adverse events do materialize, the patient becomes understandably concerned and less compliant as they are taken completely by surprise. Of course, things are made worse when the physician invalidates the patient's concerns by describing them as being medically unfounded or otherwise acceptable. Acceptable as they may be, a patient might remain unprepared to accept them for as long as their doctor fails to appreciate the significance of the adverse experiences produced by the drugs they prescribe.
Uninformed consent really is a problem.
- Scott
Posted by AC75 on February 10, 2006, at 13:13:03
In reply to Re: FINALLY! An apology., posted by SLS on February 10, 2006, at 12:46:41
Thanks, and all great points.
But sometimes I feel like Concerta IS a form of "elective therapy," at least in some ways, and the presumption I currently give in its favor could shift dramatically if I knew it was damaging my heart over the course of my lifetime.
On one end of the spectrum, you've got life-saving drugs with serious side effects. In the middle, you've got drugs that enhance life in major ways that make you function at a minimal level. Perhaps anti-depressants would be like these, in cases of major depression (or even closer to the life-saving end, if they help prevent suicide).
But with ADHD, what happens if I stop taking Concerta tomorrow? Okay, I'll get really disorganized. I'll start missing deadlines. I may have to get a different, less demanding job. So my quality of life would suffer significantly, but I would still in other senses be a functioning, healthy human being. In the olden days people in my position might have found other lines of work -- more interactive, on-your-feet, maybe as businessmen or even in manufacturing or construction -- whereas today Concerta helps me flourish in a demanding behnid-the-desk professional environment. I need to know if that's worth killing myself over.
Thoughts from others on Ritalin, Concerta, Adderall, or other stims?
Posted by mike99 on February 10, 2006, at 15:49:29
In reply to Reflections on the Value of Stimulants » SLS, posted by AC75 on February 10, 2006, at 13:13:03
So the FDA says there were 79 serious cardiovascular incidents w/ stimulants from 99-2003. 25 deaths, 19 of them children.
I am a healthy 28 year old. I took Ritalin for several months starting at age 25, but it gave me chest pain.
Stopped and had my heart checked for an underlying condition (EKG, echocardiogram). Everything OK.
Tried Strattera. Didn't help.
Switched to adderall--had to call an ambulance after taking less than 20 mgs total over 3 days.
Had my heart checked again, but this time more in depth and by 2 different cardiologists. MRI, stress echo. All good.
Switched to Dex... 15 mgs over 3 days landed me in the ER. My heart was just about pounding out of my chest... heart rate over 160, high blood pressure. They had to rule out a heart attack/stroke.
A week later EKG showed sinus arrythmia and incomplete right bundle branch block. Echo was normal except for "minor hypertrophic focus". Doc says nothing to worry about, but I still don't like the findings.
I am in a very competitive graduate program. The only time I've ever really been able to focus in my life has been on stimulants.
Nonetheless, I am thankful I have not exhausted my nine lives as some of the people did as referenced by this new report. My unmedicated life w/ ADHD is not easy, but I'm thankful to be alive and healthy.
I'm not against stimulants, but will personally never touch another. Of course all drugs have risks. However, IMHO I don't believe for a second, for example, that stimulants are safer than say NSAIDS, which are the cause of many injuries and deaths themselves.
I guess I really don't have a singular point to make, but just wanted to post my experience. I'm glad stims help many people but I also think it is important to continuously evaluate all data regarding their safety, especially given the recent increase in age, time duration and number of people taking them.
GIVEN THE PREVALENCE OF ADHD AND MARKET FOR IT'S TREATMENTS, I HOPE THE PHARMACEUTICAL COMPANIES CAN COME UP WITH NEW ADHD DRUGS WITH SAFER CARDIOVASCULAR PROFILES. I have personally been trying to get enrolled in such trials (ABT-089 by Abott and CX-717 by Cortex Pharmaceuticals).
I think stims are probably safe for lots of people and should stay on the market. However, the risks should not be minimized.
Peace
Posted by paulbwell on February 15, 2006, at 5:30:59
In reply to my 2 cents, posted by mike99 on February 10, 2006, at 15:49:29
> So the FDA says there were 79 serious cardiovascular incidents w/ stimulants from 99-2003. 25 deaths, 19 of them children.
>
> I am a healthy 28 year old. I took Ritalin for several months starting at age 25, but it gave me chest pain.
>
> Stopped and had my heart checked for an underlying condition (EKG, echocardiogram). Everything OK.
>
> Tried Strattera. Didn't help.
>
> Switched to adderall--had to call an ambulance after taking less than 20 mgs total over 3 days.
>
> Had my heart checked again, but this time more in depth and by 2 different cardiologists. MRI, stress echo. All good.
>
> Switched to Dex... 15 mgs over 3 days landed me in the ER. My heart was just about pounding out of my chest... heart rate over 160, high blood pressure. They had to rule out a heart attack/stroke.
>
> A week later EKG showed sinus arrythmia and incomplete right bundle branch block. Echo was normal except for "minor hypertrophic focus". Doc says nothing to worry about, but I still don't like the findings.
>
> I am in a very competitive graduate program. The only time I've ever really been able to focus in my life has been on stimulants.
>
> Nonetheless, I am thankful I have not exhausted my nine lives as some of the people did as referenced by this new report. My unmedicated life w/ ADHD is not easy, but I'm thankful to be alive and healthy.
>
> I'm not against stimulants, but will personally never touch another. Of course all drugs have risks. However, IMHO I don't believe for a second, for example, that stimulants are safer than say NSAIDS, which are the cause of many injuries and deaths themselves.
>
> I guess I really don't have a singular point to make, but just wanted to post my experience. I'm glad stims help many people but I also think it is important to continuously evaluate all data regarding their safety, especially given the recent increase in age, time duration and number of people taking them.
>
> GIVEN THE PREVALENCE OF ADHD AND MARKET FOR IT'S TREATMENTS, I HOPE THE PHARMACEUTICAL COMPANIES CAN COME UP WITH NEW ADHD DRUGS WITH SAFER CARDIOVASCULAR PROFILES. I have personally been trying to get enrolled in such trials (ABT-089 by Abott and CX-717 by Cortex Pharmaceuticals).
>
> I think stims are probably safe for lots of people and should stay on the market. However, the risks should not be minimized.
>
> PeaceThought it's a widespread belief that amphetamines kill a lot of users, data doesn't out the idea at all. In fact it seems amphetamines are remarkably safe, as was thought from their beginnings.
California criminologist Dr Roger Smith who headed some drug rehab programes was responsible for an exhaustive study of amphetamine use.
Smith found cases of peole mainlining speed in amounts of 15,000mgs daily, and he found that folks could withstand IV amounts of 400-500mgs, even if they had never used before, The normal dose orally is no more than 30mgs orally, 5-10mgs is more typical.
In 1967 a Tom Simpson (UK) a tour de france cyclist hopped up on Meth/Amphetamines died of heat exhaustion as he pumped his way up a mountain rd. Death from speed and hyperthermia is rare, but it's a bad idae to mix extreme physical exertion at high tempteraturates. The combo can cause heart failure and blurst blood vessules, EVEN in healthy people.
So once in a blue moon amphets cause death. The rest are killed in accidents. Mundaine accidents. Cars are crashed, deadly bactaria is i'v into vains.
Dextroamphetamine has been around for 80 years, and has a remarkably safety record, when used as directed, Some folks have taken the damn stuff for 50 years, without becoming "speed freakes".Ritalin has been around for 50 years, and many fol,ks have taken the stuff for 40 years, with no apparent ill effects.
Speed can kill, if you are chasing a high and are stupid, or are the 3 in a million who unfortunately suffer heart failure.
Cheers
>
>
This is the end of the thread.
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