What doctors don't tell you...

Remember Accutane (Roaccutane), the treatment for acne? In 2001 it was selling in its billions. It seemed like a miracle cure. But not for everyone. The father of a young man who’d committed suicide after taking Accutane approached Dr Doug Bremner, Professor of Psychiatry and Radiology at Emory University in the US.  He asked if there could be a link between the drug and severe depression. Dr Bremner investigated and found that, yes, the drug did indeed have an effect on the brain and could cause depression, so severe that it could lead to suicide or psychosis, in some people.

‘For those who suffered from extreme scarring acne it was something of a miraculous treatment,’ says Dr Bremner. ‘However the evidence started to mount that for others it was a death sentence.  Over the next few years it was estimated that between 300 and 3,000 young people on Accutane had either committed suicide or killed others.’

I met Doug Bremner on the writing website Authonomy.  I read his book, The Goose that Laid the Golden Egg about the Accutane case and how he played a key role in having the drug withdrawn from the US market, not just for its potentially depressive effects but also because it seemed it could cause birth defects and stunt growth.  I remember him being harassed and harried for his brave stance – taking on the might of a vast pharmaceutical giant takes one helluva lot of guts.

It touched a chord with me as I have always been concerned about the way pharmaceutical companies rule the medical industry.  So I asked Doug if he would answer some questions and he kindly agreed.  If you’re remotely concerned about your health (and particularly if you have children) do read through and follow the links - you might like to buy his books too. It's a long post but it's important. You simply can’t stick your head in the sand over this stuff – and, sadly, your doctor won’t always give you all the information you need.

EJ: Your first book was Before you take that Pill: Why the drug industry may be bad for your health.  Which drugs cause you the most concern? Which should we be wary of taking?

DB: The drug I get the most negative feedback on from patients is isotretinoin (Roaccutane in the UK, Accutane in the US until it was taken off the market in 2009 and is now sold as generic isotretinoin). This drug can cause depression, suicide, psychosis, mania, irritable bowel syndrome, cognitive problems, sexual dysfunction, and a range of other problems. At its peak 80% of people on it were taking it for non-cystic acne, i.e. acne that would not lead to scarring. I recommend using retinol cream first (not much is taken into the bloodstream) and using Roaccutane as a last resort and then at doses half of the recommended dose.

EJ: That’s damn scary – and good advice. Any others?

DB: The antibiotics in the fluoroquinolone group like ciprofloxacin (Ciproxin in the UK and Cipro in the US) and levofloxacin (called Tavanic in the UK and Levaquin in the US) can have some pretty nasty side effects. They are used incorrectly in 81% of cases, usually in the form of an overkill form of first line treatment for urinary tract infections in women. These drugs can cause cartilage and tendon damage which can lead to a snapping of tendons. If you are a runner you should exercise extra caution. I also get a lot of feedback that they cause strange psychological and neurological symptoms and can interact with withdrawal from psychiatric medications like benzodiazepines.

The third drug I have gotten the most feedback about is the birth control pill or oral contraceptive (OCP) Yaz or Yasmin, also known as Janya in the UK (generic is drospirenone and ethinylestradiol) which is associated with psychiatric side effects like mood swings and depression. All of the OCPs can do this but this one seems to be particularly problematic. I recommend using an IUD or other form of birth control, because I do not think it is natural to flatten out a woman's monthly variation in sex hormones estrogen and progesterone.

EJ: The pharmaceutical business is a vast moneymaking machine. Reps target GPs in the hopes they will use their products.  How can we be sure our doctors are giving us the right medication? 

DB: I think consumers should educate themselves about their medications. That is why I wrote my 'Pill' book. I have heard from a number of people who said that having the book around literally saved someone's life when they realized a problem was related to a med the person was on. I also think patients have the right to ask physicians to give full disclosure about any money they receive from the pharmaceutical industry, whether it is payment to give talks or be in studies or free meals or gifts. Many "studies" are actually marketing campaigns to pull in doctors to a new brand of medication-- the industry calls them "seed studies".

EJ: I agree. Any suggestions as to what we should do, as ‘patients’ when we’re prescribed a drug?  I assume you’re not saying we should avoid all medication?

DB: No, of course not. I prescribe medication myself. I'm just saying to educate yourself, don't passively rely on your doctor. That way you can avoid unecessary medications and recognize bad interactions within yourself. Remember that 400 years ago Paracelsus basically said that the goal of medication treatment is to offset the negative side effects with positive outcomes.

EJ: A lot of us go online to check out health conditions and medication. But there is simply so much information out there and it’s easy to become confused and lost. Any sites you recommend?

DB: Studies show that over half of medical websites contain misinformation (including one we did on websites about psychological trauma and mental health). I have a couple of hundred articles on my website and on ezine 

I also recommend community forums like medications.com because that is a great way to find out if other people are suffering from similar side effects. Sometimes the medical community takes a while to catch up to what patients are telling them.

EJ: You also target vitamins and supplements. What are your major concerns? Should we not take these products?

DB: I am not against all vitamins and supplements. Many supplements are beneficial for a variety of conditions and women and vegetarians, in particular, could benefit from a well-balanced multi. The main vitamin I am concerned about is mega-doses of Vitamin A, since it can lead to thinning of the bones and does not prevent cancer, in fact it may increase the risk in smokers. My main point is they can have side effects just like prescription medications can -- they should not be considered risk free.

EJ:  In the UK, there is a strong move towards regulating natural medicines – herbs, homeopathic preparations etc. What are your feelings about that?  Is it sensible or is it a case of the pharmaceutical companies not liking us taking medicine into our own hands, potentially taking away business from them?

DB: In general I am not in favor of increasing government regulation. If you grow catnip in your garden do you need government inspections? A possible exception might be a supplement like the weight loss aid Ephedrine which has been linked to sudden deaths.

EJ: A lot of my readers have young children. What concerns should they have? What particular advice would you give?

DB: A lot of children get ear infections and antibiotics are overused as in many cases the infection is not a result of bacteria, and even if it is, a "wait and see" approach will lead to resolution.  Antibiotics at best reduce by one day the time period of the infection. "Wait and see" has been shown in research studies to be the best approach since it avoids bacterial resistance which can increase the number of subsequent infections. Wait and see involves giving tylenol or aspirin for fever and using topical medicine for pain relief.

I also am concerned about the over-extension of vaccines, especially Gardasil and flu shots.
Another big problem, especially in the US, is overuse of antipsychotic medication in small chilren.
You can see a link to my posts about medications in children here.

EJ: Going back to your books, I was amazed at how personal your accounts are. The Goose that Laid the Golden Egg is certainly not a dry medical read – it’s as much about you, and your search for your family and identity, as about your battle with the pharmaceutical giant, Hoffman-La Roche. Why is that?

DB: I had an agent (who later died) who warned me that some people might not like the "two story thread" of the book, and in fact the people who didn't like it complained about the personal part of the story. In fact it made some people very uncomfortable. For me it was a story about honesty and emotional integrity, and for me coming clean about my past was very tied in with coming clean about the risks of a particular medication (ie Accutane). In both cases not doing so could be potentially lethal.

When I wrote it, it was also a time when a lot of stuff was coming out about what is essentially the corruption of leaders in academic psychiatry (which is where I do my "day job") by the pharmaceutical industry, and I felt like I wanted to make a clean sweep. In summary, if you are looking for a knight on a white horse story, this isn't for you, but it is a more accurate description of what it is like to be in my shoes, and there are a lot of other people out there like me.

EJ: You talk, towards the end of the book about alternative forms of healing. Do you now favour an integrated approach to healing? 

DB: I think people take the spiritual part out of healing and recovery at their own peril. We don't fully know how or why people get better. Our own treatment studies for PTSD these days are focusing on effects of meditation training and a program for promotion of mind and body. I personally have used acupuncture and found it helpful.

EJ: I remember from Authonomy that you had a lot of persecution from the pharmaceutical industry. Is that continuing?  Any thoughts on how we might get away from this situation whereby our health is being potentially comprised by big business (supported by government)?

DB: Not so much since Accutane was taken off the American market in 2009. They've moved on to other big money makers that I am not called as an expert on. I think the US court system is out of control in terms of drug litigation. They are allowed to spend way too much time and money trying to discredit experts against them. Also, sunlight is the best disinfectant, that is why I came out and wrote openly about what happened, while in the beginning I mostly kept it to myself.

EJ: What’s next for Doug Bremner? Any more books in the pipeline? Where are you in professional terms? Hopes for the future?

DB: Since the 'Goose' book I have been writing screenplays and one of them called 'Catania' (about five Italian sisters who return to their home to divide the family art and furniture) got to the quarterfinals of the PAGE competition for screenwriters in 2011. I am planning on producing that as a film with my daughter this summer. I am currently working on a novel called 'Hearts" about a cardiac surgeon who can fix other people's hearts but not his own (being posted on twitter @heartnovel, my twitter name is @dougbremner). I just sort of move to whatever interests me, but am not ready to give up my day job, which is as a psychiatrist and researcher in the area of posttraumatic stress disorder in women abused in childhood and in returning soldiers from Iraq.

EJ:  Good to hear all that and huge good luck. Before you go, could you give us your top ten tips for maintaining good health?

DB:  Sure.

1.      Don't smoke

2.      Drink in moderation (or not at all if you choose)

3.      Cook your own meals and grow your own fruits and vegetables, if possible

4.      Eat fish at least once per week.  It’s more about lessening reliance on red meat. Vegetarians should be fine – gaining protein from beans, pulses, nuts, seeds.

5.      Exercise more than three times a week (even if just brisk walking)

6.      Practice stress reduction (yoga, meditation, etc)

7.      Know everything you can about your prescription medications

8.      Have supportive and nurturing relationships

9.      Use psychotherapy if you have depression or anxiety or unresolved issues from the past

10.  Get your blood pressure checked

I'm tempted to add make your own beer and wine (which I do) since I saw your husband is a beer writer

JA: Ah, that takes me back to childhood, when my parents made their own beer and wine. My husband just likes to drink the stuff! J  Huge thanks, Doug…

Okay, so there you have it…for more detailed information on all this, do buy Doug’s books..and check out his website and blog.