The Wise List?

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October 4, 2015 | 4 Comments

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  1. Not a doctor … but it seems to me that a great deal of the usefulness of a list like this depends on its advice as to * when to use medications at all. *

    In some areas there’s a fairly clear recommendation to use drugs only in severe, “refractory” or “high-risk” cases. In others it’s not quite clear. For example, for osteoporosis they recommend bisphosphonate drugs only for those at “high risk of fracture” (Apparently there’s a WHO scale to rate this) with re-evaluation every few years to avoid the risks of prolonged use.

    The Psychiatry section is much worse, as it doesn’t set ANY threshold below which drugs should not be used, or talk about ANY alternatives! Worse yet, it advises: Treat depression to complete remission. Trouble is, very few people experience “complete remission” on drugs. In addition most drugs will cause a degree of apathy, anxiety, irritability or SOME other symptom that interferes with happy & effective living, even in “successful” cases. So this can become a dangerous prescription for endless treatment, constant drug switching, multi-drug cocktails and all sorts of strategies that are likely to end badly.

  2. This comment submitted by Neil Pakenham Walsh 06/10/2015:

    Dear all,

    I too am troubled by this publication. I have not had a chance to read it, but two things immediately stand out:

    1. The introduction states: “Generic prescribing is not allowed in Sweden…”. This seems extraordinary, when most other countries are promoting or even mandating generic prescribing. There is no attempt to dispel the prevalent myth among patients (and some prescribers) that proprietary medicines are ‘better’ than generic medicines.

    2. The publication gives generic names of drugs, together with selected proprietary names. This does indeed suggest that ‘Its a list not of which drugs are best but which marketing departments have been best’.

    This publication, and the method by which it was produced, need to be appraised by an independent body to assess the reliability of the information presented and the level of commercial bias that may have been involved in its production.

    If, as seems likely, the process has been unduly influenced by pharmaceutical companies, this is extremely serious. If this can happen in Sweden, think how much easier it would be for pharma companies to influence essential drug lists in low- and middle-income countries (LMICs).

    I invite those with an interest in information for prescribers and users of medicines in LMICs to join HIFA:
    http://www.hifa2015.org/prescribers-and-users-of-medicines/

    Best wishes, Neil

  3. NEIL>>> as answered above, the doctor prescribes the brand, the patient ALWAYS recieves the generic. But in certain cases, the patient can ask for a certain of the two. As I sticked to GSK’s own Seroxat for many years, all of a sudden it wasn’t available anymore. I then Went for Actavis Paroxetin, but recently I can’t even get that, but some “east-european” or wherever they’re from Breda Pharm. By now I know it’s regulated by patents, and the expiration of them. I do not approve with it all, but it works as long as you have access to serious manufacturers.

    Dr. Healy>>> I read the Swedish version of the psychiatric advices, I sure understand why the “wise” isn’t very “wise” there. But I also saw “Theralen” and “Mirtazapin” which are offered in prison. I never used them, but my uneducated guess is they are more benign than SSRI’s.

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