/ Health

Are you sure your much-loved medicines actually work?

Pharmacy

When I go to my local chemist, I trust that what they sell me works: after all it’s the same place that I get my prescriptions and health advice from. But how can I be sure that these products stand up to their claims?

Well, according to our latest research, I can’t. We found that some of our best-loved brands – such as Benylin chesty and tickly cough syrups – just don’t have the evidence base to prove they work, and other products have much cheaper alternatives. So what’s going on?

Medicine claims

To give some background, before medicines are approved for use, they go through clinical trials and are licensed. But before granting a licence, the regulator asks for evidence of acceptable quality, safe use and efficacy for the conditions the product claims to treat.

Yet, in the case of cough syrup, a review by the Cochrane Collaboration (the gold standard) concluded:

‘This lack of evidence of effectiveness also has implications for the regulatory bodies and brings into question how these products can continue to be promoted using language that implies that their effectiveness is not in doubt.’

So we asked the manufacturers to show us their evidence that their products actually work, and in some cases, they declined to do so. The trade body, the Proprietary Association of Great Britain, said it’s because they didn’t want to give competitors ‘commercially sensitive’ data.

Although manufacturers have invested in research and new product development it’s rare for over-the-counter medicines to have patent protection once launched. What’s more is the European Medicines Agency encourages data sharing for pharmaceutical drugs and routinely publishes the clinical data submitted by companies.

Spot the difference

Our research also picked up on products that have cheaper alternatives. For example, Combogesic and Nuromol can be fairly expensive painkillers combining Ibuprofen and Paracetamol in one tablet. But, at 25p and 29p per tablet respectively, you could combine two generic ibuprofen and paracetamol tablets from up to 2.8p per tablet for an equivalent dose.

Another product to look closely at is Otrivine nasal spray. You can buy an Otrivine spray for allergy relief, another for sinusitis and a third for nasal decongestion. But the small print on the back of the packet would tell you that all three are exactly the same!

Otrivine’s manufacturer told us that these products marketed for different conditions to help you select ‘the product most suited to your needs’. Although the regulator says it’s in line with the product’s licensing, we think it’s misleading and you could waste money buying all three.

And if you’re in the market for the Otex and Earex Advance ear drops that our expert panel looked at, the wider evidence shows that they work. However, it’s likely that cheaper alternatives including saline, water, and olive or almond oil would work just as well.

Informed decisions

We think these firms should be more transparent and share their data so we can see if medicines and other health products are really worth our money.

So have you questioned the claims of any over-the-counter medicines? Should manufacturers be more upfront about their product claims?

Comments
Guest
bishbut says:
25 August 2017

All manufacturers of everything are in business to sell products to make money some are honest about their product but others including well known names while not being dishonest use dodgy methods to sell theirs A recomdation from a “celebrity” using facts and figures that are not true or accurate just to make you buy their product not a rivals If something new and improved comes on the market they try everything to keep you custom even theirs now does very little good at all I do not take much notice or ANY advertisements anywhere but it sometimes informs me or something new then I make my own mind up about it by reading independent reviews and asking those who have one about it and their experience with it Adverts all must all be taken with a pinch of salt Old saying again

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Guest

Cough and cold medicines must be the biggest rip-offs. They can’t cure you, but you buy them anyway in the hope they will make you feel better. Some will give you a bit of relief, but it is very brief for your money and more often than not do absolutely nothing.

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Guest

I think it is always worth reading the package to see what active ingredients are used. As the header article points out, generic equivalents are often available for a fraction of the price.

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Guest

While that makes good sense Derek if it is packed with “inactive ” ingredients as well this can effect the ability of the medicine to perform its job to the same potential as another with only the essential ingredient in it. I am quoting here from personal experience and yes I have complained to both chemist+ doctor.

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Guest

As Derek says, it’s well worth reading the list of active ingredients. Generally it is easy, but there are a few pitfalls. For example, most people would assume that pills containing 342 mg ibuprofen lysine contained a higher dose of the drug than 200 mg ibuprofen, but both contain the same amount.

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Guest

Duncan mentions the use of inactive ingredients. These are also referred to as ‘fillers’ and are essential because the amount of active ingredient in a pill or capsule is often a few milligrams – a tiny amount. There are other reasons, and these are summarised in the Wikipedia article on excipients.

In most cases it makes no difference which fillers are present, making different brands equally affected. Sometimes it does make a difference and Duncan provided an example (eye drops?) in an earlier Conversation.

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Guest

Wavechange I am not on “a few milligrams ” but =100Mg of Sumatriptan which , a certain country that has the monopoly in NHS supplies has upped the price astronomically. The Indian alternative is 3 times the size packed to the gills with “fillers ” which stop the absorption of the drug until it reaches a position in the gut that has less effect on your system . This has been backed up by a clinical pharmacist and she gave me the full [pharmaceutical details.

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Sorry Duncan. I remember when you mentioned sumatriptan (a drug used to treat migraine) before, and the shortage of the drug. I accept what you are saying, but the pharmaceutical industry uses fillers for very good reasons and in MOST cases it does not matter which brand of medicine is prescribed. Many drugs are designed to release the active components slowly.

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Gaviscon would be worthy of a detailed W? investigation. The pricing strategy and re-composition of the product to retain its price at regular intervals has ensured it remains expensive, although effective.

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The key component of Gaviscon sodium alginate, derived from seaweed. I can see no reason for Gaviscon being expensive other than as a result of marketing costs. I agree that it deserves investigation, Ian.

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Guest

Beryl’s spot on about cough and cold remedies. Many folk have no understanding of the difference between the virus and the bacterium (both can be deadly) and often arrive at the surgery asking for antibiotics for the cold, and sometimes a sore throat can drive the truly desperate to trying any OTC remedy, simply to get some relief.

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I was very pleased to see Joanna’s Conversation giving the news that the makers of Nurofen were now banned from claiming that their products could target joint and back pain: https://conversation.which.co.uk/health/nurofen-painkiller-back-joint-pain-advertising-standards-agency/ It took months for the offending packs to disappear from the shelves. Hopefully more people will buy cheaper alternative brands of ibuprofen, though I would like to see much more prominent warnings of the danger of overusing this drug.

Manufacturers MUST back up claims made for all their products and the sooner this is enforced the better. The views of the Proprietary Association of Great Britain don’t matter, in my opinion.

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Guest

Perhaps we should have Which? Medicine to evaluate and report on such products given the value of the market? Or would more regular reporting in Which? do?

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Guest

They had it. Some years ago W? produced a magazine aimed at medical professionals. It stopped being produced.

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Guest

Given the amount of money that people waste on overpriced and unnecessary non-prescription remedies, I would gladly sacrifice Which? testing of kettles and toasters if that would help raise awareness of how many of us are being exploited.

Maybe it would be more effective to step up the campaign to investigate and report false claims and encourage the public to buy cheaper but equally effective products.

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Just reporting would be good enough for me. I suspect many buy any medicine that might help in the hope their ailment might respond, whatever the cost. Informing us of their efficacy, and the cheap equivalents, would help. Why buy branded paracetomol when you could use the supermarket’s own?

Perhaps a fools guide to painkillers, indigestion remedies, vitamin supplements, cold and cough “remedies”………. might educate some to how common ailments are best dealt with, and how to avoid buying expensive but unnecessary productsn. Personally, as I can’t cure a cold (as far as I know) my remedy is honey, lemon, hot water and whisky.

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In my opinion it takes more than providing people with information. We know that homeopathic ‘remedies’ do not work. As you pointed out recently, science cannot prove anything, but given the amount of effort investigating homeopathy, we can be pretty sure that it is useless beyond the placebo effect. Yet many still buy these products thanks to marketing.

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Genuine information is a start, though. Some people will gain comfort no doubt from taking dubious “remedies” but if many are informed about their efficacy or otherwise, about branded vs. generic, about what ailments can be helped and what cannot, then they can start making better informed choices.

How else do we make progress?

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Guest

But there’s a lot of information out there already. Literally tons, if you read leaflets. But where information on health is concerned Michel de Montaigne had it about right when he noted “Nothing is so firmly believed as that which we least know.” And it’s true. We supposedly live in an enlightened time, yet instead of being guided by Science and logic huge swathes of the world are enraptured by superstition, fairy stories or Breitbart.

And remember: many cannot comprehend how research actually works. There’s almost a mantra about Science, referred to as a disembodied ‘they’, as in ‘They’re always telling us..’ or ‘They told us butter was bad one month, and good the next…’

Perhaps the only avenue would not be in the written form at all, but in TV shows. But I seriously doubt most will take much notice.

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Guest

I have no problem with giving information to the public but surely we need to do more than that. I believe that every claim made in advertising, on packaging, etc. must be backed up by evidence. Specific wording can be reused, e.g. ‘This product is effective in treating Athlete’s Foot’ but it would not be acceptable to modify the claim, for example ‘This product is effective in treating foot infections’ because it’s obvious that it will not treat some infections.

Joanna wrote: “So we asked the manufacturers to show us their evidence that their products actually work, and in some cases, they declined to do so. The trade body, the Proprietary Association of Great Britain, said it’s because they didn’t want to give competitors ‘commercially sensitive’ data.” That illustrates a long-standing problem and I do hope that it is tackled as soon as possible.

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I broadly agree with the findings above and my medicine cabinet is quite sparsely populated. However there are one or two items I wouldn’t want to be without. My toothpaste does stop pain from receding gums as I have aged, TCP seems to enhance the speed and effectiveness of the way the body deals with cuts and spots. Vick vapour rub also helps during a cold and has uses as a nail pedicure which even the manufacturers don’t claim for its use. Gaviscon is always effective when I have messed up my diet and I find Strepsils help ease the discomfort of a dry or sore throat. I agree with the argument that there are other “home grown” remedies that are cheaper and as effective, but sometimes a visit to the chemist saves hassle and it’s worth a few quid just to sort something. I always have a pack of soluble aspirin handy. One of those can cure a stale head and it usually doesn’t return. I wouldn’t be without travel pills for any sea journey. They work. Cough medicine hasn’t ended any of my coughs and the relief is temporary. I still buy it and spend time at the shelf wondering which one to get. Three quarters of the bottle ends up in the fridge until the sell by date. That’s about it, anything else is “take three times a day after meals” and accompanied by a doctor’s prescription.
Patent medicine is a huge industry. It would be interesting to study what percentage of it is useful, and how much is snake oil with claims to match. It relies on the human frailty and our desire to cure or relieve discomfort instantly. If it’s serious we seek medical advice, if not, there’s always the bottles, pills and potions that clamour for our attention on the supermarket and pharmacy shelves. They sell, because we still believe in them and if one doesn’t work, we try another. I’m not sure that this is going to change any time soon, unless these products are banned from sale. If they are, the public will shout for replacements.

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Guest

The attitude of doctors seems to be to prescribe a chemical for any ailment you may have. As if a tablet, cream or liquid is always a magic potion. Clearly, many times they can be but do patients automatically expect to be “given something” – is it a comfort thing? Maybe we need a campaign to wean people away from this attitude – and save the NHS a lot of money at the same time?

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It’s well established that GPs overused antibiotics because of demand from patients. When I was young, my mum used to take me to the GP with a cold and accompanying asthma and was duly prescribed an antibiotic. When I learned that antibiotics won’t cure colds I started to decline offers of antibiotics, saying I would come back if it did not clear up. Some make a point of avoiding visits to their GP unless they are really ill.

It was a GP who alerted me to the limited value of cough remedies. Looking through my medicine cabinet I have found an unopened bottle of Co-Op bronchial mixture. Use by April 2007. I try and keep away from people when they are coughing and sneezing, and that seems to work well.

What Vynor has said about patent medicines is spot on. Most elderly people have a grand collection and in my experience, they seem to be the ones that are most likely to pay for expensive brands.

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Guest

The placebo effect seems pretty strong in the GPs case. That might be worth bottling.

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Guest

As a child I was always frightened of the GP’s case as he had awful potions in it. Some people think a placebo makes for a better B-B-Q. Sorry, this is getting silly.

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Guest

Coughs and sneezes spread diseases. A delightful piece of propaganda that was inflicted on our parents’ generation: http://www.nationalarchives.gov.uk/films/1945to1951/filmpage_cas.htm

Maybe there is a need for public information films to help reduce the number of everyday medicines we swallow like sweeties.

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Guest

Part of the problem is medical language. Physicians have long sought to portray their skills as mysterious and somehow beyond the common man. To that end they never use a single syllable where two or three will suffice and in that way they can elevate their profession to an almost mystical level. Certainly in hospitals there’s almost a priesthood of sorts, although that is dying out.

Because of that for many years folk have believed that, somehow, the Doctor knew better. That’s changing, now, and quite rapidly, but there’s still a legacy effect where people are more inclined to accept meekly what the doctor prescribes than debate it.

The internet is changing that, but sadly supplying easy answers while not teaching critical awareness or the understanding of how to assess research. And it doesn’t help that the medical profession itself hardly speaks with one voice.

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Guest

I know the reputation but as you say, things are improving. In my view, the best approach is to be respectful, interested and ask for explanations. If advice or information is clearly wrong, offer suggestions that might allow the doctor to reappraise their view rather than overtly disagreeing. Most people are protective towards criticism of their profession or knowledge, and that can often be seen in Conversations.

I am not sure where we have got to with the concept of the ‘Expert Patient’: http://webarchive.nationalarchives.gov.uk/20120511062115/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4018578.pdf

It seems a useful way of helping people self-manage chronic health problems, and I know of people who do this well, but if we all believe that we know more than our doctor, I would not like to be a GP or consultant.

Ideally the internet should be a great help to promote better understanding, but as we know, there is a lot of wacky stuff online, often designed to sell questionable products or supplements without assessment of need.

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Guest

A very interesting article Wavechange and a subject very close to my heart.

Pain management both physical and mental fundamentally emanates from the mind. For example, it is generally known in cases of multiple injury the brain solely focusses on the most severe injury at the expense of the lesser. It is also possible to manage pain not entirely by avoidance or trying to detract from it but by a form of quiet acceptance and surrender to it which, in turn, has the effect of dissipating all the associated fear and anxiety that can worsen pain or discomfort, enabling a patient to better communicate with health professionals as a partnership, helping one another to understand and decide the best way to move forward as the professor so rightly makes the point.

I know this works because I have tried it myself many times with great success and I have even eliminated the pain completely at times, never forgetting of course that pain is there to alert us to pay attention to certain malfunction of our mind or body.

All GP’s need to be made aware of this new method of treatment for it to succeed but I anticipate there is bound to be some opposition from some old school sceptics in the medical profession.

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Guest

I think we may have veered off topic but this adticle demonstrates one way in which as a nation we can become less reliant on OTC meds.

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I knew the Expert Patients document was old but it dates from 2001. Various studies followed and can be found on the NICE website. A recent document suggests that the approach could generate significant savings for the NHS: http://www.reform.uk/wp-content/uploads/2015/02/Expert-patients.pdf

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Here is a link to the Cochrane review mentioned in the introduction: http://thesgem.com/wp-content/uploads/2013/03/22895922.pdf

“PLAIN LANGUAGE SUMMARY
Over-the-counter (OTC) medications for acute cough in children and adults in ambulatory settings
Acute cough is a common and troublesome symptom in people who suffer from acute upper respiratory tract infection. Many people self prescribe over-the-counter (OTC) cough preparations and health practitioners often recommend their use for the initial treatment of cough. Twenty-six trials involving 4037 people were included. The results of this review suggest that there is no good evidence for or against the effectiveness of OTC medications in acute cough. A few studies reported adverse effects and described infrequent, mainly minor side effects such as nausea, vomiting, headache and drowsiness.The results of this review have to be interpreted with caution because the number of studies in each category of cough preparations was small. Many studies were of low quality and very different from each other, making evaluation of overall efficacy difficult.”

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Guest

Hopefully most people are careful with prescription drugs. The GP should check for possible interaction with other prescription drugs, the label will show important warnings, and the dose will be specified.

Because medicines that we can buy in from a pharmacist or from a supermarket are not prescribed, there is a danger that they are misused. An arthritic friend landed up with kidney problems from long-term use of ibuprofen. I remember being warned by a GP friend about not taking too much Sudafed.

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The last time I looked, hay fever tablets were based on 1 of 3 different active ingredients. Nearly every year a ‘new’ one comes on the market but is only one of the same 3 made to look like something brand new complete with misleading adverts.

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I would expect that the new products are also sold to ‘compete’ with other products from the same manufacturer. Now, where have we heard that before.

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Guest

What gets me annoyed is when companies (or governments) decide to scrap or ban or reformulate popular products out of existence. The original pink (non-fluoride and non-mint) Sensodyne toothpaste has been scrapped, Indian Brandy is now illegal (thanks to the EU), and Oral-B Ultrafoss has been abandoned in the UK. I will stop using a product if I thinks it doesn’t work for me but there is not much that I can do when those working products suddenly evaporate.

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I once took a course of Loratadine (Clarityn) for hay fever which reacted with levothyroxine which I take for inherited hypothyroidism, causing my heartbeat to palpitate and become irregular. It was quite scary at the time and I had to receive urgent medical attention. I have since learned that anti histamines are binding agents that can inhibit the absorption of some prescription medication. My GP never warned me of the possible interaction with anti histamines but only to avoid taking iron supplements or vitamins until at least 4 hours after ingesting thyroxine.

I have found the best remedy (although not a cure) for coughs is to sip a glass of ordinary water and take small sips of a mixture of honey and glycerin off a teaspoon to ease a sore throat or that annoying irritation that can deprive you of that good nights rest you badly need to help speed up the recovery process.

For a cold or stuffy nose one or two drops ONLY of eucalyptus essential oil sprinkled on a tissue works wonders, the fumes will also penetrate right down into your lungs bringing sweet relief for a few minutes. Apart from drinking copious amounts of various teas (peppermint is my favourite with a cold) but not coffee, and plenty of rest and warmth, a cold will usually run its course. Paracetamol is taken only if the cold is accompanied with a fever or if aches and pains become too much to bear 🙁 Oh I nearly forgot a little sympathy, even if only from your favourite furry friend 🙂

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Guest

Like Beryl, I suffered from irregular heartbeat when taking loratadine, though I was only aware if I felt my pulse. I was switched to fexofenadine and advised to drink less coffee. Thankfully the problem disappeared without cutting down on coffee.

Popular indigestion remedies can interfere with effectiveness of a variety of drugs and grapefruit juice can enhance the effect of statins. Information about possible interactions can be found in the British National Formulary: https://bnf.nice.org.uk/interaction/index.html#introduction

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Guest

Reflux of stomach acid can cause coughing, not just heartburn etc. I confess to disbelieving the first person who told me, but apparently it is quite common. Anyone who has a cough that is unrelated to a cold might be well advised to have the cause checked rather than to self-administer cough medicine for an extended period.

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My local GP surgery holds 6 monthly public meeting on topical medical issues. Following the last meeting an email was sent out requesting suggestions for the next one. I duly responded by intimating it may be of interest to warn people of the danger caused by the rebound effect of OTC ant-acids and NSAIDS (Non steroidal anti inflammatory drugs) .

They have however opted for a meeting about obesity. No prizes for guessing the reasoning behind their decision!

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More about the rebound effect for anyone interested can be found @
en.m.wikipedia.org – Rebound Effect

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Routine use of non-prescription drugs can cause rebound headaches: http://www.nhs.uk/Livewell/headaches/Pages/Painkillerheadaches.aspx

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Guest

I know what both Beryl and Wavechange are getting at , people are unwilling to face up to the truth . When it comes to stomach problems thats something I know about intimately . I was on stomach medicine for decades and have had major stomach surgery nearly ending my life . lets be honest here re-flux if left untreated can , in SOME cases lead to throat cancer , why leave it that late ? the same with a cough that goes on for years . This is no dream world we live in no matter how much adverts say otherwise pain brings reality thats why many choose the “quick ” way out. To me ,this is where being PC is really BAD for your health and existance.

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Guest

Sorry to hear that, Duncan. I knew that long-term acid reflux might cause oesophageal cancer: http://www.nhs.uk/Conditions/Gastroesophageal-reflux-disease/Pages/Introduction.aspx The number of people taking prescribed proton pump inhibitors to suppress acid production is huge.

Ranitidine tablets (another type of acid suppressant) have been on sale to the public for years. Initially these were expensive and sold under the Zantac brand. GSK had made a fortune from selling Zantac and there was no need for this, but fortunately, cheaper brands of ranitidine are widely available.

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I have found a drink of water can sometimes relieve acid reflux and also again, the recommendation in the referral, of eating smaller and more frequent meals and of course cutting down on fried and fatty foods can often relieve it before it becomes a major issue.

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This is one reason I avoid fatty foods. Gardening and other frequent bending, drinking alcohol, and eating spicy foods are best done in moderation if you are affected.

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Wavechange’s NHS referral states the rebound effect of NSAIDS seemingly only affects headaches and not other body parts which leaves me questioning why? My late sister who was on a whole cocktail of drugs for her arthritis, from strong painkillers to immunosuppressives died from a perforated bowel. Unfortunately we will probably never know the real cause of her demise as there are a number of reasons that can be attributed to this potentially fatal condition.

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Guest

The trouble with taking pills is that they affect the whole system, whereas inhalers, ointments, nasal sprays, eyedrops and the like deliver drugs to where they are needed, even if some enters the circulation.

Commonly used drugs such as aspirin, paracetamol and ibuprofen are widely available and all that has been done to control their use is to limit the pack size in the hope that this might discourage overdose. I suspect that it has encouraged retailers to push up prices, especially of the heavily marketed brands.

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Guest

There is one theory that in long term use of taking ant acids, which effectively neutralise stomach acid, causes the stomach to compensate by over producing its acid, leading to more acid reflux and therefore dependency.

Another theory (and this is my own) is that, in the absence of stomach acid through constantly taking PPI’s (dependency) the contents of the stomach is unable to perform its natural function of producing more acid in response to any more food ingested, which is then more prone to be regurgitated back into the oesophagus causing further complications.

As an aside, my chiropractor has given me a simple exercise to prevent the frequent stress headaches I was once suffering and which can also stop a headache in its tracks before it develops. I am very happy to say I can’t remember the last time I had a headache and the relief is extremely gratifying.

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Guest

I suppose mention of a Chiropractor in a topic concerned with potentially bogus medicinal claims is valid. I suspect it’s important that readers know what a Chiropractor is.

Chiropractic is a form of alternative medicine mostly concerned with the diagnosis and treatment of mechanical disorders of the musculoskeletal system, especially the spine. Its foundation is at odds with mainstream medicine, and chiropractic is sustained by pseudoscientific ideas such as subluxation and “innate intelligence” that are not based on sound science.

The Wiki article about Chiropractic is pretty damning, and when Simon Singh published this piece in the Guardian:

“You might think that modern chiropractors restrict themselves to treating back problems, but in fact they still possess some quite wacky ideas. The fundamentalists argue that they can cure anything. And even the more moderate chiropractors have ideas above their station. The British Chiropractic Association claims that their members can help treat children with colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying, even though there is not a jot of evidence. This organisation is the respectable face of the chiropractic profession and yet it happily promotes bogus treatments.”

the British Chiropractic Association sued him for libel. What was interesting was that they later withdrew the action. A “furious backlash” to the lawsuit resulted in the filing of formal complaints of false advertising against more than 500 individual chiropractors within one 24-hour period, with one national chiropractic organisation ordering its members to take down their websites, and Nature Medicine noting that the case had gathered wide support for Singh, as well as prompting calls for the reform of English libel laws.

What isn’t published is that there have been deaths involved through Chiropractor treatment and systematic reviews of research have found no evidence that chiropractic manipulation is effective, with the possible exception of treatment for back pain. A critical evaluation found that collectively, spinal manipulation was ineffective at treating any condition. The placebo effect, however, as with all those who believe in and accept alternative medicine, is strong, although it should be pointed out that faith healers enjoy similar success.

It’s a truly interesting world.

Refs Encyclopaedia Britannica, the Guardian, Nature, Wikipedia

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Guest

The above report certainly puts much emphasis on the negative aspects of chiropractic treatment and a great deal less on the positives. There is however, good evidence available that chiropractic is an effective treatment for persistent lower back pain. This means that scientific trials conducted to investigate the effect of chiropractic on lower back pain found that it did have a beneficial effect. (Source http://www.nhs.uk – Chiropractic – Evidence )

“The title of chiropractor is protected by law and it is a criminal offence for anyone to describe themselves as a chiropractor without being registered with the GCC (General Chiropractic Council). We check that all chiropractors are properly qualified and are fit to practice.” The GCC is overseen and regulated by the PSA (The Professional Standards Authority for Health and Social Care).

GCC Guidance on Claims Made for the Chiropractic Subluxation Complex.

* Chiropractors are reminded that when practising they must “select and apply appropriate evidence-based care which meets the preferences of the patient at that time”.(Standard C5. The Code: Standards of Conduct, Performance and Ethics for Chiropractors).

* When advertising, they must “use only honest, legal and verifiable information when publishing yourself as a chiropractor, advertising your work and/or your practice including your website. The information must comply with all relevant regulatory standards”. (Standard B3. The Code: Standards of Conduct, Performance and Ethics for Chiropractors). http://www.gcc-uk.org

As one who used to constantly suffer from crippling back pain and was only offered strong painkillers by my GP, providing only temporally relief until the next episode I was recommended to chiropractic treatment by a friend and I have never looked back.

The topic states: ‘Are you sure your best loved medicines actually work.’ I don’t want to become involved with any more attempts to downgrade an alternative treatment that has already been recognised as effective and sanctioned by officially appointed UK regulatory bodies.

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Guest

I agree, and the detailed reports I quoted did in fact state that Back Pain alleviation had been found to be the one area in which Chiropractic seemed to work. And I also agree that simply dishing out painkillers all the time is not the answer.

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Guest

Ian just so I dont misinterpret you , are you saying Chiropractic cures all spinal injuries ? If so medical science is patently wrong then ? I have a lower spinal injury from 35 years ago slipping off a ladder at work .I have already attended the doctor for it and diagnosed a disc /nerve problem at no time did he advise me to attend a Chiropractor . I also know many people with crushed vertebra/discs requiring detailed surgery that one slip and they are left paralysed for life or the lower parts of their body than the injury could be paralysed . Trying to downgrade this so HMG saves money is dangerous to life or limb. What do ordinary people who cant afford to pay for Chiropractor do . A family living on a sink estate on minimum benefits and either no job or a service industry low paid one ? I know what the pain is like its just a bit short of kidney stone pain of which I too had.

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Guest

Chiropractors, osteopaths and physiotherapists cannot cure all spinal injuries but they are very useful for some conditions.

Every few years or so, I put my back out or get a trapped nerve. One trip to the osteo, a good massage and a bit of manipulation and I am as good as new again. My other half has cracked vertebrae and was living on painkillers, steroid injections and on the waiting list for a back operation. He was lucky enough to be referred privately to a doctor specialising in sports injuries. Following a CT scan, the doctor organised physio with exercises to strengthen and support his lower back area. He is now off the operation waiting list, off steroid injections and only very occasionally needs pain killers or a return trip to the physio. This treatment doesn’t come cheaply, but is worth every penny.

If you go to your GP with a back problem, they give you painkillers and send you to a specialist who invariably wants to operate. Most doctors and GPs only recognise NHS physiotherapy that tends to be short and weak. There is room for alternative treatment but they don’t seem to consider it. Beryl had found a new lease of life with a chiro.

There are good and bad chiropractors, osteopaths and physiotherapists and it is not easy finding a good one.

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I actually passed out with the pain in my back on one occasion and woke up lying on the floor and had to crawl to the phone for my son to come to my aid. I did try an osteopath but it was only a temporary fix as the problem kept recurring.

It was when I booked a 3 week holiday touring Australia and New Zealand I developed sciatica and could hardly walk. With only 3 weeks before my plane took off I was about to pull out when I received the recommendation from a friend. I was assured by the chiro that he would get me on the plane but I wouldn’t be 100%. True to his word after 6 sessions working on my lower back I was able to enjoy a fabulous holiday with only just a hint of a limp.

I now attend at 8 week intervals for upper and lower spinal manipulation which keeps me from stooping over and he corrects any problems I may have developed. I also exercise and practice yoga for a few minutes most days and I still manage both the house and garden although I do have someone to cut the grass every 2 weeks.,

Duncan, it is not unusual for a woman to pay £70 for a style, a shampoo and set at the hairdresser. I always shampoo and cut my own hair and consider £30 every 8 weeks to keep me fit, free from pain, independent and active and free from painkillers in my advanced years is worth every penny with nil cost to the NHS.

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I think the general prescription for lower back pain is a painkiller; it is cheap and often effective if it is a muscle problem, in my experience. Using your back normally with the pain reduced often lets the muscles sort themselves out. But persistent pain suggests a more deep rooted problem; GPs seems reluctant to investigate with scans, X rays, and referral to an osteopath because of the cost. Here my experience is to simply be persistent and don’t be fobbed off. The GPs will usually give in to pressure if it is reasonably based.

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Beryl thanks for the info on the price of womens hairdressing , I am not criticizing the fact that –IF– you can afford it good and well but this government + the media cover up the state of poverty in this country. . You do know the UN has censured the UK for its drastic reduction on welfare benefits don’t you Beryl.UN accuses Tories of creating “human catastrophe[” for disabled people ” -quote- UN- (CRDP ) Ellen Clifford (Geneva ) -UK representatives were guilty of “shameless ” obfuscation + misrepresentation of information on disability rights. -end quote. I know its always been the case of life on this planet that the poor suffer but its getting a bit obvious now when profit comes before extreme suffering.

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Duncan, the NHS cannot afford to refer everyone suffering with back pain to a chiropracter or osteopath as it is such s common complaint. The best your GP can offer is physiotherapy if, as Malcolm says, you resort to pressure, but in my neck of the woods you will have to wait a very long time to receive it. Physiotherapy was a complete waste of time fir me after I fell and fractured my arm as I developed a frozen shoulder under their care which should not have happened with effective treatment. So back I went to the chiro who manipulated my shoulder and freed it from its locked position all in one very skilled movement.

I must add chiropractic is not for the faint hearted but if you are looking for a quick fix it is invaluable and as alpha says it is adviseable to find a good one. If you are not happy with your treatment you can refer them to the GCC.

If people can afford to pay for treatment they should do so so that the people you refer to as poor can benefit from shorter waiting lists but often it is a case of just knowing
where your priorities lie.

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Private medical treatment is often seen as ‘jumping the queue’, particularly because many consultants do both NHS and private work. I’m not sure about this and overall support Beryl that it is worth paying for treatment. I think I would prefer to be free from pain rather than have a fancy car or expensive holidays. Unfortunately, there are many who don’t have this option because we live in a society with rich and poor.

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Duncan said Ian just so I dont misinterpret you , are you saying Chiropractic cures all spinal injuries ?

No. What I said was there appears to be some evidence that in some cases they can achieve results which, because of the hard-pressed NHS referral system failing to deliver, can mean those who pay for the consultation can gain relief.

As Alfa notes there are good and bad in any profession, and there has been an issue with the Medical profession being split between Medicines or Surgery. But I had an interesting experience some years ago, which demonstrated (to me, anyway) that GPs can be remarkably ineffective.

One of my legs started behaving rather badly. Either when driving or sleeping the top of the leg muscle from the knee backwards would do something which resulted in truly agonising pain. On the usual 1 – 10 scale this was a 9.9. I’d never experienced pain like it so booked a GP appointment and they duly made an appointment to have the leg X-rayed.

Nothing was found, so I was given some painkillers. I dislike taking any tablets but tried these as instructed, but they couldn’t even dent the pain. I revisited the surgery around four times until eventually I encountered a locum who seemed to recognise that staggeringly sharp pain wasn’t ideal as a driving companion and made an emergency appointment for me to see a Physiotherapist.

I’m naturally sceptical (you may have noticed) but by this time I was on Morphine for the pain, so when the Physios rang to offer me an appointment that same day we got there at almost relativistic speeds.

Now here’s the truly fascinating bit: after lying flat on her table for a couple of minutes while she elevated my leg (and remarked how flexible it was) she asked me if I’d ever been a climber – which I had. She then told me she was certain how to cure the problem, and gave me an exercise which involved the leg muscles being stretched and held stretched for around 40 seconds, three times a day. No tablets, nothing – just an exercise.

It worked, Within three days the pain had gone and I now know how to deal with any future occurrence. But she had the entire problem diagnosed and solved within minutes.

I suspect some non-medical professionals have evolved methods of treatment which are not always accepted by the Medical fraternity. However, when they’re as effective as the exercise I was given, then I would think rapid referrals could save the NHS a lot of money.

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Wavechange I prefer to say “those who can afford to pay” rather defining people as either rich or poor. I suspect there are a large number of citizens who belong somewhere in between the two.

The point I was making was that, if those who can afford to pay for private alternative treatment should do so provided they benefit from it, thereby reducing NHS waiting lists, enabling those who are unable to, receive their treatment sooner rather than later. A typical analogy would be the annual energy payments for senior citizens. Do you think it fair that those who don’t need it should still receive it? There are those who will donate their payments to charity.

I do however question whether public funding allocated for NHS treatment should pay for private treatment in order to reduce NHS waiting lists which wouldn’t be necessary of course if more of those who can afford to pay for private treatment do so.

Ian I am glad that your physio was able to relieve you of your leg pain and you were granted an urgent appointment. Crippling pain has the effect of putting people out of work sometimes for weeks which can affect the economy.

When all your GP can do is offer pain killers which often don’t get to the root of the problem, resulting in repeated return visits and repeated pain killers, potentially causing dependency and damage to your GI system, then I really don’t envisage much improvement in our healthcare system in the near or distant future.

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I wonder how much is spent on treating people who have suffered from the effect of long term use of drugs to treat chronic conditions that might have been better managed. Your example of painkillers is well documented.

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You found a good physio there Ian. Another might have had you coming back week after week giving you very little improvement.

When my osteo was on holiday, I saw another one who spent the whole session running down other osteos and said I would have to come back for several weeks for him to ‘cure’ me. Having had that condition before and having it quickly sorted, I knew what to expect. He did a bit of massage that always makes you feel better, but mockingly refused to do the one move that would have had me out of pain there and then. I never went back. He was recommended by a friend who visited him regularly and thought he was wonderful as he gave her temporary pain relief.

If you can get an appointment with an osteo/physio/chiro quickly, you have to wonder whether they are really bad and everyone avoids them or they are really good, and don’t waste your time and money spinning out appointments for all they can get out of you.

I don’t know how various parts of the NHS get reimbursed for various treatments but I do know the same surgeons work both privately and in the NHS. The NHS does pay for private treatment when no NHS treatment is available and the cynical part of me says there might be a loss of income involved if they recommend alternative treatment. I know several people who have had back operations and wondered whether they could have been avoided with alternative treatment.

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I would like to see all surgeons and consultants practicing in the NHS, contracted in to exclude all private practice, allowing those who wish to perform privately only to do so, but still maintaining the same strict codes of practice laid down by governmental regulatory healthcare bodies.

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Absolutely agree Beryl.

We had Bupa through work for a short time and saw a whole new side to the NHS. You went on the end of a 24 week waiting list for a surgeon on the NHS, but got your choice of times within the next week to see the same surgeon privately. But it was Bupa who suggested trying the sports doctor route before going for surgery and I don’t believe it was purely a money-saving suggestion.

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Maybe if restrictions on advertising, as with smoking and alcohol and/or warnings posted on the exterior of packs as well as interior leaflets (which people don’t always read anyway) would raise awareness of the dangers and the possible risks to health of not just taken to excess, but also taking the recommended amount too frequently on a regular basis.

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I’d like to see the costs of operations examined, to explain how it will cost between £1850 and £3965 for a cataract operation (day case) and between £7600 and £15648 for a hip replacement (see Which? Sept). I am simply interested to know how these costs are arrived at – hire of facilities, fees of the team, “materials”, profit for example.

Where the NHS might exclude an option, such as a varifocal lense replacement, why can we not elect to pay for the extra cost?

I sympathise with Beryl’s view on practising either for the NHS or privately. My naive view was that if they have had their training paid for at medical school from the public purse, and work experience
that leads to their further qualifications in NHS hospitals, we have a right to the use of their acquired talents. That is naive, partly because they now pay for their university training in the main, and because the only real on-the-job training available is, I believe, through the NHS. I do not know what their contracts are, but it would be sensible to required them to spend a proportion of their time doing NHS work, on an NHS payscale, with private available to them the rest of the time. I wouldn’t want to see talented people having to leave the NHS all together, maybe by going abroad, simply to realise their aspirations. We’d lose out.

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Malcolm a visit to any NHS hospital will tell you that a high proportion of qualified specialists working there have been imported from abroad. Should they be allowed dual access to operate both within the NHS and run their private practices as well? Our own medical students presumably are free to do the same and move abroad to practice elsewhere but without putting a strain on their chosen country’s public purse.

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If someone takes a job here on a contract with the NHS, I presume that allows them to practice how they like? If we haven’t trained them they can pursue their own careers? Perhaps they would not come otherwise.

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But they do come and if our NHS contractual legislation allows them to financially benefit from both the public and private sector then they are effectively controlling not only the price of operations but the whole economics of our NHS which is felt at the lower end of the spectrum and the likes of you and I.

We are off topic. It’s about OTC medicine not doing what it’s supposed to.

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Malcolm I have cmet and talked to several people who have had hip replacements two of them had double replacements. In their cases they had local anesthetics . Each hip replacement involves cutting all the flesh etc back and SAWING off the worn end then the new replacement is fixed to the thigh bone and the cup section fitted to the hip section , this is major surgery taking hours to do correctly its not a “5 minute job ” .The hip replacement charges arent way out of line .

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It is jumping the queue because the resources – people and the facilities – are limited. One person taken to the front of the queue puts another further back. One excuse given for this – why companies and public bodies provide subsidised or free private medical insurance – is so that they don’t have “key” employees off sick for any longer than is necessary.

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The key is to find ways to shorten the queue Malcolm so that those who cannot afford to pay will receive their treatment faster.

Allowing consultants/surgeons to work what amounts to part time in our NHS hospitals to enable them to continue with their private practices, means the NHS are having to employ even more part time practitioners who, in turn, are also engaging in private practice, (which used to be described as “moonlighting”) to redress the deficit.

People and companies who can afford to pay for private insurance or treatment should receive it from practitioners operating in the private sector only, in order to allow the NHS to hire fewer practitioners dedicated to working full time, treating those who cannot afford to pay, thereby shortening the queue. At present the NHS is engaged in a two tier system whereby qualified practitioners are effectively having their financial cake and eating it too at the expense of Joe public.

Chiropractors and osteopaths normally operate in the private sector only, treating people who can afford to pay for it. If the treatment they receive helps (and I can vouch from my own experience that it does) by paying fewer visits to their GP surgery or their local hospital, then queues will automatically shorten, ultimately benefitting those who are unable to pay and eliminating the unfair practice of jumping the queue; bearing in mind of course it’s a bit unrealistic to expect no queue at all as the law of supply and demand means there is always going to be one.

Alternative practitioners have more time to advise on preventative care such as exercise, weight control and diet which can often prevent the need for surgery (as alpha has already pointed out in her post) and slow down the degenerative aging process, freeing people to live more active healthier lives culminating in shortened NHS waiting list queues.

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There are alternative models, however. A world centre of excellence I know well has developed dual private / NHS systems running alongside. Their methodology is very interesting: they treat patients from abroad in their private wings, but the charges are eye watering. Contractually, they have it set up so they’re free to install NHS patients in the private wing if needs must. But the high charges levied on the rich pay for the NHS side of the work. It’s allowed them to create a truly superb hospital, replete with en suite private rooms, every facility you can imagine and a world-class surgical team, none of whom works elsewhere.

That said, not every hospital is a world centre of excellence. But the model could be adapted, I imagine.

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Sounds to me like a highly lucrative commercial business Ian, but I would question whether private fees solely would cover NHS patient treatment.

I do happen to know someone who is a patient in a similar specialist private hospital in London. The hospital is reminiscent of a 5 star hotel but his fees are costing the NHS an eye watering £100,000 plus pa. Shortage of suitable accommodation for specialist treatment is costing the NHS dearly with public money going towards investors in the private sector.

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I doubt the fees do, Beryl; they’re set to cover cost of buildings, equipment, staff and food and – as with all private industries – to make a healthy profit (the rich rarely haggle when they’re dying) and it’s that profit which is helping the place expand private facilities to all patients.

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Under the NHS I was booked to see a specialist about my finger. This specialist flew over from Germany every other week although I still had to wait a few months to see him.

I do agree with Beryl that NHS doctors should concentrate on the NHS. Our GPs also seem to spend too much time doing private work. The result is the NHS paying for patients to see doctors privately when they can’t provide them on the NHS.

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In answer to Wavechange – thanks for the sympathy I was on proton pump inhibitors for decades but they eventually gave me double vision , weakness, tiredness and other symptoms so I stopped them myself , it took over 6 months for my body to adjust and yes a lot of heartburn . Beryl overproduction of acid taking normal anti-acid can lead to overproduction but thats why proton pump inhibitors wire introduced , the drawback though it took them 20 years to check out the the theory that lack of acid production could cause stomach cancer but long term results proved otherwise . But stomach acid is needed to kill many germs and it left you open to more illnesses. Anti arthritic drugs are well known for causing perforation of the stomach lining leading to blood poisoning and death if not IMMEDIATELY rushed to hospital and operated on . I could not take them even if I wanted to due to my blood group (O) . My wife and others have less common blood groups which make them more liable to arthritis , I think my wife is rhesus negative , I think group (A) ? they certainly were very interested in her blood

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Choice have a great video on medicine claims, quite amusing.

https://www.youtube.com/watch?v=eGryhxgYOu4
https://www.youtube.com/watch?v=_vPha4usTtI

and
https://www.choice.com.au/health-and-body/health-practitioners/doctors/articles/alternative-diagnostics

Whilst looking it up I found this reference from 2014 regarding TTP the Pacific’s equivalent to TTIP [RIP}
“Medicines

“Leaked copies of the TPP include provisions to lengthen patents for some life-saving drugs for up to 12 years,”[2] Ms Turner says.

“When drugs listed on the Pharmaceutical Benefit Scheme come off patent, prices drop by 16 percent.[3] If the TPP extends patents we’ll be paying higher prices for some medicines over a longer period of time.

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Amusing indeed, but many don’t appreciate how science is misused. There have been many suggestions that we should teach young people to manage money, but learning how misrepresentation and pseudoscience are used in marketing by well known companies is every bit as important. I would prefer drug research and development to be done by research institutes, not by industry.

Duncan – Concerns about enhanced risk of cancer as a result of PPI use were first raised in the mid-90s, if my memory serves me correct. I have mentioned that acid suppression can enhance risk of food poisoning frequently in the campylobacter discussions. I am not convinced that the medical profession sees a risk.

I think we are getting off-topic. 🙁

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I would agree that critical thinking should be taught from a very early age and not only in years 12 and 13.

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Some never get far. Look at how adults choose information that agrees with their opinion and disregard that which does not.

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This is possibly the biggest issue currently afflicting society today. It certainly explains a lot about recent elections and votes.

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Patrick Taylor provided this link above: https://www.youtube.com/watch?v=_vPha4usTtI

It relates to the validity of claims for a weight loss product. I cannot say I like the presentation but it’s not technical and easy to understand. The claims are based on information in a single research paper that involves a company that manufactures the active ingredient of the treatment. This ingredient has subsequently been investigated by the European Foods Safety Authority, which was unable to substantiate the weight loss claims: http://onlinelibrary.wiley.com/doi/10.2903/j.efsa.2010.1604/epdf

In my view, any claims made for products should not be allowed to make use of research where there is commercial involvement including sponsorship.

It is worth watching the video to see why product claims must be properly substantiated.

Guest
Leonard Powell says:
26 August 2017

Hello Which? My wife, who is 72, has had a problem with ‘dry eyes’ for some time. The only medication that seems to offer any benefit is the Optrex dry eye spray, which is very expensive for such a small amount. Unfortunately she does not get the same benefit from eye drops, which are much cheaper. Are there any suitable alternative sprays that would contain the same active ingredients and therefore provide the same benefit, yet might be less expensive?

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Hi Leonard – Your wife’s GP may be able to help and she will qualify for free prescriptions. Dry eyes might be caused by prescribed drug, so it would be good to let the doctor know.

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I’m pleased to see the report in Sept Which? describing useless or near-ineffective over-the-counter “medicines”, supplements and the like, as well as proprietary vs. generic drugs. Keep these reports coming. Maybe publish a booklet to reach a wider public.

I can understand the pharmaceutical companies not being willing to reveal all their clinical trials results to Which? or the public. Why should they make public information that could be commercially sensitive and that could be misused or misrepresented. We have a Medicines and Healthcare Regulatory Authority to look after the public’s interests. Why are they allowing products to be marketed without proof of efficacy? If they are, it is they who should be being held to account. Perhaps Which? could ask them about the products they criticise.

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The All Trials campaign http://www.alltrials.net provides examples of how the drugs industry has concealed information that might harm the reputation of some of the products.

The results of ALL clinical trials must be made public. Here is one short video by Ben Goldacre: https://www.youtube.com/watch?v=3PU5ilpz31g