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Orwell’s adverse drug reaction

The Guardian has an interesting piece on Orwell and the writing of 1984. The information about the treatment of Orwell’s tuberculosis (TB) seems to indicate that he suffered a fairly severe skin hypersensivity reaction to streptomycin.

“In 1947 there was no cure for TB - doctors prescribed fresh air and a regular diet - but there was a new, experimental drug on the market, streptomycin. Astor arranged for a shipment to Hairmyres from the US.

Richard Blair believes that his father was given excessive doses of the new wonder drug. The side effects were horrific (throat ulcers, blisters in the mouth, hair loss, peeling skin and the disintegration of toe and fingernails) but in March 1948, after a three-month course, the TB symptoms had disappeared. “It’s all over now, and evidently the drug has done its stuff,” Orwell told his publisher. “It’s rather like sinking the ship to get rid of the rats, but worth it if it works.”

Streptomycin was the first aminoglycoside antibiotic developed, in the early 1940s, and was used first line in the treatment of tuberculosis. Martindale tells us that:

Hypersensitivity skin reactions are reported in about 5% of patients, and eosinophilia may occur. There have been reports of Stevens-Johnson syndrome, toxic epidermal necrolysis, severe exfoliative dermatitis, and anaphylaxis.

Skin reactions are not uncommon. Orwell’s seem relatively severe, if not life-threatening, and is illustrative of how people make judgements about the risks they are willing to accept from treatment in the face of a disease.

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Recent articles

The Daily Mail’s latest MMR story

Gives space to Andrew Wakefield, suggests a conspiracy to brain wash children, and allows the regular JABS anti-vaccine crew to vent off. Lay Scientist lays into them.

Homeopathic victory?

About three years ago there was considerable concern about the Medicines and Healthcare products Regulatory Agency (MHRA) becoming associated with homeopathy.

The Medicines and Healthcare products Regulatory Agency (MHRA) is introducing rules to allow remedies to specify the ailments for which they can be used.

But critics argue the treatments will not be rigorously tested as they do not need to undergo the clinical trials orthodox drugs do to get a licence.

Sense about Science argued this was a move away from science, and Professor David Colquhoun was slightly more forthright.

The Pharmaceutical Journal reports that the first homoeopathic remedy has now received approval to be labelled with therapeutic indications. A homeopathy remedy called “Nelsons arnica ClikPak” is now labelled for the “symptomatic relief of sprains, muscular aches and bruising and swelling after contusions”. The MHRA told The Pharmaceutical Journal that:

“The purpose of the National Rules Scheme is to address the anomalies in regulating homoeopathic medicinal products and enable consumers to make an informed choice.

“It is not to encourage new users to make their first-time purchase, nor to give homoeopathy ‘added credibility as a safe and natural complement to conventional medicine’.”

Homeopaths don’t agree. Here’s the Chairmen of the company who obtained the approval:

“The fact that therapeutic indications may now be included on the packaging of licensed homoeopathic medicines not only opens the practice of homoeopathy up to new users but also gives it added credibility as a safe and natural complement to conventional medicine.”

The company have no scientific proof for its efficacy, nor can they provide a credible scientific basis for the whole practice of homeopathy, but they can now cite the MHRA approval as adding credibility. I find it hard to beleive that the public will not see approval of homeopathic preparations by a drug regulator as a “scientific” blessing of the product.

On the other hand, the MHRA’s move into this arena, might allow them to stamp out the worst examples of this fraudulent pseudoscience.

Make your medicines safer, sign this petition

Please read this post and consider signing the attached petition. It may increase the safety of the medicines you are given in the future.

In the UK, Section 64 of the Medicines Act 1968 says, that if a pharmacist makes a single dispensing error they have automatically undertaken a criminal act. So why should you care as a member of the public? Surely this law makes drugs safer?

Not necessarily. In order to learn from errors we need to know what they are. To this end errors can be reported to agencies such as the National Patient Safety Agency. These reports help us improve working practices, the packaging of pharmaceuticals and the computer systems we use every day.

Section 64 undermines the reporting of these errors, since pharmacist errors are deemed criminal acts. It is important to note that a single prescribing error does not make a doctor a criminal in this way; this is a highly specific crime for pharmacists. A 1968 Act designed to protect patients is having the opposite effect to that intended.

Although pharmacists have a particular interest in this issue, it would add more weight to the petition if it was shown to have public support and support from other professionals. Please consider signing it, and if you are a blogger drawing attention to it. Here is the petition and a link to it.

Background (Preamble):

Millions of prescriptions are dispensed each year and only a very small percentage result in an error. However because of the sheer volume of prescriptions given out daily, each and every pharmacist is involved in a number of error incidents throughout the length of his or her career.

Recently a pharmacist (who has subsequently resigned from practice) was given a three month suspended prison sentence for making a dispensing error. A charge of manslaughter failed because the error was judged to have played no part in the death of the patient. When pharmacists make errors they are encouraged to report them so that systems can be reviewed and improved for the benefit of future patients. This case makes it less likely that errors will be reported.

A custodial sentence is supposed to be handed down to protect the public. This sentence is likely to achieve the complete opposite. If every pharmacist who has ever made a mistake were to be criminalised in this way then there would soon be very few left to practice. This law needs to be changed and soon.

Petition:
We the undersigned call on the Department of Health to ensure that the law relating to the dispensing of medication errors is changed as soon as possible such that one-off, non-deliberate errors are no longer considered to be criminal offences.

Link to petition.

Further information on the petition at The Pharmaceutical Journal.

European Immunization Week

This week is European Immunization Week, which exists to “boost awareness of the importance of vaccination and increase the success of immunization programmes nationally and throughout the Region.” Here is the Welsh Chief Medical Officer views on vaccination:

After providing clean water, air and food, vaccination is the most effective public health intervention for saving lives and protecting our health.

And it’s not too late to vaccinate, if you found yourself caught up in a vaccine scare.

How on earth

Do you turn from a scientist who publishes an important paper on cell membranes that is cited by thousands of other papers into a man standing in front of an “Expose the 9/11 Cover-Up” poster talking about vaccine conspiracies?