The Perfect Sweet 16 Birthday Gift: Botox

[Cyrrex]

Americans are INSANELY over-medicated.  We have drugs for everything, and almost everyone is on something.  I'd wager that half of the posts here are either invented issues or highly exaggerated, though of course I can't prove it.  The point is, we are largely full of shit.  Happily, there's a drug for that, too.

How does one exagerate migraines or seizures? Maybe I just had a really strong shiver mis-diagonsed?

01101010: I wouldn't trust your PCP with a migraine diagnosis. See a neurologist. It's pretty easy to differentiate between migraine and cluster headaches (they present totally differently), for one -- and stress headaches are rarely confused with migraines by someone with an actual knowledge of both. A good neurologist will take the time to make sure, unless you come in with symptoms that are so classic you might as well be the poster-child for it. (Auras and well-defined triggers, to name two).

Nebu: 10 isn't much, man. If you have migraines, that's 2 right there. Any infection or bacterial illness will add one or two per episode. If you took 10 prescription pills a day, that would be one thing. Getting 10 filled scripts per year? Not really.

LOL.  10 a year is beyond insane (assuming that's 10 different things and not the same one getting refilled), and that's what he said was the average.  I'm not saying that it isn't warranted in some cases, but I daresay that most people having 10 or more a year need to figure out what's wrong with their heads before they worry about their bodies.  I haven't had even close to 10 in my whole damn life.

[Morat20]

LOL.  10 a year is beyond insane (assuming that's 10 different things and not the same one getting refilled), and that's what he said was the average.  I'm not saying that it isn't warranted in some cases, but I daresay that most people having 10 or more a year need to figure out what's wrong with their heads before they worry about their bodies.  I haven't had even close to 10 in my whole damn life.

You must not get sick. Or have kids. Or ever injure yourself. Last time my kiddo got sick -- lovely stomach bug floating around his school -- it ended up being three scripts for him, then three for my wife when she got it. Not counting the injection at the doctor's.

Of course, one -- or possible two, it was awhile back -- where simply so he could stop throwing up. We could have skipped those -- do medicines given to you in the hospital as you're hooked up to IVs due to severe dehydration count as 'prescriptions'?

I take three dailies -- Keppra for seizures, linsporil for hypertension that has ignored any other attempts to moderate it (It's been 130/90 for over a decade. Regardless of my weight, how much or little I exercise), and aspirin as about the only 'precautionary' way to treat a high risk of DVT. (First drug company to perfect a drug that'll deal with clots without making you a hemophiliac -- well, a drug that doesn't need to be metered via IV -- is going to make a bundle.).

So I have 24 prescriptions a year. Well, since I do three-months on Keppra it's only 15 a year. That's without getting sick. Add a case of the flu, you can add two or three more. A decent injury -- fracture or sprain -- three or four more, depending on how long I need to be on painkillers or anti-inflammatories. Food poisoning -- well, do you could the ER drugs?

Should I have my head examined? Are my seizures psychological? Will my blood pressure magically go down if I just man up?

[Cyrrex]

Hey, maybe you're one of the exceptions...

But yeah, I have kids, and yes, I get sick.  That leads to a net prescription increase of exactly zero.  Penicillin would be a different matter, but if you're on that every year, something is seriously messed up.  And I don't injure myself enough to require a prescription (I mean, wtf are you doing?) and I haven't fractured a bone since I was sixteen, and even when I did I took a single pill for pain the first day, and that was it.  It isn't about "manning up", it's about being wary about what kind of terrible garbage I'm putting into myself.  None of this stuff is natural, but people don't even think twice about inhaling it.

People are just too quick to put what amounts to poison in their bodies for what ultimately amounts to a bunch of simple ailments.  Some of yours are more serious than that Morat, I'll grant you that much...that isn't really the kind of stuff I'm talking about.  Hell, I have to take a stupid statin for my cholesterol, and I only do that with extreme prejudice and because I exhausted natural methods of getting myself out of the danger zone (it seems to be a more genetic issue with me than a lifestyle one). 

So, 10 a year in specific case is probably understandable.  But an average for the entire population?  MADNESS.

[Nebu]

Should I have my head examined? Are my seizures psychological? Will my blood pressure magically go down if I just man up?

You're the unfortunate exception rather than the rule.  Having a seizure disorder places you into a small minority as does having hypertension at a young age (since it's not due to obesity).  I don't envy your situation at all and am impressed by how you have managed to overcome it.

For the record, the list for exclusion criteria for the 10 prescription number I threw out was long.  Refills were not considered beyond the first fill.  Oral contraceptives also weren't considered. I just tossed out the number as an offhand way to demonstrate that our reliance on prescription medication is a bit overboard.   The number is even more staggering if you consider the millions of people that don't get prescriptions due to cost.  

[Sheepherder]

I've got a number of things which appear to be wrong with me medically, but I probably average around one prescription a year.  Last year I don't think I was on anything.  My disorders are unfun.

[Rasix]

Having severe seasonal allergies and bad GI issues means constant treament is a way of life.  As far as prescriptions, I only have 3 that I use and 2 are just emergencies (spray + epi-pen).  Weekly/bi-weekly allergy shots, claritin D (yay OTC), and omeprazole (only constantly used scrip) are part of my routine (lactaid and and something like pepcid as needed). At least I've worked the nasal sprays out of daily use, that was making my feel pilled.

Then.. if I get one of my many sinus infections that's usually another 2 prescriptions (antibiotic + heavy duty decongestant).  At least those have gone down in frequency. 

I'd like to be on nothing, but without the above I'd be walking around feeling terrible all day and then unable to sleep at night.  YAY.

[Morat20]

You're the unfortunate exception rather than the rule.  Having a seizure disorder places you into a small minority as does having hypertension at a young age (since it's not due to obesity).  I don't envy your situation at all and am impressed by how you have managed to overcome it.

For the record, the list for exclusion criteria for the 10 prescription number I threw out was long.  Refills were not considered beyond the first fill.  Oral contraceptives also weren't considered. I just tossed out the number as an offhand way to demonstrate that our reliance on prescription medication is a bit overboard.   The number is even more staggering if you consider the millions of people that don't get prescriptions due to cost.  

Well, if they're excluding a lot of shit -- including refills, then 10 is a bad number.

But just because it's "a lot" doesn't make it bad. You need to make an actual case beyond "God, that's a lot of stuff our forefather's didn't shove down their throats!". It's not like the human body is a perfect machine -- it's a jury-rigged collection of parts evolved to last until 40ish, and anything after that is just gravy.

I'm not exactly a fan of pharmacuetical companies (mostly because I know exactly how much price gouging goes on) but the existance, even the widespread use of pharmacueticals is neither good nor bad based on volume or quantity.

Just as a contrary example -- the fucking whooping cough epidemic in California can be tied directly to crazy fuckers who thought their kiddies got too many vaccinations, and it was going to make them sick.

[Nebu]

But just because it's "a lot" doesn't make it bad. You need to make an actual case beyond "God, that's a lot of stuff our forefather's didn't shove down their throats!". It's not like the human body is a perfect machine -- it's a jury-rigged collection of parts evolved to last until 40ish, and anything after that is just gravy.

Did you see the part of my comment that said that I do research on drug-induced disease states?

Unnecessary pharmacy is why we're observing more and more drug-resistant bacterial strains.  Polypharmacy is a symptom of the breakdown of our health care system.  Take a look at the top 200 drugs by prescription some day.  You'll see that 90% or so are purely palliative agents.

Pharmaceuticals are a great and wonderful thing for some situations (seizure disorders, migraines, cancer, infection, AIDS, etc) but they've become a go-to for years of neglect and poor body maintenance.  Patients get ANGRY when they go to a physician and don't get a prescription.  There's something seriously wrong with that picture.

We prescribe so many drugs because a) patients want to leave the office with a prescription and b) if you tell a patient to go home, fix their diet, lose weight, and exercise, they will take their business to another physician that will give them something for their type II diabetes, a statin, a beta blocker, and a loop diuretic without telling them how shitty they've abused their body for the last 20 years. 

[Morat20]

Did you see the part of my comment that said that I do research on drug-induced disease states?

And we have non-drug induced disease states. And yes, people can be over-prescribed. I have no doubt that, right now, large numbers of Americans take medication they don't need -- or wouldn't need if they'd lost weight years earlier, or died in their 50s, or exercised more.

On the other hand, I bet there's just as many Americans that don't take medication they DO need -- because they can't afford it, or because they think incense will do more than drugs, or because they think they're 'over-medicated'.

And certainly you're right about many Americans not liking leaving a doctor's without something that they think will make them feel better -- whether it's placebos or antiboitics for a viral infection. And certainly that's something that should be changed.

So the average American fills 10 prescriptions a year. There's nothing magic about that number. Nothing to say it's 'good' or 'bad'. No way to say that's the wrong number. That it means Americans are "over-medicated". (Frankly, you can't argue it at all. Whether a patient is properly medicated is entirely individual. Taking some average across a population -- especially one like ours, with highly irregular access to health care -- is pretty useless).

And then, of course, there's the question of what to do with your titular examples -- the American who needed to lose weight and exercise 20 years ago, so he doesn't feel so bad now. Should we let him suffer, if there are drugs that will allieviate his pain? We lack a time machine to fix it 20 years ago -- and in my experience, every fucking doctor I've ever BEEN to has, in fact, started any general exam (as opposed to "I can't help but notice the blood dripping off that gash, let's stitch you up" visits) with weighing me, checking my blood pressure, and asking about how much exercise I get -- and then telling me to fix it, if it's wrong.

How does telling them "You wouldn't need this if you'd eaten better over the last 20 years" unmedicate them? It doesn't change their current medical condition a damn bit, and their current condition dictates whether they -- as an individual -- need medication.

I do happily agree that more emphasis should be put on long-term care, preventative care, and other such things that would lower the incidences of Type 2 diabeties, obesity, and high blood pressure. Unfortuantely, those are the sorts of things our ad-hoc system does very poorly with. Not because of Big Pharma, but because our medical system doesn't look for cost savings over 20 or 30 years, because the people paying for it won't have the same patient that long.

Nonetheless, that doesn't make your case that an average of 10 a year is "too many". Offhand, I'm not sure you CAN make a case that any number is too little or too much. It's a disconnected number, complete absent any real context. Like, for starters, what's the PROPER number? How many prescriptions a year is 'just right'? How few is "too few"? How can you say "too many" if you can't say "just right"?

[Merusk]

Man I feel uber.. I haven't had a scrip in 4 years and I see the doctor regularly.  The kids haven't had one since the son caught strep at day care in November.  Woo.

[Minvaren]

Unnecessary pharmacy is why we're observing more and more drug-resistant bacterial strains.

Since this thread has derailed so far that it has found a new set of rails again, can I get your opinion as to the severity of this problem?  I have heard/read a couple of pieces over the last few years regarding growing difficulty in treating infections, with warnings that soon we'll have few real options against certain "bugs" (mainly found in hospitals, IIRC).

[Lantyssa]

We're over-prescribed.  We'd rather take a pill to address the symptoms than work on fixing the cause of the problem.

There's also been a lot of redrawing the lines on "healthy" to pawn off prescriptions that have no effect or make things worse.  (Statins, I'm looking at you.)  Then we let Pharma get away with changing the salt compounded with their Wonder Drug to draw the patent out another few years.  Try to push generics or things like Vitamin C & D and they quash you quick, because those are cheap and they can't get royalties off them.

[Selby]

And I thought my daily 3 drugs were excessive.  Asthma is just not fun to deal with, although I could probably go off that drug and just use the rescue inhaler as needed and save myself the $20/mo...

[apocrypha]

Unnecessary pharmacy is why we're observing more and more drug-resistant bacterial strains.

Since this thread has derailed so far that it has found a new set of rails again, can I get your opinion as to the severity of this problem?  I have heard/read a couple of pieces over the last few years regarding growing difficulty in treating infections, with warnings that soon we'll have few real options against certain "bugs" (mainly found in hospitals, IIRC).

This is already the case with some bacterial strains. Staphylococcus aureus (MRSA for example), Clostridium difficile and Pseudomonas aeruginosa are some of the main ones that have high levels of resistant and multi-drug resistant strains in the community . There are a very few anitibiotics available that basically have restrictions on their use (Linezolid for example) because they're the only drugs we have left that so far have low levels of resistance found in the wild.

Many traditional antibiotics are now essentially useless due to the rapid evolution of resistance as a result of over prescription. When penicillins were first developed they were a "magic bullet" that revolutionised infection control. Now they're pretty much completely unused outside of labs. Resistance develops quickly for several reasons (fast replication times, resistance genes being carried on DNA seperate from the genome known as plasmids, high mutation rates, etc) but over prescription of antibiotics is a major factor in this. In addition most people don't complete their antibiotic course but just stop taking them when they're better and this exerts a strong selective pressure towards development of resistance.

The other serious problem with antibiotic resistance is that R&D into new antibiotics is highly unprofitable. It takes decades of work and 10s of millions of $ to bring a new drug to market. If that drug is an antibiotic then the chances are high that it will be useless within 10-20 years because of the rapid development of resistance. Why would a drug company do that when they can make untold amounts of money by simply making new copies of Viagra and new drugs to treat diabetes and depression or new vitamin supplements instead?

It's hard to predict the precise outcome of all this, obviously, but personally I believe that we can't just leave it up to the drug companies to find solutions, we need a huge invesment into research to develop new ways to combat MDR strains and we need a major rethink on how to limit the spread of such strains, particularly in high-risk places like hospitals. Privatising things like hospital cleaning services for instance is not a correct direction to be going in.

And to lighten that mood:

[01101010]

Most prescription drugs treat the symptoms and make things more manageable for the person while their biology adapts or copes with the illness. That said, I have only taken 3 prescriptions in the past year, one of which was my own. Cleanest narcotics in the US come from big pharma companies 

[tgr]

Americans are INSANELY over-medicated. 

The average American will have 10 prescriptions per year (not necessarily concurrently).  Yes, we are over medicated. A good portion of my research centers on Drug-induced disease states.

What the christ, 10?

I've only ever taken drugs while I was younger, to curb the allergies, and the last two times I got any prescriptions were once 5-10 years ago for a serious sinus infection I just couldn't fix myself (most of them are pretty easy to fix), and once for an ear infection. The first was antibiotics, the second was just some slime inhibitor thing, and I was pretty chuffed that it wasn't some antibiotic.

[Nebu]

Since this thread has derailed so far that it has found a new set of rails again, can I get your opinion as to the severity of this problem?  I have heard/read a couple of pieces over the last few years regarding growing difficulty in treating infections, with warnings that soon we'll have few real options against certain "bugs" (mainly found in hospitals, IIRC).

Massive topic under a great deal of academic scrutiny.  Nosocomial strains of some bacteria are serious cause for alarm (i.e. MRSA) and some new evidence suggests that different bacteria can actually confer resistance to each other... which is really scary.

[apocrypha]

Massive topic under a great deal of academic scrutiny.  Nosocomial strains of some bacteria are serious cause for alarm (i.e. MRSA) and some new evidence suggests that different bacteria can actually confer resistance to each other... which is really scary.

You mean cross-species? Yeah that does sound scary, how does that work? Plasmid transfers?

[Nebu]

You mean cross-species? Yeah that does sound scary, how does that work? Plasmid transfers?

Yes.  I've attended a number of talks in the past few years that attempt to describe the mechanism of transfer.  As I'm a chemist, a lot of the mechanistic cell signalling stuff isn't in my comfort zone, but the talks were pretty scary.  I'm sure a search of NIH.gov would turn up all the information you ever wanted to read.

[01101010]

Well if you wish to go down the route, this is mother nature's way of slapping the human race around with more and more trump cards. We are long overdue for a worldwide viral outbreak that kills off a ton of people (hence the hysteria over SARS, BIRD FLU, SWINE FLU, etc.). I think humans have advanced enough to control many factors like clean water, drugs, better foods, to keep the wave at bay and might have the chance to continue to a point - but companies will continue to resurrect the specter of a global virus outbreak that kills off a ton of humans to sell shit that might only affect a small portion of the population. And hey, if the population doesn't want to fork over the money for a life-saving shot in the arm, they'll just take your tax money by pushing the gov't to protect the population by having the needles at the ready.  

[Nebu]

Viral outbreaks will happen.  We're pretty terrible at doing anything about a virus.  The scary thing is that we have a way to treat bacterial infections... when that becomes useless, then we're proper fucked.  Just look at average human lifespans prior to the discovery of penicillin for reference. 

[Bunk]

The average American will have 10 prescriptions per year (not necessarily concurrently).  Yes, we are over medicated. A good portion of my research centers on Drug-induced disease states.

 

  Seriously? 10 per year? That's mindnumbing.

Yea, my parents who are in their 60s have a few regular meds they take, but shit, I've probably had two prescriptions (amoxicilan for an infection) in the last ten years. Canadians would consider anyone under forty that has more than one or two prescriptions in a year as either a hypochondriac or an AIDS patient.

[Morat20]

What the christ, 10?

I've only ever taken drugs while I was younger, to curb the allergies, and the last two times I got any prescriptions were once 5-10 years ago for a serious sinus infection I just couldn't fix myself (most of them are pretty easy to fix), and once for an ear infection. The first was antibiotics, the second was just some slime inhibitor thing, and I was pretty chuffed that it wasn't some antibiotic.

Don't use yourself as a data point. It's human nature to decide everyone is like us, but it's not actually true.

Some people get sick easily. Some have reoccuring conditions (allergies that require a doctor, not a trip to the OTC antihistimines, diabties, migraines, whatever). Some have rough enough lives -- from work, from sport -- that they're frequently injured, and require something stronger than Alleve. Some have things like cancer or AIDS, which means your daily life is a cocktail of medicines.

And lots of people are just fucking old -- which means they need medications to deal with cholesteral, blood pressure, this or that other illness just from getting old.

When I was in my 20s, all I took was an anti-epileptic for the seizures and the occasional aspirin or NSAID for soft-tissue stuff like pulled muscles, unless I got ill enough to see a doctor. Now, I take three -- the anti-epileptic, a blood pressure medicine, and daily aspirin. Although I've been bouncing back and forth between steroid shots, prescription NSAIDs and cortico-steroids for the last six months trying to avoid surgery on my damn foot -- and that's been off and on for two years now. (I'm fucking sick of walking in pain from what is, basically, a damn pulled ligament that wouldn't heal, and then scarred).

I suspect as I hit my 40s and 50s, I'll take more -- I can think of two or three other genetic risks, just from my parents, that if they pop up require one or two medications apiece. None of which can be mitigated by diet or exercise, either at onset or a lifetime before.

So better than saying "10 is too many" -- how many, on average, unnecessary prescriptions does a patient get? How many aren't medically necessary? How many times do you leave the doctor's with a script that shouldn't have been given to you, in a world where doctors face no pressures to hand them out?

10's just a number. Is it too much? Too little? Just right? No telling, really -- not with our hodgepodge of medical data collections. But you might be able to tease out how often people get given antibiotics as placebos, or demand Drug X because they saw it on TV and the doctor just writes it to shut them up.

[apocrypha]

Yes.  I've attended a number of talks in the past few years that attempt to describe the mechanism of transfer.  As I'm a chemist, a lot of the mechanistic cell signalling stuff isn't in my comfort zone, but the talks were pretty scary.  I'm sure a search of NIH.gov would turn up all the information you ever wanted to read.

Mmm yeah enormous amounts of stuff turning up on horizontal gene transfer. Pretty amazing stuff really. Actually the basic mechanisms of this are the core of molecular biology and geneticists learning to use and modify those mechanisms in vitro created the discipline and it's tools.

Funny how quickly I forget this stuff. Only been out of the field for 3 years or so and already I've pushed it our of my head to make way for other things. Maybe I should install some more memory..... 

[01101010]

http://tardis.wikia.com/wiki/Nanogene 

[Morat20]

http://tardis.wikia.com/wiki/Nanogene 

Side-effects include zombism, creepiness, and gas-mask face. Patients run a high-risk of being hit on by Captain Jack.

[Nebu]

Still my favorite...

[apocrypha]

Haha!

So where's Pfizer's poster claiming that their placebo is better? Of course all they'd have to do is make it more expensive for that to be the case anyway 

[Tebonas]

Don't use yourself as a data point. It's human nature to decide everyone is like us, but it's not actually true.

Pot, Kettle and all that.

Some people get sick easily. Some have reoccuring conditions (allergies that require a doctor, not a trip to the OTC antihistimines, diabties, migraines, whatever). Some have rough enough lives -- from work, from sport -- that they're frequently injured, and require something stronger than Alleve. Some have things like cancer or AIDS, which means your daily life is a cocktail of medicines.

Not everybody that is fat eats like a pig. That doesn't change that the majority of fat people DOESN'T have a glandular condition.

And lots of people are just fucking old -- which means they need medications to deal with cholesteral, blood pressure, this or that other illness just from getting old.

And lots of people are young --- which means they shouldn't need medication at all. Those cancel out your old people - statistically.

10's just a number. Is it too much? Too little? Just right? No telling, really -- not with our hodgepodge of medical data collections. But you might be able to tease out how often people get given antibiotics as placebos, or demand Drug X because they saw it on TV and the doctor just writes it to shut them up.

Here is a neat trick. Compare medical data with country of comparable health care system first world health care system. Begin talks with those data points in mind.

[Trippy]

This is not Politics.

[Tebonas]

My apologies, that triggered a reflex in me and I got carried away. Two days seems to be my personal limit for letting such things stay unchallenged, I'll work on my self-control and wait for the move to politics for further discussion.

[Vision]

When I was abroad I got a total of 4 infections due to allergies. Strep throat, ear infections, and 2 head colds. I was on antibiotics, sudafed, allegra, singulair, and advair inhaler, as well as a rescue inhaler for my cough, and alieve for my headaches.

Meanwhile I realized that if I stopped taking allergy medicine, I could afford more useless shit to bring back home, so I stopped taking all of my meds and started using a neti-pot for my sinuses. My allergies went away and I never had a problem after that. Since then, Ive been able to concentrate more, and the ocassional scratchy throat and itchy eyes never seem to bother me as much when I'm not using steroid inhalors, antibiotics, a decongestant and all the crap they put into allegra D.

Point being I feel so much better when not dealing with the effects of my allergy meds that it is more than worth the occasional runny nose or sneeze.

Poll: Is it acceptable to give your 18 yr. old daughter breast implants as a high school graduation gift? Not that I even have a daughter, just wondering if I'm the only one who thinks thats bat-shit retarded.

[Trippy]

I don't know I would need to see some pics to decide

[tgr]

Poll: Is it acceptable to give your 18 yr. old daughter breast implants as a high school graduation gift? Not that I even have a daughter, just wondering if I'm the only one who thinks thats bat-shit retarded.

Unless her tits are literally going in her chest, then I would say no. And even then I would've said she would have to be teased mercilessly for this to even be a topic. There are tons of men (and women) who don't desire their SO (or fuckfriend of the day) to have 2 ton tits that stick straight out no matter what she's doing.

Quick edit: Or, of course, one tit is significantly larger/smaller than the other, but that kind of goes in under the "teased mercilessly" bit.

[Nebu]

Poll: Is it acceptable to give your 18 yr. old daughter breast implants as a high school graduation gift? Not that I even have a daughter, just wondering if I'm the only one who thinks thats bat-shit retarded.

Bat-shit insane may be a tad extreme, but it certainly sends every kind of wrong message. 

- That you should care what other people think.

- That you are your appearance.

- That the original you isn't good enough.

I have a 16 year old daughter and it's bad enough that I have to remind her daily that she doesn't need to be skin and bones to be beautiful.  Sadly her mother is the type that would consider buying her breast implants for her graduation, so I have that battle as well.