#pharmaceutical drug (medical treatment)

[senselessalchemist]

CW: blood and medical stuff

It is just over 7 years now since my diagnosis with an autoimmune* disease (~10 years since symptoms started) and I don't really have anything profound or useful to say, but A) don't let people tell you it's just stress without any further testing if you have unexplained internal bleeding and B) if you literally can't stay awake because you've been bleeding for a few months straight, don't listen to the PCP who tells you not to go to the hospital because your hands are too pink and rosy for you to actually be anemic and there's not much the hospital will be able to do for you anyway

Two-ish days after that appointment I was in the hospital and almost immediately getting a transfusion because I was so anemic. (I would end up getting a 2nd as well because continued bleeding + already low on blood = first one not enough.) Stayed there for almost a month until they got the bleeding under control.

This could have happened to anyone but it's hard not to think that being afab probably had something to do with the downplaying and dismissal of symptoms for 3ish years before being diagnosed. They did the classic "it's probably just stress" because I was a senior in college (and possibly because afab). I don't want to make this a never trust medical professionals kind of thing, because there are many good ones and some of them probably saved my life and/or prevented me from having major surgery (which turned out not to be necessary at the time b/c the med they tried started to work)... but also when things are obviously wrong and especially if they recur (like unexplained bleeding cropping up again and again over years) maybe don't take "it's just stress" as an explanation. Also fuck the doctor who thought he could diagnose anemia or lack thereof by hand color and who advised against further treatment ("just wait until your specialist appointment in a month!")

*there does seem to be some debate about whether my particular condition should be classified as autoimmune or not, but enough people do at this moment I'm just gonna go with it because it's treated like many autoimmune diseases are, with various immunosuppressants or immune system modulating medications

[thiefnessman]

i’m not gonna get too worked up about it but like. idk today some of us were talking with our instructors about our future internships and careers and how a lot of the areas we’re passionate about are things we’re unlikely to get stable positions in because scientific progress only gets rewarded if it can be profitable or in someone’s business interests. the fucking song and dance of bowing down to the interests of investors and the almighty nebulous idea of Profit is fucking screwing everything over

[gingersnapwolves]

So today I want to talk about puberty blockers for transgender kids, because despite being cisgender, this is a subject I’m actually well-versed in. Specifically, I want to talk about how far backwards things have gone.

This story starts almost 20 years ago, and it’s kind of long, but I think it’s important to give you the full history. At the time, I was working as an administrative assistant for a pediatric endocrinologist in a red state. Not a deep deep red state like Alabama, we had a little bit of a purple trend, but still very much red. (I don’t want to say the state at the risk of doxxing myself.) And I took a phone call from a woman who said, “My son is transgender. Does your doctor do hormone therapy?”

I said, “Good question! Let me find out.”

I went into the back and found the doctor playing Solitaire on his computer and said, “Do you do hormone therapy for transgender kids?” It had literally never come up before. He had opened his practice there in the early 2000s. This was roughly 2006, and the first time someone asked. Without looking up from his game of Solitaire, the doctor said, “I’ve never done it before, but I know how it works, so sure.”

I got back on the phone and told the mom, who was overjoyed, and scheduled an appointment for her son. He was the first transgender child we treated with puberty blockers. But not, by far, the first child we treated with puberty blockers, period. Because puberty blockers are used very commonly for children with precocious puberty (early-onset puberty). I would say about twenty percent of the kids our doctor treated were for precocious puberty and were on puberty blockers. They have been well studied and are widely used, safe, and effective.

Well. It turned out, the doctor I worked for was the only doctor in the state who was willing to do this. And word spread pretty fast in the tight-knit community of ‘parents of transgender children in a red state’. We started seeing more kids. A better drug came out. We saw some kids who were at the age where they were past puberty, and prescribed them estrogen or testosterone. Our doctor became, I’m fairly sure, a small folk hero to this community. 

Insurance coverage was a struggle. I remember copying articles and pages out of the Endocrine Society Manual to submit with prior authorization requests for the medications. Insurance coverage was a struggle for a lot of what we did, though. Growth hormone for kids with severe idiopathic short stature. Insulin pumps, which weren’t as common at the time, and then continuous glucose monitoring, when that came out. Insurance struggles were just part and parcel of the job.

I remember vividly when CVS Caremark, a pharmaceutical management company, changed their criteria and included gender dysphoria as a covered diagnosis for puberty blockers. I thought they had put the option on the questionnaire to trigger an automatic denial. But no - it triggered an approval. Medicaid started to cover it. I got so good at getting approvals with my by then tidy packet of articles and documentation that I actually had people in other states calling me to see what I was submitting (the pharmaceutical rep gave them my number because they wanted more people on their drug, which, shady, but sure. He did ask me if it was okay first).

And here’s the key point of this story:

At no point, during any of this, did it ever even occur to any of us that we might have to worry about whether or not what we were doing was legal.

It just never even came up. It was the medically recommended treatment so we did it. And seeing what’s happening in the UK and certain states in America is both terrifying and genuinely shocking to me, as someone who did this for almost fifteen years, without ever even wondering about the legality of it.

The doctor retired some years ago, at which point there were two other doctors in the state who were willing to prescribe the medications for transgender kids. I truly think that he would still be working if nobody else had been willing to take those kids on as patients. He was, by the way, a white cisgender heterosexual Boomer. I remember when he was introduced to the concept of ‘genderfluid’ because one of our patients on HRT wanted to go off. He said ‘that’s so interesting!’ and immediately went to Google to learn more about it. 

I watched these kids transform. I saw them come into the office the first time, sometimes anxious and uncertain, sometimes sullen and angry. I saw them come in the subsequent times, once they were on hormone therapy, how they gradually became happy and confident in themselves. I saw the smiles on their faces when I gave them a gender marker letter for the DMV. I heard them cheer when I called to tell them I’d gotten HRT approved by insurance and we were calling in a prescription. It was honestly amazing and I will always consider the work I did in that red state with those kids to be something I am incredibly proud of. I was honored to be a part of it.

When I see all this transgender backlash, it’s horrifying, because it was well on the way to become standard and accepted treatment. Insurances started to cover it. Other doctors were learning to prescribe it. And now … it’s fucking illegal? Like what the actual fuck. We have gone so far backwards that it makes me want to cry. I don’t know how to stop this slide. But I wrote this so people would understand exactly how steep the slide is.

[familythings]

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[thoughtportal]

Opinion Here’s how to get free Paxlovid as many times as you need it

When the public health emergency around covid-19 ended, vaccines and treatments became commercial products, meaning companies could charge for them as they do other pharmaceuticals. Paxlovid, the highly effective antiviral pill that can prevent covid from becoming severe, now has a list price of nearly $1,400 for a five-day treatment course.

Thanks to an innovative agreement between the Biden administration and the drug’s manufacturer, Pfizer, Americans can still access the medication free or at very low cost through a program called Paxcess. The problem is that too few people — including pharmacists — are aware of it.

I learned of Paxcess only after readers wrote that pharmacies were charging them hundreds of dollars — or even the full list price — to fill their Paxlovid prescription. This shouldn’t be happening. A representative from Pfizer, which runs the program, explained to me that patients on Medicare and Medicaid or who are uninsured should get free Paxlovid. They need to sign up by going to paxlovid.iassist.com or by calling 877-219-7225. “We wanted to make enrollment as easy and as quick as possible,” the representative said.

Indeed, the process is straightforward. I clicked through the web form myself, and there are only three sets of information required. Patients first enter their name, date of birth and address. They then input their prescriber’s name and address and select their insurance type.

All this should take less than five minutes and can be done at home or at the pharmacy. A physician or pharmacist can fill it out on behalf of the patient, too. Importantly, this form does not ask for medical history, proof of a positive coronavirus test, income verification, citizenship status or other potentially sensitive and time-consuming information.

But there is one key requirement people need to be aware of: Patients must have a prescription for Paxlovid to start the enrollment process. It is not possible to pre-enroll. (Though, in a sense, people on Medicare or Medicaid are already pre-enrolled.)

Once the questionnaire is complete, the website generates a voucher within seconds. People can print it or email it themselves, and then they can exchange it for a free course of Paxlovid at most pharmacies.

Pfizer’s representative tells me that more than 57,000 pharmacies are contracted to participate in this program, including major chain drugstores such as CVS and Walgreens and large retail chains such as Walmart, Kroger and Costco. For those unable to go in person, a mail-order option is available, too.

The program works a little differently for patients with commercial insurance. Some insurance plans already cover Paxlovid without a co-pay. Anyone who is told there will be a charge should sign up for Paxcess, which would further bring down their co-pay and might even cover the entire cost.

Several readers have attested that Paxcess’s process was fast and seamless. I was also glad to learn that there is basically no limit to the number of times someone could use it. A person who contracts the coronavirus three times in a year could access Paxlovid free or at low cost each time.

Unfortunately, readers informed me of one major glitch: Though the Paxcess voucher is honored when presented, some pharmacies are not offering the program proactively. As a result, many patients are still being charged high co-pays even if they could have gotten the medication at no cost.

This is incredibly frustrating. However, after interviewing multiple people involved in the process, including representatives of major pharmacy chains and Biden administration officials, I believe everyone is sincere in trying to make things right. As we saw in the early days of the coronavirus vaccine rollout, it’s hard to get a new program off the ground. Policies that look good on paper run into multiple barriers during implementation.

Those involved are actively identifying and addressing these problems. For instance, a Walgreens representative explained to me that in addition to educating pharmacists and pharmacy techs about the program, the company learned it also had to make system changes to account for a different workflow. Normally, when pharmacists process a prescription, they inform patients of the co-pay and dispense the medication. But with Paxlovid, the system needs to stop them if there is a co-pay, so they can prompt patients to sign up for Paxcess.

Here is where patients and consumers must take a proactive role. That might not feel fair; after all, if someone is ill, people expect that the system will work to help them. But that’s not our reality. While pharmacies work to fix their system glitches, patients need to be their own best advocates. That means signing up for Paxcess as soon as they receive a Paxlovid prescription and helping spread the word so that others can get the antiviral at little or no cost, too.

{source}

[xtruss]

Prescription drugs accumulate in a box at the Back Cove Trail parking lot in Portland, Maine, during a take-back event. Photograph By Ben McCanna, Portland Portland Press Herald/Getty Images

How You Should Dispose of Unused or Expired Medications

Flushing or throwing away leftover drugs can contaminate waterways, threatening people and wildlife. Here are some safer solutions.

— By Priyanka Runwal | Published July 22, 2022 | Sunday August 6, 2023

If you have a stash of unwanted, unused, or expired medicines in a cabinet or drawer somewhere in your home and you don’t know the best way to get rid of them, you’re not alone.

A 2021 survey conducted on behalf of Covanta, a New Jersey-based waste management company, found that 53 percent of the 2,000 Americans polled had no idea what to do with their old medications. Pill hoarding is a common outcome, and many people eventually toss these drugs into household trash or flush them down the toilet or sink—none of which may be a good idea.

Unused or expired medicines lying around at home can get into the wrong hands, leading to accidental poisoning or drug overdose. One study found that between 2000 and 2015, U.S. Poison Control Centers received roughly 32 calls a day about children accidently ingesting opioids that had either been stored or disposed of incorrectly.

When drugs are flushed or sent to landfill, the pharmaceuticals can contaminate our groundwater, lakes, rivers, and streams, threatening human and aquatic life, although our urine and feces that contain remnants of consumed medication are bigger sources of pollution. Wastewater treatment plants aren’t designed to remove these pharmaceuticals, Tim Carroll, a spokesperson for the U.S. Environmental Protection Agency, says in an email. “EPA’s first message to everyone is do NOT put leftover, unused drugs down the drain.”

So how does one dispose of unneeded over-the-counter and prescription medications accumulating in our homes? There are a few options.

Drug Take-back Programs

In an effort to find a solution to drugs languishing in medicine cabinets or lurking in waterways, the U.S. Drug Enforcement Administration launched its first National Take-Back Day in September 2010. More than 4,000 sites across 50 states collected nearly 250,000 pounds of pharmaceuticals that people returned. Since then, DEA has hosted this single-day event biannually; in April this year, more than 5,000 sites collected about 721,000 pounds of pharmaceuticals.

People can also use mail-back envelopes or drop off their unwanted medications year-round at DEA-registered collection kiosks in police stations, pharmacies, community health centers, and hospitals. These returned drugs are then sent to medical waste incinerators.

Drug Enforcement Administration agents and Soldiers from the New Jersey National Guard's Counter Drug Task Force dumped prescription drugs to be incinerated at the Covanta Essex Resource Recovery Facility during Operation Take Back New Jersey in Newark, N.J., Oct. 31, 2017. Operation Take Back New Jersey is a DEA program that provides a safe and legal method for the citizens of New Jersey to dispose their unwanted, unused, and expired medicines. The New Jersey National Guard assisted with the collection and disposal of the medications. (U.S. Air National Guard photo by Master Sgt. Matt Hecht) Photograph By Master Sgt. Matt Hecht, AB Forces News Collection/Alamy Stock Photo

In 2021 Stericycle, the largest medical waste incinerator company in the U.S., burned 40 million pounds of unused and expired pharmaceuticals, says Jim Anderson, the company’s vice president for product management and innovation. Incineration produces an inert ash that’s sent to landfills. However, one downside of this disposal method is that transporting and burning such waste and its packaging can release greenhouse gas emissions that can be potentially greater than those generated if the drugs were dumped in landfill, according to one study estimate.

But take-back programs are preferred as they reduce the risk of drug misuse and the incineration “effectively eliminates the entrance of these pharmaceuticals into our nation’s waters,” Carroll says.

However, Steve Skerlos, a mechanical, civil, and environmental engineer at the University of Michigan argues that take-back programs could still result in medicines piling up in homes—a problem such programs were designed to address in the first place. “The question is, if I have extra, unused medication, am I going to leave my house in the next day, or week, even a month, to return that,” he says, especially in rural settings where take-back sites may not be as easily accessible. “A reasonable person may consider landfill to get it out of the house fast.”

In such cases, the DEA suggests mixing medicinal tablets and capsules with undesirable substances like coffee grounds or kitty litter and tossing the mixture into the trash inside a sealed bag or container. (Don’t crush the drugs though.)

And while the EPA advises against flushing pharmaceuticals down the drain, the U.S. Food and Drug Administration maintains a list of limited medications that have the potential to be misused or result in death if taken inappropriately and so can be flushed when safer disposal alternatives are lacking.

Pharmacies also sell drug destroyers such as DisposeRx that can work with pills, tablets, capsules, liquids, and powders. “It’s about the size of a packet of sugar,” says Thomas Menighan, former CEO of the American Pharmacists Association. “You open it, put it in a bottle of unused opioids, or any medicine, for example, you pour a little water in and shake it up, it turns into a white slurry,” which can then be tossed into the trash.

But it’s unclear if these products permanently bind or inactivate the medicinal compounds so that they don’t end up in the landfill liquid, which is released into wastewater treatment plants, and can eventually contaminate our waterways.

Recycling Pharmaceuticals

Perhaps surprisingly, not all unused medications need to be thrown away.

Every year five billion dollars’ worth of unexpired medicine ends up being discarded in the U.S. That could happen because a patient dies, their condition improves and they no longer need their prescribed medication, there’s a dose change, or they experience side effects and are put on new drugs. In such cases these unexpired medications—worth an estimated $700 million—can be recycled.

“We’re wasting a lot of medication which is already paid for,” says Anandi Law, a patient engagement specialist at the Western University of Health Sciences in California. “We could have somebody else who needs it have it.”

Millions of U.S. adults skip or delay getting their prescriptions filled due to high costs. Hence, at least 40 states have passed legislation to establish medication repository programs that allow pharmacies, drug manufactures, medical and long-term care facilities, and sometimes individuals to donate their unused drugs in original sealed containers or tamper-evident packaging.

A licensed pharmacist then inspects the donated medication to check the expiry date and look for signs of tampering, misbranding, or any indication that the drug could be compromised. Once approved, the drugs can be dispensed to uninsured or underinsured individuals via state-approved pharmacies, hospitals, charitable clinics, or community health centers.

Since its inception in 2007, Iowa’s drug donation program, SafeNetRx, has served more than 117,000 patients and redistributed nearly $54-million worth of medication and supplies. Georgia’s program formally launched in 2018, and it has already filled prescriptions worth over $50 million.

“Even though over 40 states have these drug donation laws, a lot of people don’t know that they exist,” says Kiah Williams, co-founder of SIRUM, a nonprofit organization that works with pharmacies and health facilities across the country to assist with drug donation.

Donating unused medications or using take-back programs are voluntary for households, but experts hope more people will use these options instead of disposing of their leftover drugs in the trash or down the drain, which tends to be more convenient.

“All of these efforts are still relatively new,” Carroll says. “We expect we have a long way to go until households change their habits.”

[vague-humanoid]

The year is 1998. While antiviral drugs to treat HIV had been approved a decade earlier, only five out of 33 million people who carried the virus were receiving the life-saving treatment. Nowhere was the situation worse than in South Africa. The country had the highest global prevalence of the disease with nearly one in five people infected and 200,000 children orphaned.

Treatment options were limited. That year, the Minister of Health released a report outlining the deficiencies in the country’s health care system. The principal finding was that most South Africans could not afford antivirals. The average monthly income at the time hovered around $220 a month, which was nowhere near the $1,000 per month the pharma companies were charging for their wares. Faced with a virus that was decimating his population, Nelson Mandela made a choice that landed him in court for the first time since his arrest several decades earlier for resisting apartheid.

His government broke the patent regime for the antivirals that was chiefly responsible for killing his people—allowing parallel imports in which generics companies manufacture the drug without the patent-holding pharma company’s consent. He was instantly sued by 40 pharmaceutical companies. Bill Clinton’s administration cowered to pressure from the pharma lobby and placed South Africa on a watchlist, subjecting the nation to possible trade sanctions. It ended up being an enormous PR disaster for the obstreperous pharmaceutical firms. After three years of mounting pressure from AIDS activists, the pharma companies finally dropped their case.

While this story has a happy ending, Mandela’s battle against Big Pharma was only a small part of an ongoing war to provide equitable access to HIV medication. In the decades since his court case, taxpayer-funded research has contributed enormously to the development of new HIV treatments. New drugs can now allow people living with HIV to enjoy normal life spans, and completely reduce the risk of new transmissions. Used widely, medications should allow the complete eradication of HIV from the planet. The only obstacle the world is now facing is the same one Mandela stared down: corporate greed which prioritizes profits over human life.

@startorrent02

[copperbadge]

I'm researching second-line medications for ADHD, because the Adderall works well for the executive function but non-pharmaceutical solutions are simply not effective for the emotional dysregulation, which I think the Adderall might be making worse, apparently that can happen.

But what's wild to me is that it seems as though the most effective treatments for ADHD, first or second line, almost all come in one of two flavors:

-- High potential for addiction

-- Used outside of ADHD as a treatment for addiction

There are definitely some treatments that fall somewhere in the middle, but it's hilarious how often my notes read stuff like "Second-line treatment for ADHD, can be used with stimulants, also used for smoking cessation/substance use disorder/individuals with history of alcohol misuse". It's almost like addiction frequently has biological causes related to emotional regulation and impulsivity and can be treated medically. Fancy that.

I've also found fascinating anecdotes by people with ADHD who prior to their diagnosis were struggling with addiction to opiates and were able to stop when they got on stimulant medication -- which "shouldn't be a thing" because opiates are depressants, not stimulants, and shouldn't impact ADHD. I've seen the theory floated that it's not stimulant/depressant that matters so much as impact on dopamine production and reception, but who the hell knows honestly.

It is interesting to me, though, because despite the jokes I've made in the past I've always watched myself very closely when it comes to opiates. I became well aware fairly early on that "oh, this is the drug that I could get in trouble over", but part of that was always that if I took a Vicodin, I would actually go do stuff like the dishes or the laundry or my essays for grad school, and that felt really good.

Anyway, I don't think it's often discussed that medication which increases your ability to do stuff can also overblow your ability to feel stuff, and also medication for emotional regulation may also boost you onto the wagon. So there you have it.

[transmutationisms]

do you feel like SSRIs are mostly pseudoscience? I'm not sure if I should be open to trying them or avoid them at all costs since I'm not sure if they even work or if they will mess me up permanently

a preliminary note that i don't find the category 'pseudoscience' to be useful & would classify SSRI research more as 'methodologically shoddy science' or 'ideologically slanted' or 'part of a centuries-long effort on the part of psychiatrists to secure themselves professional prestige by claiming neurobiological etiologies where none are shown to exist' &c &c. imo the notion of 'pseudoscience' is itself pretty positivistic, ahistorical, and ideologically noxious (particularly apparent in any analysis of epistemological imperialism).

that aside: you raise two major issues with SSRIs, namely whether they work and whether they will cause you harm.

efficacy of SSRIs is contested. a 2010 meta-analysis found that in patients with mild or moderate depressive symptoms, the efficacy of SSRIs "may be minimal or nonexistent", whilst "for patients with very severe depression, the benefit of medications over placebo is substantial". a 2008 meta-analysis found a similar distinction between mildly vs severely depressed patients, but noted that even in the latter population, drug–placebo differences were "relatively small" and argued that the differences between drug and placebo in severely depressed patients "seems to result from a poorer response to placebo amongst more depressed patients" rather than from a greater efficacy of SSRIs. a 2012 meta-analysis found some SSRIs consistently effective over placebo treatments, but several authors disclosed major relationships with pharmaceutical companies. a 2017 meta-analysis concluded that "SSRIs might have statistically significant effects on depressive symptoms, but all trials were at high risk of bias and the clinical significance seems questionable" (emphasis added) and that "potential small beneficial effects seem to be outweighed by harmful effects".

when evaluating any of this evidence, it is crucial to keep in mind that studies on antidepressant trials are selectively published—that is, they are less likely to be published if they show negative results!

A total of 37 studies viewed by the FDA as having positive results were published; 1 study viewed as positive was not published. Studies viewed by the FDA as having negative or questionable results were, with 3 exceptions, either not published (22 studies) or published in a way that, in our opinion, conveyed a positive outcome (11 studies). According to the published literature, it appeared that 94% of the trials conducted were positive. By contrast, the FDA analysis showed that 51% were positive.

meta-analyses are not immune to this issue, either. in addition to the problem that a meta-analysis of a bunch of bad studies cannot magically 'cancel out' the effects of poor study design, the authors of meta-analyses can and do also have financial interests and ties to pharmaceutical companies, and this affects their results just as it does the results of the studies they are studying. according to a 2016 analysis of antidepressant meta-analyses,

Fifty-four meta-analyses (29%) had authors who were employees of the assessed drug manufacturer, and 147 (79%) had some industry link (sponsorship or authors who were industry employees and/or had conflicts of interest). Only 58 meta-analyses (31%) had negative statements in the concluding statement of the abstract. Meta-analyses including an author who were employees of the manufacturer of the assessed drug were 22-fold less likely to have negative statements about the drug than other meta-analyses [1/54 (2%) vs. 57/131 (44%); P < 0.001]. [...] There is a massive production of meta-analyses of antidepressants for depression authored by or linked to the industry, and they almost never report any caveats about antidepressants in their abstracts. Our findings add a note of caution for meta-analyses with ties to the manufacturers of the assessed products.

so, do SSRIs work? they are certainly psychoactive substances, which is to say, they do something. whether that something reduces depressive symptoms is simply not known at this point, though it is always worth keeping in mind that the 'chemical imbalance' narrative of SSRIs (the idea that they work by 'curing' a 'serotonin deficiency' in the brain) has always been a profitable myth. look, any medical treatment throughout history has been vouched for by SOME patients who report that it helped them—no matter how wacky it sounds or how little evidence there was to support it. this can be for a lot of reasons: placebo effect, the remedy accidentally treating a different problem than it was intended for, the symptoms coincidentally resolving on their own. sometimes the human body is just weird and unpredictable. sometimes remedies work. i'm sorry i can't give you a more definitive answer about whether SSRIs would help you.

as to potential risks: these are significant. SSRIs can precipitate suicidal ideation, a risk that has been consistently downplayed by pharmaceutical companies and studies. SSRIs are also known to contribute to sexual dysfunction and dissatisfaction, again a risk that is minimised and downplayed in much of the literature and in physician communication with patients. further (known) side effects range through emotional blunting, glaucoma, QT interval prolongation, abnormal bleeding & interaction with anti-coagulents, platelet dysfunction, decreases in bone mineral density leading to increased risk of osteopenia and osteoporosis, jaw clenching / TMJ pain, risk of serotonin syndrome when used in conjunction with other serotonergic substances, dizziness, insomnia, headaches, the list goes on.

i don't mean to sound alarmist; all drugs have side effects, some of the ones above occur rarely, and you may very well decide the risk is acceptable to you to take on. i would, though, always encourage you to do thorough research into potential side effects before starting any drug, including an SSRI. more on SSRI side effects in david healy's books 'pharmageddon', 'let them eat prozac', 'the antidepressant era', and 'the creation of psychopharmacology'; 'pillaged' by ronald w maris; and 'the myth of the chemical cure' by joanna moncrieff.

in addition to the above, SSRIs are known to come with a risk of 'discontinuation syndrome'—that is, chemical withdrawal when stopping the drug. this, too, is often downplayed by physicians; many still deny that it can even happen. some patients don't experience it at all, though i can tell you purely anecdotally that SSRI withdrawal was so miserable for me i simply gave up on quitting for over a year, despite the fact that at that point i was already thoroughly experienced with chemical withdrawals from other, 'harder' drugs. again, i am not telling you not to go on SSRIs if you decide these risks are worth it to you! i simply think this is a decision that should always be made with full knowledge (indeed, this is a core, though routinely violated, principle of medical 'informed consent').

ultimately this is not a decision anyone should make for you; it's your body and mind that are at stake here. as always i think that anyone considering any kind of medical treatment should have full knowledge about it and should be making all decisions freely and autonomously. i am genuinely not pushing any agenda 'for' or 'against' SSRIs, only against prescription of them that is done carelessly, coercively, or without fully informing patients of what risks they're taking on and what benefits they can hope to see.

[odinsblog]

Veterans’ health care


A 1996 law set eligibility requirements for military veterans to receive hospital, medical and nursing home care and authorized spending for those services and patient enrollment. That law has not been renewed, but Congress regularly allocates additional Department of Veterans Affairs funding and allows benefits to increase automatically based on inflation. VA provides medical care to more than 9.1 million enrolled veterans, according to the agency.
​

Drug development and opioid addiction treatment

Most of this spending relates to the bipartisan 21st Century Cures Act of 2016. That law provided money to the National Institutes of Health and Food and Drug Administration to modernize pharmaceutical research and medical trials. It funded research for cancer cures and state-level grants for opioid addiction and other substance abuse treatment.


​State Department

In 2003, Congress passed the Foreign Relations Authorization Act, which set policy priorities and created spending authority for the State Department. That law has not been renewed, but Congress every year since has passed annual funding bills for the department, which Trump has announced he’ll nominate Sen. Marco Rubio (R-Florida) to run.


​Housing assistance

President Bill Clinton in 1998 signed the Quality Housing and Work Responsibility Act, which overhauled federal housing assistance policies, including voucher programs and other antipoverty assistance. The Department of Housing and Urban Development and other agencies continue using this law to implement federal housing programs.


​Justice Department

In 1994, Congress passed the landmark Violence Against Women Act and has renewed it multiple times since. In 2006, lawmakers packaged a VAWA renewal with authorizing legislation for the Justice Department. As with the State Department, Congress has not approved new authorizing legislation for the Justice Department since, but it has funded the agency — and even authorized hundreds of millions of dollars more for a new FBI headquarters — every year.


​Education spending

The 2015 Every Student Succeeds Act delegated power to state and local education officials to set primary and secondary education achievement standards. It gives billions of dollars in federal grant money to state and local education officials to fund schools and school districts. Those standards are still used by the Education Department, even though the legislation has not been reauthorized. Trump has suggested he’d like to eliminate the entire department.

NASA

Stripping funding for NASA, which was last reauthorized in 2017, could spell doom for Musk’s commercial spaceflight firm, SpaceX. The company has contracts worth more than $4 billion — including for return trips to the moon and retiring the International Space Station — linked to programs approved in the 2017 law.


​Health-care and student loan programs

What’s known as the Affordable Care Act, or Obamacare, was actually passed in two separate bills in 2010. The Health Care and Education Reconciliation Act represents the second bill, which included some tax revisions and technical changes to the ACA. The law has not been reauthorized since, but the Department of Health and Human Services reported in March that more than 45 million people have health insurance coverage backed by the Affordable Care Act.

The law that made those final tweaks to the ACA also overhauled the Education Department’s student loan program. Where some schools relied on private lenders to issue federally backed loans, with this law, the government itself became the lender. That change has since enabled President Joe Biden to offer student loan debt relief, though many of his most ambitious policies have been blocked by the courts. Student loans are generally funded through mandatory spending — similar to social safety net programs such as Medicare and Social Security — and not subject to annual spending laws.


​International security programs

The 1985 International Security and Development Cooperation Act bundled together authorizations for a number of international security programs, including funding and regulations for arms sales to allies, economic aid for developing countries, airport security, anti-narcotics-trafficking policies, the Peace Corps and more. This Reagan-era law continues to be foundational to congressional funding and federal policy.


​Head Start

Head Start provides preschool education for children from low-income families. In the 2023 fiscal year, more than 800,000 children enrolled in Head Start programs, according to the National Head Start Association. The program also helped place more than 530,000 parents in jobs, school or job-training programs. It was last authorized in 2007.

(continue reading)

[weirdly-specific-but-ok]

WebMD Page for Aziraphale

As promised to you all, inspired by that video of Aziraphale as an antidepressant. The WebMD drug format, from your clearly deranged mascot, Asmi. This took way too much effort. For legal purposes, even though this blog is a lawless hellscape, this is a spoof. If you did like it, reblog it, maggoty loves of mine, because likes don't help visibility on tumblr, and I want everyone to be traumatised with my own specific brand of unhinged. No pressure though, be rebels muaha. That being said:

MENU > DRUGS & MEDICATIONS > AZIRAPHALE

COMMON BRAND(S): Guardian of the East Gate, Angel GENERIC NAME(S): Aziraphale

USES This medication is used to treat mood-related disorders ranging from depression to chronic loneliness and anxiety. It has also been proven effective in treatment of Compulsive Demonic Behavioural Disorder (CDBD) and Post Fall Stress Disorder (PFSD). The medication results in an overall improvement in mood (see Side Effects), morals, and lifestyle choices. This medication is sometimes described as a 'miracle-worker'. It is advisable to ensure that the correct dosage is taken at regular intervals. The doctor/God/Forces That Be may prescribe a lower dose at the start, gradually increasing frequency and amount over the course of millennia.

SIDE EFFECTS Documented side-effects include pining behaviour, severe withdrawal symptoms in case of suddenly stopping the medication, heart palpitations, stuttering or stammering, mood swings including irrational lashing out or defensive behaviour when faced with highly emotional situations, break-ups, misunderstands, obliviousness, amongst others. Despite the studies being limited to a single subject (see Crowley et. al. updated 2023) these effects are typically harmless in the long term. Life-altering effects may also be noted, including irretrievably falling in love, marriage, a positive character arc, tendencies to put oneself at risk to ensure continuation of medication, lifelong friendship, fate-defying romance and severe allergy to the idea of discontinuation of medication.

WARNINGS Casual or reckless consumption can be too fast for the medication, which will lessen its effects, leading to withdrawal symptoms. Withdrawal symptoms range from repeated indulging in CDBD and PFSD induced behaviours to alcoholism, depressive episodes, recklessness, listlessness, and prolonged car rides with no purpose. While the medication should not be consumed too fast, regularity is also advised. This is a long-term medication and not a short-term fix. Rare, short-term exposures will only worsen the side effects, withdrawal symptoms and may even reverse the drug effects.

PRECAUTIONS Ensure immortality so that the medication may be able to work its effect through the full course. Pre-existing trauma and heart conditions may require regular consultations with a therapist.

INTERACTIONS Drug interactions may change how the medication works or increase severity of side effects. This document does not include a comprehensive list of all drug interactions, please do adequate research and check instructions on the medication before proceeding with additional drugs. Aziraphale is known to have highly negative interactions with the toxin hellfire as well as the drugs Gabriel (only when sold as Supreme Archangel), Satan and Metatron (known toxin). Negative interference may occur due to most drugs from the class Heaven and Hell. Vague interference may occur with the drug class Homo sapiens.

OVERDOSE While less dangerous than withdrawal symptoms, overdose may lead to lack of personal space, miscommunication, and decrease in mood stability. Increased irritability is also common. Use with caution.

IMAGE

REVIEWS (1) Effectiveness: 5 stars Ease of use: 4 stars Satisfaction: 100000000000000000000e stars

It must be noted that in the country where I live (India), advertisements for pharmaceutical drugs are legally prohibited on television and other media. Which is why I was very bewildered at the initial video. But WebMD is a universal phenomenon so this shall by my contribution to the fandom. Thank you @neil-gaiman, Good Omens has given me a lot of opportunities to exercise my brain in all the weirdest ways.

[gatheringbones]

[“The psychiatrist Daniel Carlat has freely acknowledged that using the language of “chemical imbalances” at least suggests to patients that psychiatrists know what they are doing. In 2010, Carlat (cited in Whitaker and Cosgrove 2015: 187, emphasis added) declared,

I say that [“chemical imbalances in the brain”] not because I really believe it, because I know that the evidence isn’t really there for us to understand the mechanism. I think I say that because patients want to know something, and they want to know that we as physicians have some basic understanding of what we’re doing when we’re prescribing medications. And they certainly don’t want to hear that a psychiatrist essentially has no idea how these medications work.

Whitaker and Cosgrove (2015: 87) have discussed the significant benefits for both big pharma and the psychiatric profession in promoting drug use in the current mental health system. For the drug companies, psychiatry can medically legitimate their products as well as facilitate the expansion of the potential population for their products. In turn, the drug companies legitimate the institution of psychiatry as a “real” (meaning biomedically-based) part of medicine and facilitate the expansion of its areas of research and expertise through various funding and revenue streams. The outcome of this relationship has been fairly predictable—both parties have benefited enormously over time.

Pharmaceutical companies continue to maximise their profits while psychiatry’s (and, by extension, other psy-professionals’) power—as signified by the proliferation of its discourse among the general population—has significantly expanded over the past 35 years. That said, the expansion of the psy-professions in general and the proliferation of the psychiatric discourse to hegemonic status in neoliberal society cannot be explained by the success of the drug industry alone. This requires further analysis of the ideological role of psy-disciplines, which will be outlined in the next chapter. Suffice here to say that a Marxist analysis of psychiatric power always needs to consider the benefits to capitalism inferred by their changing discourse and practices. And while every part of civil society can serve the economic base, it is the value of such institutions as part of the superstructure which distinguishes them as ultimately relevant and useful to the ruling classes. So whereas we may think of the drugs issue only in terms of the economic prerogatives of capitalism, it is in fact their value as a means of social and ideological control of the population which should be given particular importance here.

As Moncrieff (2009: 238) has rightly stated of the dominant biomedical view of psychopharmaceutical interventions as effective treatment for mental illnesses, this knowledge has itself become an instrument of psychiatric power. It has facilitated the particular form of social control that is embodied in psychiatric practice, by construing psychiatric constraint as the medical cure of mental disease. It has helped to disperse psychiatric power throughout the population by concealing the moral nature of psychiatric judgements. From moral treatment to drug treatment, psychiatry’s project remains unchanged: their goal is the moral management and behavioural adjustment of populations considered socially deviant, whether unemployed, underproductive, or politically suspect.”]

bruce m.z. cohen, from psychiatric hegemony: a marxist theory of mental illness, 2016

[a-shift-in-the-lore]

There’s an AU rattling inside my head I haven’t been able to stop thinking about based on Viktor meeting Singed as a young child and them bonding over the Waverider Rio

(long thought post)

In the universe we know, Viktor learns about how Singed treats Rio and cuts contact with him, soon after they meet (we don’t know precisely how long they were working together to help Rio before Viktor discovered what Singed was doing)

What if in another universe Rio was healthier or healthy for for longer and so Viktor and Singed really got attached to each other?

We’ve already seen the lengths Singed will go for one child, imagine the lengths he’d go for two?

We don’t know much about Viktor’s childhood outside of his brief partnership with Singed and his discovery by Heimerdinger which lead him to becoming his assistant

He could be an orphan, he could have parents that are so poor they have to work more to take care of his needs, either way based on what we do know it seems he had a lot of free time unsupervised

If in this case, he spends more and more of his free time with Singed in his lab and Singed forms an attachment to Viktor, especially if it’s to the point of considering Viktor a second child, I imagine losing him or the thought of losing would make him spiral just as it does with Orianna

If Viktor later discovers Singed’s treatment of Rio, after that attachment has already formed, and Viktor tries to leave, Singed may have tried to prevent it instead of just brushing off his feelings about the matter and letting him leave

Viktor’s smart and scrappy but Singed has far more resources, I’m kind of imaging a Tangled’s Rapunzel situation except, it’s Singed’s territory in the Undercity instead of a Tower and instead of staying there willingly, Viktor’s constantly escaping his clutches only to be brought back to him by hired men

Viktor is torn because he has grown to care about Singed (as well as Orianna) but he can’t stand Signed’s methods

If Heimerdinger later discovers him still, once again he’d spiral over “his” child being taken from him, especially since Heimerdinger didn’t approve of Singed trying to save Orianna - he probably have a personal vendetta against Heimerdinger at that point

Viktor would want to go to Piltover not just for the opportunities, not just to for the chance to get better away from the grey, but also to get away from Singed and his choices

He’d maybe feel guilty over it even though he knows it the right decision and the smart decision, we’ve seen that Viktor has a hard time letting people in, even if Singed is absolutely úplně mimo or completely out of it in this AU he still grew up with him and feels a connection to him and even one with Orianna cuz he spent years hearing about her from Singed

But he doesn’t want to hurt others to save lives, not even Orianna’s, not even his own

The timeline from there would probably be similar, except Singed is constantly sending Viktor’s gifts and Silco’s sending men up to Piltover to check on Viktor and to cause trouble for Heimerdinger in ways that can’t be tracked back to him

Sometimes he’ll even show up at Viktor’s apartment and won’t leave until he’s satisfied Viktor’s okay, running tests on him until Viktor finally convinces him to leave

It leaves Viktor shaken every time because he doesn’t want Heimerdinger to know of his connection to Singed and he’s afraid of the consequences of being caught with Silco’s drug man

Anyways this goes on as long as Viktor’s in Piltover, Jayce’s lab gets robbed, boom, Viktor’s interest is piqued, Jayce and Viktor team up

Well all know the rest EXCEPT, Viktor is doing his utmost to hide his illness (self experiments? Every medical treatment he can find available in the city? Abuse of pharmaceuticals? Idk) from everyone to avoid it getting back to Singed and does his utmost to get Singed away from Hex tech and Jayce and everything else going on

It doesn’t work entirely, it’s a delicate balance, but he’s managing

But then the disease gets the better of him

When he passes out in the lab, everyone is taken aback

Jayce is absolutely devastated

Singed is deranged

Viktor doesn’t want Singed’s help at this point, so maybe because he’s been putting in the work to avoid Singed he’s much more up to date with the Undercity than in the ogverse so he knows about Ekko and goes to him instead and doesn’t take shimmer

Viktor doesn’t want that additional connection between them

Viktor’s also afraid if he dies he’ll end up in Singed’s lab along side Orianna

So he’s desperate to figure something out, which clues Jayce in, Viktor confesses his fears and then I’m thinking Jayce maybe ropes in Heimerdinger, maybe Mel and Caitlyn and Vi and Viktor’s brought in Ekko and together they figure out a different way, maybe still using the Hexcore without it ending up with him being fused with it and everything changes

A different solution is found, the team saves Viktor and then after checking that off the list, they all work together to prevent Civil War and instead help Zaun gain sovereignty (leading to other changes, like Isha not dying so Junx doesn’t die, the team plus Jinx & Isha getting Vander away from Singed and finding a cure for him, handling Ambessa’s take over in another way, etc, etc all the other loose ends come together somehow someway)

Or maybe Singed finds out, loses his mind over the thought of putting another child, even if this child is now an adult, in a mechanical coffin, and fuses him with the Hexcore himself

And nothing really changes at all

Because whether it was Jayce or Singed it was still done

against his will

in the name of love

and it wasn’t enough

——————

Anyways this AU keeps playing over in my head in new ways like a series of soap opera episodes with new ideas and endings and what have you

I hope you all enjoyed going down my never ending imagination spiral with me lol

[spooniestrong]

[Text id:

"“Do I want to take pain medications? The simple answer is no. Just like I don’t want to take any of the medications I am prescribed. But equally I know that those same drugs keep me functioning. That without them I would not be able to write this post, or stand, or walk the few steps to my toilet. Similarly, adequate pain control gives me the ability to drive 3 hours to the city for my medical appointments and to sit on the couch with my family without tears. But access is complex. And there is a pervasive idea of the drug-seeker, seen in every patient who has chronic pain. That those who simply don’t get over pain and require ongoing pharmaceutical management are weak. Friends who have used pain clinics tell stories of dismissal and blame. That they are not trying hard enough when they don’t recover, when I know the lengths they have gone to to try and alleviate their pain. And compassionate pain doctors who become the exception not the rule.”

- "When ‘Suck it Up’ Becomes the Only Pain Treatment You Are Offered" (via chronic-illness-support ) ]

[darkmaga-returns]

Story at a Glance:

•In 1906, the first FDA (Food and Drug Administration) was created in response to massive public protests against adulterated food and drugs (e.g., rotting food partially preserved with food additives or counterfeit consumer products). To stop it, food industry lobbyists attempted every tactic imaginable, eventually taking over the Department of Agriculture and in time forcing the dedicated public servant leading it (Harvey Wiley) to quit. Because of this, many toxic food additives Wiley fought against gained “generally recognized as safe” (GRAS) status and remain in use today.

•The handicapping of the FDA came to a head in 1962, when thalidomide was just barely prevented from devastating America’s children, prompting Congress to give the FDA much broader powers to police the safety and efficacy of drugs.

•Unfortunately, this law backfired, as the FDA created an impossible to reach standard of efficacy that it selectively enforced to protect the pharmaceutical industry and simultaneously began utilizing increasingly brazen (and illegal) police tactics against anyone promoting effective natural therapies.

•Because of this, many life-changing medical therapies (discussed throughout this article) were blacklisted by the FDA and faded into obscurity. This, along with the FDA’s tendency to push unsafe and ineffective therapies (e.g., vaccines or antidepressants) onto the market regardless of how much data argued against doing so, led to the FDA becoming the most protested agency in the federal government.

•Nonetheless, every attempt to fix the FDA failed. In this article, I will review the structural issues that have perpetually caused the FDA to succumb to incompetence and corruption. I propose potential solutions that can utilize the unprecedented window created by the Make America Healthy Again movement to end the FDA’s war against America’s health.

For most of my life, I have observed the FDA belligerently suppress natural treatments and any unorthodox therapy which threatens the medical monopoly while simultaneously railroading through a variety of unsafe and ineffective drugs regardless of how much public protest the agency meets. Consider for example, this 2004 Senate testimony by the FDA scientist who got Vioxx banned that accurately described exactly what would come to pass with the COVID vaccines two decades later: