Pharmacosis: So Long and Thanks for all the Fish

June, 28, 2012 | 7 Comments


  1. This has not been a “good news” week. “The FDA has approved lorcaserin (Belviq) as an adjunct to diet and exercise for ongoing weight management — the first new weight-loss drug to be approved in the U.S. in 13 years. Lorcaserin is approved for use in adults with a BMI of 30 or more, or for those with a BMI of 27 or more who have at least one weight-related condition (type 2 diabetes, dyslipidemia, hypertension). In trials, lorcaserin recipients lost roughly 3.5% of body weight after 1 year. Lorcaserin activates the brain’s serotonin 2C receptor, which may help people feel full after eating smaller amounts. Treatment can cause serotonin syndrome, especially when taken with medications that raise serotonin levels or activate serotonin receptors, including antidepressants and migraine drugs.” Well, now we have yet another potentially lethal prescription drug At least some SSRIs are associated with the clinical and biochemical elements of the metabolic syndrome, a group of factors that increase the risk for coronary artery disease, stroke and type 2 diabetes. All of the risk factors have some relationship to obesity. The two most important risk factors for metabolic syndrome are: Extra weight around the middle and upper parts of the body (central obesity) and insulin resistance, in which the body can’t use insulin effectively. So, obese individuals, already at high risk of heart attack and stroke are going to be given a drug that can only increase this risk as well as promote serotonin syndrome. MacKay, Dunn and Mann in a questionnaire study found that 85.4% of responding general practitioners were unaware of the serotonin syndrome yet were blithely prescribing SSRIs. To paraphrase Benjamin Franklin: “A man between two doctors is like a fish between two cats.”

  2. Excellent article.
    One may well describe doctors as being naive consumers but due to widespread interest conflicts (read corruption), they are perhaps not so naive after all!

  3. “a group of factors that increase the risk”: no, no, no – a risk factor is just a positive correlate – you can’t attribute action to a mere correlate.

  4. […] If they are to maintain prescription only privileges and a role for themselves in healthcare, doctors are going to have to come up with something extraordinary. They may even need to become a revolutionary class, partisans, who create a space that markets do not readily understand – a space where No is the operative word. Or else it may be time to recognize the Faustian bargain medicine was offered in 1962 for what it was, and prior to being consigned to sleep with the fishes, depart stage left with a parting shot such as “So long and thanks for all the fish”. – See more at: […]

  5. I am a nephrologist in a public hospital. I recall seeing a patient last month who was a case of end stage kidney failure on dialysis. His nephrologist at dialysis centre used to religiously refilling his prescription monthly (calcium, vitamins, antioxidants, appetite stimulants, coenzyme q, etc total of 12 drugs-most having little if any evidence of benefit).

    When I asked him which drugs he is currently on? He replied me”none”. He said I took it for few months and then started dropping one every month until I stopped everything last month. I didn’t notice any difference in my health with or without them. He requested to prescribe if he needs any drug.

    I wrote following “continue dialysis; no medications”

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