Seroxat and Ribena

In The Cockroach Catcher, Dr Am Ang Zhang had an interesting discussion with his Junior who had just transferred from one of the top London teaching hospitals:

“Do you agree that Leroy has Social Phobia ? Everything fitted in with the criteria in DSM IV.” My junior plucked up courage to ask me during supervision.

It was good to keep oneself on one’s toes with juniors who had just arrived from London and who read up on everything.

“What’s wrong with shyness?” I joked, “Do you want me to put him on SSRI (Selective serotonin reuptake inhibitors)?”

“It is supposed to work.”

“If he starts taking SSRI at thirteen, what is he going to do for the rest of his life?!”

“The newer short acting ones are supposed to be better.”

“Take one advice from me; think the opposite, the opposite to what the big Pharmas tell you. In pharmacology, shorter acting drugs are more addictive. That was what I learned in Medical School and is still true if you think carefully about it.”

Today’s Times headline: No prosecution on suicide-risk drug.

“A report suggested that GlaxoSmithKline (GSK) knew about safety risks but failed to report them to the medicines safety watchdog for five years.”

The drug concerned is Paroxetine and in the UK marketed as Seroxat and in the US as Paxil.

“GSK submitted data from clinical trials to the MHRA in May 2003 showing that patients under 18 had a six or sevenfold increased risk of suicidal behaviour if they were treated with Seroxat than if they received a placebo. Data also showed that the drug was not effective for treating depression in children and adolescents. Leaked documents suggested that GSK had known about these results as early as 1998.”

Keen eyed bloggers would have noticed Paxil CR in a previous posting of mine about how GlaxoSmithKline had all their Paxil CR and Avandamet seized in the U.S.

Now the story of Ribena has to be one of those sweet (sorry) stories one remembers for a long, long time.

Anna Devathasan (left) and Jenny Suo, New Zealand

Photo by Martin Sykes

In 2004 a science experiment by two 14-year-old high school girls in New Zealand brought embarrassment to the world's second-largest food and pharmaceutical company, GlaxoSmithKline, whose Ribena sale is around $8 million a year.

"We thought we were doing it wrong, we thought we must have made a mistake," Anna said when they found negligible vitamin C level in the Ribena they tested. The company had promoted the product by claiming that blackcurrants had four times the vitamin C of oranges.

The girls got short shrift when they telephoned GlaxoSmithKline.

"They didn't even really answer our questions. They just said it's the blackcurrants that have it, then they hung up," Jenny said.

Well, that was very clever. Blackcurrants have it, but not Ribena. So, nobody is misleading the public. You can guess the “concentration” of blackcurrant in Ribena. Have you tried the Syrop de cassis from France? The flavour of blackcurrant just bursts in your mouth.

The question must be asked of the second largest pharmaceutical company in the world. If they did not know how to check for vitamin C level, what business did they have in producing drugs that are used by millions? If they knew about it then ……wow!

The 2007 New Zealand Commerce Commission Report did not mince their words:

"Health claims are big business in today’s market, and the Commission has targeted bogus health claims in recent years. It is very disappointing to see a major pharmaceutical and health products company like GlaxoSmithKline mislead the public in this way……….a massive breach of trust with the New Zealand public."

GSK pleaded guilty to 15 representative charges of breaching the Fair Trading Act by making misleading claims about the Vitamin C content of Ribena, was fined $227,500, and ordered to undertake a nationwide campaign of corrective advertising in newspapers to explain that some forms of Ribena contain no detectable level of vitamin C.

GSK were lucky that they did not get fined over Ribena in any other country including Australia. In Australia, they avoided the fine by undertaking to explain the true nutritional makeup of Ribena on its packaging, its website and in future advertising.

Knowledge is power and it is good to know that there are young Cockroach Catchers as far away as New Zealand.

The two girls must have the last words:

Every time I see the new Ribena ad, the one where they don't mention any vitamin C, I'm just like, "Oh, yeah".

Cats Going Insane

In the mid-1950s in Minamata, “cats appeared to be going insane, and were falling into the sea. The people thought the cats were committing suicide.” The same happened in 1976, when an outbreak of pneumonia occurred among ex-service personnel attending a convention of the American Legion in Philadelphia.

In The Cockroach Catcher I wrote:

“… Take Legionnaire. It was first declared a form of ‘mass hysteria’. ‘Mass hysteria’ leading to deaths! One of the psychologists proclaiming such was carried out horizontally three days later with the same ‘hysteria’. Then a little germ was found.”

Have we learned not to jump on the psychological bandwagon? I fear not.

What happened in Minamata was in fact the start of the worst story of environmental pollution of the 20th Century and it did not happen in some backwater of a third world country – Minamata was in Japan.

The Japanese have had a long love affair with tuna and it is this love affair that caused such a major disaster. However the methyl mercury that was the main culprit was in all the seafood collected by the fishermen of Minamata Bay.

But tuna is long living and high up in the food chain, which means it accumulates the mercury gobbled up by those creatures further down the line. After the war Japan needed all the help industry could give to recover and it is well worth reading the full history of the disease development and the denial by the corporation concerned and by the government despite clear scientific evidence. In Japan, country came before people:

“……In spite of the fact that Dr. Tamiya of the Medical Department of Tokyo University - Japan's supposed authority on the subject, who was supported by the Chisso Chemical Company and other mercury-handling industries - was named convenor, the Japan Medical Association group was disbanded in 1962, also without reaching any conclusions. In this manner the issue was neutralized without the problems really being confronted.

Governmental funding for the Minamata disease research group at Kumamoto University was cut off, but the university continued its efforts to discover the causal mechanisms involved in the disease……

……The industry-related government departments evolved their own theories to counter that of the university research group, pressured the research group to hold back on publicity, and cut down on research funds……”

Now this may sound familiar:

“……Scholars receiving trust funds from industry sources would produce differing opinions that resulted in support for industry…

……Minamata disease came into being as a result of one chemical complex that was, at a certain point in time, positioned at the heart of a new and rapidly growing industry. Because of the company's pride in its own technological prowess, it was blinded to the dangers of the waste effluents that it allowed to enter the human environment. The industry and various governmental organizations understood pollution problems only in terms of economic viability, and these same sectors of society tried to evade and cover up these problems through an initially successful series of oppressive measures.”

Yet such problems are not just limited to Japan. Remember Camelford:

“……In July 1988, 20 tonnes of aluminium sulphate were accidentally dumped into the wrong tanks at the Lowermoor treatment works near the Cornish town of Camelford. As a result aluminium entered the water supply……

……A leading authority on the harmful effects of aluminium has criticised the latest conclusions of the independent team of scientists commissioned by the government to investigate the Camelford incident……

……Barbara Clayton, professor of metabolism at the University of Southampton and chairman of the committee, says the report takes into account evidence from 80 scientists, 130 other sources and the world literature on aluminium. She says the conclusions 'represent a consensus view'……”

This appeared in the Guardian in 2006:

“……The requirement to examine the DoH's handling of the incident was removed from the terms of reference. No independent expert on aluminium toxicology was included in the working group. An attempt was made to include Waring as medical adviser to the group, even though he was the author of the original letter stating that no lasting ill effects would result……”

Barbara Clayton became Dame Commander of the Order of the British Empire in 1988.

What a pity Dr. Crippen was not blogging then!

Next time your pet goes a bit funny, do not take it to the pet psychoanalyst, check the pet food.

In the meantime, Pompano is a much safer fish than Tuna and other predatorial fish. Pregnant mothers and those planning on having children should avoid Tuna, Sword fish and even King Mackerel.

We may in fact be staring at the reason for the exponential rise in the numbers of diagnosed Autistic Spectrum Disorder and not know it. Tuna, long perceived as the low fat high protein good food that is in tins and in many “healthy” salads has a high mercury content by nature of the reasons I described above.. Sushi and Sashimi are gaining widespread international fame as lean and healthy. The truth though is that the mercury content is also high and mercury is a serious neuro-toxin. One mother knew though, she was having tuna every day and both her sons developed autism.

I will stick with Pompano for now.

Also: Mercury in High Fructose Corn Syrup ---Autism: What If!

Buy the book: The Cockroach Catcher

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Paraguay: Technology Meets Ecology
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The Cockroach Catcher and Pompano

In about a week’s time, fish will start migrating from the warmer waters of the tropics to more temperate waters in search of food. So will the Pompanos.

I wrote in The Cockroach Catcher:

“……Mother always bought fresh fish from the market, often a Pompano which when fresh has tender flesh with a delicate flavour and makes a popular Teochiu dish. It is perhaps very apt that the first fish I caught... some forty-five years later was none other than a Pompano……”

Pompano caught 45 years later.

Pompano is a favourite fish for the average fisherman as it can be caught on a light tackle and it gives a good fight for the weight of the fish. It is a quick maturing fish and as such do not tend to pick up mercury. In the US it is one of the highest priced gourmet marine fish on the market and for a good reason. It is a delicate fish in terms of texture and flavour.

The classic Teochiu way of cooking Pompano is to simply steam it in with sliced ginger and spring onion. What makes it special is the addition of Teochiu urn preserved mustard green. This ingredient imparts a distinctive delicate flavour that my parents loved. I suppose it reminded them of the home village they left behind.

Another great way to prepare the Pompano is to wok-sear it. This is very similar to pan-searing that is now fashionable. The best fat for searing this fish is Goose Fat, but if it is not available then chicken fat is a good enough substitute. It has to be from good quality free range chicken though. We usually finish the searing with ginger, spring onion and soy sauce.

I can nearly taste it now.

Artistic rendition of Pompano - (Trachinotus carolinus) in Aruba

The best wine to go with Pompano is Pinot-gris from Alsace and my favourite vignerons are Hugel & Fils and Dopff and Irion in the quaint Alsace village of Riquewihr. As Pompano is delicate in flavour you need a wine with a nice firm flavour and a balanced acidity to go with it. There is no need to pick a very acidic wine. I particularly like Dopff and Irion's Sporen Tokay Pinot-gris. It fits the bill perfectly. It is subtle yet complex in flavour and will not over-power the fish like some heavily oaked chardonnays will.

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More Expensive Placebos Bring More Relief

There is an eye catching headline in today’s New York Times:

More Expensive Placebos Bring More Relief.

“In marketing as in medicine, perception can be everything: a higher price can create the impression of higher value, just as a placebo pill can reduce pain.

Now, researchers have combined the two effects. A $2.50 placebo, they have found, works better than one that costs 10 cents.

The finding may explain the popularity of some high-cost drugs over cheaper alternatives, the authors conclude; it may also help account for patient reports that generic drugs are less effective than brand-name ones, though their active ingredients are identical. The research is being published Wednesday in The Journal of the American Medical Association…..”

In The Cockroach Catcher, Dr Am Ang Zhang mentioned one of his consultants who was nicknamed the “Chief”:

“…….There were two lady consultants and the “Chief”. The “Chief” was an Austrian émigré, six foot six and a very formidable figure that most people were scared of. He was a highly intelligent man with a French wife and two highly intelligent children. Fortunately we hit it off from the very start……”

I had my own Chief and he had his eccentric ways. He famously created three “drugs” for use with his patients: Maplac Blanc, Maplac Verde, and Maplac Rubra. These could not be found in the British National Formulary (BNF), but were only available from our hospital pharmacy, white, green and red capsules, dispensed in bottles complete with proper Hospital labels.

For those who could not swallow capsules there was only one Maplac Rubra Syrup.

“Plac” is the short for placebo. In those days there was no rule against placebos and for a long time various vitamin preparations, including Vitamin B12 injections, were used for such effect.

Some prescribed drugs may have only worked as a result of the placebo effect. In any case, some drug tablets have been found not to contain the specified dosage of the active ingredient, as with GlaxoSmithKleine’s ever popular antidepressant Paxil CR and Avandamet (used for Type II diabetes).

“FDA inspections revealed that some lots of Avandamet tablets are not always manufactured uniformly and that these tablets may not have an accurate dose of rosiglitazone (one of the two active ingredients in Avandamet). FDA also found that some lots of Paxil CR tablets are not manufactured properly and can split apart, so that patients may receive a portion of the tablets that lack any active ingredient or a portion that contains the active ingredient and does not have the intended controlled-release effect.”

Wow. A lot of drug trials would be like triple blind control trials. You would need to analyse hair samples to decipher which patients have been administered the active ingredient in the end. It could be the reason why some drugs were shown to be not more effective than placebos.

Paxil is of course one of those Antidepressants implicated in the Hull report, which is causing a lot of frenzy. As far as I can tell, the story continues.

I remember attending one of these huge American Psychiatric Association (APA) conferences shortly after Olanzapine was launched. I had some first hand experience of the voracious appetite induced by this drug. I thought I should ask a question about their supposedly double blind control trial. Written questions had to be submitted in advance. So I wrote and asked how it could be a true double blind trial if within a short time relatives reported ravenous appetite in the active drug group. “It would have been so obvious!” I wrote.

Guess what happened? They just ignored my question! I was young then.

According to the “Chief”, the white tablets were good for bed wetting and green for “naughty” children. Red was great for sleep problems.

“Taste this.” He once poured me some of the red stuff.

“It’s bitter!” How clever the “Chief” was!

Then I thought: I knew the flavour.

Angostura Bitter! It is safer than anything we can think of and we would only need to add a small amount.

“Is it legal?” No, I did not ask him.

“Now, I have this mother. Her two kids won’t sleep and I gave her two bottles of Maplac Rubra, one for each kid. She took them all herself and was unconscious for 48 hours.” The Chief told me.

As far as I know, “The Chief” never lied.

I once went to a lunch time talk by someone from a well known London hospital. It was a presentation of his findings on the effectiveness of the newer SSRIs compared to that of placebos. In his final slide he showed a cartoon of two Pharma executives during the lunch break of a big launch of one of their SSRIs, one asking the other, “How can we move into Placebo?” I could not get my hands on that slide, but did find some good Placebo cartoons on the Net. I like the one about placebo rehab!

Did you catch these?

So far in Cockroach Catcher: Phew! I am still catching my breath! I learn that most blogs have a weekly or monthly summary. There was no summary from me at the end of January as I had only just started, but below is a summary of the postings to date.

Nature

Anhinga in Costa Rica - Faking Is Not All Bad

Bauhinia blakeana and other health warnings

Elephant and teenage pregnancy

Lunar Eclipse

Mother Nature should be ecstatic

The Cockroach Catcher in Costa Rica

Turtles in Barbados

Yunnan

Food

Antioxidants and cooking

Chinese New Year and the Goose

Papaya and Nobel Prize

Quinoa: the super grain

The secret is out: recipe for Teochiu Braised Goose

The sliced Goose and a natural dose of Glucosamine

Child & Adolescent Psychiatry

A Brief History of Time: Anorexia Nervosa

Adoption

Anna Freud and Common Sense

Anorexia Nervosa: a cult?

Autism and Money

Child Psychiatry, Ping Pong, Paper Planes and Toys

Hiccup Boy

Please don't poison our children with stimulants

Religious Fanaticism and the Ice Maiden of Peru

The doctor is the drug

The William Tell Mom and Peas

This Child Psychiatrist also uses the Stethoscope

Trust Me

Unwillingly to School

Medicine & Medication

Autism, the Brain and Tiger Woods

Che Kung Temple (che gong miao) and the Power of Prayers

Flight into Health - Why Do People Get Better?

Groundhog Day and Prozac

Monkeys and NHS

Multiple Sclerosis, Iguanas and Wrong Foot

Orthodoxy and Knowledge

Rashomon and Prozac

Sadness medicated to extinction

SARS and Quorum Sensing

The Knowledge' and the Brain

Traditional Chinese Doctor

Leisure Pursuits & Health

Barbados

First Encounter with Mondrian

Golf and Health

Medicine and Snorkelling

Pleasure Principle and Wine

Tiger Woods and Breathing

Buy the book: The Cockroach Catcher

Papaya and Nobel Prize

Papaya Plantation - Costa Rica

In my book, the Cockroach Catcher reminisced about going home after the final medical school examinations:

“……The guavas were not quite ready but our own giant papaya tree seemed capable of fruiting through the year. These were yellow fleshed and delicious though without the special fragrance associated with the red variety……”

As fashion in food recommendation changes with time, I prefer to eat what I like and I happen to like papaya. Right now, non-green fruits and vegetables seem to be the flavour of the month, and in this respect papaya certainly fits the bill.

View recommendations with some caution, and if it fits in with how you feel then go for it.

Papaya – red variety from Costa Rica

Papaya contains the enzyme Papain, which has a special ability to break down peptide bonds. This makes papaya ideal for marinating. Go easy though. If left too long the meat may be over tenderised. I definitely prefer the fresh fruit to the commercial preparation.

As early as in 1978, the Time Magazine reported on the controversial use of Papain for treating slipped discs. Chymopapain, the enzyme derived from Papain was legal in Canada then but not in the U.S. Some individuals may be allergic to Chymopapain. I often wonder if there might have been other reasons. The Time Magazine article pointed out that 170,000 Americans underwent disc surgery every year. The best recommendation was perhaps by the Chicago Orthopaedic Surgeon Dr. Noble, who not only referred his patients but also himself to a Canadian Hospital for the treatment. He sort of “put his back where his mouth was”.

Papaya and its extract has other uses. Papain is used in some preparations of soft contact lens cleaning solution.

Small Jelly Fish - Barbados

In the unfortunate event of a swimmer or snorkeller getting stung by a jelly fish, papaya is by far the best treatment as a local application. It is also wonderful as a facial mask. Next time when you buy a whole or half papaya, keep the skin after cutting off the flesh. Rub your face with the flesh side of the skin and leave for ten minutes before washing off – this beats most other facials. Just make sure you do not have cuts or scratches on your skin. The last time I checked the prices of some facials containing Papaya extract, they were upwards of £16.

Now you have a secret recommendation from the Cockroach Catcher.

However, you may be too late to get the Nobel Prize. Rodney Porter in 1972 was awarded the Nobel Prize in Medicine for his ground breaking work on the chemical structure of antibodies, jointly with Gerald Edelman:

“ … Porter aimed at separation of those parts of the molecule that are responsible for the capacity of the antibody to react specifically and combine with that foreign substance, that antigen to which it is specifically fitted. He found that this indeed could be done with the aid of the protein splitting enzyme papain.

The Nobel press release concluded:

“Their discoveries represent clearly a break-through that immediately incited a fervent research activity the whole world over, in all fields of immunological science, yielding results of practical value for clinical diagnostics and therapy.”

Buy the book: The Cockroach Catcher

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Rashomon and Prozac

Rashomon (1950) was made by one of Japan’s top directors Akira Kurosawa when Japan was just recovering from the Second World War. The director even had difficulty finding a horse for a crucial part of the film. I am sure many working in the field of mental health have heard of the Rashomon Effect, although many may not have had the chance to see the film. I used to keep a copy to loan to my staff. The Film, in black and white, was extremely well made and has been hailed by other film directors as near perfect. It just shows how lack of funding does not necessarily mean lack of quality.

Rashomon is fundamentally about truth and subjective truth. At the end of the film you are still not too sure but you have some idea. The story was simple enough:

“This landmark film is a brilliant exploration of truth and human weakness. It opens with a priest, a woodcutter, and a peasant taking refuge from a downpour beneath a ruined gate in 12th-century Japan. The priest and the woodcutter, each looking stricken, discuss the trial of a notorious bandit for rape and murder. As the retelling of the trial unfolds, the participants in the crime -- the bandit (Toshiro Mifune), the rape victim (Machiko Kyo), and the murdered man (Masayuki Mori) -- tell their plausible though completely incompatible versions of the story.”

(from the: New York Times Review: March 1, 2008)

The murdered man was in fact a Samurai who had the task to maintain the honour of the Samurai tradition, even as a ghost. This was to some the most shocking part. We know people lie: but GHOSTS?

In today’s news, the Oliver star Mark Lester now divorcing his wife has his story to tell so has his wife.

Not many days ago, Prozac and other SSRIs hit the big news worldwide. The big Pharmas have their stories so have these and other researchers from around the world. The millions of patients on one of these drugs have their stories too. If NICE were to make a pronouncement, would that not be just like the words of the Samurai’s ghost? Are we to believe it would not be driven by political or economical considerations? Not too many years ago Ernest Saunders was let out of prison early because of Alzheimer’s disease though he later denied it. What about Pinochet? O. J. Simpson?

Rashomon has remained one of the top hundred films ever made. The ending at least gave the poor monk, who probably would have committed suicide or would nowadays be reaching for Prozac or other SSRIs, some hope.

A baby was heard crying. It was an abandoned baby. The woodcutter, who was poverty stricken, decided to adopt and look after this poor baby. He had six children – one more mouth would hardly make much difference.

There is hope in the world still.

Buy the book: The Cockroach Catcher

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A Brief History of Time: Anorexia Nervosa

Il faut manger pour vivre et non pas vivre pour manger.
(One should eat to live and not live to eat.)
- Moliere (1622 – 1673): L'Avare (The Miser)

Some hae(have) meat and cannot eat,
Some cannot eat that want it:
But we hae meat and we can eat,
Sae let the Lord be thankit.
- Robert Burns (1759 – 1796): The Kirkcudbright Grace

This is not about Stephen Hawking’s famous book that sold over 9m copies world-wide, but a collection of material that relates to Anorexia Nervosa in a chronological order. You see, I believe in free sharing of knowledge.

First introduction of the term Anorexia

Sir William Withey Gull (1816 – 1890) first used the term:

“In… 1868, I referred to a peculiar form of disease occurring mostly in young women, and characterized by extreme emaciation…. At present our diagnosis of this affection is negative, so far as determining any positive cause from which it springs…. The subjects…are…chiefly between the ages of sixteen and twenty-three…. My experience supplies at least one instance of a fatal termination…. Death apparently followed from the starvation alone…. The want of appetite is, I believe, due to a morbid mental state…. We might call the state hysterical.”

Source: Anorexia Nervosa (apepsia hysterica, anorexia hysterica).
Transactions of the Clinical Society of London, 1874, 7: 22-28.
Classic description of Anorexia Nervosa.

Earliest published accounts

Richard Morton (1637-98), a London physician: The Treaty in his book Phthisiologia, or a Treatise of Consumptions, first published in Latin in 1694.

Ernest-Charles Lasègue (1816 - 1883), a professor of clinical medicine in Paris: “De l’Anorexie Hysterique” containing descriptions of eight patients.

More recent views

Girl in a Chemise circa 1905 Pablo Picasso (1881-1973)
Tate Collection

Anna Freud’s psychoanalytic view (1958):

• Adolescent emotional upheavals are inevitable
• Anorexia Nervosa is the outward manifestation of the battle between the ego and eating, with the former struggling for it’s very survival

Bruch (1966): relentless pursuit of thinness

Crisp (1967): weight phobia

Russell (1970 ): a morbid fear of becoming

Crisp (1967 - 1980):

• Anorexia nervosa serves to protect the individual from adolescent turmoil.
• Anorexia nervosa reflects a phobic avoidance of sexual maturation.
• Unsettling effects of sexual maturation at puberty may drive the female adolescent to a pursuit of thinness leading to greater acceptance, self-control and self-esteem.
• Anorexia nervosa tends to appear in families with buried, but unresolved, parental conflicts.
  

Palazzoli (1978) on women’s role (not just Anorexia Nervosa)

• Women are expected to be beautiful, smart and well-groomed.
• They are expected to have a career and yet be romantic, tender and sweet.
• They are expected to devote a great deal of time to their personal appearance even while competing in business and professions.
• In marriage, they are expected to play the part of the ideal wife cum mistress cum mother.
• They are expected to put away her hard-earned diplomas to wash nappies and perform other menial chores.
• The modern woman is therefore exposed to a terrible social ordeal, and the conflicting demands and dual image of the female body as sex symbol and as commodity.
• An adolescent girl may develop feelings of insecurity and alienation toward her changing body.

Finally, it is appropriate to close with two quotes:

L'appetit vient en mangeant.
(The appetite grows by eating.)
- Rabelais (1494 - 1553): Gargantua

One hath no better thing under the sun than to eat, and to drink, and to be merry ...
- Ecclesiastes 8.15

Other Posts:
Anorexia Nervosa: Olanzapine (Zyprexa)-Veganism
Anorexia Nervosa: Bach
Anorexia Nervosa: What If!
Anorexia Nervosa: a cult?

The Book: The Cockroach Catcher

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