Potential Pharmaceutical Niche?

In my experience, doctors never prescribe anything to stimulate or accelerate actual healing. They only prescribe stuff for pain, and to kill the boojums that cause it, but all they’re really doing is removing the obstacles that stand between your natural healing mechanisms and your injury.

Is that accurate? Are there exceptions? Help me out here…

Here’s the experience I would have LIKED to have with the doctor:

“Well, Howard, it looks like you’ve separated your shoulder. I’m going to give you enough painkillers that you’ll sit down and do nothing for four days, but you HAVE TO TAKE THEM. That will prevent you from injuring yourself further, and you’ll be too stoned to be bored. I’m also going to give you a nutritional supplement that will ensure that your body has the necessary materials to quickly rebuild that shoulder of yours.”

Then the doctor would hand me some pieces of paper, I’d go to the pharmacy, and I’d come away with a rejuvenative, regenerative cocktail, and I’d understand why I needed each of the pieces.

I know, I know, there are lots of supplements out there. Off the shelf I could probably acquire steroids, ligament strengtheners, and protein isolates which would dramatically accelerate the process by which my useless shoulder is made useful. I’m also very nearly smart enough to figure out what to buy without the help of a doctor. Sure, some of it is snake-oil, and even the stuff that appears to work for everybody has very limited “scientific” support in the form of clinical trials, but hey… I could figure out what’s what on my own.

My question is why won’t doctors do that for me? Isn’t there money to be made there? Wouldn’t it make sense for an association of (for instance) doctors who specialize in physical therapy to get together with (for instance) a company that makes protein powders, and underwrite a formal study on using supplements to treat (for instance) separated shoulders?

No, the pharmaceutical companies don’t stand to make quetzlcoatillions of dollars selling non-patentable protein powders, but certainly your local pharmacy could make a buck or two. SOMEBODY out there (besides us miserable convalescents) stands to benefit from the formalization of prescription-strength “healing aids.”

I’m sure some of you will tell us how the modern medical establishment is little more than a conspiracy to keep natural healers on the lunatic fringe and make the megapharms and their stockholders fithily richer. I want answers that are a little more firmly grounded.

–Howard
ps: I mixed up some glutamine and creatine this evening, and my shoulder started to burn about an hour later. It felt like the burn I get after a workout, not like an injury. It was “new” pain, and it fascinates me. And this evidence of the existence of a niche for prescribed supplements is not especially firmly grounded.

61 thoughts on “Potential Pharmaceutical Niche?”

  1. IMHO, my guess is that most doctors (and researchers) still have only a limited idea as just how the body does it’s magic, and are reluctant to tinker with it for fear of breakign that process, or screwing it up in some manner and getting their heads handed to them on a silver platter via lawsuit.

    1. Okay, let’s expand on that for a moment:

      1) Clinical trials are expensive.
      2) Basic research is expensive.
      3) The profit to be seen from “proving” that a certain non-patentable mix will accelerate healing is low enough that those with the money to fund the basic research and the clinical trials would rather fund more profitable treatments.

      That seems to hold water, in that it explains why (for instance) Glaxo-Wellcome isn’t jumping on board.

      Are the trials and research so expensive, however, that a company like (for instance) Weider Global Nutrition can’t afford it? The payoff, remember, is getting your product prescribed by doctors.

      1. It costs many millions of dollars (and a decade or so) to get FDA approval for drugs. And, of course, if some of the supplements are tested and -don’t- work, then, well, they’re out that product. The herbal companies are in a very good place right now, and have too much inertia to change tracks.

      2. My uncle used to be a pediatric oncologist specializing in cancers caused by aids before he got sick of watching children die and became a lecturer. (That’s my understanding, anyway; the reality is presumably much more complex, and I’ve been out of touch for a few years anyway.)

        My understanding is that insanely high malpractice insurance premiums became a dominant factor in the industry some time ago. The wave of consolidation and related things like HMO’s and “managed care” are all related to this: doctors can barely afford to practice, and the are smothered in bureaucracy and ass-covering. They run huge amounts of unnecessary tests because if they miss something, they get sued for millions of dollars.

        This is apart from the fact that if you _do_ try to speed up healing the most likely thing to happen is that the healing goes wrong. A drug that stimulates cells to divide would greatly increase the risk of cancer pretty much by definition. Excessive or misplaced scar tissue can easily be a bigger problem than the original injury. Joints that get screwed up in fairly subtle ways have a nasty habit of becoming arthritic years later… Do you want a twinge every time it rains? I’m not saying it’s not possible, just that it’s not easy.

        More to the point: people react differently. (Read up the history of the first trials of nitrous oxide as an anesthetic.) Not just to drugs, but even to nutritional supplements. (Heck, my ex-roommate’s mother is allergic to SALT. Her body hoards it and can’t get rid of it through normal channels; she can’t even have tap water. How did she get this condition? She was on medication that her body reacted badly and permanently to, damaging or destroying some normal regulation mechanism.) There are many people out there allergic to _latex_, who can’t have it in contact with their skin. (How much fun is it to find out halfway through surgery that the patient is reacting to the gloves the doctors are using?))

        In this lawsuit-happy environment, anything that has a 95% chance of speeding up recovery by 50% but which has a 0.01% chance of you reacting badly enough to it to possibly sue, is something to be avoided.

        Hence the insanely long clinical trials, and the lack of support for things that work just fine: for 95% of the people out there…

        Plus, you’re going to know more about you than the doctor does. The doctor can categorize your blood type, but really doesn’t care about your response to chromium supplements. And the way they find out whether or not you’re alleric go something is really to notice when you react badly and not do that again.

        So they have to come up with the lowest common denominator treatment regimens. 95% of advanced medical technology would be much better, broader, detailed, and individually customized medical diagnostics that figure out what will work best on _you_, and can use stuff on you that wouldn’t work as well on the next patient. (Heck, it’s only in the past couple decades that they started making sure to test new drugs on women as well as men…)

      3. The problem is quite simple. How do you determine that something aids healing?

        Well, you have to have injured people. And then you have to treat some of them AND LEAVE THE REST ALONE.

        Without a “control group” you can’t really be sure that the treatment is what’s making the difference. Under current federal law, you can’t *get* funding for a study that has a proper control group because congres-critters who didn’t understand who that sort of thing works poassed a law saying that federally funded trials can’t *not* give something that might help to participants in the trial.

        Also, since there’s no known means of “accelerating” healing (nor any known way such could work, well except for accelerating cell division, which is apt to turn into cancer) the “best” you can do is insure that the person has adequate rest, doesn’t irritate the injury, and has adequate nutrition.

        Due to the way the digestive tract work, you aren’t going to get a lot of those “supplements” you see into the bloodstream intact. They’ll get broken down to simpler chemicals first.

        Tissue repairs just need adequate vitamins, minerals, protien (which gets broken down into amino acids before getting into the blood) and some lipds (fats/oils) and carbohydrates.

        Typical US diets include *hundreds* of times as much protien as your body needs. So that’s not a problem, unless you are a vegetarian who isn’t eating “complete” protiens (some amino acids are a lot scarcer in vegetable products). We likewise get lots of fats and carbs.

        So it’s “just” the vitamins/minerals that could be a problem. And folks vary *widely* in how well they process those.

        Your body builds stuff up from simple raw materials. As long as it gets those, it’ll do the best it can.

  2. For the last two years, I’ve been taking Glucosamine to keep my arthritis from getting worse, and it’s working great. It’s subtle enough that it took me a while to realize that the reduction in pain in my hands wasn’t due to the change in climate — but when I run out and go without for a couple of weeks, oh, boy, do I know it.

    In conjunction with over-the-counter naproxene, it also let my old rotator cuff injury heal up.

    1. I’ve heard good things about glucosamine. I didn’t take any because I didn’t have any lying around the house. I’ll talk to the doctor about it tomorrow, and see what he thinks.

      (And then I’ll read up, and probably go buy some regardless of what he tells me.)

      –Howard

      1. I’ve been experimenting with glucosamine-chondroitin for the past six years, and (admittedly lacking a control) my personal results have been inconclusive. The wisdom I’ve heard from those who make a living from knowing about such things is that glucosamine-chondroitin will not repair anything, and may not significantly help repair anything faster, but does help prevent an injured joint from deteriorating further.

        (Actually, on that basis, I need to remember to take mine. I’ve been largely forgetting since our last move, because we’re so short on storage space that the vitamins and supplements are rather out of sight, out of mind.)

      2. Be a little careful with this. We tried this with my mother and made her a lot worse because.. guess what?… she’s allergic to anything sulfa and what you get in the store is glucosamine sulfate. If you’re sensitive to sulfa drugs, I don’t recommend it at all! (otherwise, sure, go for it.)

      3. glucosamine

        as was mentioned above, there’s glucosamine sulfate and glucosamine chondritin, I’ve been taking the chondritin – I don’t know if it *really* helps, but I do know that my fingers used to pop all the time, and that after I sat down with the PS2 for a couple hours, my fingers *burned* (in particular my thumbs from those analog sticks) and after taking the glucosamine for a couple of days, that stopped – despite continuing to play. I’ve since run out of time to play the video games and am still taking glucosamine…and the pain comes and goes, but never as bad as it was before, and usually worse when I forget for a few days…so take from that what you will. just my 2cents.

  3. Um, Howard, what part of the simple message “rest and recuperation” is not actually getting through?

    The medical profession should put up warning posters for impatient folks like you.

    Either stop messing with mother nature or buy a dart board. :p

    1. Yes, they SHOULD put up warning posters. For some of us, painkillers are things we take so that we can ignore the pain and get some work done. If the doctor wants me flat on my back, he needs to tell me why, and then he needs to provide me with a decent enabler. In this case I figured it out my own self, and have spent at least half of the day flat on my back.

      Mostly, however, this post is about the nutrition aspect of healing. Whether or not I’m getting enough rest, it would be nice to know what I should/shouldn’t be eating.

      –Howard

      1. I admit that the nutrition side is fascinating – just keep in mind that your kidneys will complain to the union if you take too much of a good thing – and you are relatively inactive at the moment.

  4. I believe it’s the case that your body normally has pretty much about everything it needs to perform the repairs, as long as you’re not actually suffering from deficiencies of anything. In other words, provided you’re eating a reasonably complete and healthy diet, there is no “magic supplement” to kick your body’s healing process into high gear. The best thing you can do is treat it carefully to avoid undoing any of your body’s repair work.

    That said, it’s most likely important to make sure you get plenty of protein, and taking a little extra zinc isn’t going to hurt anything either. In both cases, it’s not going to supercharge anything, it’s just a case of making sure your body has enough on hand.

    (The gripping hand is, yeah, all this wisdom aside, there’s been more than once I’ve had to just swallow enough painkillers to function, grit my teeth, and just do it however much it hurts, in the full knowledge that I’m going to be sorry when the painkillers wear off and the doctor’s going to cuss me out … because it has to be done, and has to be done now.)

      1. Re: Already something like that

        I wish there would be some kind of sea-change in the medical community. I mean, currently there’re two kinds of doctors, in the public eye: “frauds” whose work will do nothing or will actively harm you, and people who’re informed and can help. Unfortunately, depending on who you ask, both the naturopathic community and the standard medical community will fall into both roles. 😉

        The standard MD could learn a lot about whole-body wellness, alternative treatments, and simple attention to the patient and bedside manner.

        The naturopathic community could be well-served by actually being ‘real’ doctors, too — that is, being comprably educated to your standard doctor and being able to prescribe prescription medicines. (This isn’t any kind of slur on NDs — I know a few and I have respect for them. It just seems that everyone would be better served if they also had traditional training.)

        1. Re: Already something like that

          yeah. This is why I’m looking (right now, as I just stared a job and need to pick a PCP for my benefits) for a regularly-educated MD with enough of an open mind to consider certain homeopathic/holistic approaches to medicine without relying exclusively on them.

        2. Re: Already something like that

          Osteopaths have full hospital rights, can prescribe drugs, and can have pretty much any specialty they’d like. They’re DO’s, not MD’s. They can perform surgery. They’re ‘real’ doctors, but the split between osteopaths and MD’s happend about a hundred years ago. They’re the only non-allupaths that are allowed to fully practice medicine in the US. Some of them use naturopathic medicine. The empahsis with osteopaths is how the full body systems effect each other, and supporting healing and health through manipulation of the bone structure first, among other things.

          For instance, during the flu pandemic of 1919, osteopaths did a lot of work in making sure that people’s rib cages were unobstruced and fully functional, so that their bodys were under a minimal amount of stress, and their lungs had lots of room. Their mortality rates were about 1%. The top of the line allupathic hospitals had a 40% mortality rate.

          However, there are some Osteopaths who are basically allupath wanna be’s. Those guys aren’t very good or useful. The total number of osteopaths in the US is only about 6% of all doctors, so finding a good one is tough. (They made a huge political mistake and admitted black people and women into their colleges in the 1920’s, with the attitude of “If you can do the work, do it”. This made them undesirable to a lot of people, but they seem to consitantly be about 75 years ahead of the allupaths. My great grandmother got accupuncture from her osteopath in the 1950’s to help her quit smoking.). Osteopaths tend to pick up things that work- even if they can’t explain it. They don’t really give a damn about needing 18 years of clinical trials to see if yogic deep breathing helps- they’ll try it, they’ll ask their paitients to try it, and if it seems to help, they’ll tell other people to do it. If you can find a Fuller trained cranial osteopath (there are only about 900 in the world), they’re amazing.

          This is why I might go into osteopathy, but there’s no way I would ever go to a traditional medical school. I’m fundamentally interested in solving the underlying disorders and helping people get better, than in treating symptoms all day every day.

          Hope that helps.

          1. Re: Already something like that

            Aah! I didn’t realise this, mostly ’cause I didn’t know what an osteopath was. Very cool, thanks. 🙂

          2. Re: Already something like that

            I’m afraid the information about osteopaths’ flu pandemic mortality rates in 1918-1919 being under 1% is untrue. Mortality was often from “secondary causes”, most frequently pnuemonia resulting from lung inflammation. Where pneumonia did NOT develop, flu mortality was lower than in those where flu was “medicinally treated”; where pnuemonia DID develop, it was higher. Overall mortality was much the same, between 6-10% when averaged across all areas. (Highest mortality vs. lowest mortality within geographical areas and treatment groups was dependent, not on treatment method, but on age; unlike most flu, the hardest hit groups were not the youngest and oldest, but previously fit young adults in the late teens to mid-twenties. This points to a different immune response pathway to this flu than to others.)

            Know what’s behind your statistics, and there is still much to be said for evidence-based medicine.

          3. Re: Already something like that

            /me nods

            Thanks for that. I know better than to trust statistics I vaugely remember, but ocassionaly I slip up and quote them anyway. I’m just glad I did that here instead of at home- I live with a physicist. We google our facts during debates- when you have the Beuro of Labor and Statistics website layout memorized for policy point arguments, it makes life a little more interesting ;^)

            I agree about what you said about evidence-based medicine. I actually have quite a lot to say about that, but I don’t want to hijack this thread. Would you mind if I wrote you an e-mail, or swinging by my LJ and commenting so we can contine talking about this elsewhere? (I’d prefer LJ- I’m stupid busy these days, and I like LJ because I can shoot off something quick, and come back to it later easier than w/ e-mail).

            Bippy

          4. Re: Already something like that

            Sure, delighted to discuss elsewhere — I deeply appreciate what you say bout the ability to discuss at leisure, too.

            I’ve left a note at your LJ on the ADD post; we can pick up the discussion there or from another post if you prefer.

  5. 1) FDA is responsible for certifying drugs and other remedies that can be used by doctors.
    2) Not enough research exists with regards to natural remedies and those that exist suggest that they may/may not work (meaning it’s roughly 50/50 right now and the FDA wants something closer to 80/20)
    3) If the FDA were to certify a product and the testing was incomplete, they would be held liable for any lawsuits that came through as a result.
    4) As more tests are done and more research data is tabulated, more natural remedies will come on the market and be FDA-certified.

    At least, I think that’s how it’s done. Not sure. =)

    1. The FDA does not regulate herbal supplement claims because the herbal companies see no need to make their claims medically-tested for validity. They turn large enough profits from people self-diagnosing and self-prescribing using available literature that there is no need for them to go talking about medical tests demonstrating anything.

      As a result, they can get their products on the market through the FOOD section of the FDA – which has a much lower standard of regulation than even that of the drug division (which isn’t great). To be marketed as a dietary supplement, a product merely has to demonstrate than any potentially-harmful effects are listed on the packaging. It doesn’t need to demonstrate that it HELPS anything at all – and considering that some herbal supplements have suggested claims that they can help cure anything from memory loss to cancer, they don’t really want their more-outrageous suggestions to fall under the rigors of scientific testing. People buy it enough without them doing so.

      1. I really do wish that there could be more comprehensive testing and regulation of herbal supplements, but, currently, the market can’t and won’t support it.

        I’d love to see medically active herbal supplements come with actual information on dosing, side-effects, interactions, contraindications, and all that stuff. Too many people stupidly think: “Oh, it’s natural, it’s not a ‘drug’ or anything, so it won’t hurt me.” I don’t know how people can manage the cognitive dissonance of taking an herbal supplement like a drug and yet denying that it is one….

        1. My brother is a radiologist, and says that you can get a clinical trial to say anything you want it to.

          Note this is seperate from FDA approval…

          There is this one zinc based supplement that made a big deal about how two independent double-blind clinical trials proved that it made your cough go away faster. I asked my brother about it, and he chuckled and made the above statement.

    2. A doctor certainly can recommend things to patients, whether they’re prescription medications or non-FDA-regulated herbal supplements. There’re a few factors in why they don’t: MD hubris and the fact that someone might land a malpractice suit on them if they don’t take the doctor’s ‘standard’ treatment and just do the support treatments.

      The main reason that most herbal supplements aren’t federally approved is because it costs a lot of fucking money to do so. Pharmaceutical companies can do this because they can patent the medications, and have a monopoly on them for a short time, making a huge amount of money to offset the costs. In the case of herbs, however, you have a lot of small companies with no exclusivity all selling the same thing. This is the real reason, I think, why the herbal industry has fought all attempts at regulation.

      1. The “herbal industry” would be able to make plenty money on many of the supplements if they passed testing, and they can certainly patent their remedies, as much as any pharma company can. The problem, of course, is that in order to pass clinical trials you need to demonstrate positive benefit as well as a minimum standard of safety. Of course trials take a long time and cost a lot of money; with the combination of that, plus the fact you actually need to prove your claims, why on earth would the “supplement” industries want to subject themselves to that???

        They are not innocent victims. There are no angels, when it comes to profit.

  6. I take the full Usana Health Pack, day and night. http://www.usana.com/en/index.shtml

    trace of tears: Germany actually does a lot of research into herbal medicine and supplements, and it’s pretty good stuff, but not a lot of American doctors can read German.

    My diabetes is 20-30 points lower on the days I do this. That’s enough for me to belive. It’s run by doctors out of Utah. They actively publish research. It’s good stuff, but it’s expensive.

    If you’re interested in nutritional medicine, I’m thinking of making that my specialty and I’d be more than happy to talk with you about what I know about it. If you want, send me an e-mail at madpiratebippy@gmail.com

  7. As I’m sure you don’t know this, I work as a legal assistant for a plaintiff’s law firm. We handle medical product liability – when people take something medicine-wise, or have a surgical procedure done, they talk to us if it causes them injury.

    Working at this job, I can tell you precisely why most doctors don’t prescribe things “for healing” – that reason being that nothing heals the body quite so well as the body. Everything you are prescribed as a patient exists primarily to create an environment where the body CAN heal itself – and generally, when it can’t, people are boned. Sure, you can replace a liver or give insulin when the body doesn’t produce any… but you can’t make a nonfunctioning pancreas work again and there’s no way to turn a failed kidney back “on.”

    Every time the medical profession seeks to create a way to artificially “heal” someone, something bad inevitably happens. Non-biological implants inevitably wear out, or cause negative immune responses, or create centers of weakened body tissue where infections can grow. Medications to artificially-regulate the endocrine system, to boost mood or modify behaviour, must be taken for life because they merely mask an existing issue with your glandular system which doctors really don’t know how to fix. Taking such things for prolongued periods almost inevitably causes extreme side-effects, as these additional chemicals react with the body’s precise functioning in an unpredictable way. Truly though, the only way they could “repair” the problems with the glands would be to replace them with some other persons’ glands – and that would only work if the glands were the problems themselves, and not some issue in the brain which causes mixed-up signals to GO to the glands in the first place.

    Modern medicine is still largely a Frankensteinian art. We don’t know HOW the body works, so much as just that it does so, and so doctors focus primarily on providing a way by which the mechanisms of the body can work in the way they’re supposed to in order to heal the patient. Get a cut? They stitch you back, and let you heal. Have a veinar embolism? They go in, cut out the troubling part, stitch you back together into a reasonable whole, and let you heal. Have liver failure? They go in, cut out the liver, replace it with a liver from someone else, stitch you back together into a reasonable whole, and let you heal. So on and so forth – even in cancer, the basic treatment is to remove or kill the cancer and let the body do the cleanup and maintainance around it.

    Yet there’s nothing that is known to make the body heal. You can provide the materials so that it can heal, but in general most people get those on a regular basis anyways. All the protein powders or herbal supplements in the world only supply the basic necessities for healing – they don’t cause it. The only things that can do that are rest, hydration, proper diet, and a positive attitude. And no one’s quite sure why.

    When people try to shortcut that, usually there are problems. Not even medical scientists know exactly how the system that is our body functions exactly how it does, so attempts to get it to do specifically what someone wants it to generally ends up in a boatload of unintended consequences. Diet pills cause heart damage from prolonged elevation of the pulse. Drugs that promote insulin-production cause liver failure. Blood-thinning OTC medications meant to reduce headaches cause hemorrhagic strokes.

    The safest way is just to reduce discomfort, and provide a situation in which the patient is capable of self-healing. Only the body knows how it runs, completely in any case, and so it is generally the best at making sure it keeps itself running.

    That said, get well soon Howard.

    1. It seems like what Howard was looking for was less a shortcut and more a cocktail that would ensure that he’s getting the correct amounts of the things he needs for the healing process, which isn’t quite the same as the living process. One assumes Howard is doing at least passing fair in getting the things that he needs to live. Since he’s still, you know, alive.

      Does one require additional bits in order to ensure proper healing? Or does your standard daily diet cover this kind of extracurricular activity?

      1. Exactly.

        Is the proportion of minerals to water the same in the repair process as it is for the rest of my dietary needs? Would more iron help? More chromium? More sodium or potassium?

        *sigh*

        –Howard

        1. Listen to your body. If you are craving a banana, you need more potassium… etc.

          When I had a bad injury (muscle, not cartilidge) I suddenly was craving meat like crazy even though I had been vegitarian for five years. I didn’t quibble, I ordered a large pizza (at the hospital, delivered to my room) with as much dead corpses as they would pile on it. They planned to keep me there for a month. I went home in three days.

        2. More iron is unlikely to help unless you’ve been bleeding a lot…

          Chromium, copper and zinc are needed in such trace amounts that you probably get plenty from tap water.

          Potassium won’t do you any harm. My advice for a useful supplement would be “cod liver oil”, though, if you can stand to take it, since the vitamin A and the long-chain oils in there will give your body material for joint healing. Stick by the recommended dosage, however, more does not equal better; an overdose of vitamins E or A will do you serious damage. Also, if you get 10-15 minutes of sun a day (that’s all you need) you will get the vitamin D you need — we really need to synthesize our own D, what you get in supplements is rarely absorbed.

        3. For the most part, a balanced diet rich in minerals will cover everything you’d potentially ever need. If you truly feel that you’re missing out on something, make yourself a nice stew with liver and that’d contain absolutely anything you’d be needing as far as amino acids go. Keep in mind, however, that aside from a few essentials your body is perfectly capable of making whatever it is you’d need to perform repairs – and a decent steak contains almost all of those.

          Americans in general consume more vitamin and mineral content than any other nation on the planet, due to the perfunctory enrichment of everything available in the marketplace. We take in enough vitamin C in a day that it exceeds the suggested RDA by tenfold. By far, the geneal population consumes quite enough to be able to have everything they need to function.

          My reccommendation is as follows, so far as promoting your self-healing goes: try not to overwork your injured shoulder, make sure to relax enough to let your body work on getting itself put back together, and if you start craving any foods then consume them – that’s usually your body’s way of telling you that there’s something in the food it needs.

          Try to get a book on tape, and spend at least part of the day just laying out listening to it and focusing on things other than what you need to be doing. Perhaps do so out in the sun, if you think you’re a little low on your vitamin D or melatonin production, but otherwise don’t worry about it. Unless you’re on an extremely-restricted diet, you should be getting what you require.

          1. We take in enough vitamin C in a day that it exceeds the suggested RDA by tenfold.

            It’s probably worth making the small noted quibble that there is no such thing as a suggested RDA for vitamin C — the numbers in the “nutritional information” blocks on food packages are a minimum RDA, below which one is likely to get symptoms of deficiency. I don’t believe there’s any reason to suggest that the minimum amount to avoid symptoms of deficiency is necessarily the optimum amount, particularly with water-soluble vitamins such as C where the body can easily get rid of any that it deems “excess”.

  8. Maybe you can take your type A’ness and focus it on healing. By this, I don’t mean figuring out possible short cuts and treatments but actually forcing yourself to mellow out and let your body do it’s thing. Like Jimmy Stewart said in Carbine Williams, when put into solitary hot box; “you can’t think of two things at once so, in order to deal with the pain, I started thinking about making guns.”

    Use this time to go over lots of stuff in your head but don’t worry about trying to record it. Just give your inner files a good going over while keeping your arm immobilized. Plot a hundred new comics and stories. Who cares if you ever use them or even remember them. The mental exercise will be good for ya’.

    Cartilage (the stuff your rotator cuff is made of), is really slow healing. When it’s damaged, it also inflames, causing pain. When it’s inflamed and you move your arm, you can pinch it and cause it to become worse. You can spiral that thing right up to where you need surgery. That’s the worst thing about rotator cuff injuries; you really have to just let them be. You can’t really do any exercises or anything, until after the cuff is healed. Then you can start building up the muscle so as to help hold the joint together and keep from hurting it again.

    1. If you haven’t already, I’d suggest you read “The Tactics of Mistake”, by Gordon R Dickson. It is one of the “Childe Cycle” novels, has nothing to do with Vampires, and is the first (chronologically) of the Dorsai portion of the Childe Cycle.

      It also has the protagonist do some reasonably miraculous healing of his knee using little more than his type A’ness.

  9. Getting complicated

    Drug interactions are funny things. I have a few examples, but I’m not going to take the time to look up references and I welcome correction.

    Drinking: When people drink alcohol, they often get headaches. When people get headaches, they often take over-the-counter painkillers. The trick here is that by taking the wrong over-the-counter you could be stacking strain on strain, where your organs are concerned. Specifically, dealing with alcohol requires your liver to do a lot of work, eventually it can even get broken. Notably, dealing with acetaminophen (Tylenol, Excedrin (which includes caffeine to speed-up the soak-up)) also requires your liver to do a lot of work. To resolve alcohol-related headaches, it is therefore best to use aspirin (Bayer, etc), ibuprofen (Advil, Motrin, etc) or naproxen-sodium (Aleve). These are also better anti-inflammatories, which may help out better with that alcohol-related headache you might pick up.

    As an aside, if I recall correctly, opiates put your kidneys to work and ibuprofen and its friends can be a bit rough on your kidneys. Some care may be recommended here. (Consult your yadda-yadda/your mileage may vary)

    Grapefruit: Here’s a tragically funny one, because something in grapefruit juice messes with about everything else that your body might react to (read: “medications”, “drugs”, even some “supplements”). No, it isn’t the vitamin C, because the other citrus fruit don’t do it. In some cases it will amplify the main, intended effect, in some cases it may deaden it, in some cases it may amplify a side effect, in some cases it may facilitate a reaction with other things you might put in your body, and in some cases it does something else entirely.

    As an example within an example, regard caffeine, nicotine, ephedrine, and many flavors of street and pharmaceutical amphetamines. Grapefruit juice will lengthen the effective period of these stimulants and will decrease the rate at which your body makes relatively long-term adjustments to them. For the all-night-worker (coders, writers, artists, and any given workaholic), this effect is very useful because it slows down the rate they at which must increase their dosage to achieve the same level of ‘performance’. (Periods of hiatus are also useful, of course.)

    (If someone intended to use grapefruit juice to compliment stimulants of some sort, that someone should use non-sweetened brands. More bitter is more better.)

    While some of the quirks of grapefruit juice have been informally circulating for a while (an article in 2600 c. 1995 was what alerted me to it, I believe), formal recognition of the full range of its meddlesome nature came more recently. I think it might have been only a few years ago.

    To fully appreciate the dark, tragic humor of this facet of drug use, consider the number of senior citizens who, prior to publication of related information, drank large amounts of grapefruit juice for health. Now consider the wide range of medication any one of them may be on. Again, I’m not looking up references for this and I welcome correction, but I believe this situation killed people.

    I think that might truly, actually be ironic. (It’s getting hard to tell, anymore.)

    I definitely need to do something about my average sentence length . . .

    1. Re: Getting complicated

      Warnings against grapefruit juice interactions have been present for many meidcations for well over a decade; shame on doctors and pharmacists for not making people more aware of that if people still don’t know.

      For dealing with hangover headaches, aspirin is far and away the easiest thing on the body, despite some effects on the stomach and large intestine (these can be helped by using buffered aspirin). I’ve become more and more wary of Ibuprofin over the years, it has some complicated interaction pathways and many of those aren’t good for you — for instance, (relevant here) DON’T take it for injuries, as it interferes both with bone healing and blood-vessel growth!

      Another drug interaction not enough people are aware of — the “natural supplement” of St. John’s Wort, which is taken to relieve mild depression, has serious interactions with antibiotics and the birth control pill, among many other medications — it stops them from working. That’s why the push about 5 years ago to get it forcibly removed from the supplements available unregulated over the counter. It also needed to be subjected to testing so that the full range of drug interactions could be discovered.

      When people take “health food supplements” they are specifically taking molecules which alter the body’s function; bioactive molecules are bioactive molecules are bioactive molecules, that’s what drugs are! The so-called “natural” part of natural supplements is absolutely meaningless, given that “natural” does not in any way mean less bioactive or more healthy (belladonna and strychnine are purely natural substances as well), and about 80% of existing drugs are plant-derived anyway. I wish people had a bit more basic biology knowledge and a lot more logic about things like this.

      1. Re: Getting complicated

        The best way to deal with hangovers is to prevent them. Drink a glass of water for every drink, and when you’re done drinking, as soon as you can remember it, drink a big glass of water and take a B-complex vitamin. Alcohol depletes the body of water and one of the B vitamins, don’t recall which. Speaking as a person who used to drink a lot, and I rarely have had bad hangovers doing this. Those OTC hangover cures don’t work.

      2. Re: Getting complicated

        My favorite entry in the tylenol/asprin discussion came from a toxicologist who was in town for a murder mystery writer’s confrence and came in to talk to the bio department at my university. She said that it is fairly easy to overdose on tylenol, and since the main result is organ failure you don’t get over it. To make matters worse, tylenol stays in your system for a longish time, so an accidental od is easy. On the other hand, while a smaller dose of asprin is toxic, your body works to expel it. She said, “I can kill you with asprin, sure thing. But I need a pound of it and a sock and pennies are cheaper for the weight.”

        1. Re: Getting complicated

          Yes; the UK seemed to have a real problem with people poisoning themselves with paracetamol for a while.

          I love the sock-and-pennies quote!

    2. Re: Getting complicated

      I’m well aware of the grapefruit-juice interaction. My wife’s on thyroid-related medications and some other related things. She loves grapefruits dearly, but for the last many years since she started having to take these medicines, she can’t have any.

      (And I can’t really have any either, because having them around the house is just cruel.)

      Recently, I discovered that there are a range of fruits that are similar to grapefruits and taste a lot like them. A bit of research into the scientific literature found that someone else already thought of that, though, and did some tests and sadly discovered that they also have the same effects. (The effects are also present in other citrus juices, incidentally, but in much lower quantities — though I seem to recall that drinking glasses of lemon juice straight was found to be sufficient to cause notable interaction, too.) So none of those for her, either.

  10. Remember your history:

    Surgery originally developed from the treatment of battlefield wounds.
    Given the number of physical problems that soldiers go through, a dislocated shoulder should be a familiar type of injury with a well documented history of prognosis and responce to treatment.

    It’s not as if it were a new type of cancer where no one knows the best method of treatment yet.

    I suspect that if better treatment were available out there, it would be extremely well documented by military and sports physicians who deal with this type of injury every day.

    I’m not a doctor, but I suspect that most of the muscle building protien suppliments only work in the case where the patient is actually exercising. In your case, apparently, exercise is not a good option at this stage of the recovery. It will probably be more so when things generally stop hurting.

    Pain is your body’s way of saying “Hey. You’re injuring yourself. Cut that out, go away and let me heal.”

    BTW, if you do end up coming to Austin for Linucon, you’re quite welcome to stay in my apartment. I’ve got a fold out couch in the living room. You should be fairly comfortable, and it’d be a blast to actually meet you!

    1. BTW, if you do end up coming to Austin for Linucon, you’re quite welcome to stay in my apartment. I’ve got a fold out couch in the living room. You should be fairly comfortable, and it’d be a blast to actually meet you!

      You should plan to come to Linucon yourself, Scott. If you’re in the area already, then it’s cheap as free, and it’s a very webcomic-friendly event. Sure, it’s full of bithead panels (they call it the “technical track”) but bitheads love their SF, and lots of ’em take it black, no cream, no sugar, just straight up Hard SF goodness.

      I’ll be staying in the hotel if I go — there’s too much to miss if I’m not right there. Thanks for the offer, though!

      –Howard

      1. Hmm! I assumed it was an Operating System convention.
        I didn’t realize it was a Science Fiction convention too! Cool!

        I’ll have to look into it further.

        BTW, I note on their page, they’re already advertising your presence!
        Guess you’ll *have* to go now! 🙂

  11. I’ve worked with supplements for several years, and did a lot of research on muscular/skeletal injuries recently for some serious back problems. I’m not going to go into the allopathic vs. naturopathic debate more than to say that any good retailer ought to have people who can advise on or look up known interactions (i.e., don’t take St. John’s Wort with the pill or with any psychoactives, don’t take fish oils if you’re already on blood thinners, etc.) and who know when to say, hey, this is something you need to see a doctor about, we CANNOT advise you! retailers can state what a given supplement tends to do in the body based on such trials as do exist (and there are a lot), and anecdotal reports, but cannot say, “This will make you feel better” because EVERY BODY IS DIFFERENT. Ideally the various systems of medicine should be compatible, but it’s very very difficult indeed to find a doctor willing to practice that way.

    Having said that, this is what I would do if I had your injury:
    1) tie my arm to my side if necessary. overdoing it as soon as it feels better and ending up in four times as much pain the next day SUCKS.

    2) There is a homeopathic remedy called Arnica which is used to speed healing and will not harm you. You may find a lot of people who will say it doesn’t do anything at all, but it will not harm you. (homeopathy is just plain WEIRD. I don’t scientifically see how it can possibly work, but I have seen it work on both infants and pets who did not respond to normal treatment.)

    3) Lay off the sugars and empty starches if you haven’t already, but especially white sugar. White sugar has a demonstrated negative effect on the body’s immune and regenerative systems.

    4) Research. An excellent place to start is with a program called Healthnotes, available at gnc http://www.gnc.com/healthnotes –they’ll ask you to accept that GNC themselves do not supply the information and you can’t sue them, which is fair. http://www.gnc.com/health_notes/healthnotes.aspx?ContentID=1276004&lang=en gets you to the page with the ‘sprains and strains’ information (arnica is listed, as are enzyme blends (which barring a really odd allegy) are also very safe, as they are extant in the body and in foods anyway. Enzymedica makes a blend called “Repair” which is excellent if you should decide to go that route). The site is updated yearly with all the research they can find and is extensively footnoted. Ask your doctor if there is any reason you shouldn’t try it. (I just know that when a friend of mine gave me some of her repair enzymes, my back started getting better about 3x as fast.)

    1. No white sugars?

      The protagonist of this story lives in America, avoiding white sugars would not be . . . trivial, no?

      No soft drinks (or most hard drinks for that matter, though I assume something like 190-proof grain alcohol doesn’t have much in the way of white sugars left), no enriched flour breads, no canned pastas, no canned soups (well, I’m sure there are specialized versions out there), no canned fruit, no sweets, pastries or jellies, no non-fresh fruit juices. . . it’s quite a bothersome list. It eliminates a great number of the ‘cheap foods’, in fact it eliminates a large amount of the Deseret-branded foods sitting in my own pantry (these being foods produced at very affordable costs and meant to have a long shelf-life).

      1. Re: No white sugars?

        BELIEVE me, I understand the difficulty here. hell, i’m a big old fan of white sugar, with a sweet tooth approximately the size of the Louisiana Purchase. But staying away from it as much as possible seems to be a very helpful thing for healing. {shrug}

  12. The clearly pathetic allopath weighs in…

    I am passionate enough about this subject to create a livejournal account JUST to post at this moment.

    I am a Family Physician with 28 years under my belt, 25 of them in the military. I have ALWAYS made less than 85% of the docs in the country, and not because I’m incompetent. (I retired a Colonel, having spent 3 years as deputy commander of the hospital at West Point.) I’ll let everyone judge from that whether I am a pawn of the economic/drug company/evil medical establishment.

    My experiencce with creatine is that is causes cosmetic and incredibly reversible swelling of muscles. At its (rare) worst, it causes congestive heart failure. I don’t like it.

    Glucosamine and chondroitin have good evidence that they’ll repair joints in about 1 in 5 people. Howard, a 30 day trial of that wouldn’t hurt (unless it gives you stomach upset, which is possible).

    Otherwise, research has shown that virtually all of the items mentioned in the previous 53 comments have no advantage over placebo in any well-designed research, if it took place. For most, well-designed research hasn’t taken place because the pilot studies are underwhelming.

    Pharmaceutical companies would LOVE to have a cheap-to-make natural chemical that helps people. Military hospitals would REALLY REALLY REALLY love treatments that get soldiers and sailors back to duty faster after injury. They look for them. A lot.

    They haven’t found any that beat physical therapy, limited rest, and temporary pain relief.

    As far as “I took this and it worked great”, please remember that in placebo studies versus powdered camel dung for ANY symptom, both will work 15-30% of the time. Our bodies, minds, and souls are very powerful.

    And MRI’s at the drop of a hat are one reason that 20% of the country has NO health insurance. (To be fair, allopathic, chiropractic, osteopathic and naturopathic docs on the take, greedy insurance companies, and greedy drug companies are three more reasons.)

    I am relieved, Howard, that your insight into your desires versus your reasoning remains intact. As for the rest of the insights, please remember that there are doctors as well as cartoonists who are real, caring people and not just money-grubbing automatons.

    —drkenfp (pausing to wipe up the leftover bile from his cathartic spleen-venting)

    1. Re: The clearly pathetic allopath weighs in…

      Hee, for a lot of “Doctors are pawns of the man” folks, military service isn’t going to score you any credibility points.
      I don’t know if you noticed this but your 1 in 5 beneifit rate for Glucosamine and chondroitin is well within the 15-30 percent placebo effectiveness rate you quoted. Maybe you should have suggested a cheaper placebo. Starlight mints or something. Ooh… starlight mints.

      25 years as a military doctor? Congratulations man. That is impressive.

      1. Re: The clearly pathetic allopath weighs in…

        Note in the placebo paragraph, I said FEEL better. Glucosamine shows changes in the structure of the cartilage and joints in 20%, so that is more than a placebo effect.

        Thanks for reading critically, however 🙂

        God Bless,
        –drkenfp

        1. Re: The clearly pathetic allopath weighs in…

          Hum, and there were no physiological effects with the placebo? I had been lead to believe that placebo effects could reach into the realm of actual physically observable effects, but then I took the field bio path not the physiology path in my undergrad so I could just be misremembering.

          1. Re: The clearly pathetic allopath weighs in…

            Placebo effects can indeed be physical, usually in terms of vital signs. However, placebo changes in cellular tissue are pretty unusual, and blur the line into spiritual healing (which I have seen, and is real, but is rarely attributed to the pill/supplement/camel dung). 🙂

            God Bless,
            Ken Franklin

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