Drug advertising and other musings

September 5, 2013

In the UK, due to budgets primarily, GPs will tend to prescribe the generic versions of drugs. Often new drugs are expensive and as such, unless the research data has been reviewed appropriately, say by NICE, the drug won’t be prescribed. For example, a GP would prescribe Ibuprofen as it’s cheap and effective, rather than Nurofen which is expensive and as good as the cheaper versions.

Most new drugs have a 10 year license and after that it must become generic. Recently Atorvastatin has come off patent and since it works better and has fewer side effects than Simvastatin and is now cheap, most practices are swapping onto it. Sometimes a drug company will try and extend a license or create a new formula to create a new license eg Esomeprazole is basically Omeprazole with a few molecules jigged.

In the USA, all drugs are sold via their trade name not generic eg Claritin as opposed to Loratadine. So customers pay higher. Also I’ve noticed many general magazines have drug advertising and there are regular drug adverts on the TV.

Yesterday we saw a programme in TV called The Drs, where some very photogenic doctors explained different conditions and showed graphic surgery. Bit like Embarassing Bodies, hosted by models.

Americans are constantly bombarded with adverts to make them thinner and look better. No wonder some of them are hypochondriacs. But, I wonder whether Americans are more aware of the pills they take and what they do, rather than in the UK where little information is given about a drug and most people have no idea what they are taking.

In the UK, we are aware that the NHS is having financial problems and although all drugs are subsidised by the prescription fee it costs the NHS a lot per year. Especially with the growing elderly population with complex needs. Whereas in the USA, care is paid for by medical insurance so doctors will prescribe new and expensive drugs knowing they will work and they will get paid. But if a person can’t afford their drugs, they are essentially screwed, whereas in the UK, people on tax credits or unemployment benefit will get free drugs.

So what is the better system? Any thoughts?


So good, it’ll kill ya… eventually!

August 31, 2013

I’ve been travelling across the USA with my fiancée for nearly 4 weeks now. We’ve eaten lots if different meals, from local delicacies to the occasional fast food meal. 95% of the time the food has been delicious and wholesome, but one thing is apparent the portion size in the USA is massive!

After a few weeks of travelling, we realised that sharing a normal American portion was generally the best thing to do. Portions such as this are aimed at ONE PERSON:




No wonder America has a rapidly developing diabesity epidemic. The trouble is, all the food tastes so good. The tastiest foods tend to be the high fat fried meals which in turn cause heart disease, diabetes, hypertension, renal disease and cancer leading to increased morbidity and mortality. Bummer!

I’m sure this is a crass generalisation, but my impression is that lower income individuals and families unable to afford expensive, healthy meals tend to eat processed food or fast foods which are high in calories and due to lifestyle factors, are less able or less inclined to exercise.

In New Orleans, a poor city with a majority Afro-American population, obesity is a big issue due to the high GI foods consumed. As my partner and I walked all the harbourside, the only people we saw exercising were white American runners, who tend to be on faddy diets which also harm the body.

I feel I have gained weight whilst here on holiday and have had several days off certain foods due to excess consumption eg BBQ meats, burgers.

The trouble is putting weight on is easy- I can attest to that. Getting the weight off is the hard bit. Apparently it took Morgan Spurlock, the director of Supersize Me, 18 months to lose the weight he gained. For many the time taken and the effort needed has led to the exponential growth of the dieting industry, which continues to expand despite only 5% of diets ever working.

So, once I get home, I’ll be back to UK portion sizes, less high GI foods daily and start some exercise.

Let’s hope I don’t become a statistic and burden on the NHS sooner rather than later.

The US healthcare system

August 27, 2013

To a Brit like me, Michael Moore’s docu-film Sicko have showed his biased view of the US healthcare system is really like. Sicko painted the image that without medical insurance you were screwed. News of low income groups or the poor being turfed onto the street was shocking!

The NHS is free at the point of use. A Socialist system as the Americans paint us, where there are waiting lists, use of cheaper drugs etc etc.

I have become more aware of the types of care in the US healthcare system when I stayed in Flagstaff, AZ, as one of our hosts was the equivelant of a district nurse for people with chronic diseases eg COPD. She explained to us the healthcare system and this is what Wikipedia says:

Medicare- a national social insurance programme. Administered by the federal govt since 1965. It guarantees access to health ins to people over 65 yrs and the young with disabilities and people with ESRF and Amytrophic Lateral Sclerosis (Lou Gehrig disease). The financial risk is spread over society to protect everyone. It is different from for-profit private insurers. (Read the Wikipedia entry for more details).

Medicaid- the health service available for low income individuals and families. It’s mean tested and funded by state and federal governments. Poverty does not guarantee Medicaid provision.

That actually sounds better than the picture Sicko tried to portray. Of course there will always be people that slip through the gaps and the high cost of some drugs can be a struggle for those with a low paid job, especially as there is no minimum wage in the US. The basic wage can be as low as $2, so those waiters in the bar really depend in your tips! Actually everyone working in the service industry in the US depends on tips.

As a GP, many of my colleagues have mentioned that a private system probably would help eliminate DNAs and wasted consultations. But this would also create a two- tier healthcare system.

I don’t know which country has the best healthcare system. Maybe it’s the country with the highest life expectancy. Well turns out that it is Monaco, which is a tax haven for the super-rich who can afford whatever healthcare they like because they tend to have more money than sense and want to live forever!

Pudgy animals

August 17, 2013

We humans have got a lot to answer for. We have our own obesity epidemic and it now looks like we’re making animals fat too.

On the Mist Trail at Yosemite NP, I saw some particularly pudgy squirrels.


During our walk through Zion NP, we happened on this wide eyed, slightly hyperactive squirrel.


It seemed this squirrel was out of sorts because some idiot fed it a Ferrero Roche.

Back home, I’ve noticed that the seagulls near where I live come in two varieties. Normal, athletic, chicken sized seagulls or fat, overweight, turkey sized seagulls. The latter have become obese as a result of scavenging at the McDonalds bins.

Imagine being knocked out by an obese seagull falling out of the sky after having a premature heart attack from excess fat consumption…. Hmmm, might be one way to rid the streets of these flying bastards!

UPDATE: 20/8/13- seems the 2nd photo of our hyperactive furry friend may have been of a chipmunk not a squirrel.

Maybe you’ve been brainwashed too?

August 14, 2013

Final day in San Fran.

Just like LA, this city has its health junkies.

Americans have sold themselves the lie that our bodies need help and to stay healthy you need vitamins, juice drinks, dieting etc.

Our Airbnb hosts all seem slaves to their pills


Sure, Americans especially Angelenos tend to be at the forefront of faddy and extreme diets. But at the same time, effort to eat healthily i.e. fro-yo tends to be off set by the sweet additions which add the calories back.

But the food that is produced, although comes in massive portions, does taste damn fine! That is def not true in the UK.




That last one was particularly big and was large enough to have a half for dinner. Almost developed a Burritto coma afterwards though.

Legal highs in the City of Angels

August 8, 2013

I’m currently on holiday in the USA with my fiancée on a 5 wk fly-drive holiday.

Have spent 3 days in LA so far.

There are many coastal areas but Santa Monica and Venice beach are the famous ones!


On Venice promenade there were lots of guys dressed up in green surgical scrubs pretending to be checking your medical marijuana for consistency.


It would seem that in Calif, you can legally take MM for glaucoma if you have a card. Well it seems as though many locals have glaucoma it seems…


This is in contrast to the rest of LA which is chock full of vitamin shops, yoga gyms or 24 hr gyms, plastic surgery centres and medical advertising. As well as multiple junk food eateries and meal portions to be aghast at!

These cookies are bigger than the length of an iPhone 4S!

A new chapter begins…

August 3, 2013

Woah! Has been 5 years since I last updated this blog. Guess life was too busy or more likely, I had nothing interesting to say.

Since my last entry, I left the world of hospital medicine and applied for GP training.

In less than 1 week, I become a GP proper having attained my CCT and thus MRCGP.

I will enter the GP landscape as a locum and hopefully in due course I will be a salaried and possibly eventually a partner somewhere locally.

Lots has happened in the intervening years and I’ll try and summarise it so:

  • Did ITU- loved practical skills experience. Job too hardcore.
  • Did MAU. Loved it.
  • Did CMT2 in Manchester. Made great friends. Ummed and erred about future work life.
  • Did Trust grade A&E in Bath. Missed friends.
  • Met via Guardian Soulmates, my fiancee, Emma in 2009.
  • Started GP training 2010
  • Finish GP training Aug 2013
  • Go on 5 week epic fly-drive in USA Aug 2013
  • Sep 2013 onwards- life as GP begins

Looking back at my past entries, I can see that I was quite good and writing prose and have a comedic slant to my entries.

During my ITU job, I helped to write a ‘Beginners’ guide to ITU at the hospital I was working at, at the time. The guide was accepted by the staff and uploaded to the trainee website.

Since then I have blogged regularly for The Pulse GP medical journal since March 2012. I am about to come to the end of my blogging for ‘GPs to be’ and hopefully continue medical blogging in the future.