john banks

https://www.scoobynet.com/932700-app...-or-not-3.html

Following on from the above thread which went well off topic.

Can we debate the methods by which prescription drugs are licensed and used legally and compare them to how similar drugs are used illegally?

If we agree the scope of discussion it can proceed in an orderly manner.

GlesgaKiss

I'd personally be interested in knowing the principles and areas where Jef disagrees with the medical profession. It wasn't entirely clear in the other thread.

Only once the specific areas of contention are clearly established can a decent debate take place.

john banks

I would suggest we leave out (although they are interesting points):

1. Legality of obtaining the substance without a prescription from a medical practitioner
2. Source and quality of supply including appropriate storage, contamination, dispensing by a qualified pharmacist, recall notices, bad batches, safety alerts.

I would suggest we debate:

a. The method and evidence to support a treatment programme in terms of efficacy and safety.
b. The method and evidence to decide who, how and when is responsible for checking of contraindications, monitoring of complications, interactions, side effects.

Rules of engagement:

1. Scientific method is the gold standard

2. On point a I'd be happy to relax the requirement to prevent or treat illness and allow an alternative endpoint such as muscle strength or bulk, performance, VO2 or whatever you want, but it must be defined.

Debate the preamble, then we can get stuck in ?

Turbohot

Good idea. I have been following the discussion the the other thread for I am finding the debate and facts very interesting and of good use.

Carry on.

ALi-B

iTrader: (1)

May I add a twist?

What are the ramifications of a professional(s) for both recommending (in papers, research or otherwise) prescription drugs and the subsequent prescribing by practitioners to a patient without laying out the side effects, consequences or even acknowledging the negative effects they have on a patient's life?

I'm not going into direct specifics, but as a generalised example; A anti-depression drug prescribed for pain management that was prescribed without warning or any follow-up monitoring on how it affects the person's well-bring, ability to work and operate heavy machinery (like driving a car).

Is the recommendations and prescribing of a licensed drug by a licensed practitioner without due care as bad as those who would recommend or try to obtain the same via non-legal means?

jef

iTrader: (13)

im very willing to contribute,
and can much better explain my veiws ect. and hopefull people realise i can hold a discussion in a perfactly non derogetary fashion.

although a prior warning from me will be my input will be solely based on sports science and assocaited points,

so if people feel itll just be boring, non-relevant ect ill refrain from posting.

i can also conduct my discussion without putting anyone in a aposition that they may feel breech any codes of condcut. although ill fully admit, i dont fully know all boundaries.

also as i work, my input may come later in the thread.

Luan Pra bang

I don't see how this is even a debate, I will use the medication I feel is necesary, there are too many crap doctors out there to trust them with anything and its really not anyone elses concern what medication I choose to give myself. Stupid people may well cause themselves great harm with this philosophy buts that is still their choice.

alcazar

iTrader: (2)

Can someone post a link to the previous thread, please?

D'oh, just seen it..........too many drugs today.

john banks

It is not expected that the prescriber will go through the entire list of side effects, but good practice would involve highlighting important side effects which require to be reported to the prescriber where they are a warning sign of something serious, or for example where the drug may cause sedation. Some drugs require lab monitoring and some require proper counselling supported by appropriate literature before they are used. It would be wise for the prescriber to document these discussions in the record and check patient understanding.

If something is prescribed outwith its licensed indications, this should be discussed with the patient. The use of some antidepressants for pain control as well as many drugs used in children fit are typical situations.

If a single research paper shows a positive result for an unlicensed use of a drug it doesn't give the go ahead to use it straight away, although if the trial is particularly landmark and it opens up a new therapeutic option then this can be considered. The research paper author is not legally responsible for the patient, the prescriber is.

When amitriptyline is used for pain control, it is good practice to outline the side effects that include sedation and constipation, as I also do with weak opiates like codeine. I tell people starting antihypertensive medication to be wary of first dose hypotension, risk of falls etc.

Substandard prescribing without due care is IMHO worse because trust has been placed in the professional. However, side effects and complications from drugs can be severe even when all precautions are taken, some of my prescribing has put people in hospital, but that does not mean that the prescribing was substandard or without due care.

john banks

After I read your first nine words I didn't know what side of the fence you were going to be on, so perhaps it is a debate?

Crap doctor should be a reason to find a better one?

For prescription only medicine, legally, it is not their choice.

I would be interested if you have the time to outline it, rather than giving examples of crap doctors, how you decide what non-prescription medicine (apart from over the counter stuff) is necessary and what difficulty you would find in obtaining it through a prescription?

john banks

jef, if you are in agreement to the contents of post #3, I look forward, when you have the time, to your contribution and would like to compare and contrast it with the equivalent process that is used to license prescription only medicine (POM) and devise the summary of product characteristics (SPC).

alcazar

iTrader: (2)

Not sure I COMPLETELY agree with the above, but I DO see where you are coming from.

My own take is hating the interference of government.

The last lot of knowalls removed the right of GP's to prescribe Co-Proxamol, despite most health prefessionals being against the idea and 99% of users.

It has left me now using morphine twice daily for pain relief, which I wll probably use for the rest of my life.

And for what? To save the lives of a very few people who ACCIDENTALLY overdosed on Co-Proxamol.
Those who deliberately used it to leave this world have already found another way.

Meanwhile, hundreds of thousands of people are now struggling with pain relief, or dependant on FAR stronger drugs.

What a stupid piece of legislation.

And despite that IDIOT Burnham's assurance that GP's would still be able to prescribe it on license, the BMA went as far as writing to all GP Practises warning them that so to do would leave them open to claims of malpractice and no insurance to help them if one came. The result? Most, like mine, bottled it.

Fekking Labour Party, if I hate them for one thing that would be it......

john banks

I also stopped prescribing co-proxamol, because as above I was advised that it left me personally exposed to unlimited liabilities. I would have every sympathy with someone obtaining supplies by other means as I completely agree with all you say alcazar, and would prefer if I was their doctor to note that on their medical record and check for interactions with other prescribing and be aware of it in the presentation of any new symptoms.

A better method would have been to allow a physician to justify it (and be insured for prescribing it) in limited situations but remove it as a commonly used option. The reality was that I have never initiated it anyway (despite some that benefit it has for years been flagged as not a good thing to prescribe), but would continue it if it suited someone where everything else more suitable didn't.

Apart from this one situation, which is obviously very important in your case, I can't think of any other MHRA decisions I have had particular trouble with.

jef

iTrader: (13)

before gong into my points, im a bit guilty of not quite self prescribing, but definatley making suggestions to my GP of medication that id consider relevant.

although im not in the position of needing POM on a regular basis

on the couple of occassions ive made suggestions has went along with me. but thankfully currently my health doesn not require regular medication, this may well change as i get older - and looking t family history i can see where problems are likley to occur

john banks

I often get patients asking me for medication. Often I've give it to one of their family and they've tried it and like it. It is quite nice knowing a whole community, especially if most of them are bloody nice like my lot.

jef

iTrader: (13)

to be fair firstly, the title of the thread doesnt really cover my points and veiws.

"evidence" is open to the individuals interpritation

regardless, my thoughts in my area of interest are.
i live in an area of the country with high rate of adult and child obesity, with overall standard of living could be described as below average.
my town suffers from the very common issue of drinking culture in the young, high cases of social disorder and fairly serious recreational drug use/abuse.

its not all like that but the area has been on the list of top unhealthy places in the uk for several years.
theres evidence of local authority involvment and schemes, but interest/results ive perceived to be all but non-existant.

throuh my years trining ive encountered gym goers from bodybuildrs to rugby players gymnasts ect.

and from near the begingin there was always talk of AAS users ect. i trained away natyrally, listening to the talk, starting reading on the side lines. no-one tried to push me in any direction. and i trained naturally for years.
i read more nd more articles on nutrition, and the role it plays in bodily functions, but empahasis on muscle growth.
as i learned more on nutrition my gains in muscular deelopment increased along with my understanding, i was surpassing guys that were openly using AAS.

i heard so many lies, about gh, from bone growth to giantism, masive scarmongering on insulin use, listen to doses guys had been running consistantly since the 80's. there was never mention of recovery, time off, cholesterol checks even simple bp checking!

this was when the internet was in its infancy, but i continued to read study after study, from turinabol administered to young female swimmers in the USSR to the controversay surrounding americas golden boy carl lewis being between buy the drug cheat ben johnstone - and the public outrage it caused in america - and then the subsequent witch hunt that follwed.
i kept hearing of higher and higher doses in gyms, seeing bad side effects such as extreme acne, massively increased libido, followed by lows in some cases. i continued to hear lie/exaguration/half truths and still hear the same in gyms today.
real knowledge is limited, AAS use is hidden, taboo and finding reliable info very difficult. add to that most advice came from sellers who had financial gains at heart, not advice.

over the years ive known many many hundreds of users, from heavy to light.

so that a tiny snippet of background.

next thing to set straight is a certainly do not advise AAS, or imply that using will increase anyones health.
what i do is give advice on those that have already have decided to use and seek some information on how to use in as safe a manne as possible.
for me there is a process of understanding that needs to be absorbed by any user -

the number 1 area of importance is an understanding of nutrition, from totla kcal intake and from there the macro breakdown of daily food consumption -this is so the users now understands that AAS does not result in muscular development, but that comes from food intake and timing of nutrients.
the next is to explain dosages and results do not have an exponetial relationship.
then a complete list of potential risk list of side effects. and some simple tips to minimise the risk of side effects, starting with an initail blood test to get a glimpse at pre-cycle base levels, anti-oxidant food intke, other relevant supplement info.
then discussed is existing health problems and also an understanding of family genetic history to highlight potential increased risks, to moniotr.
i go quite in depth with the point of gentics to explain everything from body type to muscle tie points, and the varying results in idividuals with respec to there genetic response to nutrition an training, and hormone use.
i fully explain the process of aromatisation, and ways to combat it, which are regularly aromasin, arimidex or the likes of a SERM, and the associated health implications.

next we discuss halflifes, and inj fequency, and esters attached to any hormone administered.
after that discusion of recoveery is mentioned, and again this is where several blood tests can be of use,

others ive missed incude the discusssion of bp monitoring, water intake and carb types and tailoring diets to the individuals aims. usually a base maintenance kcal intake level is established so as to make diet manipulation easier.

this is a very very slight insight into my approach, i spend tiem dismissing myths, I.M inj techiques, safe disposal of used equipment ect ect.

i explain thing like liver toxicity of certain subsatances, and how alcohol can increase stess/damage, and make sure people understand alcohol consumption while on cycle will increase the risk of side effects, and reduce the potential results yeailded.

there is a whole load of aftercare advice for "time off" and nderstanding the mental effects that maybe encountered along the way and when coming off. .

like i say much missed. (like the ever increasing instances of females thinking steroids will burn fat ect)

you may ask the point of the post so far?

but as i said fom the start its education!

basically a guy training at gym and hearing all manner of b/s, has decide to run a cycle, has litlte or know understnding of the immense importance of nutrition, generally typicaly youngish males just see steroids as a get big quick/easy technique - they binge drink/reccy drugs at weekend, eat sh*te all week long, dont uderstand the nutrient profile of foods are
this complex info alone puts many off right awayas they dont realise the commitment involved.
so some come with zero understanding and leave with an greatly increased knowledge of whats invovled and as such alter there lifestlye- this is the main health benefit. short term sensisble cycles can be run with minimal impact on health - and increase health through excercise/diet understanding. and the initial level of health from shocking diets/drug use and no excersise, can be positivley altered.

knowledge which is greatly missing from the vast majority

now john can correct me but ime experience advice form GP'S is dont take steroids.

where do users go from there, they wil use regardless of gp's advice.

now id consider this as evidnec, but if required ill look through some studies - altho i often find even if not about my area of interest studies or extracts are shown i the publishers interests in findings or taken out of context.

wevee now got an infux of peptide bonded hormones coming from china, which are ridiculously proemted by suppliers - these are outwith legal classification as "research chemicals" but still on the rise in popularity

jef

iTrader: (13)

wow sorry for the monumental post

and even reading it back,

its still not putting what im getting at across very well, sorry lol

njkmrs

Think i need some drugs .!!
Just to understand what the hell your on about .!!

jef

iTrader: (13)

lol

a study with a mildly unbiased reprt

http://rphr.endojournals.org/cgi/content/full/57/1/411

a study with a negative opinion
http://www.steroidabuse.com/side-eff...-steroids.html


and the oh so many inbetween

some are full of extremely out of date info and dont consider how other facts can influence side effects?

GlesgaKiss

It isn't just a case of numbers when it comes to 'studies'. It's about quality and method. You don't make a decision on issues like this based on the number of opinions and studies. I think this is what John is trying to explain when it comes to his approach differing from yours. Also, what issues are these studies addressing? They need to address certain specific issues with a view to achieving a predetermined outcome. That's where 'evidence' comes in, i.e. there is 'evidence' of certain things happening. That kind of evidence is not a subjective thing open to an individuals interpretation even though similar trials may yield slight differences based on small differences in method or conditions. But on the whole the evidence will point to the same thing: the 'truth', or cause and effect, of what happens in a certain set of circumstances.

The methods for achieving this understanding of cause and effect were to be the subject of this debate. It seemed as though that was what you were questioning: the value or appropriateness of certain methods when weighed against your own life experiences and knowledge gathered from other studies?

Post 16 doesn't seem to address this area of contention, reading more like a series of opinions and one-off experiences in different areas taking in all sorts of different aspects, conditions, points... the list goes on. The difference between what you've written and the way in which the medical profession or scientific community will decide upon whether something is suitable or not for a certain purpose is so vast as to be incomparable and difficult to engage with.

If you could address specific points, or certain methods that you disagree with, it would be much easier.

Dirk Diggler 75

Ask John...................................

jef

iTrader: (13)

post 16 is a fair mumble tbh

just an attempt to show a background from where my veiws have been influenced - thats whay i mentioned that the thread title didnt entirley represent what kind of input id have.

if johns happy id refer to the previous thread where his comments id directly disagree with.

but id leave that up to him tbh

im not wanting to drag up things to try prove a point.

the thread title and its direction isnt really applicable to any points ive made. - my veiw point doesnt really tie in with the intended direction of this thread tbh.

and why i highlighted this at the start.

john by his own admission has almost zero experience with patients with related issues, neither does he have any interest in it, which is fine. why would he

i can clarify issues if need be, although again the thread title doesnt really encompass issuesrelated to me tbh

john banks

In this post I will outline the scientific method to develop guidelines on interventions (whether they be investigation, treatment).

http://www.sign.ac.uk/pdf/qrg50.pdf

This document (which is a quick reference to a larger document) outlines the development of clinical guidelines in Scotland, I am not suggesting you read it all but in a moment I'll drill down into the relevant bit. You will see the processes they use to develop evidence based guidelines, and their systematic method is typical of the processes used in modern medicine to provide trustworthy and reliable advice to the clinician on the ground like me.

The section of particular interest is the way they systematically weigh evidence:

Here is an example comparison checklist to look at the quality of a randomised controlled trial:

http://www.sign.ac.uk/guidelines/ful...checklist.html

Here is a table showing the grading of evidence that is produced for each recommendation:

SUMMARY:

What the information presented above establishes is a robust and reliable method to produce a guideline for (amongst other things) a treatment programme.

I would assert that it refutes jef's claim in post #16:

From there I would claim that it doesn't matter if I personally have only discussed androgenic steroid use with more than a few patients in ten years as a GP any more than it matters that I've made more important treatment decisions in only one patient with mysasthenia gravis that I've had in those ten years. It also doesn't matter when I treat drug users or alcoholics that I haven't been either of these things myself. The grading of evidence from an "expert" is low down the pecking order. The clinician who furnishes himself with quality guidelines can make better decisions that that.

I would also point out that trial data does get overturned later, decisions for treatment in practice are rated as best made by a combination of quality, prospective randomised controlled trials rated for quality using objective criteria. Sponsorship sources must also be declared.

john banks

I would further assert that jef's information presented is below level 4.

Quote from second link in post #16:

Rather than berate the authorities and the quality of their intervention on nutrition and health of steroid users, he would first have to prove with good quality evidence as outlined above that his interventions worked.

I would further assert that because he is not using scientific method in the development of his intervention, then it has neither been proven to be beneficial nor shown that it will not cause further harm compared to another method. To intervene in this situation could be considered unethical despite best intentions, but the history of interventions that are not evidence based is littered with well meaning people causing harm.

Giving technical background and then making unsupported assertions without trials of number needed to treat and number needed to harm is IMHO dangerous.

jef

iTrader: (13)

john OMG!!

this is the route youve wanted to go down?

this hasnt been a thread whith a discussion interest at heart, your using it to outline medicanal guidlnes/practices/rules. then outlined testing rprocedure accepted in medicine usd to approve a drugs, capability and saftey.?
i wandered why you had everyone agree to " scientific method is the gold standard"!!

youve quoted again a tiny snippet of a massive article - to try directly disprove me

now i could now go on and open a thread thats entitled

discussion of anabolism and its effects.

then in my first post state all comments cannot come from people that have no direct exerience. as first hand experience is "the only gold standard" those that havent peronally experienced it are giving input that they do not know to be true and threrefore quite proabably harmful

the fact is john like it or not the number of performance enhancind drug users is on a massive rise. massive!
youve told us the same story ive heard from most whove visite gps, dont take steroids.

thats not advice! thats a get out clause.

the simple fact of the matter im helping people understand, you are altogether dismissing the issue. i care about the people i know and are friends with, and i tell them the truth.

due to your governing body, your unable to step outside your box, to take an ever so slighhtly different veiwpoint.

finally are you saying all my info above is what youd class as dangeerous?

john banks

If you can't agree that scientific method is the gold standard (rather than personal experience) to discuss the effective and safe use of drugs then I have no reference or purpose for debate with you. That is why I tried to establish the rules of engagement at the beginning of the debate.

The scientific method could be applied to the advice you provide. If you did this then others could have confidence in applying the advice you devise to their clients knowing that it was of good quality. I can step outside the box you perceive me to be in to debate with you without little constraint from my governing body, but I choose not to debate drug efficacy or safety without reference to scientific method, as the alternatives result in quackery, and yes, until proven otherwise, your advice could be classed as dangerous when it involves quack advice on prescription only medicine. I hope you have indemnity insurance for the advice you provide.

The only productive thing I think I could help you with further would be how to devise a scientific method to support your advice. I have a faint hope that if I could get you to see the holes in your supporting structure that you would reconsider, but I can only do this if you agree that the scientific method is the gold standard.

john banks

This wikipedia page is quite good and I would assert that if you abandon scientific method is what you are falling into, despite no doubt the best intentions.

http://en.wikipedia.org/wiki/Quackery

GlesgaKiss

I think that just about says it all. Very well put.

jef

iTrader: (13)

firstly john, i do not promote my services in any way, i am not a plc or sole trader, there is no financial recompense for anytime i devote.

its done through pure enjoyment., some may find difficult to comprehend , but thats the facts.
my competition preperation diets are done free of charge - with the emphasis put on the individul to start learning process and eventually take over themselves.
i do not advocate aas use to anyone, but if somone asks i will never ever refuse to help.

1 instance a guy, told me he had 20ml of testosterone enanthate, and 20ml nandrolone deconate. he was advised to run 1g of test and around 800mg of deca per week, as a first cycle.
the guy was 12 ish stone with a years or so training expereice behind him, the first comment is always you dont need steroids to grow, you need food, followed by, what does your diet consist of, and its mostly met with i couldnt eat anymore mate, its 90% spot on.
after some discussions ive heard 90% spot on diets to consist of a cup of coffee for breakfast, roll and sausage or pot noodle for lunch and lasagne and chips for dinner - accompanied by 1.5 litres of irn -bru.

weekend consist of mass alcohol consumption and quite regulalry recreational drugs - and thats there calorific intake covered.
and these are some of the guys considering using AAS!!!

because, AGAIN my point the accurate understanding of AAS is not wide public knowledge, its a media education. the general concensus, and its displayed on here regularly, is steroids make you huge, period. and anyone who is bigger then what people expect must be using steroids.
your comment about the relationship between nutrition and AAS use being sporradic does not display to me you have an understanding- thats why i emphasised it.

now john you and me can go through the scientific method you suggest. now how much red tape, studies, opposition and ultimatley time would it take for this to be concluded? serious question.

and what happens to all the guys in the meantime while you and me discuss scientific methods?

ive stated time and time again, i do not promote AAS use. under THE RIGHT circumstances they can have positive effects that outweigh the negative. Providing education is getting to te guys who are already using or have decided to use.

further discussion now is hard because as people and life experiences we are worlds apart - as a person i find education and potential harm reduction NOW a moral obligation, even if you feel its outwith medical guidance/acceptance.

your stance is stemming from an ideal world with ideal scenarios, with unlimited resources. mine is from the ground so to speak.

your time would no doubt be better spent dealing with the pending obesity issues and its myriad of associated implications, and work with patients which require care outwith the niche area of PED saftey or use.

jef

iTrader: (13)

and as for quackery , lol.

yes throughout time its been proven that anyone giving any information must have a certificate to prove they are comeptant eh?

even when in mnay mnay cases teachings have been influenced or corrupted for a multitude or reasons.

its a wonder the human race got anywhere pre-certification eh.

and as legislation and training are also there to provide correct teachings, there also put in place to work in our current society with regard to blame and compensation culture.

im open minded to learning about many many things, and frankly love to learn in my areas of interest - once you stop having the ability to accept new ideas or dismiss without thought - your no longer suited to the profession.


people shouldnt beleive my posts even, but should certainly go and look for there own evidence, in a fair manner. and as with all internet info taken with a pinch of salt - then with there own personal experiences can come to a fairly well educated cocnlcusion.