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Biologics Make Him Yearn for Natural Remedies
from Daryl C.

Ed: So far I have been able to keep my mild psoriasis bearable with narrowband light and an occasional topical. I have experienced flares a couple of times, the most recent about a year ago. I bugged my doctor about prescribing a biologic but now I am glad he did not. I just recently started reading the psoriasis sites on the web, including some of the blogs, and there seems to be three points of view on biologics. The first is the advocates: they are very impressed by their own results with biologics and encourage everybody to give them a try. (You appear to be an advocate.) The second is "last resort": either because of cost or side effects, these people are stand-offish about using biologics. The third is the anti-biologic point of view: using biologics is a big gamble, messing with the immune system is dangerous, just say "NO" to biologics.

I wish I could gauge the populations in each of these points of view as news, good and bad, comes and goes about biologics. I think the anti-biologic point of view would have attracted a lot of people right after Genentech pulled Raptiva from the U.S. market. Don't you?

Following the news-making medicine stories makes me yearn for a return to natural remedies. I know that if natural remedies worked as well as medicines we invent, we would not have a pharmaceutical industry. Now I wonder how much our sheep-like attraction to drugs are supported by the momentum of the industry instead of effectiveness of the medicines? (Tell me something: Where would network television and magazine publishing be today without pharmaceutical advertising? It has replaced cigarette ads in the U.S. Think about it.)

If you haven't read Our Daily Meds by Melody Petersen, I highly recommend it.

Because I do not have severe P or psoriatic arthritis it would be unfair for me to downplay what motivates others to use biologics. I know that when I flare I'm miserable and depressed and would consider almost any recommended drug that promises to stop the psoriasis. But I think even after I considered biologics I would say no. My psoriasis isn't going to kill me and that means I have time to see what the future holds for biologic medicines. Who knows, next year or in five years it may be commonly agreed that the biologics are more "natural" and less likely to cause adverse reactions than the chemical drugs we swallow by the bushel. -Daryl C.


Ed's Response: Don't forget, Daryl, the two oldest biologics prescribed for psoriasis Remicade and Enbrel have been around for over ten years. Both were used to treat rheumatoid arthritis for several years before they were approved for the treatment of psoriatic arthritis and, later, skin forms of psoriasis. Both these biologics are TNF-alpha mediators, this type of blood cell is a key component in our immune system's inflammatory response. The effectiveness of these early biologics against psoriasis suggested then that psoriasis was a byproduct of inflammation in the skin and subsequently that's become a widely shared theory about what psoriasis is. (Raptiva was not a TNF-alpha mediator. It was a CD11a "blocker" the only one of its kind in the line-up of biologics for psoriasis.)

I think your position on the subject of biologics is shared by a large population of flakers. It contributes to the disappointing numbers of prescription sales the biologic manufacturers have experienced. Other contributors, of course, are the high cost and slower-than-expected acceptance of biologics for psoriasis by insurance companies. Intermediate "conditions" for covering prescribed biologics have also infuriated doctors and patients alike. (Some insurance companies insist that other systemic remedies methotrexate, cyclosporin, Soriatane be tried and found wanting before they'll approve a biologic. Ironically, biologics should be a safer, longer term treatment choice than any of those earlier systemics.) The injection or infusion requirement for the current biologics is another hurdle. One day we may be able to "sniff" our biologics, but that technology isn't quite ready for prime time.

I have read Petersen's Our Daily Meds. The cover of my paperback edition reads, "How the Pharmaceutical Companies Transformed Themselves into Slick Marketing Machines and Hooked the Nation on Prescription Drugs." That tag line, or subtitle, or whatever else it might be called leaves little doubt about Ms. Petersen's "side" on the issue. Having said that, her argument is eminently readable and compelling. It is extensively documented and, as an indictment, leaves the other side breathless at times (I'm sure there's a pill for that). I annotated my copy of Our Daily Meds but remember most, when I finished reading it, thinking this aspect of health care the pharmaceutical business is going to be one of they biggest obstacles in just about any strategy for health care reform. I had an opportunity to speak briefly with my rheumatologist who, unfortunately, had not read the book; however, as I described some of the marketing strategies Petersen unravels in great detail, my rheumy nodded her head in familiar appreciation.

Thanks for your observations, Daryl. -Ed

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