Psycho-Babble Medication Thread 898245

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Re: Are the drugs that we're taking killing us? » Andy Behrman

Posted by Larry Hoover on May 30, 2009, at 19:23:47

In reply to Re: Are the drugs that we're taking killing us?, posted by Andy Behrman on May 30, 2009, at 17:05:47

> But the drug companies hide not only side effects but mortality statistics during clinical trials - - not to mention slanting their studies to lessen what side effects "look like."

That is not only an extraordinary accusation, I can provide circumstances where it is absolutely false. In fact, I know of situations where drug critics are the ones that have slanted what side effects look like, to create the perception of harms where none were shown to exist.

> Bristol Myers Squibb, and how they handled their wonder drug, Abilify, is a perfect example.

It is not a perfect example of anything. You, sir, are biased by the fallacy of inductive generalization. Even if your experience is accurately portrayed in your video, it is not reasonable to generalize from such a specific situation to the broader population of others treated with this specific drug. It's the inverse corollary of the truism that you cannot apply statistics to an individual. You cannot generalize from a specific case, because it cannot be ascertained how frequent that unique response might be. That same logical knife cuts both ways.

> And that's why it's making news!
>
> http://www.youtube.com/watch?v=9VzMZX4nBz8

It is not news. It is propaganda.

Take it elsewhere, dude.

Lar

 

Re: Are the drugs that we're taking killing us?

Posted by Andy Behrman on May 30, 2009, at 19:31:16

In reply to Re: Are the drugs that we're taking killing us? » Andy Behrman, posted by Larry Hoover on May 30, 2009, at 19:23:47

It has been discussed in a national forum like the Wall Street Journal. It has been discussed on more than thirty websites. It has been mentioned in newspapers across the country. This makes me believe that it is news.

The news - - and it's actually old news - - is that Bristol Myers Squibb knowingly marketed Abilify for young children before it was approved by the FDA. For that, they paid the United States government $515 million. The fact is that Sonia Choi, the spokeswoman for BMS, denies knowing that akathasia is a side effect of Abilify.

And honestly, the video is important because it brings the subject of pharmaceutical companies and side effects into the mainstream - - not just on this website but on the front page of the Wall Street Journal.

And this issue will blow up in the coming weeks and months.

Again, it's time for big pharma to see this as a wake up call.

Is there something so wrong with bringing this issue out into the open in a forum like youtube?

http://www.youtube.com/watch?v=9VzMZX4nBz8

I wouldn't have produced this video if I hadn't thought it was an important issue.

And there are plenty of other videos on the interent on the same subject.

 

Re: Are the drugs that we're taking killing us?

Posted by bleauberry on May 30, 2009, at 19:59:20

In reply to Re: Are the drugs that we're taking killing us?, posted by Andy Behrman on May 30, 2009, at 17:05:47

> But the drug companies hide not only side effects but mortality statistics during clinical trials - - not to mention slanting their studies to lessen what side effects "look like."
>
> Bristol Myers Squibb, and how they handled their wonder drug, Abilify, is a perfect example.
>

Yeah, and suicides happened in Cymbalta clinical trials. Unless someone is actively looking for them, they are well hidden. I suspect a fair share of negative things have happened in most drug trials. Hey, Paxil had just as many failed trials as positive ones. Only the positive ones were submitted to the FDA. And even those weren't very convincing without some twisting of words and numbers. Like all meds actually.

Hey, some people do awesome on meds and their lives are magically turned around. And we don't hear much about those, so it goes both ways.

With all meds, and herbs, and supplements, and vitamins, and minerals, there is a risk/benefit decision to make. The wrong substance at the wrong dose at the wrong time for the wrong person can do great harm.

While aspirin is good at lowering the risk of heart attacks when taken low dose daily, aspirin has killed people.

Tylenol kills people, probably a lot more than Abilify ever will. Just to put it in perspective.

It's all about risk versus benefit. There is always the risk that any med...prescription or OTC...can aggravate an existing problem or an unseen unsuspected problem, create a new problem, or cause some mysterious thing to happen that no one can explain. That's just the way it is.

Back to the title of the thread, "Are the drugs that we're taking killing us?", I would say to a very tiny percentage, yes. We're talking real small numbers. More likely however, I believe it is the illnesses we have that are causing our depression and anxiety, illnesses that are not recognized, hunted for, tested for, or suspected, that are killing us.

 

Re: Are the drugs that we're taking killing us?

Posted by Andy Behrman on May 30, 2009, at 20:01:53

In reply to Re: Are the drugs that we're taking killing us?, posted by bleauberry on May 30, 2009, at 19:59:20

I agree that depression, schizophrenia, bipolar disorder and other mental illnesses kill.

But it's NOT accpetable that one person dies from a drug like Abilify - - and BMS has to be accountable.

 

Re: Are the drugs that we're taking killing us? » garnet71

Posted by SLS on May 30, 2009, at 20:12:21

In reply to Re: Are the drugs that we're taking killing us?, posted by garnet71 on May 30, 2009, at 12:07:04

> Well comparing those of us who have suffered from poor health care from doctors with a bad car salesman really does diminish our experiences,

How so?

> it's not much different from someone telling you that your experience you choose to discuss is "old and tiresome"

Again. For the third time. I was talking about the video and the people who promulgate the dysinformation we have all come to know and be hurt by. It is very old.

Again. For the second time. This is not about you.

For the first time. It is not about anyone's experiences with the health care system. It is about the rhetoric of falsehoods.

For the last time. It is not about my ignorance and insensitivity. Thank you very much. (It is always about me).


- Scott

 

Re: Are the drugs that we're taking killing us? » Andy Behrman

Posted by Larry Hoover on May 30, 2009, at 20:20:11

In reply to Re: Are the drugs that we're taking killing us?, posted by Andy Behrman on May 30, 2009, at 19:31:16

Whether or not you perceive it to be an important issue is immaterial. It is equally immaterial for the lay press to expound upon scientific issues with no factual basis. It is scientifically invalid to generalize from specific cases. Unless you are prepared to argue that the FDA, and similar bodies, are complicit in suppressing evidence of demonstrable harms, and that no one else but yourself (and like minded individuals) are in possession of the truth, then you are nothing but a propagandist.

Present factual evidence for your allegations, or cease claiming knowledge of such "truths". Side effects are not a surprise. Your ignorance of that prospect is.

Lar

 

Re: Are the drugs that we're taking killing us?

Posted by garnet71 on May 30, 2009, at 22:25:52

In reply to Re: Are the drugs that we're taking killing us? » garnet71, posted by SLS on May 30, 2009, at 20:12:21

I was only talking about the comment you wrote below-the post you wrote in reponse to good or bad doctors; it says nothing about this video. It only says that you yourself have a good doctor, and that there are bad doctors, nurses, and car salesman, and that it gets old hearing about those who complain of "bad" doctors. This is what you wrote, unless someone else was using your computer.

Yes, it does diminish others experiences to say those of us who suffered from poor medical care is old and tiresome to hear about. Bad doctors cannot be compared to bad car salesman-I can guarantee you that it is not like getting a bad deal on a car.

But this is my limit in regard to how much drama I can tolerate.

Actually, I don't give a f*ck anymore. I have too many things to do. If you want to go around and say that hearing about bad doctors is old and tiresome after I just posted a comment in this thread that my whole life is falling apart due to the poor decisions of doctors, be my guest. I don't have to read about it anymore.

---------------------------

> He's about as thorough as they come. I have to imagine that there are a lot of other psychiatrists out there who take things equally seriously.


Yeah. Mine is pretty good, too.

I think you struck a healthy chord here. There are good ones as there are bad ones. This is true of doctors, nurses, and car salesmen.

It gets old.


- Scott

 

Re: Are the drugs that we're taking killing us?

Posted by ricker on May 30, 2009, at 23:02:14

In reply to Re: Are the drugs that we're taking killing us?, posted by garnet71 on May 30, 2009, at 22:25:52

The topic of this thread, and a lot of it's content, goes to show just how much we need our meds.... and they really do "save lives"! :-)

Rick

 

Re: Are the drugs that we're taking killing us?

Posted by greywolf on May 31, 2009, at 2:24:07

In reply to Re: Are the drugs that we're taking killing us?, posted by Andy Behrman on May 30, 2009, at 17:05:47

> But the drug companies hide not only side effects but mortality statistics during clinical trials - - not to mention slanting their studies to lessen what side effects "look like."
>
> Bristol Myers Squibb, and how they handled their wonder drug, Abilify, is a perfect example.
>
> And that's why it's making news!
>
> http://www.youtube.com/watch?v=9VzMZX4nBz8

And this is where I think you're a little light. Give me the proof that the company is hiding mortality statistics attributable specifically to Abilify (as opposed to other meds or physical/mental conditions). Give me proof that the company is hiding potential side effects (I seem to remember a whole list of potential side effects in Abilify's accompanying literature). And give me proof that the company and the universities/hospitals working with it on multiple clinical trials slanted what the side effects would look like.

Finally, if information concerning the alleged excessive and unacceptable mortality rate of Abilify is so widespread, don't you wonder why all of these pyschiatrists supposedly in the know are still prescribing it? Either they don't care about the health of their patients or they're getting paid off.

I don't buy it and I think the video is unnecessarily scaring people based on anectdotal reports.

My suggestion is that you might better spend your time putting a class action lawsuit together proving your allegations than simply encouraging people you don't know to go after your doctor and Bristol.

Good luck.

Greywolf

 

Re: Are the drugs that we're taking killing us?

Posted by Andy Behrman on May 31, 2009, at 2:32:15

In reply to Re: Are the drugs that we're taking killing us?, posted by greywolf on May 31, 2009, at 2:24:07

The doctors prescribing Abilify are being paid off in several ways -- I can assure you of that.

You may want to read this re: side effects of Abilify and "how BMS is hiding it."

http://psychcentral.com/blog/archives/2009/05/11/hiding-akathisia-in-abilify/

This is just one of MANY reports. You can google the rest.

The facts are there. And BMS can no longer hide. Because the media is on to their knowledge of both the side effects and the danger of Abilify and they've already reporting their crooked marketing techniques - - but there's plenty more that will be exposed in the next month/s.

After all, I had an inside view into what was going on at BMS for almost two years.

Stay tuned.

 

Re: Are the drugs that we're taking killing us?

Posted by greywolf on May 31, 2009, at 2:43:46

In reply to Re: Are the drugs that we're taking killing us?, posted by Andy Behrman on May 31, 2009, at 2:32:15

> The doctors prescribing Abilify are being paid off in several ways -- I can assure you of that.
>
> You may want to read this re: side effects of Abilify and "how BMS is hiding it."
>
> http://psychcentral.com/blog/archives/2009/05/11/hiding-akathisia-in-abilify/
>
> This is just one of MANY reports. You can google the rest.
>
> The facts are there. And BMS can no longer hide. Because the media is on to their knowledge of both the side effects and the danger of Abilify and they've already reporting their crooked marketing techniques - - but there's plenty more that will be exposed in the next month/s.
>
> After all, I had an inside view into what was going on at BMS for almost two years.
>
> Stay tuned.


It's odd then that the first common side effect mentioned on Abilify's web site is akathisia occurring at more than twice the rate of the placebo.

http://www.abilify.com/depression/aripiprazole/side-effects-faqs.aspx

Making akathisia your very first safety warning is an unusual way of hiding it.

Greywolf

 

Re: Are the drugs that we're taking killing us?

Posted by Andy Behrman on May 31, 2009, at 2:48:17

In reply to Re: Are the drugs that we're taking killing us?, posted by greywolf on May 31, 2009, at 2:43:46

Apparently, you didn't read the article on the link. Maybe you should read it again.

Or, as Sonia Choi, the spokesman for BMS was quoted as saying, "I wasn't aware that akathasia was a side effect of Abilify."

The more important point is that it's a horrible side effect, extremely common and doctors are turning their backs on the problem and continuing to prescribe it. Sure, it's there. In fine print. But when a large percentage of consumers suffer from the side effect, don't you think it's time to think about the safety of Abilify?

Have you experienced the side effects of Abilify?

 

Re: Are the drugs that we're taking killing us?

Posted by greywolf on May 31, 2009, at 2:58:50

In reply to Re: Are the drugs that we're taking killing us?, posted by Andy Behrman on May 31, 2009, at 2:48:17

I took Abilify for about 10 months. Didn't experience a single side effect or a single benefit. I treated it like I do all my meds--met with my doctor and told him it was ineffective for me so we discontinued it.

On many other occasions I've experienced moderate to severe side effects from certain medications and I did what I would hope most people would do--visited my doctor, explained the problem and, usually, discontinued that form of treatment. Seems like that's what people would naturally do if they were having problems with Abilify.

Greywolf

 

Re: Are the drugs that we're taking killing us? » Andy Behrman

Posted by SLS on May 31, 2009, at 7:26:01

In reply to Re: Are the drugs that we're taking killing us?, posted by Andy Behrman on May 31, 2009, at 2:48:17

> Apparently, you didn't read the article on the link. Maybe you should read it again.
>
> Or, as Sonia Choi, the spokesman for BMS was quoted as saying, "I wasn't aware that akathasia was a side effect of Abilify."
>
> The more important point is that it's a horrible side effect, extremely common and doctors are turning their backs on the problem and continuing to prescribe it. Sure, it's there. In fine print. But when a large percentage of consumers suffer from the side effect, don't you think it's time to think about the safety of Abilify?
>
> Have you experienced the side effects of Abilify?
>


If you can find fault with the way Abilify has been marketed and dispensed, then I think that is where you ought to focus your attention. This is not the fault of the drug itself. The drug is what it is. What it is, is a lifesaver for me and many other people. The drug is unique and cannot be replaced by anything else in the current pharmacopia. Abiliy has side effects, some of them - akathisia specifically - that are due to this drug's unique pharmacology. It is this uniqueness that is the reason Abilify is chosen to be used in the first place. There is a significant chance that anyone starting Abilify will experience mild to moderate akathisia in the beginning. There is a good chance that if it appears, it will disappear within two weeks on its own. There is less of a chance that it will be so severe as to require discontinuation. However, this is a calculated risk, and one that is usually very easy to justify taking. This akathisia is not irreversible as would be tardive dyskinesia, which Abilify seems to be singularly exempt from producing among the neuroleptics.

Abilify is not a demon drug. There are plenty "worse" if you are looking at side effect severity and irreversibility alone as criteria to forcibly remove a drug from the public healthcare system.


- Scott

 

Re: Are the drugs that we're taking killing us?

Posted by linkadge on May 31, 2009, at 7:47:57

In reply to Re: Are the drugs that we're taking killing us? » Andy Behrman, posted by SLS on May 31, 2009, at 7:26:01

I think these medications are killing us. Perhaps not outright. There seem to be a lot of common health problems among psych patients who have been taking medications for years. Especially bipolar and schizophrenia medications. Sure, its not cause and effect but you know.

Linkadge

 

Re: Are the drugs that we're taking killing us?

Posted by SLS on May 31, 2009, at 10:05:26

In reply to Re: Are the drugs that we're taking killing us?, posted by garnet71 on May 30, 2009, at 22:25:52

> If you want to go around and say that hearing about bad doctors is old and tiresome

I never said that.

What I do find old and tiresome, though, is being subject to the endless train of generalizations made that all doctors are worthless and incompetent, and that psychiatry is quackery. This position is not only untenable, but it is also harmful. It prevents people from being vigilant in their seeking of adequate health care. It sabotages their trust of any doctor, and thus their treatment. It is just not accurate.

> after I just posted a comment in this thread that my whole life is falling apart due to the poor decisions of doctors, be my guest.

I am indeed sorry that you have had a bad time with things.

It is good that you now have explanations and understandings that you didn't have before.

As for me, I have learned that in order to move forward in the pursuit of successful medical treatment, I must first move past the mistakes of others and avoid the tendency to invest myself in fixing blame. This was not an overnight process, though.


- Scott

 

Re: Are the drugs that we're taking killing us? » Andy Behrman

Posted by Larry Hoover on May 31, 2009, at 10:07:16

In reply to Re: Are the drugs that we're taking killing us?, posted by Andy Behrman on May 30, 2009, at 20:01:53

> But it's NOT accpetable that one person dies from a drug like Abilify - - and BMS has to be accountable.

It is unacceptable that the drug might be blamed for any deaths. The blood sugar irregularities are quite manageable with proper medical care.

In a less specific sense, it is far too easy to blame a drug manufacturer for a previously unrecognized severe side effect, particularly one with very low incidence.

But why focus on this one drug? Why interpret the situation so harshly? Non-steroidal inflammatory drugs (NSAIDs) are responsible for the deaths of 16,500 people each year in the United States. Depending on your age, the risk of dying from using them can be as high as 1 in every 647 people. Nobody thinks twice about taking a headache tablet, or chronic use for arthritis pain, and neither has the deadly consequences that might be associated with untreated major mental illness.

http://www.medicine.ox.ac.uk/bandolier/booth/painpag/nsae/nsae.html

Lar

 

Re: Are the drugs that we're taking killing us?

Posted by linkadge on May 31, 2009, at 10:22:40

In reply to Re: Are the drugs that we're taking killing us?, posted by SLS on May 31, 2009, at 10:05:26

Thats not true, psychiatry is only a partial quackery.

Linkadge

 

Re: Are the drugs that we're taking killing us? » Andy Behrman

Posted by Larry Hoover on May 31, 2009, at 10:24:40

In reply to Re: Are the drugs that we're taking killing us?, posted by Andy Behrman on May 31, 2009, at 2:32:15

> You may want to read this re: side effects of Abilify and "how BMS is hiding it."
>
> http://psychcentral.com/blog/archives/2009/05/11/hiding-akathisia-in-abilify/

Andy, these discussions are logically flawed. No matter what the incidence of akathisia might be, it is not possible to predict that side effect in any patient. It is thus impossible to prevent the side effect, unless the drug is simply not ever used at all. And any doctor and any patient who enter into a trial of any antipsychotic agent must be prepared for akathisia as a possible outcome. It's the nature of the treatment itself.

Moreover, the incidence of akathisia in antidepressant augmentation trials was never suppressed. It is fully and completely in the public domain.

Your evidence is also propaganda. Your pundits are the selective reporters.

Lar

 

Re: Are the drugs that we're taking killing us? » linkadge

Posted by SLS on May 31, 2009, at 10:52:59

In reply to Re: Are the drugs that we're taking killing us?, posted by linkadge on May 31, 2009, at 10:22:40

> Thats not true, psychiatry is only a partial quackery.
>
> Linkadge


LOL

Very good.


- Scott

 

Re: Are the drugs that we're taking killing us?

Posted by bulldog2 on May 31, 2009, at 15:58:53

In reply to Re: Are the drugs that we're taking killing us? » linkadge, posted by SLS on May 31, 2009, at 10:52:59

> > Thats not true, psychiatry is only a partial quackery.
> >
> > Linkadge
>
>
> LOL
>
> Very good.
>
>
> - Scott

psychiatry is more art than science. Like a good chef cooking up a new recipe.

 

Re: Are the drugs that we're taking killing us? » Andy Behrman

Posted by Larry Hoover on May 31, 2009, at 16:36:56

In reply to Re: Are the drugs that we're taking killing us?, posted by Andy Behrman on May 31, 2009, at 2:32:15

> This is just one of MANY reports.

Unfortunately, the plural of anecdote is not data.

I've addressed some important questions to you, and you've ignored each one. I can only form a negative opinion from that.

Lar

 

Re: Are the drugs that we're taking killing us? » Andy Behrman

Posted by SLS on May 31, 2009, at 18:15:50

In reply to Re: Are the drugs that we're taking killing us?, posted by Andy Behrman on May 31, 2009, at 2:48:17

> Apparently, you didn't read the article on the link. Maybe you should read it again.
>
> Or, as Sonia Choi, the spokesman for BMS was quoted as saying, "I wasn't aware that akathasia was a side effect of Abilify."
>
> The more important point is that it's a horrible side effect, extremely common and doctors are turning their backs on the problem and continuing to prescribe it. Sure, it's there. In fine print. But when a large percentage of consumers suffer from the side effect, don't you think it's time to think about the safety of Abilify?

Gosh. Many other neuroleptics produce akathisia, some worse than Abilify. Why single out this one drug? You said that Abilify treated you the worst of the 38 drugs you have tried. It sounds personal to me. It sounds like vengeance. You certainly have the privilege to express yourself. I disagree with you passionately, but I am happy that you have remained civil, despite having few advocates at the moment.

I don't know what the rate of coma and fatality is with Abilify. Do you? Isn't that the crux of the matter? To say that even one is too many is a rhetorical argument, and neglects the true value of a drug to society. Rare idiosyncratic reactions can occur with a great many important drugs. A couple of people taking prednisone have died of congestive heart failure. Of course, they had the biological vulnerability to have such a thing happen to them. A warning is contained in the drug monograph. Should we take this drug off the market?

What is the rate of coma and death as the result of taking Abilify?

If you cannot produce an answer to this question, then I imagine we have come to a good place to suspend this discussion as it relates to coma and fatalities. Otherwise, all of the other complaints you have about Abilify are already well recognized here on Psycho-Babble as potential side effects that we have seen emerge in real life. They range from being minor nuissances to being uncomfortable to being intolerable - just as with other psychotropics that give people back their lives. Your particular reaction to Abilify had more to do with your unique biological constitution than it did with some universal effect of the drug. The things that happened to you don't happen to me. Don't think for one minute that I am going to passively allow you to take this drug out of my mouth just because you didn't like the way it affected you individually.


- Scott

 

Re: Are the drugs that we're taking killing us?

Posted by bulldog2 on May 31, 2009, at 18:35:47

In reply to Re: Are the drugs that we're taking killing us? » Andy Behrman, posted by SLS on May 31, 2009, at 18:15:50

> > Apparently, you didn't read the article on the link. Maybe you should read it again.
> >
> > Or, as Sonia Choi, the spokesman for BMS was quoted as saying, "I wasn't aware that akathasia was a side effect of Abilify."
> >
> > The more important point is that it's a horrible side effect, extremely common and doctors are turning their backs on the problem and continuing to prescribe it. Sure, it's there. In fine print. But when a large percentage of consumers suffer from the side effect, don't you think it's time to think about the safety of Abilify?
>
> Gosh. Many other neuroleptics produce akathisia, some worse than Abilify. Why single out this one drug? You said that Abilify treated you the worst of the 38 drugs you have tried. It sounds personal to me. It sounds like vengeance. You certainly have the privilege to express yourself. I disagree with you passionately, but I am happy that you have remained civil, despite having few advocates at the moment.
>
> I don't know what the rate of coma and fatality is with Abilify. Do you? Isn't that the crux of the matter? To say that even one is too many is a rhetorical argument, and neglects the true value of a drug to society. Rare idiosyncratic reactions can occur with a great many important drugs. A couple of people taking prednisone have died of congestive heart failure. Of course, they had the biological vulnerability to have such a thing happen to them. A warning is contained in the drug monograph. Should we take this drug off the market?
>
> What is the rate of coma and death as the result of taking Abilify?
>
> If you cannot produce an answer to this question, then I imagine we have come to a good place to suspend this discussion as it relates to coma and fatalities. Otherwise, all of the other complaints you have about Abilify are already well recognized here on Psycho-Babble as potential side effects that we have seen emerge in real life. They range from being minor nuissances to being uncomfortable to being intolerable - just as with other psychotropics that give people back their lives. Your particular reaction to Abilify had more to do with your unique biological constitution than it did with some universal effect of the drug. The things that happened to you don't happen to me. Don't think for one minute that I am going to passively allow you to take this drug out of my mouth just because you didn't like the way it affected you individually.
>
>
> - Scott
>

Again I ask why are psychotropic drugs being singled out? I know of a child who took an antibiotic and died of aplastic anemia. Thousands die from advil and tylenol use. If your liver is destroyed by tylenol do we go on a crusade against it?I repeat once more all drugs have the potential to kill and injure. Why do doctors tell us to use a nsaid for inflammation when we risk ruining our and stomach. This is medicine today. There is nothing unique about psychotropic drugs.
The reality is stop using meds and be all natural if you fear sides. Not just psychotropic drugs but all drugs. The next advil you swallow for a heaache may kill you!!

 

Re: Are the drugs that we're taking killing us?

Posted by Sigismund on May 31, 2009, at 18:56:59

In reply to Re: Are the drugs that we're taking killing us? » Andy Behrman, posted by Larry Hoover on May 31, 2009, at 10:07:16

>But why focus on this one drug? Why interpret the situation so harshly? Non-steroidal inflammatory drugs (NSAIDs) are responsible for the deaths of 16,500 people each year in the United States. Depending on your age, the risk of dying from using them can be as high as 1 in every 647 people. Nobody thinks twice about taking a headache tablet, or chronic use for arthritis pain, and neither has the deadly consequences that might be associated with untreated major mental illness

That is a good example of the toxicity of the meds we have. I have a neighbour who had her gut resectioned after years of use of NSAIDs. There are alternatives, effective ones that I use, but they are more expensive and are not made by pharmaceutical companies.


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