On March 27 th. , I made a grim and macabre prediction estimate that the numbers of civilian casualties at that stage would be more like 50K . Than the numbers being bandied about. . The evidence is mounting that this might be an accurate tally. The Ukrainians don't yet know about numbers in Mariupole or Karkiv, ,or indeed the full trail back to Belarus. Remember people starve and die from dehydration and from lack of medicines , just as surely as from an explosion.
Brexit, for once some facts.
- Thread starter flecc
- Start date
As someone who, along with partner, relies on daily medicine, the lack of necessary medical supplies is always at the top of our list when thinking about such situations.
The UK's dogmatic insistence on 28-day prescribing would have me very concerned if there were any military action within the UK - however unlikely. It is just natural to think of what is happening there and then ask what would happen to us?
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Not for me, my prescriptions in a London NHS England heath trust are for 56 days and have been that for the last 14 years. Before that I had no prescriptions.
My current prescription is dated 10/2/2022 and I'll be renewing it online this week.
So if English regiments enter Wales next week on a special operation to rid it of Nazis, while insisting Wales has always been part of England, I'll still be happily pill popping.
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I actually get 84 days!Not for me, my prescriptions in a London NHS England heath trust are for 56 days and have been that for the last 14 years. Before that I had no prescriptions.
My current prescription is dated 10/2/2022 and I'll be renewing it online this week.
So if English regiments enter Wales next week on a special operation to rid it of Nazis, I'll still be happily pill popping.
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But when I lived in England, I had to argue to get 56 days rather than 28.
And the levothyroxine costs less than a pound a pack of 28. The dispensing charges over three months are greater than any possible savings.
The insistence on 28-day prescribing reached a pinnacle of nonsense for the medicine I took on an 'as needed' basis. What is a 28-day prescription for something you might need anything from zero to four times a day? (Though it was most often zero in reality.)
The policy, as written for the area, did not take any account of such issues - it simply said that all prescriptions should be for 28-days (or fewer that was all that was needed such as a 14-day course of antibiotics).
Very strange. My prescriptions for ongoing medications have always been for 56 days, and it's just occurred to me that my brother's in Dorset were also always for 56 days.
Of course there were sometimes those for much shorter periods for antibiotics or to deal with a specific complaint needing only shorter treatment.
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I found it ridiculous that the report from the Commission on Human Medicines report - prepared for the MHRA - expressly said that three months was appropriate. While that is what I now get, most patients get 28 or 56. Doctors, CCGs, etc., up and down the land are ignoring this.
Levothyroxine Tablet Products: A Review of Clinical & Quality
Considerations
07 January 2013
9. Levothyroxine should be prescribed and dispensed in quantities covering three months supply, where appropriate, in order to address issues of continuity of supply and also to improve convenience to patients.
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/420997/CHM_Review_for_MHRA_website_Levothyroxine_sodium_FINAL_04_Jan_2013.pdf
One thing that is routinely ignored here are prescription review dates. My one's current review date is 27th April 2022, but when I renew it this week, taking my medications far beyond that date, there will be no query or review.
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Afraid review dates are a bad joke.
The usual regime is one test a year. Which completely ignores things that affect our need for thyroid hormone - such as temperature and activity levels.
If you happen to be tested in the summer, after a few days of low activity, you could well end up with your dose cut, or not increased. Even though for the next 360 days you would end up under-dosed. (Or vice versa, of course.)
I have gone months after review without anyone seeming to notice! And partner hasn't had a review in about seven or eight years - she dropped off the old surgery's radar and was not picked up on the new surgery.
(And neither of us has ever been offered any of the GP age-based special reviews - at 50, 55, 60, 65 or 70 or whatever the period is.)
I see Viktor Orbán, Hungary's prime minister has just been re-elected for another 4 years after 12 years of already holding the post. Seems electorates like dictators, since like Turkey's President Erdogan, he behaves like one, slapping people in prison without trial and restricting the press. Orbán's rule is regarded as a kleptocracy, since he accepts funds from the EU, then transfering them to allies and his relatives, but like Erdogan, he has no trouble getting re-elected without fiddling the vote. They are both pals of Putin too, while being in NATO and in Hungary's case, an EU member too.
Orbán's election poster was extraordinary. Picturing head shots of him and Putin side by side, the Hungarian message was, "Elect your Putin", and they did!
So much for a united Europe over Ukraine.
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Orbán's election poster was extraordinary. Picturing head shots of him and Putin side by side, the Hungarian message was, "Elect your Putin", and they did!
So much for a united Europe over Ukraine.
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My prescriptions are typically 6 months. The medical practitioner decides the duration not a committee of civil servantsNot for me, my prescriptions in a London NHS England heath trust are for 56 days and have been that for the last 14 years. Before that I had no prescriptions.
My current prescription is dated 10/2/2022 and I'll be renewing it online this week.
So if English regiments enter Wales next week on a special operation to rid it of Nazis, while insisting Wales has always been part of England, I'll still be happily pill popping.
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I'd have been content if the decision of one committee of civil servants' decision had been accepted, and not replaced by the decision of another committee of civil servants. When two such committees disagree, somehow it is always seems to be the less palatable decision that stands.
Does anyone know where the majority of our drugs here are made (or does it depend on what type?)
I read something recently that claimed 97% of antibiotics in the US, come from China!! Can this be correct?? sounds a bit short sighted of the US government to me if so.
It depends very much on what you mean by "drugs"!
There are, broadly, two components to most medicines: the Active Pharmaceutical Ingredient(s) (API) and the Excipients (inactive ingredients).
The pharmaceutical industry is very closed. We simply do not know where the actual pill makers get their APIs and excipients from. Indeed, even is we know that A buys something from B, we don't know where B gets their raw materials from.
About some products we know quite a bit - the actual factories used to produce many of the Covid vaccines, for example. But even then, the steps can be divided - with Wockhardt in Wrexham doing the "finishing" of AstraZeneca's vaccine. But we likely know nothing of the raw materials used by AZ.
Nonetheless, I think we can reasonably claim that Pfizer, Moderna, AstraZeneca vaccines were not made in China.
The levothyroxine powder used to make the tablets I take could come from anywhere. Nor do we know where the excipients come from. The 100 microgram tablets are made in Barnstaple, Devon (and possibly Tyneside, as the manufacturer bought up a factory up there). While the 25 microgram tablets are made in Brighton.
Occasionally we know a bit more. For example, if the excipients include branded products (such as Opadry or coatings).
And we know that all USA desiccated thyroid products are made from thyroids harvested from pigs in the usual USA food chain.
It seems quite possible that large quantities of APIs come from China. Have a look at Ali Baba. Last time I did, I saw levothyroxine powder in vast quantities. My own tablets contain approximately 112.5 micrograms per day. Which works out at around 40 milligrams a year. Or half quite a small tablet (if it were pure API). So just what would you need huge numbers of kilograms for? In a few minutes, you could order more than the population of the UK would need for at least a year. A few more minutes and you'd have enough for Europe.
We are in difficulty in that substantial quantities of some APIs are used for animals.
We know that there are three factories in the world that make vitamin B12 - with virtually all European product coming from a French company. They use a sophisticated bio-reactor process.
And we knew that some European liothyronine products had their API manufactured in Austria.
Oysters answer is very comprehensive. Ireland is a major producer of pharmaceuticals. There are the producers of the active ingredient which are acquired from labs all over the world ,and then the fillers or diluents,and the packaging. . Although the packaging might seem to be the low end part of the business ... nothing could be further from the truth. The key is to ensure that the active ingredient is uniformly distributed at the correct concentration in each and every capsule, then to ensure that there is no microbiological growth , then of course there must be full batch QA and audit trails
Packaging is crucial for many products.
Levothyroxine is susceptible to reduced potency due to light, oxygen, humidity and heat. Further, the precise chemical form varies - with it changing between anhydrous and pentahydrate and possible intermediates.
The blister packs must be properly specified to have low permeability to oxygen and humidity. Ideally, they would also be lightproof.
The use of old-style bulk packaging is rarely seen by people like me who get their prescriptions dispensed in high street pharmacies. But it is a concern that they are still used for preparing dosettes and in institutions.
The MHRA has clearly been taken to task re distribution of API in tablets. In general, no tablets should be split or broken unless the instructions (PIL) say so. The mere presence of a line across a tablet does not mean it can be divided.
A small number of medicines have been updated to ensure that the API is distributed and the accuracy of breaking/cutting is good enough. Specifically, this happened with hydrocortisone.
Many say that it is OK to break in order to swallow. But if it doesn't say that, it should say that it must be swallowed whole.
Despite all this, variability is too great.
And we need to have some proper recycling or composting of packaging. We have to put them in unsorted waste.
Numbers vary all over the place. UK is fairly standardised on 28. But many countries go for 30.
Other common numbers are 50, 90, 98, 100.
There are specialized companies which will take in, say, medicines in 30s and repackage them in 28s. Or vice versa. Typically, when stock needs to move between countries which standardised on a different number.
Adding:
Just checking through some documentation I have and find 20, 112 and 250 also used for some products.
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The Nostril Pickin' kid isn't a happy bunny
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Iain Duncan Smith MP
@MPIainDS
https://twitter.com/MPIainDS
It is beggars belief that the Govt is going to stand idly by whilst Nexperia, a Chinese-controlled company, attempts to take over Britain’s largest microchip factory (NWF). It's another example of Whitehall’s failure to think strategically when it comes to critical industries."
They really need to work on fair sharing of the loot!
"
Iain Duncan Smith MP
@MPIainDS
https://twitter.com/MPIainDS
It is beggars belief that the Govt is going to stand idly by whilst Nexperia, a Chinese-controlled company, attempts to take over Britain’s largest microchip factory (NWF). It's another example of Whitehall’s failure to think strategically when it comes to critical industries."
They really need to work on fair sharing of the loot!
they perhaps won't vote for ditherers, those prefer sitting on the fence forever to avoid making mistakes.
Still, I reckon even dictators will lose after making a big mistake.
Orban hasn't yet but Putin has.
That is yet to be seen. It's only the view back home that counts, and that is not remotely like the western media spin from a minority of Russian vox pops.
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