A warm welcome to the April 2009 edition of the Gout Dugout newsletter, and to those new readers who have signed up since the March edition.

ULORIC (FEBUXOSTAT) IS NOW AVAILABLE ONLINE, BUT IT'S NOT CHEAP

It's bad luck for Takeda Pharmaceuticals in the U.S. that they have had to launch Uloric (febuxostat) in the teeth of the worst economic recession since the 1930's. And they have of course spent millions patiently developing the product over many years.

But the recession does not seem to have been factored into their thinking about pricing. Uloric (ie. febuxostat, or Adenuric in E.U. countries) is not cheap, without medical insurance or government assisted help of some kind. If you live in the U.S. and you have to pay for it yourself, an 80 mg, 30 tablets pack will set you back US$6.13 each or about US$184 per 30 tablets pack, at one online pharmacy I examined. This roughly makes it as expensive as caviar, or maybe more so.

Buy 60 tablets or 90 tablets packs and the price per 80 mg tablet falls by just 10 or 20 cents each. This isn't much at all for buying twice or three times as many in a single purchase.

Taking a longer view, if you need febuxostat for just about a year (4 purchases of Uloric 90 tablets, 80 mg daily for 360 days supply) that will set you back US$2134.56.

Compare this with the online cost in the U.S. of generic allopurinol 300 mg 28 tablets for us$4.70 or 17 cents per tablet.

It's now crystal clear why Britain's NICE (National Institute for Health and Clinical Excellence), on behalf of Britain's National Health Service, said that febuxostat will only be prescribed for gout sufferers if they can't tolerate allopurinol, or if allopurinol hasn't worked. NICE's examining committee did a number of financial quality of life calculations on febuxostat's benefits and costs and they noted that febuxostat would be, to them, 13 times more expensive than allopurinol.

Here's a site where febuxostat is available

www.usdrugs.com

One reader of this newsletter, a healthcare professional in the U.S.,got Uloric at this site:

www.rightsourcerx.com

COPING WITH GOUT - DON'T BE CASUAL

I had conversations with two gout sufferers in March, and there's a lesson to be learnt. Both of these gout cases were fairly mild ones. One middle aged man had an attack a few years ago after a very long flight(about 20 hours). Of course he wondered whether the plane flight had caused it. Could a plane flight cause a gout attack? It might. I can think of three reasons - the dehydration, the poor blood circulation from over sitting in a cramped location if you're in economy class, and possibly the wine with the meal. Or a combination of all three. This person had the classic big toe attack for a few days, but never since.

The other sufferer, a man in his late sixties, had suffered just a few big toe gout attacks over the years, usually after drinking what he described as 'poor quality wine'. I think this wine description was meant as a joke, and what he really meant was that alcohol had tipped his hyperuricemia into an attack.

Although I didn't have the chance to probe their attitutes more closely, both seemed to be taking the view that these attacks were unplesant but bearable events which might happen again and nothing to be too bothered about. Neither man knew much about the foods to avoid, nor exactly what their cause was. Neither knew that tophi can develop.

My feeling is that their attitudes were too casual and too dismissive. Once you have a tendency to overproduce uric acid and it has led to a gout attack, another attack at some future ponit is very likely.

So too is an attack at normal levels of uric acid. And as you age the chances are the attacks will become more frequent and possibly more difficult to treat.

So the moral of these stories? Take a gout attack seriously. Find out what's really causing it - purines, insulin resistance, hereditary. Monitor your uric acid levels and know what foods you need to avoid.

VITAMIN C AND GOUT PREVENTION

Last year I ran a few articles in this newsletter about vitamin C for gout. And all subscribers have been able to receive a free copy of the Vitamin C and Gout report when they subscribe to it. Late last year there was a new (and another)study about the benefits about vitamin C in gout treatment which I haven't yet written about, but will.

In March academic researchers made another connection between gout prevention and taking plenty of vitamin C. Results came out from the Health Professionals Follow Up Study (about 47,000 men) which showed that over 20 years, 1317 of them got gout. But if they took plenty of vitamin C, (from food or dietary supplements) the less likely they were to get gout.

How much is plenty? At least 500 mg daily. Take 1,500 mg or more daily and your risk falls 45% compared compared to someone taking less than 250 mg daily. Or, another stat, for every additional 500 mg of vitamin C daily the risk of gout falls 15%.

Remember, if you take vitamin C supplements, the best are those with added bioflavonoids (helps absorption), ester C (non acidic) and time release (vitamin C is excreted quickly).

Read up on gout and vitamin C here

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Thanks for reading and all the best.

John Mepham

165,Union Street,Maidstone,Kent,United Kingdom.ME14 1EY

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NB. The contents of this newsletter contain medical information, not medical advice. Please always discuss gout remedies with a doctor or other health care professional before implementing any treatment.