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The Gout Dugout.Issue #047 |Jimmy Savile's gout |the cost of colchicine | gout scans
November 23, 2011
A FAMOUS GOUT SUFFERER PASSES AWAY
Jimmy Savile, Sir James Savile, is not a name a majority of readers of the Gout Dugout will know because he wasn't an international megastar. But in his native Britain everybody knew him. His considerable fame began in the 1960's as the DJ and presenter of the popular "Top of the Pops." I used to watch it in those days and the idea that Jimmy, who was introducing The Beatles one week, and the Stones the next, would get gout was incredible. But life moves us on.
Jimmy went on to another successful T.V. show "Jim’ll Fix It." And when that and other shows ended, he remained hugely popular and in demand. Jim was generous, down-to-earth, worked hard for charities, and amused millions with his zany clothes, hair and expressions. Rather eccentric from some accounts, wholly likeable and apparently carefree. H.M. Queen Elizabeth actually told him, affectionately, he was odd. Margaret Thatcher said he could "ring her bell anytime."
Sadly Jimmy died on October 29 at the grand age of 84. You can watch a short You Tube video from British ITV news:
Why am I writing this? Because for the last years of his life Jimmy Savile was a gout sufferer. And gout was something that Jim could not fix, and in fact didn't wish to fix.
He said about his gout: "I gave it to myself, so I’ll live with it."
If you haven't heard of him, wherever you live, Jimmy Savile's gout has some important reminders. So let's have a look at it, and what he did about it.
Keep in mind that your uric acid level has a tendency to rise slowly as you age.
JIMMY SAVILE'S GOUT FILE
What did Jimmy do that could have stimulated gout?
BEHAVIOUR Over exercise is not thought to be good for gout. It's thought it aids the build-up of uric acid. Jimmy had years and years of running (6 miles daily); marathon runs (217 of them); professional wrestling bouts (107 wins); 3 Lands End (Cornwall) to John o' Groats (Caithness) walks (the two inhabited places on the island of Great Britain that are furthest apart; by classified road: 838 miles (1349 kilometres); straight line: 603 miles (970 kilometres)).
And it's not well known about Jimmy Savile that he was an honorary Royal Marine. That's why a Royal Marine detachment carried his coffin at Leeds Cathedral in northern England on November 9. There is a photo of him wearing his Green Beret, standing next to Charles, Prince of Wales. A Royal Marine Green beret is not given away and cannot be bought. It means Jimmy passed grueling physical fitness trials and tests for Royal Marine entry, among the world's toughest. Most young hopefuls fail, let alone an older man like Jimmy Savile. Royal Marines' fitness is said to be equal to that of international athletes.
My own feeling is that charging around like this after you've reached middle age is going to raise your uric acid level by more than would otherwise be the case. And as I'm going to explain soon in this newsletter, and later on the website, you should be careful of too much exercise, which is not good if you wish to avoid ending up with gout. If you exercise a lot, measure your uric acid frequently.
He actually said his gout would go away for a few weeks but would return after he had been out running.
DIET What was Jimmy Savile's diet like? Elvis Presley and his banana splits spring to mind. Jimmy lived on pork pies (nothing
wrong with pork pies, I love 'em too).
But you need to eat fresh vegetables and fruit too as part of a more balanced diet. Apparently Jimmy ate pork pies, potato crisps (potato chips) and chips (fries), biscuits and cakes. And probably not from a plate. Of course people with a diet like this aren't certain to get gout at all, but the extra carbs in this kind of food could lead to the insulin resistance cause of gout. I suspect with all that exercising he did… this was his cause of gout, but we shall never know.
He boasted he had five properties and not one had an oven (cooker). This means it is certain that apart from pork pies, biscuits, cakes and the like (plus his trademark cigar of course) Jimmy lived on snacks, takeaway food and restaurant meals so it's very likely he wasn't watching purines or carbohydrates or ensuring he ate healthy fruit and veg and nuts, which gout sufferers need for their antioxidant properties as well as their vitamins and minerals. And those cigars he smoked? That depletes Vitamin C which stimulates uric acid excretion.
It seems he made no attempt to reduce his purines, (which can be somewhat helpful) or his carbs (and sugar, also a carb), the insulin resistance cause of gout. Whilst these foods might not raise uric acid he certainly wasn't eating anything which would help reduce it.
Would he have read what I've just written, and thought "I really should do something about my gout." No he wouldn’t ! Quote: "I’ve always tried to avoid putting anything in my mouth that would do me any good." Ouch. Well he did live to be 84, but remember he was dealing with gout not a cold.
ATTITUDE TO GOUT Basically Jim had decided to live with his gout, not fight it, not learn much about it and not do much about it at all. No keeping regular doctor's appointments, no taking meds daily or twice daily, no pouring over gout websites for ideas. Certainly his diet didn't change and he probably still over exercised. I'd be very surprised if he drank the cherry juice someone promised to send him. Jim just didn't take life seriously enough to take gout seriously enough.
THE GOUT TRIGGER He kicked at a jammed door and broke a toe (probably a big one).His first gout attack occurred soon after and he correctly blamed it on the broken toe. No doubt at this point his uric acid was high.
STAGE OF HIS GOUT On the way to chronic gout, if not already there. In chronic gout, after a few years, of gout, gout is flying around joints, and the periods between attacks shorten. Jim complained of gout pain going to his knees one, day, elbows the next, and then back to a knee.
This famous gout sufferer forgot that gout is progressive, or didn’t take this into account. Gout gets worse.
So do you think this famous gout sufferer handled his gout well?
If you've read the Gout Dugout for any length of time, you know what I think. In two sentences:
Gout is too serious a matter to be treated casually. It demands concentration, dedication, discipline,rigour,and a re-examination of one's life. Otherwise, sometime down the line it will deliver a very nasty surprises.
If you are a gout sufferer in the U.S. it's virtually certain you will know of the colchicine price controversy and you'll be aware of how much more expensive monopoly priced colchicine is compared to the old, non-approved colchicines in that country. One estimate of the colchicine price was that the average cost for 23 days' supply rose from US$6.72 to US$185.53. Another, the price of a pill rose from 9 cents to US$4.85. And if you're not a U.S. gout sufferer, read on to learn what can happen to drug prices in another country.
Basically what happened in July 2009 was that when the FDA approved colchicine, it only approved one brand, and supplies of all other non-approved brands eventually disappeared. The approved brand’s (Colcrys) price rose steeply.
The Autumn Crocus, the little flower from which colchicine is made
The developers of Colcrys, URL Pharma, only obtained a three years' monopoly (euphemistically called "marketing exclusivity") for its use in gout treatment in the U.S. They had to pay for one main trial and other trials and studies. There was the risk that the FDA wouldn't approve their new colchicine. After three years (actually probably only two in practice) there will be competition again, so their sales and profits will fall.
The developers got a bad press because they acquired a monopoly and played hard ball with it. Even the New England Journal of Medicine carried a critical article. But the consumer got a safer colchicine (there had been 169 deaths in the past 40 years) linked to non-approved colchicine in America, and a better dose. The whole world learnt about this better dose, (a lower dose was found to be just as good or better), verified by the FDA, free of charge.
Co-pay or More-pay? The developers to their credit also launched a price reduction programme (program) with their new approved drug Colcrys, which made it seem in the less well-off would not pay the jacked up price. Depending on who you read, it was jacked up 15 or 50 times. But I read specific cases where the co-pay (for non U.S. readers that's the amount the buyer actually pays, the balance being paid by the insurance company), itself went up 5 – 7 times and that’s steep too, even if the drug has been declared safer and reasonably effective.
Satisfactory outcome? So was the outcome satisfactory? In some respects it was as I've indicated above, but in another wasn't. The problem has been those people who have posted on the Internet that they couldn't afford Colcrys, were in pain, and didn't fit into any co-pay scheme. That they had used it before, when colchicine was cheap, and never had a problem. I assume their posts were sincere and accurate. In which case the price reduction programme (program) appears to have holes in it, which people fell through, and this IMO should not have happened in a rich country like the United States.
How often do we hear of a gout misdiagnosis, or no diagnosis at all? Too often. Sometimes it takes years for gout to be correctly diagnosed during which time it won't be treated as well as it could be. After all the gout diagnosis guidelines of medical authorities are a number of main gout features. Tick more than eight or so, and it's gout. Or is it?
And the so-called gold standard diagnosis, the joint aspiration or arthrocentesis needle and syringe test, which is so often written up in a you-just-have-to-do-it and gout will be correctly identified tone, is in fact more difficult than usually portrayed.
Firstly, it can be hard to get synovial fluid out of the big toe joint, the most "popular" gouty joint. The knees are said to be the best, but knee attacks in the first five years of gout are not common. So not many will be diagnosed from the knees.
Secondly, the doctor doing it must be trained to do it, or have someone on the staff who is trained.
And thirdly it has to be said, and this happens too, the doctor wants to keep a patient, not pass him/her onto a rheumatologist or podiatrist.
So be aware that CT scanning to search for gout's MSU crystals is making in-roads into this key area of diagnosing gout quickly and accurately. In August, a U.S. Defense Dept. clinic, the Eisenhower Rheumatology Clinic, said it was using Ultrasound scanning to look for gout crystals. A couple of weeks ago America's famous Mayo clinic presented its CT scanning techniques (quick, painless) for gout diagnosis to rheumatologists at the American College of Rheumatology's annual bash in Chicago. When the Mayo clinic endorses a technique you can be pretty sure it's valid.
How fast CT scans for gout, and Ultrasound scans for gout, spread globally depends on training, budgets, medical management alertness and so forth. But if you aren't sure you really have gout, you can always ask your healthcare professional if he/she knows where Ultrasound scans for gout or CT scans for gout can be done for you.
But note, even CT scans in patients with acute gout did not diagnose gout in 30% of cases!
The UASure is a DIY home uric acid test kit. It measures the level of uric acid in the blood. Click on the link below to visit a company who can ship it world-wide, including the United States and Canada, from Britain. I say this because it cannot be bought in many countries.
NEXT MONTH'S EDITION
I've promised a piece on sweating out gout and it's coming next month. The GD these days is dispatched about the 20th - 23rd of each month but you'll be very busy during these days next month, so expect the December issue in your inbox around 10 December.
John Mepham BA.(Econ).
799, Infantry Street,
P.S. You may distribute this newsletter freely and free-of-charge, providing any links in it remain unchanged and it remains intact. Partial copying is not allowed.
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.
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