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IN PRO PER
c/o UMPA
Box 213
Palo Alto, CA 94302-213
IN PRO PER
UNITED STATES DISTRICT
COURT
NORTHERN DISTRICT OF
CALIFORNIA
Individually
Does One to a
Trillion
Plaintiff(s), Reply to Pfizer’s Answer
v.
Defendant Rock Star David
Lee Roth, et al.
other "Defendants"
defined as
Defendant(s)
Does One Trillion One to Two Trillion
________________________________________/
This
case involves Dilantin, cunningly known as Phenytion, also know as Diphenyl hydantoin SODIUM
(turn to
about page 25 for quotes about Chloride rather than SODIUM as being primarily
responsible as the cause of seizures), an ANTI-EPILEPTIC DRUG (AED); AED’s
can have a 75% misprescription rate; there may have been about five or more
reasons Dilantin should not have been given to Kenny Naatz, who was in an
alcohol treatment program, which was not properly secured at Safe Harbor
Shelter that was put into the hot water container by Rock Star David Lee Roth about
Christmas 2001. Epilepsy is often
misdiagnosed, can have many different causes, and likely can even be brought on
by stress. Delirium tremens (DT’s) from alcohol withdrawal should not be
a reason to prescribe Dilantin, but often rule out methods are not used prior
to properly prescribing medication, especially in the economically volatile Bay
Area of California doctors may misdiagnose or misprescribe to maintain large
number of patients and revenue in their medical practices, and to get them on
disability to maintain high real estate values. This case is similar to an
insurance case with government oversight, and the Safe Harbor Shelter facility
receives much of its resources from County and Federal funds; the Federal
Government is the insurer of last resort, and the Racketeer Influenced Corrupt
Organiztion Act (RICO) is one of the strongest oversight tools of government
funds. The government needs to enforce
the right to protection of the waterways from pandemic
causing, ecosystem-destroying, ECOLOGICAL-CYCLE POISONING, drug poisoning,
especially of innocent children and wildlife, partly due to increased birth
defects from the environmentally polluting drugs, which cost-shifts expenses to
various branches of the government, decreases the quality of life and life
expectancy, national competitiveness, violates constitutional guarantees, and
THEREBY, increases Federal and State Debt, RESULTING IN fractional murder (greatly reduced live
expectancy often due to poverty, sex or racial discrimination, incompetent or
unfair access to medical care resembles GENOCIDE); therefore, the statutes of
limitations should be extended to match that of the criminal statute of
limitations for murder; Preserving life
is of great value in THE SUPREME COURT OF THE
STATE OF KANSAS in Pipe v. Hamilton, 2002 WL 31431631: opined that if
there is a 10% chance of recovery in medical case where a medical
procedure was not provided to meet the recovery it would be legally actionable
as follows: “10 percent loss of chance cannot be said to be token or de
minimis”. Stewart
v. New York City Health and Hospitals Corp., 207 App.Div.2d
703, 704, 616 N.Y.S.2d 499 (1994), too, suggests there is the highest value on
creating and preserving life: “[I]f jury found that plaintiff lost even a 5
percent to 10 percent chance and that this chance was substantial the verdict
would be justified…We agree. As a matter of law, a 10 percent loss of chance
cannot be said to be token or de minimis.” Whereas, the policies regarding
preserving life in the heavily populated United States of America are inferior
to those in better managed Industrial Counties that have better safety nets,
which makes the United States of America increasingly unstable and
noncompetitive due to the misuse of resources, especially publicly funded and
non-renewable resources. Many of the publicly funded products and services have
negative value; for instance, the combination of surgery and drugs needed to
allow surgery is often more dangerous and expensive than nutritional and other
more conservative treatments, and the manufacturing of drugs can be toxic for
the environment, and the secretion of drugs into the sewage system can be
harmful if the drugs are recycled in drinking water or into the environment,
and at worst resembles genocide in violation of the GENOCIDE Convention
signed by the United States of America and other countries which states:
“Article I: The Contracting
Parties confirm that genocide, whether committed in time of peace or in
time of war, is a crime under international law which they undertake to prevent
and to punish… Article II: In the present Convention, genocide means any of the
following acts committed with intent to destroy, in whole or in part, a
national, ethnical, racial or religious group, as such:(c) Deliberately
inflicting on the group conditions of life calculated to bring about its
physical destruction in whole or in part;... Article III: The following acts
shall be punishable:…(c) Direct and public incitement
to commit genocide; (d) Attempt to commit genocide; (e) Complicity in genocide.”
18
U.S.C. § 3281 reads “An indictment for any offense punishable by death may be found at any
time without limitation”. Treason and murder tend to be capital offenses. If the preexisting probability of survival is entirely eliminated, it
resembles Fractional murder or MURDER. DILANTIN-CAUSED
STILLBORNS MAY BE ABOUT 2-7 TIMES THE
(1) "Malice" means
conduct which is intended by the defendant to cause injury to the plaintiff or
despicable conduct which is carried on by the defendant with a willful and
conscious disregard of the rights or safety of others.
(2) "Oppression"
means despicable conduct that subjects a person
to cruel and unjust hardship in conscious disregard of that
person's rights.
(3) “Fraud" means an intentional
misrepresentation, deceit, or concealment of a material fact known to the
defendant with the intention on the part of the defendant of thereby depriving
a person of property or legal rights or otherwise causing injury.
The statute of limitations should at very least cover the length
of copyrights and patents for fairness, especially if a large class of persons
and/or the government is defrauded. The Statue of limitations for False
Claims act is 6 years, and the statue of limitations for the RICO should be at
least 6 year for crimes similar to those in the False Claims Act, especially if
the government is also defrauded; Legal,
medical, education and government Documents are often held by law for 7 years
which suggests that it takes that long to resolve problems in court; other
civil statues of limitations can be up to 15 years are usually used against the
consumer are not equitable if malpractice (with a one year or 3 year statute of
limitation) resulted from a medical procedure paid for on a credit card debt
(statue for limitations for a consolidated loans of credit card debt may exceed
6 years and could be up to 20 years). Low settlements, of about 22% or less
than actual damages are common, and often medical malpractice cases are never
prosecuted or filed, and there are often unfair decisions with a pro-medical
professional bias when adjudicated. Ultimately
a disability claim is filed against the Federal government when a unfair lawsuit settlement occurs or when the patient is no
longer able to work. Anything else is unreasonable and supports crime,
blames the victim for not being a lawyer, medical professional, or a top
scientist, and would presume there are lawyers and doctors everywhere who
support perfection, and not their own self-interests, can practice in Federal
Court, who understand a variety of problems, and like to work for free.
That is not likely to happen in the expensive Bay Area.
The Nexus of a Pattern of Political Influence of
Executive Branch:
This case may involve at least one victim, Jan L. Carroll, who had
a suppressed memory of Ritual Human Sacrifice cult, allegedly a daughter of an
engineer, (Carroll’s who seems to now have had at least 18 addresses in
Ashland, Oregon according to ussearch.com); Jan L. Carroll went to Mary E.
Wheeler, MS MFT of Santa Clara, CA, claims Norma Withrow (who claims she was the daughter of former U. S. Treasurer Mary E.
Withrow), Carroll’s
former roommate and also a Wheeler patient.
Withrow claimed Wheeler wasn’t very good. Norma alleged she opened Carroll’s medical
statements, and saw that Carroll had been given a partial hysterectomy,
believed Carroll had a possible prolapsed rectum, and also alleged Carroll put
her head through a door and needed to wear a halo, Carroll had a multiple
personalities, and was a forced birth on father’s day or her father’s
birthday. Norma alleged that Jan
Carroll claimed THAT SHE WAS RECOVERING HER MEMORY AND FINDING HUMAN REMAINS,
and that in the 1990’s there were 300 members in the cult, which may suggest
the cult is centered in the computer industry and that there may be some
systemwide abuse in the computer industry, or in the Silicone Valley and the
dominant political parties, and whom and what they support! NORMA told me she REPORTED the Ritual Human
sacrifices TO A STATE LAW ENFORCEMENT OFFICER AFTER I CONTACTED STATE ATTORNEY
GENERAL GERALD BROWN. Mary Christian
Erickson who claims to be conserved in Santa Clara County (SHE TOLD ME SHE SOLD
A CURVED KNIFE TO AN UNSTABLE PERSON) also alleges that ritual human sacrifice
was witnessed by two persons who identified some local politicians from photos
she selected off the web after one claimed one was a local politician
(allegedly San Mateo Supervisor Niven beheaded a person with a sword, and the
most prized human sacrifice is a red haired female because that is most rare
coloring). RICO AND THE FALSE CLAIM ARE ESPECIALLY
GEARED TOWARDS FEDERAL HEALTH INSURANCE FRAUD AS SEEN IN HUMANA
INC. V. FORSYTH 119 S. Ct. 710, 719 (1999) unanimously affirmed.
“Because RICO
advances the State’s interest in combating insurance fraud,
and does not frustrate any articulated Nevada policy, we hold that the
McCarran-Ferguson Act does not block the
respondent policy beneficiaries’ recourse to RICO
in this case”. UNITED STATES OF AMERICA v. STACY
LYNN MALONE UNITED STATES COURT OF APPEALS TENTH CIRCUIT No. 99-5201 argues Hobb's Act does not require a
showing of a substantial effect on interstate commerce (http://www.kscourts.org/ca10/cases/2000/08/99-5201.htm
this citation likely is not needed in this case because health care costs are
usually the largest part of both the State and Federal budgets): “We do not believe that either of these decisions
affect this court's prior holding that only a de minimis showing is required
under the Hobbs Act. “ MUSCARELLO
v. UNITED STATES 118
S. Ct. 1911, 1913 (1998) , affirmed the nexus elements of a crime showing a
“relation[ship]” needed for RICO definition: “A provision in the firearms chapter of the federal criminal code
imposes a 5-year mandatory prison term upon a person who ‘uses or carries a
firearm’ ‘during and in relation to’
a ‘drug trafficking crime.’… For these reasons, we
conclude that the petitioners’ conduct falls within the scope of the phrase
‘carries a firearm.’” Dilantin was forced upon the
Plaintiff due to theft by Rock Star David Lee Roth of Naatz’s misprescribed
Dilantin, excessive false advertising AND IMPROPER WARNINGS ABOUT Dilantin as
improper alcohol treatment RESULTING IN a 75% off label use of anti-seizure
drugs, which Roth put in the hot water container at Safe Harbor Shelter,
amounting to a pattern of fraud and extortion, in violation of the Hobbs Act
and California Penal Code §§ 518-20 and 523 which read as
follows, and Political intimidation, government subsidized Medical Malpractice,
as a consistent scheme would be in violation of supra “518. Extortion is
the obtaining of property from another, with his consent, or the obtaining of
an official act of a public officer, induced by a wrongful use of force or
fear, or under color of official right.” In part using fear-induced medical
malpractice as defined by expertlaw.com:
“Medical malpractice, sometimes
referred to as medical negligence, occurs when a health care provider violates
the governing standard of care when providing treatment to a patient, causing
the patient to suffer an injury. Medical malpractice can result from an action
taken by the medical practitioner, or by the failure to take a medically
appropriate action. Examples of medical malpractice include:
·
Misdiagnosis of, or failure to diagnose , a disease or medical condition;
·
Failure to provide appropriate
treatment for a medical condition;
·
Unreasonable delay in treating a
diagnosed medical condition[.]”
would be in violation of: supra
“519. Fear, such as will
constitute extortion, may be induced by a threat, either: 1. To
do an unlawful injury to the person or property of the individual threatened or
of a third person…3. To expose, or to impute to him or them any deformity,
disgrace…”; Pfizer
knows Dilantin causes extreme medical complications, which would be in violation of supra “520. extort[ing]s any money or other
property from another…by means of force, or any threat, such as is mentioned in
Section 519, shall be punished by imprisonment in the state prison for two,
three or four years”. Therefore, the mismanagement rate in health
care can be easily be anywhere of 100% to even over 1,000,000% for extreme
complex cases, especially brain cancer cases, and may have an inflation rate of
18% may actually reflect the litigation expense, which is still likely far too
low. This mismanagement rate directly effects government and expenses of
insurance companies thereby is reflected in all costs of government and
businesses; health care generally is one of the largest portions of the Federal
budget and State of California budget so it both indirectly and directly
affects interstate and world commerce partly because disease, pollution or
poisoning of the ecological cycle easily crosses national boundries. For
example, previously the Bald Eagle, the national bird, almost went extinct due
to its egg shells breaking due to poisoning by DDT. Therefore, BROADLY the
Health Care issues in this case, especially due to all the National or
International touring travel Rock Star David Lee Roth does, meet the definition
of TITLE
18 USC § 10 which would be in violation of supra “523. Every person who, with intent to
extort any money or other property from another, sends or delivers to any
person any letter or other writing…expressing or implying, or adapted to imply,
any threat such as is specified in Section 519, is punishable in the same
manner as if such money or property were actually obtained by means of such
threat.” Obtaining State and Federal funds under false pretenses satisfies the pattern
and nexus elements of a crime substantially impacting Interstate Commerce
because at least over $900 million dollars of Anti-Epileptic drugs are misprescribed
due to off label sales; this meets the relationship needed for RICO definition
for the additional RICO elements of fraud and extortion because rock star seems GUILTY OF A
PATTERN OF POLITICAL INTIMIDATION AND/OR POLITICAN INFLUENCE BECAUSE HE perhaps
also in the water container that caused Senator Hillary Clinton and her staff
to become ill; WAS previously was unprosecuted for spraying booze on his
audience as piss from Devil gargoyles which he admits to in his book Crazy from the Heat, performed
"Jump" with the Boston
Pops Symphony Orchestra on July
4th, 2004 –traditionally the artist is the choice of the US President, and Bush
was the U S President at that time; and allegedly Dave has been in contact with
president Bush, and Lusher of Labproductions.com alleged that he witnessed Bush
and Roth in compromising positions, and Lusher has also alleged he has
compromised himself. Therefore, both the
Democrats and Republicans at executive level may be controlled by David Lee
Roth and his family that is prominent within the medical establishment; it also applies to the standard of Youngberg v. Romeo, 102
S. Ct. 2425, 2462-63 (1982): “We repeat that
the State concedes a duty to provide adequate food, shelter, clothing, and
medical care…In this case, we conclude that the jury was erroneously instructed
on the assumption that the proper standard of liability was that of the Eighth Amendment.””David Lee Roth using Pfizer’s drug Dilantin attempted to
control and enslave Tanis Jocelyn Watt, and also used extortion (defined DUHAIME'S ONLINE LEGAL DICTIONARY
as “Forcing a person to give up property in a thing through the use of
violence, fear or under pretense of authority.”) or broadly defined as fraud by asosai.org as
“gaining of an unfair or unjust advantage over another” and in violation
of The Preamble and Amendments 14
Sections 1, 13, 8 of the United States Constitution; the government
should apply the progressive evolving standard of mandating the reduction of the
various costs shifted on to the government by more broadly defined as done by
reducing “the unnecessary and
wanton infliction of pain[.]” Estelle
v. Gamble, 429 U.S. 97, 102-03 (1976), 97 S.Ct. 285, 290, usually caused by promoting hate, violence, addiction, fraud, extortion, abuse and/or waste
within government-funded entities, which reflects the intent of the Preamble of
the U.S. Constitution of “promot[ing]
the general Welfare” by constantly increasing the evolving domestic standards and by
NOT denying Watt the “Blessings of Liberty…Domestic Tranquility…a more perfect Union”; “evolving standards”
is again mentioned in “the evolving standards
of decency that mark the progress of a maturing society,” supra Estelle v. Gamble; for example, the children borne with
birth defects due to the use of Dilantin, which is often unnecessary, worst
practices; even more shocking was that high-priced private software was used by
the county, rather than Federal government contractor software with Federal
government oversight and allowed audits without the need for a court order for
Medicare and/or Medi-cal claims processing, and that the county was denied
about $10 million per year in Federal Funds for using their private software
that tends to lead to the impoverishment of the government and reduced jobs and
services for employees and taxpayers! The 14th Amendment (
TITLE 18
USC CHAPTER 41 § 875 defines extortion as: “(d) Whoever,
with intent to extort from any person, firm, association, or corporation, any
money or other thing of value, transmits in interstate or foreign commerce any
communication containing any threat to
injure the property or reputation of the addressee or of another…” promoting
targeting alcoholic for off label Dilantin sales likely falls under
wikipedia.org definition of:
The Civil Rights Act of 1871, also
known as the Ku Klux Klan Act of 1871, now codified and known as 42 U.S.C. § 1983 "1) 'to override certain kinds of state laws';
2) to provide 'a remedy where state law was inadequate'; and 3) to provide 'a
federal remedy where the state remedy, though adequate in theory, was not available
in practice.'" Blum & Urbonya, Section 1983 Litigation, p. 2 (Federal
Judicial Center, 1998) (quoting
The Israel-Egypt Peace Treaty seems to contain language that would prevent cost shifting to the government using wrongful
warnings about Dilantin could be perceived as: “organizing, instigating, inciting, assisting or participating in acts
or threats of belligerency, hostility, subversion or violence against the other
Party”; The
cost-shifting to the government are substantial regarding alcoholics using
Dilantin as seen in NEDER V. UNITED STATES 119 S. Ct. 1827,
1844 (1999) suggests the material omissions about the dangers
of Dilantin likely consistently result in mis-prescriptions, dangerous
and least favorable medical practices: “Accordingly, we
hold that materiality of falsehood is an element of the federal mail fraud,
wire fraud, and bank fraud statutes.” The following statistics from seem
to reflect the same truth that there is a health care fraud pandemic that
resembles genocide, in Global Corruption Report 2006 by German anticorruption
transparency.org:
Corruption in health care: Theft, bribery and extortion robs
millions of health care dollars each year while deaths are caused by counterfeit
drug use, drug-resistant disease and inability to pay bribes…[E]ach year at
least 5% of the US$3 trillion spent on health services worldwide are lost to
corruption.
The
website sciencedaily.com reports that a substantial amount of persons are
misdiagnoised with seizure disorder: “Up to 30
percent of those diagnosed with epilepsy don't actually have the disorder. They
have psychological nonepileptic seizures, or psychogenic seizures, that are
caused by psychological conditions, not by the abnormal electrical activity in
the brain that causes epileptic seizures.” The following report by
suggests misdiagnosis of epilepsy can cost the government about substantial
amount of money in healthywomen.org:
“A trio of new studies, in the June
issue of Neurology, explore the issue of psychogenic non-epileptic
seizures (PNES), which affect between 5 percent and 20 percent of people thought to have
epilepsy…Side effects from these medications and treatments can be significant
and the costs extremely high. In his editorial, LaFrance estimated that the
expense of repeated medical tests and treatments for PNES may run as high as $900 million annually in the
Restating the problem, the usually highly respected
jama.ama-assn.org by S. S. Dikmen, N. R. Temkin, B. Miller, J. Machamer and H. R. Winn article Neurobehavioral
effects of phenytoin prophylaxis of posttraumatic seizures Vol. 265 No. 10,
March 13, 1991 writes the in a clinical trial
Dilantin only worked for two weeks and in some it had negative
value:
In order to determine potential negative neurobehavioral
effects of phenytoin given to prevent the development of posttraumatic
seizures, 244 subjects were randomized to phenytoin or placebo. They received
neurobehavioral assessments at 1 and 12 months postinjury while receiving their
assigned drug and at 24 months while receiving no drugs. In
the severely injured, phenytoin significantly impaired performance at 1 month...We conclude that phenytoin has negative cognitive
effects. This, combined with lack of evidence for its
effectiveness in preventing posttraumatic seizures beyond the first week,
raises questions regarding its use for long-term prophylaxis.
http://www.ascp.com/publications/tcp/1996/aug/pkaanhr.html
claims an association with phyentoin and elevated liver enzymes: “A total of 74
residents receiving phenytoin therapy were monitored over 32 months; 38 residents
were eventually excluded from the final analysis because of decreased renal
function, elevated
liver enzymes.” Misprescribed anti-seizure drugs is normal at about 75%
according the article “Off-label scripts a growing problem”, Chain Drug Review,
[T]he basic purpose of the 1986
amendments was to make the FCA a “more useful tool against fraud in modern
times”…Local governments now often administer or
receive federal funds.
Discrete
covert criminal acts forbidding travel to support criminal activity, such as
selling unnecessary drugs, misuse of federal funds met the standard in UNITED
STATES OF AMERICA v. ROBERTO
BARRIO UNITED STATES COURT OF APPEALS TENTH CIRCUIT D.C. No. 00-CR-25-R published as http://www.kscourts.org/ca10/cases/2002/03/00-6387.htm
which argued the “superseding convictions” of multiple conspiracies confirmed
that the Travel Act convictions:
Elsa Barrio appeals her convictions on Counts 1
(conspiracy), 4 and 5 (interstate travel)
of the superseding indictment. Counsel asserts two grounds for reversal: (1)
"[a]n impermissible variance existed between the indictment, which charged
a single conspiracy, and the proof at trial which established the existence of
multiple conspiracies;" and (2) "[t]he 'Travel Act' convictions must
be reversed because the government failed to allege an overt act in furtherance
of illegal activity performed after the interstate travel which is an essential
element of the crime." We are not
persuaded by either argument…Count 1 charged a single conspiracy with multiple
objectives, which is permissible. See
UNITED
STATES OF AMERICA v. SHAWN P. WILLIAMS, No. 02-1519 UNITED
STATES COURT OF APPEALS TENTH CIRCUIT argues omissions of warnings in drug
warning labels and/or Internet advertising, or by Federal Funded medical
practitioners (http://www.kscourts.org/ca10/cases/2004/07/02-1519.htm):
To convict a defendant for mailing
threatening communications under § 876, the government must prove that the
defendant authorized or knowingly caused the threatening material to be
mailed.” See
Evans
v. United States 112
In a two count
indictment, petitioner was charged with extortion in violation of 18 U.S.C. § 1951 and
with failure to report income in violation of 26 U.S.C. § 7206(1)...The Court of Appeals held, however, that
"passive acceptance of a benefit by a public official is sufficient
to form the basis of a Hobbs Act violation if the official knows that he is
being offered the payment in exchange for a specific requested exercise of his
official power. The official need not take any specific action to induce the
offering of the benefit.
UNITED
STATES OF AMERICA v. LYNDON BAINE BENJAMIN United States Court of
Appeals For the First Circuit No. 00-1059 (http://www.ca1.uscourts.gov/pdf.opinions/00-1059-01A.pdf)
is similar in that the Dilantin was
likely paid for using either State and/or Federal funds, and Safe Harbor
Shelter is also funded through Federal Block grants: “the bank is federally insured, suffices to satisfy the requirement
that the transactions had at least a minimal impact on interstate commerce. See
United States v. Ford, 184 F.3d 566, 584 (6th Cir. 1999)
(construing 18 U.S.C. § 1956 and § 1957).” In UNITED STATES COURT OF APPEALS
FOR THE FIRST CIRCUIT No. 94-1852 (http://www.ca1.uscourts.gov/cgi-bin/getopn.pl?OPINION=94-1852.01A)
UNITED STATES OF AMERICA v. JACK BLACK interstate commerce was affected
by the movement of stolen goods which compares to the misuse and/or theft of
government health care and/or Federal block funds and or the sale of Dilantin
across state lines and sending profits from sales to another state or country
is similar to: “charged him with receiving,
concealing and disposing of a shipment of stolen…merchandise moving
in interstate commerce … and of knowingly possessing stolen goods
comprising part of the same shipment. 18 U.S.C. § 2315…” Holmes
v. Secs. Investor Protection Corp. 112 S. Ct. 1311, 1327 (1992)
should also apply to the beneficiary rights in publicly funded health care
situation, insurance, Medi-cal, and/or Medicare as follows: “RICO plaintiffs alleging predicate acts of
fraud in the sale of securities need not be actual purchasers or sellers of the
securities at issue.”
Amisys Synertech, Inc. intentionally makes an untrue representations about an important facts:
Cathe Periera WHO HAS COMMON
ILLNESSES claims she went from 18 drugs (she recently told me that the Drug
Enforcement Agency will no longer allow her to have painkillers due to a drug
diversion action) allowed by the Health Plan of San Mateo using Amisys Synertech, Inc software to
3 (three) when she spent over a month at Mills Peninsula Medical foundation
with same diagnosis! MORE IMPORTANTLY,
ANNETTE WHO told me she VOLUNTEERS FOR THE CHIEF OF STAFF AT STANFORD MEDICAL
CENTER ON TUESDAYS on Mon, 03 Jul 2006 alleges that Dr. Charles Fracchia that
uses Health Plan of San Mateo using Amisys
Synertech, Inc software misprescribed a beta blocker for a chronic
Pulmonary Obstructive Disease patient (alleged her boyfriend and adopted son of
the former head of Pathology at Stanford University Medical Center). Dr. Charles Fracchia was formerly head of the
Department of Primary Care of San Mateo General Hospital with eleven years of
experience in evaluating disability applications for San Mateo County, will
continue to evaluate disability applications for San Mateo following his
retirement from the San Mateo County Hospital recently recused himself from
Marilyn Davis disability case in San Mateo and seems to have been sued by his
former wife for possible failure to pay child support twice IN THE LAST 7
YEARS; furthermore, San Mateo county seems to be setting up many alternative medical
programs so patients can avoid their practitioners at their own hospital.
It seems that Amisys Synertech, Inc’s software
is not actually saving STATE OF CALIFORNIA and the Federal governments a combined $30
million a YEAR and if the county were to terminate its
contract with the health plan, it could receive up to $10 million per year in
extra Federal funds according to http://www.examiner.com/a-91001~Insurance_plan_nearly_broke.html;
This is because it is primarily
reducing the amount allowed to be paid for drugs, but NOT the amount of drugs
prescribed; the Health Plan of San
Mateo reimburse
providers at 123 percent of the normal
Medi-Cal fee-for-service rate according to http://www.attachmate.com/en-US/CustomerStories/HPSM.htm, nor does it seem to be able to recognize if the
proper diagnosis is being made or proper tests done to make a proper diagnosis.;
Moreover, most of the savings seem
to be from reduced drug costs at the expense of consumer choice at the expense
of local businesses as reported on April 5, 2006 sfgate.com that:
“Burge stopped filling prescriptions Saturday for Health Plan of San
Mateo, a nonprofit, government-sponsored insurer that covers the county's
47,000 Medi-Cal patients. The decision will cost Burge about a third of his
business, or about 5,000 prescriptions and at least $150,000 in revenue a
month. But Burge says his store will go bankrupt if he continues to accept the
terms set by the health plan and MedImpact Healthcare Systems, its pharmacy
benefit management company. He estimates he's lost about $75,000 since the formula
went into effect at the beginning of the year…He said he loses about $7 per
brand-name prescription and more for generic drugs through Health Plan of San
Mateo...Burge said he had to fire four long-term employees and cut back on the
store's hours.”
Pfizer intentionally
makes an untrue representation
about important facts in
violation of (TITLE 31 U.S.C. §
3729 (7) reads “cause[d] to be made or used, a false record or
statement to conceal, avoid, or decrease an obligation to pay or transmit money
or property to the Government…(C) (b) (2) “act[ed] in deliberate ignorance of the truth or falsity of the information” and from CALIFORNIA
FALSE CLAIMS ACT § 12651 reads (8) “inadvertent
submission of a false claim to the state”…):
Pfizer
neglects to state that Dilantin, rather than Chronic Alcoholism, is more likely
to cause both liver damage and cancer. Pfizer
implies chronic alcoholics are Dilantin- or phenytoin-deficient;their
link (Exhibit 94 is http://www.pfizer.com/pfizer/download/uspi_dilantin_infatabs.pdf)
states:
“Acute alcoholic intake may increase phenytoin serum levels
while chronic alcoholic use may decrease serum levels…Patients should also be cautioned
on the use of other drugs or alcoholic beverages without first seeking the
physician’s advice… Drugs which may decrease phenytoin serum levels include:
carbamazepine, chronic
alcohol, abuse… [P]atients with impaired liver function, elderly
patients, or those who are gravely ill may show early signs of toxicity...In
acute overdosage, the possibility of other
CNS depressants, including alcohol, should be borne in mind.”
“[O]verdose” and “alcohol” mentioned above seem in conflict
with Pfizer’s Dilantin-related statements.
Restates alcoholism.about.com: “Acute alcohol consumption increases the
availability of phenytoin (Dilantin) and the risk of drug-related side effects.
Chronic drinking may decrease phenytoin availability, significantly reducing
the patient's
protection against epileptic seizures, even during a period of abstinence.”
The web site drugdigest.org WARNING ABOUT NOT MIXING
ALCOHOL AND DILANTIN (phenytoin), both which impair movement, may even be more
logical and obvious: “Alcohol can make you more dizzy, increase flushing
and rapid heartbeats. Avoid alcoholic drinks.”
Pfizer
also neglects to suggest that Brain Tumors rather than Epilepsy are likely the
cause of reduced Intelligence Quotient (IQ) in dilantin-caused birth defects
(IQ can increase after tumor is removed), and they seem to be mistaken about whether other AEDs cause a lower
rate of birth defects; moreover, if IQ is the best measurement of birth
defects rather than a mixed group of
physical birth defects, the birth defect rate is likely closer to 100 percent than Pfizer’s
warning of only 10%. According to
http://www.pfizer.com/pfizer/download/uspi_dilantin_kapseals.pdf:
“The overall incidence of
malformations for children of epileptic women treated with antiepileptic drugs
(phenytoin and/or others) during pregnancy is about 10% or two- to three- fold that in the
general population. However, the relative contributions of antiepileptic
drugs and other factors associated with epilepsy to this increased risk are
uncertain and in most cases it has not been possible to attribute specific
developmental abnormalities to particular antiepileptic drugs.”
Pfizer may be in err when they state there is no “cause and effect
relationship” with lymphomadenopathy; yet Dilantin is generally known as a
Class D drug, Pfizer acknowledges “Pregnancy Category D”.
Pfizer does not to seem to
understand how Dilantin works, or rather does not work, (higher chloride
concentrations rather than excessively high sodium concentrations may be the
cause of seizures which you can turn to page 25 to see the research about that)
in their link www.pfizer.com/pfizer/download/uspi_dilantin_kapseals.pdf Pfizer only
states that “[p]ossibly…reduce[ed] sodium gradient”
reduces “excessive stimulation” quoting:
“Possibly by promoting sodium efflux from neurons,
phenytoin tends to stabilize the threshold against hyperexcitability caused by
excessive stimulation or environmental changes capable of reducing membrane sodium
gradient.”
http://www.emedicine.com/emerg/byname/toxicity-phenytoin.htm
may erroneously explain: “Phenytoin blocks voltage-sensitive sodium channels in neurons.”
http://www.elephantcare.org/Drugs/phenyto.htm
warning is better than Pfizer’s:
Some data suggest that additive hepatotoxicity may
result if phenytoin is used with either primidone or Phenobarbital...
This list includes only agents used commonly in small animal
medicine, many more agents have been implicated in the human literature: The
following agents may increase the effects of phenytoin: allopurinol, cimetidine,
chloramphenicol, diazepam, ethanol, isoniazid, phenylbutazone, sulfonamides,
trimethoprim, valproic acid, salicylates, and chlorpheniramine. The
following agents may decrease the pharmacologic activity of phenytoin: barbiturates,
diazoxide, folic acid, theophylline, antacids, antineoplastics, calcium
(dietary and gluconate), enteral feedings, nitrofurantoin, and pyridoxine. Phenytoin may decrease the
pharmacologic activity of the following agents: corticosteroids,
disopyramide, doxycycline, estrogens, quinidine, dopamine, and furosemide. Phenytoin may decrease the
analgesic properties meperidine, but enhance its toxic effects. The
toxicity of lithium may be enhanced. The pharmacologic effects of primidone
may be altered. Some data suggest that additive hepatotoxicity may result if phenytoin is used with either primidone
or phenobarbital…Liver function tests should be monitored in patients on
chronic therapy as hepatotoxicity (elevated serum ALT, decreased serum albumin,
hepatocellular hypertrophy and necrosis, hepatic lipidosis, and extramedullary
hematopoiesis) has been reported.
The Proper Warning May Actually Be:
DILANTIN IS A DRUG OF LAST RESORT THAT MAY BE ADDICTIVE (not defined as compulsive need but as increased dosage to be effective and/or causing physical dependence) may CAUSE MUTATION, REDUCED INTELLIGENCE AND decreased COGNITIVE ABILITIES, AND PERHAPS UP TO 100 PERCENT BIRTH DEFECT RATE IF REDUCED Intelligence Quotient (IQ) IS THE BEST INDICATOR OF BIRTH DEFECTS, can cause drug induced liver disease and should not be used by those with liver disease and/or addictive personalities. When used during pregnancy, phenytoin can cause a syndromes of birth defects referred to under various names (some sources list 30-38% birth defect rate likely for syndromes of various names) that include Dilantin congenital defects, fetal hydantoin syndrome, Meadow syndrome, congenital hydantoin syndrome, Dilantin syndrome, fetal Dilantin syndrome, fetal phenytoin syndrome, and hydantoin syndrome. Varied malformations have been reported to occur because of phenytoin intake during pregnancy. Hand and foot defects include fingerlike thumbs, aplasia or hypoplasia of the distal phalanges, supernumerary phalangeal epiphyses, and clubfoot. Dilantin may cause the same symptoms it is intended to cure, can lead to possible abuse of street drugs in a downward cycle, perhaps consisting of : acute alcoholism => (=> is the symbol for leads to) low enzymes levels perhaps with fast metabolism => high Phenytoin levels => weakened liver => chronic alcoholism => high enzymes levels with slow metabolism => low Phenytoin levels => drug induced liver disease => also addicted to street drugs and/or criminal behavior to support street drugs. Dilantin likely causes loss of vitamins and minerals, low HDL, diabeties, liver disease, shrinkage of the cerebellum, cell death, mutation, cancer, tumors, birth defects. Dilantin is not for low glucose seizures or seizures caused by hypertension or excessive salt, sodium, or sodas in the diet, or due a chloride deficient diet or due to excessive stress causing the depletion of HCl in the stomach, which may result in chloride deficiency.
The untrue representation is reasonably believed by the victim(s) THAT DILANTIN IS
BENEFICIAL:
However, the common off-label
prescription for Dilantin is angermanagment as seen in the article by Matthew
S. Stanford, Rebecca J. Houstona, Charles W. Mathiasb, Kevin W. Grevea, Nicole
R. Villemarette-Pittmana and Donald Adamsc,
“A double-blind placebo-controlled
crossover study of phenytoin in individuals with impulsive aggression”,
Psychiatry Research Volume 103, Issues 2-3, 20 September 2001, Pages 193-203 as
reported in sciencedirect.com:
Abstract
The present study
examines the behavioral and psychophysiological effects of phenytoin (PHT) in
individuals who display impulsive-aggressive outbursts. In a double-blind
placebo-controlled crossover design, individuals meeting previously established
criteria for impulsive aggression were administered PHT and placebo during
separate 6-week conditions. The efficacy measures used were the Overt
Aggression Scale (OAS) and the Profile of Mood States (POMS).
Psychophysiological measures (evoked potentials) were taken at baseline and at
the end of each 6-week condition. Photic stimulation was used to evoke the
mid-latency P1–N1–P2 waveform complex. Analysis indicated a significant
decrease in the frequency of impulsive-aggressive outbursts during PHT
administration compared to baseline and placebo. Analysis of the
psychophysiological data showed significantly increased P1 amplitude and
significantly longer N1 latency during PHT administration. In addition, a
reduction in N1 amplitude during PHT administration was also suggested. These
findings indicate reparation of physiological abnormalities previously observed
in impulsive-aggressive individuals and imply more efficient sensory processing
and effective orienting of attention. Taken together, these results provide insight as to the physiological
mechanisms by which PHT serves to ameliorate.
The victim(s) relies upon
and acts upon the untrue
representation Instead of considering the following statistics, experiments,
studies, that suggest Civil Right
Violations:
Dilantin forced on prisoners or
forced into the environment by corrupt, misinforme, and/or bribed government officials, including
State or Local Government officials would likely be a Civil Rights Violation! Using harmful substances (even if
they are labeled as drugs or negative value substances with extreme side
effects) with, or without, causing economic, chemical warfare, or covert
invasion of the waterways with secreted drugs from human waste, especially done
by foreign drugs companies, suggests treason, likely would be a violation of
the False Claims Act, and if innocent classes of persons or wildlife are more
effected than others, it could be a Civil Rights Violation without informed
consent to drugging and/or poisoning. Often, better treatments using
nutrition is more effective than drugs that tend to be dangerous and/or have
side effects, which tend to suggest the treatment is improper; Off-label prescriptions
(non-FDA approved prescribing that is often encouraged by the drug
manufactures) rates run is high as 90%. http://www.atra.org/wrap/files.cgi/7963_howtortreform.html
states: “The
The notion that many medical-malpractice
lawsuits are frivolous and intended to generate undeserved riches for
plaintiffs and their lawyers isn't borne out in a new study…A review of almost
1,500 randomly selected malpractice lawsuits in the United States finds that
instances of healthy people successfully suing a doctor for malpractice are
exceedingly rare and are far outnumbered by cases in which a patient injured by
medical error goes uncompensated, health-policy researchers report in the May
11 New England Journal of Medicine...Among the plaintiffs who received
compensation were 6 uninjured people and 145
injured individuals whose injuries had not been convincingly linked to medical
error. On the other hand, 236
plaintiffs who did suffer an injury from medical error received no
compensation…"This research shows that the problem with
medical-malpractice litigation is not that too many undeserving people get
paid, but rather that not enough deserving people get paid," says Tom
Baker, an attorney at the University of Connecticut in Hartford…Nevertheless, 73
percent of plaintiffs whose claims had merit received compensation, according to the study.
That figure suggests that the fact-finding involved in litigation, although
expensive and time-consuming, "does a pretty good job of sorting out valid
from invalid claims," says Neil Vidmar, a social psychologist at Duke
University in Durham, N.C. "This is as thorough a study as has ever been
undertaken of these issues," he adds…Litigating a malpractice claim
through trial can take as long as 6 years.
The new findings indicate that streamlining the process would yield more
savings than simply capping payouts, says Studdert. He points out that in
The
These waters effect the water quality of the navigable water and thus
there is a “substantial nexus”.
According to thinkquest.org states a substantial 40% of streams samples contained
detectable concentrations of common over-the-counter drugs and break down
slowly:
"Researchers say drugs reach
rivers and streams the old-fashioned way: With each flush of the toilet, body
wastes containing traces of pharmaceuticals leave for septic tanks, which too
often leak. Or they flow through wastewater treatment facilities that don't
scrub pharmaceuticals from water...Field studies conducted at wastewater
treatment plants in California, Arizona and Texas found in their recycled sewer
water a substance called organic iodine--a chemical used in medicinal X-ray
examinations, says Joerg E. Drewes, associate director of Arizona State
University's National Center for Sustainable Water Supply. These seem to be
slow to break down in the environment; they were still found at high
concentrations in groundwater six to 12 months later...Meanwhile, in
metropolitan Kansas City, more than 40 percent of stream samples analyzed by
U.S. Geological Survey scientist Donald Wilkison had detectable concentrations
of common over-the-counter drugs--notably ibuprofen and acetaminophen--as well
as prescription medicines for high-blood pressure (diltiazem) and antibiotics
(trimethiprim-sulfamethoxazole)..."Deleterious environmental impacts are
likely, either as agents of endocrine disruption, or through direct harm to
bacterial and aquatic health," Wilkison reports.
The website statesman.com
further explains BIRTH DEFECTS ARE occurring in fish:
Scientists working on
related studies found signs that young salmon of both genders from the
Willamette River around Portland held traces of an egg yolk protein usually
found only in adult female fish beginning to develop eggs — something that
would happen if their bodies were tricked by artificial endocrine disrupters
that interfere with the systems that manage hormones.
THE FDA in
http://www.fda.gov/cder/news/thalinfo/thalfaq.htm claim only ONE DOSE OF
CERTAIN DRUGS SUCH AS Thalidomide MAY CAUSE BIRTH DEFECTS AND MANY OF THE
ANTI-EPILEPTIC DRUGS ARE SIMILAR TO Thalidomide in the nature of the birth
defects they cause partly because the various syndromes tend to look similar. Most poor people tend to be minorities, women
or children who are unable to afford bottled water, which would be one step in
preventing tap water borne birth defects. The EPA (and so should the Social
Security authorities) was allowed stop construction of a major pollutant
emitting facility permitted by a state authority, which is similar to
preventing a state to allow the pollution of the human body by the use of
federal funded drugs as seen in A.
D. E. C. v. E. P. A. 119
The
reason some of these problems are so poorly recognizable is due them happening too slowly to recognize or stop similar to the frog experiment from conservativetruth.org:
In the experiment a frog was dropped into a pot of hot (not
boiling) water. It immediately jumped out, as would any sensible frog. Then it
was placed in a pot of cool water sitting on a stove. This was more to its
liking, so it swam about and lounged comfortably. The heat was turned on and
raised very gradually. Soon it was hotter than the water in the first
experiment, but the frog didn’t jump out. This was because there was no
dramatic difference, as there had been when it was taken from room temperature
and dropped into hot water. The frog became accustomed to the increased
temperature as it was raised little by little. Before long the temperature was
so high that the frog was unable to jump out of the pot, and it died.
Peace
Treaty of Versailles (1919) ARTICLE 23 recognizes that drugs
should be controlled: “ (c) will
entrust the League with the general supervision over the execution of
agreements with regard to the traffic in women and children, and the traffic in
opium and other dangerous drugs[.]” The Convention on the Rights of the
Child, G.A.
res. 44/25, annex, 44 U.N. GAOR Supp. (No. 49) at 167, U.N. Doc. A/44/49
(1989), entered into force Sept. 2 1990 seems to concur in Article 33
states: “Parties shall take
all appropriate measures, including legislative, administrative, social and
educational measures, to protect children from the illicit use of narcotic
drugs and psychotropic substances as defined in the relevant international
treaties, and to prevent the use of children in the illicit production and
trafficking of such substances.” The
drug-obsessed culture seems to be verification of the experiment above, the
GRADUAL legal and illegal drugging of American residents seems to eventually
cost-shift as a government expense as incarceration that seems to center around
certain races, sexes, ages, and those with certain medical conditions seem to
have, which further suggests it interferes with interstate commerce in the
United States quoting from hrw.org:
Drug offenders constituted 57.8 percent of all federal
inmates…The Department of Justice estimated that 9.4 percent of all black men
in their late twenties were in prison in 1999 compared to 1 percent of white
men in the same age group.
“Studies also show that homosexual men who
have sex when drunk or high are far more likely to become infected [Human
Papilloma Virus] than those who don't.” claims fathersforlife.org. Health care access is unequal! States pcusa.org: “In 2002, 20.2 percent of African Americans and 32.4
percent of Hispanics/Latinos were uninsured, compared to 11.7 percent of
whites, according to the
http://www.nlm.nih.gov/medlineplus/ency/article/000694.htm
suggests low blood sugar may be the primary cause of most seizures and it may
be further speculated that low blood sugar (often due to drinking alcohol) also
can be due to stress:
Sometimes seizures are
related to a temporary condition, such as exposure to drugs, withdrawal from
certain drugs, or abnormal levels of sodium or glucose in the blood. In such
cases, repeated seizures may not recur once the underlying problem is
corrected.
http://en.wikipedia.org/wiki/Seizure:
Checking glucose levels,
for example, is a mandatory action in the management of seizures as hypoglycemia
may cause seizures, and failure to administer glucose would be harmful to the
patient. The site lef.org shockingly explains “Alcohol-induced hypoglycemia
can result from alcohol ingestion after fasting long enough to exhaust glycogen
stores, making liver glucose output dependent on gluconeogenesis. Hypoglycemia
can be induced by blood alcohol levels well below the legal driving limits
(Barzilai N 1999)” Duncan, J. S. (1997). "Imaging and epilepsy. [Review] [274 refs]." Brain 120(Pt 2): 339-77. states: “The hallmark of an epileptic focus is an area of
reduced glucose metabolism, identified using [18F]fluorodeoxyglucose (18FDG),
that is commonly more extensive than the underlying anatomical
abnormality.” Ng, S. K., W. A. Hauser, et al. (1988).
"Alcohol
consumption and withdrawal in new-onset seizures."
“We studied alcohol use before the onset of a first seizure in 308 patients with seizures and 294 controls. The risk of seizures increased with increasing current alcohol use…We conclude that the relation of seizures to alcohol use is dose dependent and appears to be causal, and that seizures can be interpreted as a disorder induced by the ingestion of alcohol, independently of alcohol withdrawal”
For
instance, ALCOHOLICS ARE PRONE TO HYPERGLYCEMIA; THEREFORE, IF DILANTIN PROMOTES
HYPERGLYCEMIA, IT SHOULD NOT BE USED BY ALCOHOLICS. “Hyperglycemia (high blood sugar) may
occur in people taking Dilantin, which blocks the release of insulin. People
with diabetes may experience increased blood sugar levels due to Dilantin…”
writes drugs.com/pdr/dilantin.html. Shockingly, Pfizer also advises that
there is a problem “Hyperglycemia, resulting from the drug’s inhibitory effects
on insulin release, has been reported….Phenytoin may also raise the serum
glucose level in diabetic patients.”, which
was quoted from http://www.pfizer.com/pfizer/download/uspi_dilantin125.pdf.
The website . rxlist.com/cgi/generic/phenyt_ad.htm confirms “Phenytoin may cause
increased serum levels of glucose, alkaline”.
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=387262
correlates high glucose concentrations are
associated with proconvulsant effects:
Similarly,
in the in vitro experiments, epileptiform activity was promoted by increased
and suppressed by decreased glucose concentrations. Data indicate that, in the
adult rats, high glucose concentrations are associated with proconvulsant
effects.
http://www.montana.edu/wwwai/imsd/alcohol/Jewel/nutrition/presentation/side9.htm
states HYPERGLYCEMIA
is Common due to: “1.Alcohol-induced release of adrenaline into the bloodstream
(a hormone that raises the level of blood sugar). 2.Alcohol
inhibition of the body’s response to insulin (the hormone that normally lowers
blood glucose levels).”
http://alcoholism.about.com/library/blnaa22.htm
agrees: “Hypoglycemia can occur when a fasting or malnourished person consumes alcohol. When
there is no food to supply energy, stored sugar is depleted, and the products
of alcohol metabolism
inhibit the formation of glucose from other compounds such as amino acids (7).
As a result, alcohol causes the brain and other body tissue to be deprived of glucose needed for energy and
function.”
http://www.rxmed.com/b.main/b2.pharmaceutical/b2.1.monographs/CPS-%20Monographs/CPS-%20(General%20Monographs-%20P)/PHENYTOIN.html
writes: “A small percentage
of individuals who have been treated with phenytoin have been shown to
metabolize the drug slowly. Slow metabolism may be due to limited enzyme
availability and lack of induction; it appears to be genetically determined.”
http://www.epilepsy.com/medications/a_phenytoin_seniors.html
explains: “Older people metabolize phenytoin more slowly than younger adults and
they are often more susceptible to side effects.”
http://ww3.komotv.com/global/story.asp?s=1230730
states “Reducing or eliminating alcohol use can improve fatty liver due to
alcohol toxicity… minor elevation of liver
enzyme tests.”
http://www.jeffmann.net/NeuroGuidemaps/hypoglycemia.html
concludes:
“alcohol-induced hypoglycemia in the non-diabetic patient typically follows binge drinking, by 6 - 24 hours, if the chronic
alcoholic patient also doesn't eat
food, and also has depleted hepatic
glycogen stores due to malnutrition”.
http://cheapceus.com/Alcoholism.htm states:
“Approximately 90 to 100 percent of heavy
drinkers show evidence of fatty liver, an estimated 10 to 35 percent develop
alcoholic hepatitis, and 10 to 20 percent develop cirrhosis…. The liver can metabolize
only a certain amount of alcohol per hour, regardless of the amount that has
been consumed. The rate of alcohol metabolism depends, in part, on the amount
of metabolizing enzymes in the liver, which
varies among individuals and appears to have genetic determinants. In general,
after the consumption of one standard drink (a standard drink contains about 14
grams of pure alcohol), the amount of alcohol in the drinker's blood (blood
alcohol concentration, or BAC) peaks within 30 to 45 minutes. Alcohol is metabolized more slowly than it is absorbed.
Since the metabolism of alcohol is slow, consumption needs to be controlled to
prevent accumulation in the body and intoxication.”
Dilantin
SEEMS TO PROMOTE A MORE DANGERIOUS ADDICTION THAT MAY LEAD TO CANCER. It
may be addictive, which suggests it is not a cure because “Physical
dependence does develop and may produce accentuation of
seizures in epileptics when the drug is abruptly withdrawn” writes www.rxlist.com/rxboard/dilantin.pl?noframes;read=122
http://www.pfizer.com/pfizer/download/uspi_dilantin125.pdf writes: “Abrupt withdrawal of phenytoin in epileptic patients may
precipitate status epilepticus…. There have been a number of
reports suggesting a relationship between phenytoin and the development
of…lymphoma, and Hodgkin’s disease.” CANCER IS ANOTHER
NAME FOR lymphoma, and Hodgkin’s disease.
“Phenytoin may accumulate in the cerebral cortex over long periods of time, as
well as causing atrophy of the cerebellum when administered at chronically high
levels.” declares http://the-medical-dictionary.com/dilantin.htm:
“Phenytoin (Dilantin TM) is another cause of shrinkage of the cerebellum. ‘…it
usually leads to atrophy of the entire cerebellum, not specifically the
vermis.” Restates medhelp.org: “Long-term use of Dilantin can
cause atrophy of the cerebellum and in some people can cause ataxia (or
unsteadiness).” Dilantin, alcohol, smoking all likely increase the risk
for cancer; therefore, they
likely shouldn’t be used alone or in combined according to pintnetwellness.org:
“Too much alcohol puts you at risk of cancer of
the mouth, larynx (voice box), oesophagus (foodpipe), liver, breast and maybe
bowel. Smoking and drinking together increases your risk even more. Researchers
also estimate that alcohol causes 2000 cases of breast cancer in the
The victim(s) suffers loss of money,
health, security,and/or property as a
result of relying upon and acting upon the untrue representation:
The site ibis-birthdefects.org reports suggest mutation caused by
Dilantin is possible perhaps even for adults:
Phenytoin (diphenylhydantoin, dilantin) is
metabolized by cytochrome P-450 monooxygenases to several oxidized products,
including parahydroxylated and dihydrodiol metabolities … Arene oxides, which
are reactive electrophilic compounds, are intermediates in these oxidative
reactions. If not detoxified, arene oxide metabolites can covalently bind to
cell macromolecules, resulting in cell death, mutation,
tumors, birth defects.
http://www.inchem.org/documents/pims/pharm/pim416.htm reports that since 1976 it
has been known that Dilantin can cause cancer and other systemic problems:
Phenytoin is classed as a teratogen risk factor D (Positive
evidence of human fetal risk, but the benefits from use in pregnant women may
be acceptable despite the risk)…. It seems likely that an aetiological
relationship exists between phenytoin treatment and lymphoma. There is evidence
of depressed immunological function in patients given phenytoin (Brandt &
Nilson, 1976;
Rodriguez-Garcia et al., 1991; Ishizaka et al.,1992; Kondo et al., 1994; Abbondazo
et al.,1995)…
A phenytoin hypersensitivity syndrome occurs and is characterised by hepatitis.
Overall mortality rate when liver is involved is between 18% and 40%(Harinasula
& Zimmerman 1968;
Dhar et al., 1974;
Parker & Shearer, 1979; Ting et al., 1982; Smythe & Umstead, 1989; Howard et
al., 1991,).
Furthermore, medscape.com/medline/abstract/4043024 reports:
Sister chromatid exchanges in adult epileptic patients on phenytoin therapy. Environ Mutagen. 1985; 7(5):711-4 (ISSN: 0192-2521) writes: Sister chromatid exchanges (SCE) were studied in lymphocyte cultures of 12 adult male epileptic patients on long-term monotherapy with phenytoin (PHT) and of matched controls. Significantly increased frequency of SCE was observed in the epileptic patients as a group and in almost all individuals, indicating a detectable chromosome damaging effect of PHT therapy on its human users.
The link http://www.emory.edu/WHSCL/grady/amreport/litsrch98/p981117a.html
argues that Phenytoin seems to increase seizures (seizures
secondary to alcohol withdrawal) for alcohol withdrawal in
Delanty N. Vaughan CJ. French JA., Medical causes of seizures, Lancet. 352(9125)383-90, 1998
Aug 1:
Abstract: Seizures are commonly
encountered in patients who do not have epilepsy. Factors that may provoke such
seizures include organ failure, electrolyte imbalance, medication and
medication withdrawal, and hypersensitive encephalopathy. There is usually one
underlying cause, which may be reversible in some patients. A full assessment
should be done to rule out primary neurological disease. Treatment of seizures
in medically ill patients is aimed at correction of the underlying cause with
appropriate short-term anticonvulsant medication. Phenytoin is
ineffective in the management of seizures secondary to alcohol withdrawal, and in those due to theophylline or
isoniazid toxicity. Control of blood pressure is important in patients with renal failure and
seizures. Non-convulsive status epilepticus should be considered in any patient
with confusion or coma of unclear cause, and electroencephalography should be
done at the earliest opportunity. Most ill patients with secondary seizures do
not have epilepsy, and this should be explained to patients and their families.
Only those patients with recurrent seizures and uncorrectable
predisposing factors need long-term treatment with anticonvulsant medication.
Chance JF., Emergency department treatment of alcohol withdrawal
seizures with phenytoin, Annals of Emergency Medicine. 20(5)520-2, 1991 May agrees:
“Abstract: STUDY OBJECTIVE: Prevention of recurrent alcohol withdrawal seizures
is a common emergency department problem. A prospective, randomized,
placebo-controlled, double-blind study of adequate size was designed to assess
the efficacy of phenytoin in preventing recurrence of alcohol withdrawal
seizures. METHODS: Fifty-five patients who had seized from alcohol withdrawal
were randomly assigned to treatment with IV phenytoin or placebo. Patients with
known seizure disorders and those receiving any anticonvulsant were excluded.
The study was terminated after seizure recurrence or passage of a six-hour,
high-risk seizure interval. RESULTS: Six of 28 phenytoin-treated patients
(21%) had recurrent seizures compared
with five of 27 placebo-treated patients (19%). The 95% confidence interval for
the difference in response probabilities was +16% to -20%. There was no
statistically significant difference between the response rates for the two
treatments (P greater than .05). CONCLUSION: Phenytoin does not show
significant benefit over placebo in preventing recurrence of alcohol
withdrawal seizures.”
The website www.healthsquare.com/newrx/dil1136.htm
argues Dilantin can be dangerous for those with damaged livers (alcoholics tend
to have damaged livers): “Because Dilantin is processed by the
liver, people with impaired liver function, older adults, and those who are
seriously ill may show early signs of drug poisoning…Avoid drinking alcoholic beverages while taking Dilantin.” The site healthworks2000.com claims: “Phenytoin such as Dilantin can
deplete a wide range of nutrients including biotin, calcium, folic acid,
vitamin B1, vitamin B12, vitamin D and vitamin K.” Futhermore, answers.com warns:
“Patients should not drink alcoholic beverages while taking this
medication, as phenytoin can accumulate to toxic levels in the body of
non-compliant patients.”
http://www.epilepsy.com/articles/ar_1064956631.html
suggests dilantin is the most dangerous drug to give alcoholics:
RATHER, chronic alcoholics ARE likely unable to metabolize
phenytoin due to liver damage, which likely leads to the problems similar to
the problems of chronic alcoholics. This may suggest that Phenytoin is
the most dangerous drug to give to chronic alcoholics. There are serious
flaws in the logic of urging chronic alcoholics to use Dilantin when it can
cause chronic alcoholics then to have the same illnesses that dilantin tends to
cause: drug
poisoning through cumulative use, suppressed
immune systems, cancer, liver damage, high blood sugar, physical dependence
(addiction to a drug far more dangerous than alcohol, which tends to also cause
psychological problems).
The website allexperts.com warns: “Other causes of increased HDL are:
…Regular substantial
alcohol consumption… Treatment with phenytoin.” http://janis7hepc.com/Your%20Liver%20Functions.htm
states: “Phenobarbital, phenytoin (Dilantin) and other
aromatic drugs typically cause GGT elevations of about twice normal. A mildly
elevated GGT level
is a typical finding in patients taking anticonvulsants and by itself
does not necessarily indicate liver disease.22,23” The site herbalprovider.com states medications
can cause abnormal liver enzymes levels. Examples include: “Anti-seizure medications such as phenytoin
(Dilantin)… What
are the treatment options for high liver enzymes?...
stopping certain suspected
drugs”
Scolnik D, Nulman I, Rovet J,
Gladstone D, Czuchta D, Gardner HA, Gladstone R, Ashby P, Weksberg R, Einarson
T, et al, Neurodevelopment of children exposed in utero to phenytoin and
carbamazepine monotherapy. JAMA. 1994 Mar 9;271(10):767-70 shows that clearly Dilantin exposure reduces
the IQs of children:
OBJECTIVE--To compare
pregnancy outcome prospectively after phenytoin and carbamazepine monotherapy
with outcome in matched mother-child pairs exposed to nonteratogens to evaluate
the relative fetal safety of these drugs. DESIGN--A
prospective, controlled, and blinded observational study.
PATIENTS--Thirty-six mother-child pairs exposed to carbamazepine monotherapy
and 34 pairs exposed to phenytoin monotherapy, all prospectively studied, were
compared with mother-child pairs exposed to nonteratogens. The controls were
matched for maternal age, time of consultation, obstetric history, and
socioeconomic status. MAIN OUTCOME MEASURE--The primary end point of interest
was the children's global IQ measured by either the Bayley or the McCarthy
scale according to their ages. SETTING--A teratology
consultation program and two neurology services in
Vanoverloop D, Schnell RR, Harvey EA, Holmes LB., The effects
of prenatal exposure to phenytoin and other anticonvulsants on intellectual
function at 4 to 8 years of age., Neurotoxicol Teratol. 1992 Sep-Oct;14(5):329-35. demonstrates that
ultimately IQ is a better indicator of birth defects due to Dilantin than “minor
anomalies”:
Twenty phenytoin
exposed children between 48 and 99 months of age had an evaluation of behavior
and intelligence by a single examiner who was unaware of exposure status. The
controls were 98 children identified at birth as having three or more minor
anomalies. None of the children evaluated were mentally retarded. In both, a
case-by-case comparison and a comparison of the two entire groups, the phenytoin-exposed
children had significantly lower scores for both Performance
IQ (PIQ), Full Scale IQ (FSIQ), and Visual Motor Integration Test (VMIT).
Similar abnormalities have been found in studies of animals exposed to
phenytoin in utero. These results suggest that the teratogenic effects of
phenytoin may include an effect on cognitive function.
http://www.cop.sc.edu/MyClass/400/404/404tero.pdf states that the birth defect rate is at least 30% due to exposure to
Dilantin:
Exposure to phenytoin results in a
cluster of abnormalities termed the fetal hydantoin syndrome (facial
abnormalities, growth retardation, distal nail
hypoplasia). There is a 10% risk for the
full syndrome and a 30% risk for some abnormalities. A functional
abnormality associated with exposure to phenytoin is impairment of gross and
fine motor coordination and poor communication skills in offspring 2 yrs.
post-exposure.
The government will likely need to
cover expenses for the lower IQ of dilantin- exposed children because of the increased
needs of persons with lower IQs as seen in http://www.geocities.com/rnseitz/Definition_of_IQ.html:
"People with IQs
between 75 and 90 are 88 times more likely to drop out of high school, seven
times more likely to be jailed, and five times more likely as adults to live in
poverty than people with IQs between 110 and 125. The 75-to-90 IQ woman is
eight times more likely to become a chronic welfare recipient, and four times as likely to bear an illegitimate child than the
110-to-125-IQ woman."
http://www.asam.org/publ/dilantin.htm CONCLUSIONS are:
Recommendations
for the role of phenytoin
in the management of alcohol
withdrawal for different classifications
of patients were formulated based upon available research evidence and/or the
consensus of expert clinicians.
- For patients with alcohol withdrawal syndrome and no
history of seizures, phenytoin
is not recommended as routine prophylaxis against alcohol withdrawal seizures. (Grade A
recommendation.)
- For patients with alcohol withdrawal syndrome and a
history of seizures that are not alcohol-related,
phenytoin or other
anticonvulsant therapy appropriate for the seizure type, in addition to
adequate sedative-hypnotic medication, is recommended. (Grade C recommendation.)
- For patients with alcohol withdrawal syndrome and
history of alcohol withdrawal seizure, evidence
is limited and conflicting, and expert opinion is mixed as to the benefit
of adding phenytoin to
adequate sedative-hypnotic medication. Therefore, sedative-hypnotics alone
or with phenytoin are
both options. (Grade C
recommendation.)
- Long-term phenytoin prophylaxis,
except when indicated for seizure disorder unrelated to alcohol, is not recommended.
(Grade C recommendation.)
- For patients with alcohol withdrawal syndrome and
other possible epileptogenic factors: Factors that may increase the risk
of alcohol withdrawal seizures, in
addition to previous history of withdrawal
seizure, include head injury, focal brain lesion, meningitis or
encephalitis, and family history of seizure disorder. However, no
available research evidence clarifies the significance of these factors or
provides guidance for appropriate management, and there is no clear
consensus among experts. Therefore, sedative- hypnotics alone or with phenytoin are both options. (Grade C recommendation.)
- For patients with acute alcohol withdrawal seizures:
Intravenous phenytoin
is not recommended for patients with isolated, acute alcohol withdrawal seizure. (Grade
A recommendation.).)
- For patients with alcohol-related status
epilepticus: Anticonvulsant therapy, which may include intravenous phenytoin, is appropriate
for patients who develop alcohol-
related status epilepticus. (Grade C
recommendation.) …
http://www.ncemi.org/cse/cse0104.htm implores:
“do not treat alcohol
withdrawal seizures with phenobarbital or phenytoin. Both
lack efficacy (and necessity, since the problem is self-limiting) and
can themselves produce withdrawal seizures…If the seizure is clearly related to
alcohol withdrawal, ascertain why the patient reduced his consumption. He might
be broke, be suffering from pancreatitis or gastritis that requires further
evaluation and treatment, or have decided to dry out completely. If the last,
and is demonstrating signs of delerium tremens, such as tremors, tachycardia
and hallucinations, his withdrawal should be medically supervised, and covered with
benzodiazepines (e.g. Librium, Valium, Ativan). Many emergency physicians
presumptively treat alcohol withdrawal symptoms with an intravenous infusion
containing glucose,
l00mg thiamine, 2Gm magnesium and multivitamins.”
http://ostinato.stanford.edu/detox/content/5d.htm
confirms “Other agents, such as beta-blockers, dilantin, and clonidine, are
generally not considered as appropriate monotherapy for alcohol withdrawal, but
may be considered in conjunction with benzodiazepines in certain
patients.” http://my.epilepsy.com/ adds that physical dependence is
likely possible for anti-seizure medicine:
Breakthrough seizures (those which suddenly appear after
control) generally fall into one of two groups. Note: I've capitalized the name
in each group in the descriptions below.
"Some people with epilepsy find that over time they
have to take larger and larger doses of their seizure medicine to achieve the
same result. This effect is known as TOLERANCE…The other circumstance in which
tolerance can be important in the care of patients with epilepsy is what many
refer to as the "HONEYMOON EFFECT." For some individuals, the
effectiveness of medication tends to wear off over time much more than for most
other people, either because of the particular way in which their bodies
function or because of the nature of their epilepsy and its underlying causes.
These individuals often do very well with a new medication for some weeks or,
more often, some months. Then the effectiveness of the medication begins to
decrease and seizure control gradually may be lost. Many patients who are said
to have "medically refractory epilepsy" are those for whom the
honeymoon effect is most prominent. These patients often do well at first with
a new medication, an increased dose, a change or adjustment in the distribution
and timing of medicines during the day, or a new combination of antiepileptic drugs.
But after a relatively brief period-as little as a few weeks or occasionally as
long as 6 months or a year-their excellent seizure control has deserted
them."
A brain tumor likely is the
underlying cause of reduced IQ of some with epilepsy because http://www.cancer.med.umich.edu/cancertreat/brain/brain_tumor.shtm
suggests tumors (usually cancerous type) can cause seizures:
“When located in the brain, both benign and malignant tumors
are very serious. That is because as a tumor grows, pressure builds up in the
brain. This can cause frequent headaches that worsen when you lie down. Other
symptoms may include seizures,
nausea, blurred vision, sleepiness, mental impairment, personality changes, weakness on one side of the body, difficulty speaking and
loss of hearing in one ear.”
The web site http://brain.oxfordjournals.org/cgi/content/full/126/3/556
reports by A. M. Devlin, J. H. Cross, W. Harkness, W. K. Chong, B. Harding, F.
Vargha-Khadem and B. G. R. Neville, Clinical outcomes of hemispherectomy for
epilepsy in childhood and adolescence,
Brain, Vol. 126, No. 3, 556-566, March 2003 suggests brain tumors are
responsible for reduced IQ: “[C]hildren showed a >15 point improvement
in DQ/IQ following surgery and moved from the severely impaired
to the moderately impaired developmental category.”
To
further understand the reality of the situation we can see the profit motive
seems to exist less in livestock medicine as deaddoctors.com confirms:
To eliminate random mineral deficiency disease in livestock The agricultural industry
added minerals and trace minerals to feed pellets so that every mouthful the
animal consumed contained optimal levels of minerals. By contrast humans
have historically been told that "you can get everything you need from
your four food groups." You can not get everything you need from your four
food groups!...We have used the simple fertilizer NPK for over 100 years in
America for maximum yields of tons and bushels per acre, as a result our farm and range
soils are exhausted of organic material and depleted of essential minerals.
Therefore it is more important now than ever before to supplement our diets with minerals…
The Reality: Senate Doc. #264
No longer does a balanced and fully nourishing diet consist
merely of so many calories or certain vitamins or a fixed proportion of
starches, proteins and carbohydrates. "We know that our diet must
contain in addition something like a score of mineral salts."
It is bad news to learn from our leading authorities say
that 99% of the American people are deficient in these minerals, and that a
marked deficiency in any one of the more important minerals actually results in
disease. "Any upset of the balance,
any considerable lack of one or another element, however microscopic the body
requirement may be, and we sicken, suffer, shorten our lives."
Those
statistic likely do not reflect bad human medical theory and practices opposed
to better veterinarian medical theory practices according to Dr. Joel Wallach, B.S., D.V.M., N.D., is the author of numerous scientific articles,
several books, and the audio cassette, "Dead Doctors Don't
Lie." From american-longevity.com:
The reason we use nutritional formulas with
animals is that we don't have
insurance to pay for animal care. If we were to use a human health
care system for animals, there would be sticker shock, because every hamburger
would cost you $275 and ounce, just
to pay for health care…\
They actually thought in the 1970's that most cancer was due
to a virus, which is quite false. They haven't made an inch of progress
in curing cancer or treating cancer. The rate of cancers has gone up 15
to 25%. Cancer death rates have gone up 6% since 1971. So they're
now saying that this effort should be turned to prevention. Well, we've
know this since the 1950's in the animal industry! With my
patients, we've been doing things like giving large doses of the trace
mineral, Selenium, which has proven to be able to reduce your risk of
cancer from anywhere from 60-80%.
The more unconventional theories may be that the underlying
cause of seizures are due to either a
tumor (cancer) caused by mineral deficiency, such as selenium deficiency, or by
low blood sugar partly caused by STRESS, or by excessive sodium or lack of
chloride. Here is some of the SUPPORTING research
evidence:
1) Moreover, http://ods.od.nih.gov/factsheets/selenium.asp
link restates that selenium helps cure cancer:
“Selenium and cancer Observational studies indicate that
death from cancer, including lung, colorectal, and prostate cancers, is lower
among people with higher blood levels or intake of selenium [34-40]. In addition, the incidence of
nonmelanoma skin cancer is significantly higher in areas of the
Research suggests that selenium affects cancer risk in two ways. As an
anti-oxidant, selenium can help protect the body from damaging effects of free
radicals. Selenium may also prevent or slow tumor growth. Certain breakdown
products of selenium are believed to prevent tumor growth by enhancing immune
cell activity and suppressing development of blood vessels to the tumor [42].”
2) Furthermore, http://www.news.cornell.edu/releases/Jan97/selenium.ssl.html concurs that
selenium helps cure cancer:
“The University of Arizona-Cornell research team reported in
1991 that low selenium levels in the blood were linked to increased risk of
neoplastic polyps in the colon, a precursor to colorectal cancer. And in other
studies at Cornell, colleagues of Combs' reported in 1995 that animals fed
diets high in selenium had 50 percent fewer tumors than those fed diets of
average selenium content.”
3) Lack
of Chloride
and not excessive sodium is implied as a cause of seizures in www.nlm.nih.gov/medlineplus/ency/article/001424.htm:
“[C]hloride ions are required for
a muscle to relax…The abnormal chloride channels also cause
an accumulation of potassium outside the cells and an activation of sodium
channels in the muscle cells (sodium ions trigger muscle contraction). When the
cells have more than enough sodium but not enough chloride, abnormal repetitive
electrical discharges cause a stiffness called
myotonia”.
4) http://www.sciencedaily.com/releases/2005/11/051107083159.htm confirms lower chloride
concentrations in adults “inhibit[s] seizure activity”:
“GABA activation opens up channels that allow chloride to
move into the cell. The cell thereby acquires a negative charge and becomes less excitable,
inhibiting seizure activity...”
Chloride seems to have been known
since 1915 to be a cure for seizure because a French surgeon, Prof. Pierre
Delbet, M.D discovered that Magnesium Chloride
could be used to treat Parkinson's Disease, senile tremors; Parkinson's disease
is treated with two drugs that contain chloride: Chlorvescent consists of Oxybutynin Chloride
and Ditropan consists of Potassium
Chloride. This also suggests that
Chloride is the commonality to treating seizures. The article titled “MIT: Pulsing Light Silences Overactive
Neurons” with the tag of “Work could lead to non-surgical treatment for epilepsy,
Parkinson's” states “Light activates the chloride pumps, which
drive chloride ions into the neurons, lowering their voltage and silencing
their firing.” located at http://news.biocompare.com/newsstory.asp?id=176231
suggests that it is common knowledge by better scientists that Chloride is the
best treatment for both epilepsy and,
Parkinson's Disease, and LIKELY DOES NOT CAUSE SIDE-EFFECTS THAT WILL
EVENTUALLY BE COST-SHIFTED TO THE GOVERNMENT! Dilantin 100mg 84 for about $20 seems listed at CanPharm.com, Chlorinum (chlorum) 2 dram $5.29 for seems listed at homeopathyworks.com. CHLORIDE
may work for all seizures, senile tremors, even bipolar for persons who are
more aware or sensitive to danger, (which may be about stress causing the depletion
of Cl from HCl burning up in stomach during stress as part of the flight or
fright reaction similar to what may happen in Peptic ulcer disease, which is
caused by the hypersecretion of stomach acids also called Gastric acid consisting
of hydrochloric acid (HCl), and small quantities of potassium chloride (KCl) and sodium
chloride (NaCl)!
The
final argument is based on the following logic (logic is usually the best
evidence). BASICALLY, IF THE SUBSTANCE
WAS OF ANY REAL VALUE ONCE IT PERFORMED ITS VALUE, IT WOULD NO LONGER BE CRAVED
- satiation would exist. IN FACT, NEGGATIVE SYMPTOMOLOGY (increased side
effects) WOULD EXIST UPON TAKING THE SUBSTANCE. All tetragenic
medications likely produce negative symtomology (side effects). Where
this really gets more obvious is when alcoholics are given Phenytoin when
alcohol likely increases Phenytoin side effects, which resemble the side
effects of alcohol, but tend to be much more dangerous than the similar side
effects of alcohol. All tetragenic medications
are likely addictive (we will define addiction as induces dependence and
withdrawal symptoms, and not as only compulsive behavior) and/or are not a cure
and all addictive substances likely eventually cause cancer. Therefore,
epileptic patients with cancer may often be treated with a medication that may
increase their cancer, and the underlying cause of their cancer is left
untreated. This can lead to fatalities from accidents, especially
blackouts when driving due to a tumor on the optic nerve. The proper cure
is often less expensive and dangerous. This author thinks stress brings on episodic
(occasional) seizures of the low blood sugar (hypoglycemia) and high salt seizures
(hypertension) type. Seizures caused by
Brain tumors likely should be treated with selenium before considering brain
surgery. Alcohol withdrawal seizures
likely should be treated with mild sedatives or nutritionally.
THE
AUTHOR’S OPINION IS ALMOST ALL CHRONIC CARE IN THIS COUNTRY IS A NEGATIVE VALUE
SITUATION. WHAT IS REALLY unfair is SOME OF THESE PATIENTS'
CO-PAYMENT FOR DRUGS MAY COST MORE THAN IT WOULD HAVE COST FOR SUPPLEMENTS THAT
WOULD LIKELY MAKE THEIR CO-PAYMENT FOR DRUGS UNNECESSARY. BUT
PATIENTS TEND TO LIKE TO GO TO THE DOCTOR, AND THEY MOSTLY LEARN THIS FROM
WATCHING MEDICAL DRAMAS! Therefore, epileptic patients with cancer may often be
treated with a medication that may increase their cancer, and the underlying
cause of their cancer is left untreated. Some might conclude that Dilantin is
often used as a murder weapon. The med field is filled with very misguided and co-dependent
persons, this is partly due to all the political intimidation due by various
entities dependent on expensive medical treatments, or even dependent on
forming personal relationships with their patients.
Respectively
Submitted to the Court,
Signed:
Table
1: Patients with Alcohol Withdrawal Syndrome and No
History of Seizures
|
Study |
Patients |
Interventions |
Results |
Authors' Conclusions |
|
Rothstein 1973 RCT |
160 with no history of seizures admitted for detoxification (sub-group of 200 total patients). |
Control: CZX 50-100 mg PRN x 5 days. vs CZX + phenytoin 400 mg/day x 5 days. |
No seizures. No adverse outcomes. |
Anticonvulsants not needed in addition to CZX. |
|
Sampliner 1974 RPCT |
Group 2: 2200 alcoholics, free of seizures, admitted to detoxification unit. |
CZX alone. |
4 seizures. |
Phenytoin not indicated for patients without history of seizures. |
CZX =
Chlordiazepoxide RCT =
Randomized controlled trial
RPCT = Randomized placebo-controlled trial
Table
2: Patients with Alcohol Withdrawal Syndrome and History
of Seizures
|
Study |
Patients |
Interventions |
Results |
Authors' Conclusions |
|
Rothstein 1973 RCT |
40 with history ofwithdrawal seizures admitted for detoxification (sub-group of 200 total patients). |
Control: CZX 50-100 mgPRN x 5 days. vs CZX + phenytoin 400 mg/day x 5 days |
No seizures. No adverse outcomes. |
Anticonvulsants not needed in addition to CZX. |
|
Sampliner 1974 RPCT |
Group 1: 157 alcoholics with history of adulthood seizures (of any type) admitted to detoxification unit. |
Group 1A: Phenytoin 300 mg/day + CZX PRN x 5 days. Group 1B: Placebo + CZX PRN x 5 days. |
Group 1A -- Phenytoin +CZX: No siezures in first 50 hours, 2 seizures after discontinuation.Group 1B -- Placebo + CZX: 11 seizures in first 50 hours. None after 50 hours. p<.005 |
Phenytoin added to CZX significantly more effective in control of seizures in patients with alcohol withdrawal and history of seizures. |
CZX =
Chlordiazepoxide
RCT = Randomized controlled trial
RPCT =
Randomized placebo-controlled trial
Table
3: Patients with Acute Alcohol
Withdrawal Seizures
|
Study |
Patients |
Interventions |
Results |
Authors' Conclusions |
|
Alldredge 1989 RPCT |
90 with acute alcohol withdrawal seizure |
Placebo vs Phenytoin 1000 mg IV. |
Placebo: Recurrent seizures in 6 patients. Phenytoin: Recurrent seizures in 6 patients. |
IV phenytoin fails to prevent subsequent alcohol withdrawal seizures. |
|
Chance 1991 RPCT |
55 with acute alcohol withdrawal seizure. |
Placebo vs Phenytoin 15 mg/kg IV, maximum 1000 mg. |
Placebo: Recurrent seizures in 5 of 27 patients (19%). Phenytoin: Recurrent seizures in 6 of 28 patients (21%). No side effects. |
IV phenytoin fails to prevent subsequent alcohol withdrawal seizures. |
|
Rathlev 1992 RPCT |
100 with acute alcohol withdrawal seizure. |
Placebo vs Phenytoin 15 mg/kg IV. |
Placebo: Recurrent seizures in 12 patients (24%). Phenytoin: Recurrent seizures in 11 patients (22%). |
IV phenytoin fails to prevent subsequent alcohol withdrawal seizures. |
RPCT =
Randomized placebo-controlled trial
Table
4: Patients with Alcohol-Related
Status Epilepticus
|
Study |
Patients |
Interventions |
Results |
Authors' Conclusions |
|
Lowenstein 1993 RR |
39 with alcohol-related status (19 with previous alcohol-related seizures, 6 with non-alcohol seizures, 14 with no seizure history). |
Standard loading doses of either phenytoin or phenobarbital IV in addition to diazepam. |
70% of the 39 patients responded to first line therapy |
Status epilepticus precipitated by alcohol abuse and status of other etiologies both respond similarly to anticonvulsant therapy |
|
Alldredge 1994 (in press) RR |
27 with alcohol-related status epilepticus (acute intoxication or closely following cessation/reduction). |
IV phenytoin (1000 mg or more) +/- diazepam. |
Status epilepticus controlled in 18 of 27 patients (66.7%). |
IV phenytoin effective for the termination of alcohol- related status epilepticus. |
RR =
Retrospective review
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