Funny Goings-On in Norfolk
There’s some strange things happening in Norfolk and I’m more than a little concerned about what’s going on.
A phone call to the office yesterday (one of 14 we took) made me aware of some dark arts being practiced in a rural community health centre. The lady who called had been diagnosed with Pernicious Anaemia 15 years ago. Last October a new doctor at the practice told her that “new guidelines say we have to treat PA with tablets now and injections are a thing of the past”.
My spirits, which weren’t particularly high anyway began to sink.
The caller went on:
“The thing is I’m getting all the symptoms back. I’m constantly tired, I’ve got pins and needles in my feet, I’m feeling depressed and I can’t function at work”.
My spirits took another nosedive.
I asked what strength tablets she was taking and how often;
“They are 1mg Cyanocobalamin tablets and I take one three times a week”.
I asked where she got them from;
“They’re prescribed by my doctor and I take the prescription to my local chemist”.
Now this was interesting because as far as I’m aware 1mg cyanocobalamin tablets are not available as a prescribed tablet. The biggest strength available on prescription is a measly 50mcg, which is totally unsuitable for treating Pernicious Anaemia. Because oral treatment rests on the premise that around 1% should be passively absorbed in the stomach taking a full 1mg would mean that around 10mcg should be absorbed, which is four times what a normal person would need on a daily basis. I don’t want to go into the arguments against using oral tablets now but I will remind my readers what the latest Guidelines on Cobalamin and Folate say:
“the efficacy and cost–effectiveness of oral treatment in wider population-based settings has yet to be established. There are arguments against the use of oral cobalamin in initiation of cobalamin therapy in severely deficient individuals who have poor absorption, especially due to pernicious anaemia”.
I asked the caller if she was sure that it was a 1mg tablet that she got from the pharmacy.
“Oh yes, it’s 1mg. The funny thing is though that they come in a plain brown paper bag without any patient information leaflet or anything”.
See what I mean about there being funny goings-on. I shall make some more enquiries and keep you up to date.