reSee.it - Tweets Saved By @DrJaclynnMoskow

@DrJaclynnMoskow - Dr Jaclynn Moskow

When do drugs really expire? Which ones take decades to degrade? Why does the US government use secret expiration dates for pharmaceutical stockpiles — but make pharmacies & hospitals discard perfectly potent meds? I went down a wild rabbit hole for us https://t.co/ntgsYdKXWD

@DrJaclynnMoskow - Dr Jaclynn Moskow

In 2012, Dr. Lee Cantrell, a Cali pharmacist-toxicologist, finds a box of drugs that had been stashed away on a shelf for decades He wonders if any of the meds are still effective Most people stop at wonder — the scientifically-minded amongst us find a way to get an answer

@DrJaclynnMoskow - Dr Jaclynn Moskow

Dr. Cantrell hits up a UC lab for some liquid chromatography & mass spectrometry They analyze various meds that had expired 28 - 40 years prior Very cool study https://t.co/QRl2OiKvEk

@DrJaclynnMoskow - Dr Jaclynn Moskow

Study synopsis? The average % of active ingredient still present compared to decades-old label: • Acetaminophen — 100% remaining • Hydrocodone — 100% • Caffeine — 100% • Methaqualone — 100% • Codeine — 95% • Phenobarbital — 94% • Amphetamine — 49% • Aspirin — 1% https://t.co/M1N1wu9EEZ

@DrJaclynnMoskow - Dr Jaclynn Moskow

The implications of these findings received press coverage a few times over the years — but public discussion always quickly dissipates What incentive does pharma have to extend expiration dates!?

@DrJaclynnMoskow - Dr Jaclynn Moskow

Imagine how much money pharma would lose if pharmacies, hospitals, & patients were to STOP routinely trashing & replacing large quantities of Rx & OTC meds What would it take for the pharma-funded FDA to tell pharma to take that kind of monetary hit? https://t.co/8z7kz9VtvM

@DrJaclynnMoskow - Dr Jaclynn Moskow

But the reality is, for decades, the US federal government has been quietly studying the true shelf-life of medications They stockpile pharmaceuticals around the world for the military, as well as for “emergency preparedness” programs like the Strategic National Stockpile

@DrJaclynnMoskow - Dr Jaclynn Moskow

Rather than throw out stockpiled drugs on assigned expiration dates, the government tests them The Shelf Life Extension Program (SLEP) began in 1985 – a joint venture of DoD & FDA State & local governments are not permitted to participate (despite having their own stockpiles) https://t.co/arHBXtFfNt

@DrJaclynnMoskow - Dr Jaclynn Moskow

When SLEP finds that a drug is still useful, they extend the expiration date for their stockpiles — but not for us consumers In fact, they have a strict policy to never share drug testing results or extension decisions Yes, they are gatekeeping efficiency in this case Crazy

@DrJaclynnMoskow - Dr Jaclynn Moskow

~20 years back, the AMA called SLEP out In turn, SLEP released a single lone paper revealing a bit of what they know about the true shelf-life of carefully-stored pharmaceuticals This disclosure, however, flew under the radar Very few know of it You are about to be in the few

@DrJaclynnMoskow - Dr Jaclynn Moskow

SLEP divulged that they were able to extend the expiration date for 88% of 122 stockpiled drugs tested over a 20+ year period They examined & reexamined potency, pH, ability to dissolve, water content, impurities, etc Some meds tested “still good” since the program's inception https://t.co/DjO1yQ7HRF

@DrJaclynnMoskow - Dr Jaclynn Moskow

The tables in this SLEP paper are a bit tedious to digest, but I dug through them to compile us some lists In their carefully-stored government stockpiles, the following drugs NEVER failed testing: • Acetaminophen pseudoephedrine (capsules) • Amoxicillin sodium (tablets) • Amyl nitrite (inhalant) • Ampicillin (capsules) • Atropine sulfate-pralidoxime chloride (autoinjector) • Benzonatate (capsules) • Bretylium tosylate (solution) • Bupivacaine HCl (solution) • Calcium chloride (solution) • Calcium glucepate (solution) • Ceftriaxone sodium (powder)  • Cephalexin (capsules) • Chloroquine HCl (solution) • Chlorpromazine HCl (solution) • Cimetidine HCl (tablets) • Ciprofloxacin (tablets & suspension) • Dexamethasone sodium phosphate (syringe) • Dextrose 10% (solution) • Dextrose & NaCl (solution) • Diphenhydramine HCl (syringe) • Dobutamine HCl (solution) • Doxycycline hyclate (capsules & powder) • Edrophonium chloride (solution) • Enflurane (liquid) • Ephedrine sulfate (solution) • Erythromycin lactobionate (powder) • Fentanyl citrate (solution) • Guaifenesin ER (tablets) • Halothane (liquid) • Hetastarch in NaCl (solution) • Hexachlorophene cleansing (emulsion) • Hydrocortisone sodium succinate (solution) • Iothalamate meglumine (solution) • Ketamine HCl (solution) • Mafenide acetate (cream)  • Mannitol (solution) • Mebendazole (tablets) • Meperidine HCl (solution) • Mepivacaine HCl (cartridge) • Morphine sulfate (syringe) • Naloxone HCl (solution) • Naproxen (tablets)  • Neostigmine methylsulfate (solution) • Oxacillin sodium (powder) • Penicillin G benzathine (suspension) • Phenylephrine HCl (solution) • Phenytoin sodium (solution) • Potassium iodide (granules & tablets) • Povidone-iodine (ointment) • Prochlorperazine edisylate (solution)  • Promethazine HCl (solution) • Protamine sulfate (powder) • Sodium bicarbonate (solution) • Sodium chloride (solution) • Sodium nitrite (solution) • Sodium thiosulfate (solution) • Sulfisoxazole (tablets) • Triamterene & hydrochlorothiazide (capsules) • Tubocurarine chloride (solution) • Undecylenic acid & zinc salt (powder)

@DrJaclynnMoskow - Dr Jaclynn Moskow

Which drugs did SLEP find failed expiration testing more often than passed? There were only 10: • Albuterol (inhalant) • Diphenhydramine HCl (spray) • Epinephrine & lidocaine HCl (solution) • Ergotamine tartrate & caffeine (tablets) • Isoproterenol HCl (solution) • Levarterenol bitartrate (solution) • Mefloquine HCl (tablets) • Penicillin G procaine (powder) • Phenobarbital sodium (cartridge) • Physostigmine salicylate (solution)

@DrJaclynnMoskow - Dr Jaclynn Moskow

But, about epinephrine… Dr. Cantrell recently tested 40 EpiPens, 1 - 50 months past expiration All devices still contained 80%+ of their labeled concentration About half contained 90%+ I would 100%+ use an expired EpiPen if I were going into anaphylaxis & it was all I had https://t.co/WsKwPGfqsc

@DrJaclynnMoskow - Dr Jaclynn Moskow

What about insulin & nitroglycerin? Not included in the SLEP study Perhaps they didn’t want to waste resources testing meds already widely known to degrade But in an emergency, I would use those expired, too (& call for help!) https://t.co/DaQMAzmi21

@DrJaclynnMoskow - Dr Jaclynn Moskow

Quite interestingly, SLEP tested 4 drugs MUCH more often than they did any others: 1) Pyridostigmine bromide (nerve agent prophylaxis) 2) Atropine sulfate (nerve agent antidote) 3) Pralidoxime chloride (nerve agent antidote) 4) Ciprofloxacin (broad-spectrum antibiotic that can be used to treat anthrax) In fact, over 50% of ALL tests conducted in the SLEP program during the study period were on these 4 drugs! Remember, this info was published 19 years ago, during the 911-era I am grateful to learn they were protecting us in this manner (Veteran readers — ty for your service!! 🇺🇸🇺🇸🇺🇸)

@DrJaclynnMoskow - Dr Jaclynn Moskow

What did SLEP find out about antidepressant stability? Well, They didn’t report examining them at all Is this omission an indirect admission from the government? Perhaps antidepressants really aren’t important for our military & public health? I digress,

@DrJaclynnMoskow - Dr Jaclynn Moskow

You may be wondering, Say a med truly does expire & becomes less effective or ineffective — does it ever turn TOXIC? Toxicity is almost unheard of Once upon a time, I learned expired tetracycline can potentially degrade into a dangerous compound & cause kidney problems Modern formulations are now designed to prevent this — but it is still theoretically possible with tetracycline specifically There are also some theoretical reasons that the breakdown products of expired hydralazine & chlorpromazine could cause harm to the body — but there is no evidence it’s ever happened

@DrJaclynnMoskow - Dr Jaclynn Moskow

Common sense will tell us that expired liquid meds & ointments may eventually grow bacteria &/or mold Expired biologics like immunotherapies & vaccines may also pose increased risk as molecules denature / aggregate (according to… my brain) – potential for immune rxns & etc

@DrJaclynnMoskow - Dr Jaclynn Moskow

Common sense will also tell us: 1) Meds that need a “propellant”, like an inhaler, may fail to dispense over time 2) Gelatin capsules will eventually break down 3) Hard tablet pills will live the longest

@DrJaclynnMoskow - Dr Jaclynn Moskow

Yet, right now, almost all pharma meds expire within 1-3 years So what’s the deal with this seemingly arbitrary selection of inaccurate, quick expiration dates? When pharma submits a drug application to the FDA, they are required to assign an expiration date & include stability testing to show it can make it to said date Picking a far-off expiration date delays getting a drug to market, pharma would need to sit around waiting to get test results Speed is everything in business and some pharma products are legit — patients need them now vs later In theory, pharma could retest after drug approval & resubmit to extend dates But the FDA does not require that they examine stability in this way So, they don’t! Retesting costs money Extending expiration cuts into the profits that come from forcing repurchases

@DrJaclynnMoskow - Dr Jaclynn Moskow

But what about the SLEP research? Why hasn’t it led to the FDA instructing pharma to extend expiration dates? That would be too logical SLEP uses their data to extend expiration in their stockpiles only https://t.co/QXwyIEWA2t

@DrJaclynnMoskow - Dr Jaclynn Moskow

Extensions for “the rest of us” come from pharma’s testing data, not SLEP’s This will generally only happen if pharma can’t keep up with demand in an ~emergency~ Examples: • EpiPens in 2019 • Tamiflu per 2010 Swine Flu • COVID vaccines during the marketing of a pandemic

@DrJaclynnMoskow - Dr Jaclynn Moskow

But most of time, pharma can easily meet demand & perpetually supply new batches and make new sales The result? Hospitals, pharmacies, & patients collectively spend billions of dollars per year replacing perfectly potent, safe, useful drugs — prescription & over-the-counter

@DrJaclynnMoskow - Dr Jaclynn Moskow

It’s illegal to export expired drugs — so donating them to countries in crisis isn’t permitted The lol-WHO even issued an instruction manual on how to dispose of drug donations, including those “near expiry date”

@DrJaclynnMoskow - Dr Jaclynn Moskow

There have been documented instances in which the unavailability of certain antibiotics led to the prescribing of broader-spectrum ones – which, in turn, led to increased antibiotic-resistant strains appearing in hospitals & communities Disastrous & unnecessary

@DrJaclynnMoskow - Dr Jaclynn Moskow

So, should the incoming FDA revisit pharma med expiration dates? Our tax dollars have already funded decades-long research on this matter SLEP has many of the drug-stability answers we need Pharma prefers they continue to keep those answers to themselves Lmk what YOU think

@DrJaclynnMoskow - Dr Jaclynn Moskow

Link to share from top —

@DrJaclynnMoskow - Dr Jaclynn Moskow

When do drugs really expire? Which ones take decades to degrade? Why does the US government use secret expiration dates for pharmaceutical stockpiles — but make pharmacies & hospitals discard perfectly potent meds? I went down a wild rabbit hole for us https://t.co/ntgsYdKXWD

@DrJaclynnMoskow - Dr Jaclynn Moskow

Which pharmaceuticals, medical devices, & surgical procedures have the LARGEST dedicated online communities of patients reporting harm? I obsessively & autistically dug into it — so that you don’t have to! (Research thread) ↓↓↓ https://t.co/3WAtivYnge

@DrJaclynnMoskow - Dr Jaclynn Moskow

To locate patient harm communities, I extensively & repeatedly searched Google, FB, Reddit, 𝕏, & my brain, plus prompted AI, & also reached out to harmed individuals / community leaders I used these intensive search tactics for all categories represented in this analysis — & for countless others that did not make the cut (due to a lack of communities, or minuscule-sized ones) More about my research methodology & segmentation as I delve into specific categories of results ↓↓↓

@DrJaclynnMoskow - Dr Jaclynn Moskow

FIRST PLACE: COVID-19 vaccine harm communities 456,000+ membership sign-ups I found more patient harm communities specific to COVID vaccines than I did for any other medication, product, or procedure These communities are concentrated on the FB platform, where I identified 124 active COVID vaccine harm support groups, with combined memberships totaling over 440,000 You may be thinking, “some people will join multiple groups, so that total membership number may be inflated” — this is true for all items in this thread & therefore does not significantly distort comparisons — if anything, repeat joiners underscore the gravity of the harm / impact a given intervention has on those affected Somehow, it does not appear that FB is currently putting forth major effort into censoring COVID vaccine harm groups — I was able to locate them fairly easily, and Google is even indexing some of them Most of such groups are “closed” & require an application to join — this helps prevent bots & maintain privacy Some may say, “not everyone in those communities is truly vaccine injured!” — and I would say — how do you know?  I am merely reporting the (startling) group membership numbers that I found — not playing the “true harm” police Some key search terms to locate these support groups include “COVID vaccine” AND “side effect” “adverse reaction” “injury” “harm” “victim” AND/OR “name of specific pharmaceutical company” “name of specific adverse event”, etc To be clear, I ONLY tabulated groups that speak explicitly to vaccine injury / harm as defined by their group title / description / posts I did NOT include the many groups with themes such as “anti-vax” “unvaccinated” “vaccine free” “recipient” “fight” “truth” “information” “discussion” “awareness” “questions”, or even “vaccine experience”  – nor did I include groups about the disease / syndrome of COVID I also did NOT include most “d*ed suddenly” groups, as most do NOT appear to be support communities, but are instead sensationalized & speculative and I did NOT include groups in which the topic is general vaccine harm that encompasses multiple vaccine types or a specific, non-COVID vaccine — that data is in a separate category of this analysis All groups that I included use at least one search term in English in their title and/or description — this is true for the COVID vaccine harm category & every other category in my study Outside of the many FB groups, other support options for COVID vaccine injury include: Subreddit: r/vaccinelonghauler 𝕏 community: Storiesofinjury I discovered SO MUCH about SO MUCH by investigating these communities – which I will report on further, over time One observation — many Australians & Canadians are PISSED ↓↓↓

@DrJaclynnMoskow - Dr Jaclynn Moskow

SECOND PLACE: Prescription opioid harm communities 380,000+ membership sign-ups *I am not anti-opioid, they are an extremely useful tool when used with precision, & I actually believe they are TOO hard to obtain in 2024 Nevertheless, there was a period of time during which they were wildly easy to obtain — in fact, when I began medical school in 2008, there were more pill mills around town in Broward County, Florida, than there were McDonalds If you are younger, you may not know this, but back in the 90s many physicians fully believed & told patients that Rx opioids were non-addictive (because, well, that is what pharma claimed & marketed) There are thus countless support communities for harm caused by prescription opioid use (& in many cases, misuse) Calculating group membership numbers for these medications was more complicated than for any other item in my study FB banned many prescription opioid harm groups due to drug sales — so entire communities were erased & not included in my total — additionally, other online forums were closed over the last few years per similar concerns To further complicate matters, these days, it is hard to find communities dedicated to prescribed-only opioid harm — most groups & forums are now geared towards “street use” — which often began as prescribed Nevertheless, I did some major autistic analysis to estimate membership across online support forums for Rx harm & it’s certainly in the hundreds of thousands You may argue that if someone is prescribed an opioid, and eventually decides to source it illegally, they are not iatrogenically harmed Or you may not argue that There is grey area in this topic matter, but it would be inappropriate to leave opioids off this list while including benzos — and it would be inappropriate to leave benzos off, but include SSRIs — and it would be inappropriate to leave SSRIs off, yet include other non-psych med pharmaceuticals — see the slope? Some examples of active communities in which members support each other as they speak to opioid harm, addiction, withdrawal, recovery: r/OpiateRecovery r/NarcoticsAnonymous FB NA groups Intherooms Soberrecovery Examples with a bit more of a focus on active use / harm reduction: Bluelight Drugs-forum It is unfortunate that someone who feels overwhelmed by a current & legit opioid prescription can no longer find a dedicated community, and is left only with forums that are heavy on illegal use — but this is where we are at ↓↓↓

@DrJaclynnMoskow - Dr Jaclynn Moskow

THIRD PLACE: Breast implant harm communities 345,000+ membership sign-ups This number was derived by totaling membership of all FB groups for breast implant complications / illness I found dozens of groups on FB for this topic — there do not appear to be any large communities or forums elsewhere, all internet roads lead back to FB for this one One very active & well-known FB group — Breast Implant Healing and Illness By Nicole – has an astounding 193K members Symptoms of breast implant illness may include autoimmune reactions, increased allergies, rashes, swollen lymph nodes, frequent infections, chronic fatigue, brain fog, joint & muscle pain, hair loss, headaches, mood disruptions, insomnia, endocrine dysfunction, GI issues, tingling / numbness in extremities, shortness of breath, & more Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) is also a risk — particularly with textured implants ↓↓↓

@DrJaclynnMoskow - Dr Jaclynn Moskow

FOURTH PLACE: Intrauterine device (IUD) harm communities 210,000+ membership sign-ups This number was derived by totaling all injury, support, & side effect FB groups for IUD harm Some discussion of IUD harm can also be found across various birth control Internet forums – but dedicated IUD support communities are primarily contained to FB, as far as I could find Mirena is the most commonly cited IUD associated with harm — but there are women in these groups representing all IUDs on the market The body often doesn’t like foreign material inserted into it… “Cite your source for that statement!” No ↓↓↓

@DrJaclynnMoskow - Dr Jaclynn Moskow

FIFTH PLACE: SSRI / SNRI harm communities 176,000+ membership sign-ups There are 64,000+ membership sign-ups to FB groups related to SSRI harm & withdrawal Some FB groups are generalized to any/all SSRIs, while other FB groups are drug-specific I investigated groups for all SSRIs on the market While I only counted membership sign-ups for HARM-specific groups, it is worth noting that there are also MANY members of generalized drug side effect discussion groups who feel harmed In terms of SNRIs, there are several FB groups for duloxetine & venlafaxine harm, with membership totaling 47,000+ SurvivingAntidepressants(dot)org has 20,000+ members PSSD Network subreddit has 14,300+ members (PSSD = Post-SSRI Sexual Dysfunction) Plus, there are other, smaller forums & threads for SSRI / SNRI harm – including psych med harm discussions in general mental health online communities — and many conversations specific to a given drug The majority of members of SurvivingAntidepressants(dot)org are there for SSRIs/SNRIs as opposed to other types of antidepressants — but not all Similarly, a subset of r/PSSD joined for finasteride harm as opposed to SSRI/SNRI harm I accounted for the above facts, but they are near-negligible I have been investigating psych med harm for over a decade, and I am as close to “sure” as one can be that these communities only represent a tiny, tiny fraction of the total number of patients harmed by these drugs ~ Just the tip of the iceberg ~ You can find more about this topic on the highlights section of my page — and much more is to come from me about this, so follow my account if interested ↓↓↓

@DrJaclynnMoskow - Dr Jaclynn Moskow

SIXTH PLACE: Benzodiazepine harm communities 161,000+ membership sign-ups *I am not anti-benzo, these medications can be a g-dsend short term Benzobuddies(dot)org withdrawal support & more forum has 34,000+ members Subreddit r/benzorecovery has 43,000+ members FB groups about benzo harm total 45,000+ members There are also benzo-specific support containers on various substance use forums across the internet ↓↓↓

@DrJaclynnMoskow - Dr Jaclynn Moskow

SEVENTH PLACE: Botulinum toxin & dermal filler harm communities 152,000+ membership sign-ups  Many FB groups combine Botulinum toxin harm with dermal filler harm — so, our data reflects this combination as well I looked into this topic “late” in my research process, as I did not anticipate finding a large number of membership sign-ups But alas, there are oh-so-many people with Botulinum toxin & filler horror stories (and photos) While the vast majority of support groups are concentrated on FB, r/BotoxSupportCommunity is also an option The nature of the “harm” in these groups is wide-ranging — from serious adverse events requiring hospitalization, to dissatisfaction with cosmetic results Regardless of whether or not we would ~personally~ classify an outcome as “harm”, it is a patient’s lived experience that defines such impact Individuals considering injections for cosmetic purposes would be well-served by first exploring these groups I personally love my wrinkles & natural face — I hope you love yours too! (and yes, there are non-cosmetic indications for Botulinum toxin) ↓↓↓

@DrJaclynnMoskow - Dr Jaclynn Moskow

EIGHTH PLACE: Amphetamine harm communities 70,000+ membership sign-ups *I am not blanket anti-stimulant, but it is important that patients know the risks Amphetamine harm community membership numbers are challenging to quantify with precision, but I tackled this nonetheless As with Rx opioids, it appears all FB groups for amphetamine harm support have been removed due to drug sales occurring within, causing entire communities to disappear My searches led to FB labeling me as likely having an addiction of sorts, and proclaiming “we would like to help you find ways to get free and confidential treatment referrals” — that’s actually pretty nice, right? I know nothing of what happens if you take them up on this, but it seems like their heart is in the right place Back to my analysis… ADHD-med harm threads are commonly mixed in with other substances Some active communities include: r/StopSpeeding r/AdderallAddiction r/AddictedtoADHDmeds r/NarcoticsAnonymous Bluelight FB NA groups Drugs-forum Etc ↓↓↓

@DrJaclynnMoskow - Dr Jaclynn Moskow

NINTH PLACE: LASIK eye surgery harm communities 65,000+ membership sign-ups This number was derived by totaling all FB groups for LASIK eye surgery complications, plus r/Lasiksupport Some of you will comment that you loved your LASIK — I am glad it worked out for you — it doesn’t for everyone In fact, fwiw, in the 90s, one of my family members’ vision was destroyed by LASIK complications, plus chronic pain that persists to this day & other life-altering effects I personally have extreme myopia and will NEVER undergo elective eye surgery Contacts & glasses for life, for me ↓↓↓

@DrJaclynnMoskow - Dr Jaclynn Moskow

TENTH PLACE: General vaccine harm communities 62,000+ membership sign-ups There is, of course, a history of censorship with this topic — which has stifled some groups’ discoverability & membership numbers Yet, most FB groups for vaccine harm / injury are surprisingly functional at the moment For the purposes of this analysis, I defined “general” vaccine harm communities as those that encompass multiple vaccines types, or are specific to any non-COVID vaccine Among non-COVID vaccine harm groups, I discovered that Gardasil is the most commonly represented I ONLY included groups in my tabulations that specifically & explicitly speak to vaccine harm / injury as defined by their group title / description / posts — I did NOT include the many groups with themes such as “anti-vax” “unvaccinated” “vaccine free” “vaccine discussion” “vaccine concern” “vaccine truth” I also joined ChildrensHealthDefense to investigate their community — while not all members are there for vaccine harm, if I personally was looking for information & support related to vaccine injury, I would turn to their threads / resources before FB I am also fortunate enough to have physicians within my personal network who are experts in vaccine injury — physicians you have almost certainly never heard of, as they have no major public presence (by design) I am hopeful that under the new Trump administration, my colleagues who are bravely treating vaccine-injured patients will no longer feel the need to hide ↓↓↓

@DrJaclynnMoskow - Dr Jaclynn Moskow

ELEVENTH PLACE: Detransition communities 60,000+ membership sign-ups Detransitioners may be the fastest-growing population of harmed patients → r/detrans is the largest of the support groups & discussion & r/detransition_support is another resource, as are some smaller FB groups I think that it is likely that many (most?) transitioners will also, eventually, feel as if they were iatrogenically harmed — but for the purpose of this particular analysis, I only tabulated communities with members who  ~self-identity~ as harmed, right now — ie are detransitioning (vs transitioning or transitioned) I did it this way in order to remain congruent with how I tackled other topics in this thread ↓↓↓

@DrJaclynnMoskow - Dr Jaclynn Moskow

AND MORE HARM COMMUNITIES: 12) Essure contraceptive (pulled from market) — FB groups for complications, support, & litigation → 45,000+ membership sign-ups 13) Gabapentin / pregabalin — FB groups for harm & withdrawal, plus r/gabapentin with focus on “issues”, plus discussion on other psych & neuro med forums → 34,000+ membership sign-ups 14) Atypical antipsychotics — FB groups for harm, plus some representation on SurvivingAntidepressants & other forums → 33,000+ membership sign-ups (it seems many individuals who take or have taken atypicals feel their side effects are/were “necessary” vs that they are/were harmed — I will get into this more another day!) 15) Tricyclic antidepressants (TCAs) — FB groups for withdrawal & harm, mostly specific to amitriptyline, plus some representation on SurvivingAntidepressants & other forums → 27,000+ membership sign-ups 16) Accutane / Isotretinoin — FB groups for long-term side effects & subreddit for recovery → 27,000+ membership sign-ups 17) Transvaginal & hernia mesh, bladder slings — FB groups for injury → 23,000+ membership sign-ups 18) Proton pump inhibitors (PPIs) — FB groups for harm → 14,500+ membership sign-ups  19) Gastric bands — FB groups for harm → 13,500+ membership sign-ups 20) Statins — FB groups for harm→ 13,000+ membership sign-ups (this number would be much larger if more people realized that some of the symptoms they attribute to disease, aging, genetics, bad luck, etc are actually being caused by statins — this is outside the scope of today’s data dump — we’ll “go there” soon!) 21) Gadolinium contrast dye — FB groups for harm, plus a community on groups(dot)io → 11,000+ membership sign-ups (my brilliant clinician friend says this category of harm is massively under-recognized) 22) Fluoroquinolone antibiotics — FB group for toxicity → 9,000+ membership sign-ups 23) Finasteride — propeciahelp(dot)com, plus small FB group & discussions of PFS on r/PSSD → 7,000+ membership sign-ups 24) Bupropion — some harmed patients go to general anti-depressant help groups, plus FB groups for drug-specific harm → 5,000+ membership sign-ups Now for discussion time! ↓↓↓

@DrJaclynnMoskow - Dr Jaclynn Moskow

Interestingly, all medications & procedures for which I identified a large community of patients discussing harm can be categorized as some combination of “avoidable” “elective” “unnecessary” “substitutable” and/or “optional” and one was, sadly, in some cases, “mandated” ↓↓↓

@DrJaclynnMoskow - Dr Jaclynn Moskow

Of note: To be extra clear: I did not include drug / procedure support communities that focus on anything other than harm — ie I did not include any of the groups where people cheer each other on as they battle psych meds side effects, or deliberate on cosmetic procedures, or make sense of the hell of chemo, or etc Only HARM-specific groups were tabulated! Community name & description inform whether group is harm-specific In fact, some “side effect” communities that I discovered specially indicate that only “positive” discussions are welcome & that those with a negative opinion of the associated medication / procedure should not join In my analysis, I did not consider such groups to be iatrogenic harm groups ↓↓↓

@DrJaclynnMoskow - Dr Jaclynn Moskow

It is also very important to understand that not every pharmaceutical, device, or surgery HAS an online community of harmed patients  In fact, MOST do not ↓↓↓

@DrJaclynnMoskow - Dr Jaclynn Moskow

Additionally — “harm” can vary widely in manifestation, intensity, duration, impact, & disability ↓↓↓

@DrJaclynnMoskow - Dr Jaclynn Moskow

and, of course, some pharmaceuticals are prescribed more frequently than others & some procedures performed more often than others Rarer treatments may appear to cause less harm simply because fewer individuals are exposed and vice versa ↓↓↓

@DrJaclynnMoskow - Dr Jaclynn Moskow

This data/analysis is not meant to imply that the treatments or procedures with the most community members are necessarily the most harmful, but rather to highlight raw numbers of harmed patients seeking support through online communities ↓↓↓

@DrJaclynnMoskow - Dr Jaclynn Moskow

Wow this is long! I will wrap it up More on what I discovered & calculated to come I actually had sat down to write a “quick post” off the top of my head about harmed patient communities — and it turned into full days of obsessing ↓↓↓

@DrJaclynnMoskow - Dr Jaclynn Moskow

If this thread leads to one single person more deeply considering a proposed treatment, and/or if it prevents a single iatrogenic injury, then my time was perfectly spent ↓↓↓

@DrJaclynnMoskow - Dr Jaclynn Moskow

What do you make of all this? Surprised? Unsurprised? Did any of these medications or procedures harm you or someone you know?