Sorry
I meant urate not irate. The autocorrect changed it.
If someone is taking allopurinol they will still get gout attacks if they aren’t taking enough. The maximum dosage is 800mg. The experts are criticising GPS for not taking the bi annual checks seriously enough, not increasing the dose to stop attacks, and not appreciating the consequences. (At 17 years after being diagnosed heart problems increase by 60% in men; no change at all in women).
To reiterate though - getting the urate down to say 5.9 is ok for a never-had-gout person. But for a gout victim it needs to be more like 4.0 (the level we were on in our 20s).
And it is well established that more expensive placebo treatments work better than cheap ones.
Don't even get me going on placebo readings in medical testing. Heck, I even suspect that when I was a kid, a pediatrician gave me a placebo prescription for antihistamines. A one-sample test is bad enough without worrying about placebo effects, I'm not about to double-blind myself!
I've had attacks about every two or three years since 1999, however since just a few weeks ago recognizing pseudo-gout as a separate condition, I have to go back in time and analyze which were real gout and which were probably pseudo-gout - or if they might just occur together or in close sequence. In retrospect I think I have not had a real gout attack now in about five years, which I triggered with a couple of mistaken meals of fresh trout within a two-week period. Since then I've watched my diet more and started taking celery seed, at first sporadically and now regularly. I had what was probably a modest pseudo-gout attack a few months ago, and then this crazy neck thing a few weeks ago.
Will have to get my last urate number, looks like it was not even on this latest blood test. But as you point out most of the urate is metabolic, not diet, so I infer that the benefit from the 3NB is also wider than just affecting diet. Of course I'd rather seen this worked out in detail on lab rats, but we just have to do what we can.
So how much do I have to pay for a placebo to get a full and permanent cure?