When people ask me how I feel about going on Humira, I should probably just respond with ‘it’s complicated’. When I tell people I have been refusing the drug for close to 5 years because instinctively it doesn’t sit well with me, they look puzzled. Perhaps it’s time to explain my logic at this time when unfortunately it looks as though I have run out of options and am on the road to beginning Humira in just a few weeks.
Before I explain what Humira is; let me explain a little more about Crohns; as an auto immune disease.
Auto-immune means the body’s immune system appears confused and attacks it’s own healthy tissue creating an inflammatory response somewhere in the body; like bleeding, rashes, pain etc. This response can be seen in diseases like Crohns in the bowel, Rheumatoid Arthritis of the bones and MS of the nervous system. But it can also be seen more commonly in conditions like Psoriasis, Alopecia and Eczema. In all of these instances, GP’s often prescribe some form of steroid treatment, be it injection, ointment or oral medicine. Steroids are powerful anti-inflammories which lessen the reaction to the auto-immune response but cannot put a stop to the response reoccurring. To put it simply, modern medicine doesn’t seem to be interested in educating it’s patients to question what triggers an auto-immune response, which is often very personalised to each patient and can be noticed and managed with careful consideration. Instead, they will prescribe a quick fix bandage and the patient will go away, feeling like they have been seen to, and often the problem will re-appear as it was never truly dealt with in the first place.
Having taken many hundreds of milligrams of steroids in my time, and causing my poor bones some hefty damage in the process. I have now been offered a different type of drug; Humira – a biologic. For many, this drug seems to have offered up a miracle. It has allowed chronic sufferers of arthritis and Crohns to experience relief and normalcy. But for me, the way the drug works, yet again overlooks each patient’s personal auto-immune triggers and merely blocks a crucial cell protein that is designed to take care of that patients immunity.
Humira is called such, because it delivers human cells in a neat little injection into the patients body. These cells are called TNF blockers as they wander along to the part of the patient’s cell with the naughty over-reactive immune proteins and bam! Block it – put a bag over it’s head and grip it into a tight headlock, so it stops being overdramatic and upsetting the chemical peace. Now that it’s blocked and silenced, the patient won’t have their pesky auto-immune response anymore, but rather unfavourably they won’t really have much of an auto-immune response at all. So the likelihood of getting something nasty and not being able to fight it, is increased. This includes little nasties like viral infections and the big nasties like cancer. So maybe you can begin to see my reservations?
A trainee doctor friend of mine, very kindly tried to reassure me about Humira by making me consider that Crohns is purely genetic. “It’s a genetic mutation whereby your cells are over stimulated to fight. You can’t reverse the cause or get to the origin because your DNA is constantly making new cells that have the same issue. So you need to do damage control.”
This made sense to me briefly, I am indeed predisposed to IBD because my father had it, and his father likely had it. And the gene pool I belong to; with my persecuted European Jewish ancestry intermarrying right left and centre was not exactly known for being very large. But although my genetic disposition doesn’t help, there are other triggers and factors to the disease, and similarly ways of avoiding flares.
It’s certainly cannot be a co-incidence that Crohn’s prevails in Western super-sanitised cultures, but in countries where hygiene is more compromised, and immune systems develop to be strong from birth – no Crohns exists. This to me highlights that Crohn’s is not merely genetic, but environmental factors and the intestinal microbiota – our guts complex tapestry of bacteria good and bad, has a very large part to play in our recovery. After all, our gut health accounts for two thirds of our immune system!
So when you ask me, how I feel about Humira, 700 words later – you too, may feel “it’s complicated”. But it’s only complicated because I am not, and never will be a passive patient. I will always seek to question the causes, and not just the affects of my body’s malfunctioning immune response.