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A great deal of prescription medication has gelatin and if you tell your pharmacist you can’t eat gelatin you’ll be passed back to your doctor who needs to write an alternative script for an entirely new medication that may not be as effective because they simply don’t make an alternate preparation without gelatin.
A lot of prescription strength PPIs are like this: esomeprazole, omeprazole, etc. the otc ones can come in capsules that are just the enteric coating (the gelcaps are filled with granules each coated with enteric, which is basically a time release coating). Enteric itself is not automatically vegan, older formulations have shellac and gelatin, though newer formulations are vegan using plant derived cellulose and copolymers (a proprietary compound called Eudragit).
The frustrating thing here is that gelatin is used for reasons (improving absorption, mainly) but this can be achieved through vegan means like hydroxypropyl methylcellulose or pullulan, which is superior to gelatin in many ways.
Not just pills either, wound care stuff in hospitals - hemostatic sponges, gelfoam, hydrocolloid dressings. The frustrating thing here is that there are numerous other ways to make a hydrocolloid matrix. Gelatin was just the first well established one really. But especially over the past like 40 years understanding of hydrocolloids have expanded drastically.
With medical stuff obviously change moves slowly, new formulations need to be thoroughly tested, but the final frustrations are that these paths either arent being tested/explored (to my knowledge, in terms of like dressings), or they are established but aren’t being implemented because of cost. So when you get acid reflux or cystic acne and you tell your dr you’re vegan or halal or orthodox Jewish or whatever they will shrug and be like well sorry that this pill uses porcine gelatine, tough shit I guess?
Why isn't shellac vegan? Isn't it just bug shit?
Two things I can think of: first, that the harvesting process will unavoidably involve killing a lot of lac bugs, even if they're filtered out later, and secondly, that some vegans include insect-produced substances (notably honey) in the things they avoid.
Such weird reasoning to me, given it's impossible to produce/harvest vegetables without killing bugs.