What are your views on prescription drug use?

[Guest ConfusedStudent]

I was just wondering, how you view the use of drugs. Like should they always be depended on, or should they be a last resort type thing.

 

I've had many different views from many MDs I've met. Some perfer to focus on nutrition on for certain problems related to their nutrition, vs pescribing drugs.

 

Some just pescribe pescribe pexcribe, because that's the only treatment method of healing they've been taught in medschool. (how true this is, I don't know)

 

The best one I've heard so far is "the cure should never be worse than the disease" as in saying, the drug should never leave sideffects or do something that may get rid of the problem, and leave something worse behind. Case in point, I was referred to a specalist for a condition I had (by my GP), it was an injection of some sort. the Specalist (to save me money) wanted me to go back to my GP to do it. The GP refused, because what it would do (because there was a highchance of this sidefect) would be worse than just leaving the condition (which was a scar, an itchy/annoying/irratating scar).

 

My view is the last one (although I'm not yet a medical student), combined that we should be also be very careful, because pharmacuital companies are out there to make money, so sometimes proper long term testing isn't possible, and we discover severe long term effects after.

[Guest TimmyMax]

Hey,

 

My opinion is that prescription drugs definitely have their role in treating disease, and that when used appropriately, they are a very powerful ally. Problems arise when they are prescribed inappropriately and/or people have unreasonable expectations/demands about being treated with prescription drugs when it is inappropriate or not indicated for their condition (ie: sinusitis, common URTIs). If people were more willing to accept the fact that not every condition needs to be treated with prescription drugs, and that it can take time to decide whether treatment with prescription drugs is appropriate, we wouldn't have such a problem with drug-resistant bugs and the world would be such a better place. I think that a lot of times, society has unreasonable expectations of our health care system, especially with respect to the common cold, etc.

I guess this post has more to do with prescription of antibiotics than anything, but nonetheless, it's my two cents!

 

Best of luck!

Timmy

[Guest satsumargirl]

Some just pescribe pescribe pexcribe, because that's the only treatment method of healing they've been taught in medschool. (how true this is, I don't know)

 

 

Well so far this hasn`t been true in terms of med school education.

 

There are several guidelines for treatment for various conditions and the recommended treatments depends on the stage/severity of the condition. But for things like hypertension, cardiovascular disease, diabetes, asthma, COPD, behavioural/lifestyle changes are key in management and often the first thing to be looked at...adding meds (in various stages) as the condition progresses or if behavioural and lifestyle changes haven`t had the effect needed.

 

We have had several lectures on effects of exercise and diet on health and even effects of culture (with different definitions of health etc...) on health.

 

Of course, if you are going to study allopathic medicine, you are going to be prescribing drugs which have an important place in treatment. But certainly it is not accurate to think that MDs are just going to prescribe drugs without looking at other factors simply because all they know how to do is prescribe drugs.

 

pharmacuital companies are out there to make money, so sometimes proper long term testing isn't possible, and we discover severe long term effects after.

 

Yes pham companies want to make money. But they still have to meet the requirements set out by say health canada or the FDA in the States. So I am not sure what you mean by "sometimes proper long term testing isn`t possible". If the proper testing hasn`t been done and proven the drug should not be approved. Long-term effects can be found down the road...but that isn`t necessarily due to negligence on the part of the pharmaceutical company or the regulatory bodies.

 

 

I do think that in the general public there is a view that new drugs are better drugs. They see an add for a new med (and I really don`t see the reasoning behind marketing meds to the general public) and they come in and ask for it. I believe studies have shown that if a pt specifically requests a drug they are more likely to have it prescribed for them. Although I have seen some docs stick to the tried and true even when a pt requests something else.

 

With any treatment the benefits should outweigh the risks. And the patient should be making an informed decision before starting a treatment.

[Guest ConfusedStudent]

I think the thing that bothers me the most, is the advertising to the general public, promoting the drug, making it seem like it's a miracle worker. Drugs are fine, I think as long as they are taken properly, and when needed.

[Guest thatuvicguy]

This might seem like an obvious question but I haven't had a TV for 12 years now so I'm not clear on whether direct-to-consumer prescription drug advertising is allowed in Canada. I was under the impression that it wasn't, am I wrong? Or Is it US stations on cable TV that have drug advertising on them?

 

Cheers,

thatuvicguy

[Guest ploughboy]

-----BEGIN PGP SIGNED MESSAGE-----

Hash: SHA1

 

 

Hey there,

 

Ya, so far in my limited allopathic education there hasn't been any emphasis on drugs, prescription or otherwise. Once I get to 2nd year pharm, that might change, but right now the powers-that-be are still trying to pound "see the patient as a whole person" into me.

 

Ripping off one of the senior members here - I'm all about evidence-based medicine...if a patient tells me that St. John's Wort is helping his depression, well there's my evidence...

 

My personal pet peeve is people who won't take a pure and controlled dose of a drug prescribe by their doc, but aren't at all phased by taking the same chemical in questionable potency and efficacy because it's quote-unquote natural.

 

I'm not saying that drug companies are wonderful, because in some respects I think that they're evil personified, but I think that they might be necessary...

 

Regards,

 

pb

 

 

-----BEGIN PGP SIGNATURE-----

Version: GnuPG v1.4.0 (FreeBSD)

 

iD8DBQFEGNXi/HNgbK3bC2wRAsB3AJ9fgTllB+31r249xFxrfGLIAYTK7ACeIN8G

OWduXZUlIOllivkpAb6a+pc=

=c39X

-----END PGP SIGNATURE-----

[Guest satsumargirl]

I am not 100% sure...if I had to guess though, I would say the advertising is American. But I don`t know, I have seen ads for Paxil, Viagra, Zyban

 

www.hc-sc.gc.ca/dhp-mps/advert-publicit/index_e.html

 

Well...I just checked it out and apparently drugs that can be legally prescribed in Canada can be advertised....so maybe they were Canadian. I do believe it is relatively new though and the ads are regulated it seems

[Guest johnwoo19]

I think for your question it depends a lot on the disease-state and the particular drug in question. As someone else mentioned, a decision should be based on evidence-based medicine. However, having evidence for the use of a particular drug does not exactly mean a drug should be used. Patient values should always be taken into account. A lady with high blood pressure may be asymptomatic and although there is evidence for the use of a beta-blocker to lower BP, it doesn't mean metoprolol, etc. HAS to be used. I think it's more a matter of discussing the benefits/risks of drug treatment (in the situation where this is appropriate) and having a shared decision with the patient.

[Guest moo]

That's a bad example. Patients who are hypertensive tend to be asymptomatic. Hypertension is treated to 1) reduce strain on the heart and 2) to reduce end-organ damage. But I see your point. If patients try lifestyle changes and that does not get their BP under control, then drugs would be appropriate. I wouldn't run straight to drugs as a first step.

[Guest Lurkergonepublic]

I believe the current prescription drug ad policy in Canada (unlike the US) is that you cannot advertise a drug AND state what it is supposed to treat. Look closely at the Candian network ads and you'll see they never actually say what it's for - although there are numerous advertising techniques to imply it strongly enough to get the point across. Some drugs are so well known (viagra) that they don't need to say what they do, and an ad for a birth control pill tends to get the message across without ever mentioning what its for. Advertising in sleazy business, and getting around that little technicality is not much of a problem for pharm comps these days.

 

It's kind of ironic, since if your advertising a non-controlled "natural" product (like glucosamine, or poison-ivy or horse manure - all strictly natural, so they must be good for you) you can almost say more about it in a commercial than you can a drug. It seems to me that the natural remedy industry is quickly getting as big and powerfull as the pharm industry, and both should be getting a bit more restricted in what they're allowed to claim.

[Guest peachy]

although there are numerous advertising techniques to imply it strongly enough to get the point across.

I guess. There have been a bunch of times that I've looked at drug ads and had no idea what they were advertising, it's a strange feeling to have no idea what an ad is for...

[Guest muchdutch]

One that comes to mind is the one where all these different people (who you don't see for very long so you're not sure what they're doing, hence, don't know what the drug is really for) say, "I'm not here to tell you what to do, I'm here to tell you just to ask.....(different person) ask your doctor......ask.......ask.....(announcer's voice) ask your docotor about Julie's story"

WTF? I still have no idea what that's all about. I might be mashing two commercials into one, as they are in my brain, but either way I have NO IDEA what the heck they may possibly be advertising!

[Guest Lurkergonepublic]

Anyone ever hear a paitent in a clinic ask about that?

[Guest happy2bme]

I think that it's for a weightloss drug, that was my impression about julie's story...

[Guest satsumargirl]

"Julie's Story"

According to the Globe and Mail (02/24/05) the "Julie's Story" ad campaign is being funded by Hoffman-LaRoche to promote sales of their pharmaceutical, Xenical (also known as Orlistat). Xenical is no magic pill that simply melts the pounds away for those of us wanting to lose a few, as the ads may suggest, but a prescription medication approved only for the treatment of obesity.

What Xenical does to your bodyXenical works by preventing the absorption of dietary fats from the foods you eat, with undigested fat removed through bowel movements. In the process, the absorption of some important fat-soluble vitamins and beta-carotene in the diet are blocked. So those taking Xenical must also take vitamin supplements to get the essential nutrients they are no longer able to absorb from the foods that they eat.The most common side-effects of Xenical are the following: Oily or fatty bowel movements (stools) Increased number of bowel movements

 

Ok...the whole list of common side-effects didn`t get copied. But this is what I found doing a quick google. I remembered those ads and also had no idea what is was for! So I looked it up (that I and am procrastinating!)

[Guest PreyOnWords]

Muchdutch,

Although somewhat random and much delayed, I have to say your comment about Julie's story is absolutely hilarious. I think I am in the same boat as for as understanding drug commercials go. I know they have a commercial for Etanercept, where adults are playing in the park (this could be mixed up as well), but I really had no idea what the h#$$ it was for. It may as well be birth control in light of all that fertile green grass in the backdrop. I really do question their strategies of direct-to-consumer marketing, but I guess this is probably a good thing......

[Guest ploughboy]

-----BEGIN PGP SIGNED MESSAGE-----

Hash: SHA1

 

 

(announcer voice) "Ask your doctor about Julie's oily bowel movements" just doesn't have the same ring to it somehow...

 

I'm really not sure when it would be appropriate for a pt to take something like Xenical instead of, oh I dunno, cutting back on the amount of fat in their diet. Anybody have any ideas?

 

pb

 

 

-----BEGIN PGP SIGNATURE-----

Version: GnuPG v1.4.0 (FreeBSD)

 

iD8DBQFEL2+o/HNgbK3bC2wRAtagAKCdZTQX3ybGfFANDLuVs9Hb1OXBzgCgiwql

g+W4fRuwmTrNM5EtlaT2NS8=

=XDc6

-----END PGP SIGNATURE-----

[Guest Lurkergonepublic]

Found this news article, and thought it was appropriate to resurrect this old thread to put it in, as it brings up the same issues. Thoughts?

 

CBC drug advertising story

 

I also enjoyed reading this linked viewpoint about drug ads in medical journals:

 

viewpoint

 

I've always felt a little uncomfortable with the influence and money the drug companies have in the medical profession - of course some is necessary, but there's so much room for a conflict of interest, especially when doctor's have such limited time to keep up with new drug developments.

[Guest muchdutch]

I've always felt a little uncomfortable with the influence and money the drug companies have in the medical profession . . . there's so much room for a conflict of interest

 

I agree. It's always a big joke on tv shows (scrubs especially) how some doctors really take advantage of the pharmaceutical companies offers. Sure, dangle a sparkly *insert-object-of-desire-here* in front of any person - they'll bite, it's human nature to want more. Perhaps doctors shouldn't be put in this situation in the first place, and once the door is open to that type of advertising, what's next??

 

I really hope that this case gets thrown out. Sure, they can't compete with the Americans, but that's why they're a Canadian broadcast company - so abide by the different rules that come in Canada. While I think it's hilarious to see American drug ads that have an announcer very quickly saying 'may cause anal leakage, kidney failure, heart failure, liver failure, blindness, epilepsy, polio, measles, ebola, and more!', most people see the larger message that Julie actually did lose weight and will go ahead and tell their doctor they want it...

[Guest UWOMED2005]

I actually subscribe to the "House of God" approach when prescribing medicine: I like to the do the least to the patient that leaves me feeling comfortable.

 

What I mean by this is I wouldn't feel comfortable NOT prescribing Warfarin to a patient who has a large stroke risk. But if I'm prescribing "because it's probably not going to cause harm," then I say leave it alone.

 

If it isn't broken, don't fix it. You're more likely to cause an adverse event or drug interaction than help the patient.

[Guest cracked30]

That's a question I find that Medicine docs cant answer anymore.

 

Say I am faced with a 90 yo woman, recent hip fracture, but sprightly and mobile. Maybe a little unsteady, hence the fracture. She is off her fragmin as she is ambulating well. But has new a-fib. I ask the medical docs, what is the benefit of starting warfarin in this woman, she very likely has an increased bleeding risk and could fall and get a brain bleed.

 

They never hav an answer.

[Guest strider2004]

Then the docs haven't been reading the trauma journals where there have been clinical trials - patients randomized to warfarin or not, looking at strokes and epidural bleeds as outcomes. Depending on the trial, you'd have to fall between 50-200 times a year before your risk of cerebral hemorrhage outweighs your risk of catastrophic stroke.

 

But she's 90, so maybe you shouldn't subject her to routine blood testing in the hopes of preventing a cerebral event, because changes are she's going to die of SOMETHING in the next few years - MI, pneumonia, whatever.

[Guest Malikar]

Back on topic, I think part of the blame for doctor's overprescribing medicine (if you really want to call it that) is largely because of patient laziness.

 

Oftentimes, unhealthy patients who could solve or control their own medical problems by taking certain actions, simply won't. Obese patients can't be bothered to exercise or eat healthy (not saying its easy, but what is?) so they end up have an MI and being put on Coumadin, Altace, etc. Elderly who are at risk for osteoporosis can't be bothered to exercise and eat better (again food comes into the equation), so then they get their Fosamax prescriptions. Patients who have trouble sleeping due to stress and poor sleeping habits can't be bothered to practice good sleeping habits and learn to control their stress. So they get put on Imovane or Ativan. These are just a few examples.

 

Its been dicussed many times by health professionals and the same conclusions seem to come out. Basically patients see medications as an easy fix, without considering the deeper-rooted problems. Granted, sometimes the meds are useful, and even necessary to maintain QOL (like Fosamax, cause eventually diet and exercise just don't cut it for some).

 

I don't want to sound anti-meds or anything but I think some blame for prescription-bloat (as I like to call it) should lie with the patient, not just the overzealous (walk-in-clinic) doctor.

[Guest NurseNathalie]

patient laziness ???????????

[Guest leviathan]

If I remember back from my health psych class, I think patient compliance with taking medications is only 50%, and that statistic doesn't change when it's parents giving medications to their children.