"Should I switch from Avandia — or should I buy a home defibrillator?"
Dr. Marcia Zucker, a primary care physician at Massachusetts General Hospital, recently faced this very question from an 81-year-old diabetic patient on Avandia.
Similar accounts from other primary care physicians suggest that Zucker may not be alone in fielding questions from patients about the safety of the popular diabetes drug.
Recent studies of Avandia and its potential to cause heart attacks have created a commotion in the news, in doctors' offices, between scientists, and even in Congress.
And while one study in the New England Journal of Medicine on May 16 suggested that Avandia might increase heart attacks by 43 percent, the same journal on Tuesday released interim results from another study suggesting that Avandia may not be all that dangerous.
Many patients don't know what to do with this barrage of information about the drug's questionable safety. And what are their doctors telling them?
"Patients have asked questions about Avandia," said Dr. Patrick Cogley, a primary care doctor in Iowa. "I have told them to continue taking their Avandia."
Cogley added, though, that he has not given out any new prescriptions for Avandia, and a committee in his practice is further investigating the drug's safety.
Dr. Stanley Mirsky has taken an opposite approach. An endocrinologist at New York City's Lenox Hill Hospital, he said, "In my practice, I have stopped Avandia."
Mirsky said he is substituting other diabetes medications for Avandia.
Dr. Anthony McCall, professor of diabetes at the University of Virginia, said he takes a collaborative approach to the Avandia question, given all the controversial results.
"I hope patients will talk with their physicians," he said. "I would tell them I am unsatisfied with the inconclusiveness of the analyses available to date."
McCall wants patients to better understand the information themselves so that they can help make the decision based on their preferences.
"If they are uncomfortable, I am happy to provide them with an equally effective medication," he said.
But, he added, if they remain unconcerned, he is OK with them continuing it. McCall notes, however, that he will not be starting Avandia on any patient who is not already taking it.
While some doctors report receiving many calls about Avandia, others feel that little has changed.
"For me, it's been a minor issue," said Dr. Lloyd Axelrod, an endocrinologist at the Massachusetts General Hospital Diabetes Center and associate professor at Harvard Medical School.
Axelrod only had four patients on Avandia when concern about the drug first hit. He has always maintained that the drug was difficult to use and also very costly. In 40 years of practice, the only patients he had on the drug were those four who came to him already on it.
"I've been in touch with all of them," said Axelrod. "In each case, they ask me what I think and they'll do what I recommend."
And for each of his four patients who use Avandia, he has recommended that they stop the drug.
"It is unlikely that, in the near future, we will get conclusive data," said Axelrod. "I don't think it will be settled in the near future."
Faced with the Avandia-versus-defibrillator question, Zucker felt that having her patient stay on Avandia was out of the question, so she switched her to a different diabetes medication and recommended that she start insulin instead.