If There's No Benefit, Why Tolerate Any Risk?

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We don't know for Avandia. However the precedents are daunting. Long-term experiments, randomized controlled trials, with earlier generations of drugs that lower blood sugar are not encouraging. One famous trial lasted over a decade.

There is no precedent for any of these drugs saving a life, a limb, an eye, kidney or anything else important. There is no demonstrable benefit except the lowering of blood sugar. Who cares?

I have practiced medicine for 40 years. I have never prescribed a pill to lower blood sugar. I still see no reason to do so. If I am disadvantaging my patients, it's to a trivial degree at most. However, I know I am sparing them known and unknown hazards.

And I won't let you measure my blood sugar or the measure of its persistent elevation, the hemoglobin A1c. I don't care, and I won't care till there is compelling science that something meaningful can be done if it is elevated.

Drugs to Treat Painful Joints

Vioxx and Bextra were pulled off the market because of data suggesting they imparted a tiny hazard for heart disease. It's perhaps a slightly more convincing hazard than that purported for Avandia, but there's little here worthy of alarm.

I am a rheumatologist. I have never prescribed Vioxx, Bextra or their cousins such as Celebrex. But I never prescribed them for reasons other than their possible effects on the heart.

Do you know that no drug of this class has ever been shown to be more effective than aspirin? Do you know that no drug of this class has ever been shown to be safer than aspirin? Only Vioxx convinced some who are swayed by tiny differences. But Vioxx never convinced me.

Why would I ever prescribe this class of drugs? I don't care if there are TV advertisements claiming magical effects like you, too, can skate on ice. I don't care if the occasional patient swears nothing else helped. I am unwilling to prescribe a drug that has no important benefits over the old standbys and has no long-term track record for safety.

I spend much more time explaining my philosophy to my patients than the seconds required to fill out the prescription, or to give a sample. By the way, neither drug company sales people (detail representatives) nor drug samples are allowed in my clinic -- and never have been allowed. I'll take the time to explain my philosophy or stop practicing medicine.

However, I am a "senior" clinician; if my students, and there are many out there, practiced the way I taught them, they'd starve. There is something horribly rotten in the United States, not in Denmark.

Drugs to Lower Cholesterol

Baycol is a statin. That's a drug that lowers cholesterol. It was pulled from the market because of about 50 cases of a complication that almost never occurs unless you are on a statin.

This is a complication that causes the muscles to die, and often the patient follows. It occurs occasionally with all statins (Lipitor, Pravachol, Simvastatin, Crestor, and others). But somehow the number of cases ascribed to Baycol lead to its banishment and not the others. After all, the common wisdom is that lowering cholesterol is too good a thing to pass up.

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