Medicine is Not Always the Answer

In fact, it hardly ever is - though that is not a well advertised fact!

I have lauded Senator Charles Grassley in the past and continue to see this man as a friend to consumers of medicine. He was instrumental in starting the conversation about the influence of drug companies on prescribers and patients. Because of his efforts, the health care legislation will require what we in Florida call, sunshine.
There will be searchable database that allow you and I to review industry ties of our doctors. There have been rules in the past – there are rules now, but they were written in ways which allowed some abuses and led to the accusations of bias, greed and fraud.

One specialty, psychiatry, has the distinction of having more drug ties than others. The heads of both the American Psychiatric Association and the National Institute of Mental Health have come out with statements regarding their intention to end these relationships.

If you are wondering, the practices can be as simple as a free lunch, and as elaborate as tickets to a playoff game. Companies fund research for scientists and thus bring money into colleges. Scientists may have stock portfolios and use of private jets. Also, education and office materials with the name of the drug being promoted are often given free of charge to various practices.
I remember making a note of all the objects I saw with drug names during my last doctor visit.

I am not a fan of pharmaceuticals - period. Thomas Insel is the NIMH president and he has a current commentary in the Journal of the American Medical Association. JAMA does not offer free access to all its content and I cannot link it here. Dr. Insel did make a very important statement however and I was encouraged by it. He said that many times the ties that psychiatrists have with industry can lead them to prescribe name brand drugs over cheaper generic ones AND that the ties also influence treatment decisions – often preferring meds to some amount of behavioral therapy. It is nice to see that in print.

Medications, especially these new psychotropic meds that are advertised to the point of absurdity, have serious side effects. Talking to someone may be time consuming and oh yes, uncomfortable, but it will not make you fat or cause insulin resistance.

The next challenge? Get health insurance companies to cover the cost of “therapy” at the same rate they cover medicines!

Drugs Not Needed

I was pretty dumbfounded this morning when I heard a commercial regarding a medication created to treat the very condition discussed in my last blog. The reason I was taken aback is because as I wrote here, the experts state that the most effective treatment for lowering triglycerides and raising HDL-C is NOT a medication but watching your weight, exercising and eating lean proteins and including unsaturated fats in ones diet.

So why in the world would the FDA approve a medication for this. A medication which does not lower any heart disease death or disability over the statin therapy one takes for lowering their LDL-C. Even the TV ad tells us that the medicine will not do that.

The reason we lower any of the numbers, whether it is cholesterol, blood pressure, CReactive protein, triglycerides, etc is to lower the risk of disease and death. If this new medication lowers triglycerides while putting the patient at great risk for side effects for NO OTHER REASON than to have a lower number.... WHY would a person take it, a doctor prescribe it or an insurance company PAY for it. This is how our country spends so much money on health care without having the best healthy life expectancy.

So, I am blasting about a drug called Trilipix... cute huh. The scientific name is fenofibric acid. The drug company did complete severe phase III trials before gaining FDA approval and I was able to read a little about that. The company used the drug in conjunction with statins (i.e. Zocor and Lipitor) of different strengths compared to a group that just used the new drug. In the combo therapy all numbers changed to the better, lower LDL and TG and higher HDL but again, there are no improved health outcomes so why would you subject yourself to the risk factors and the cost of another medicine?

Better than that, the TV ads and the literature on the drug insist that it is to be used WITH a diet regimen. In fact, the print warnings and prescribing info for clinicians states that diet and other non medicine strategies should be exhausted before prescribing Trilipix. The consumer ads and website just say to talk to your doctor about this new drug. Heck they even give you a print out of talking points so that you, the patient, can educate the doctor and advocate for this treatment on your own behalf. This is certainly playing to our cultural leanings toward pill focused solutions.

But pills come with more than a financial cost. The physical risk can be great as well. For this drug, side effects include

Muscle Pain
Tenderness
Weakness
Tiredness
Fever
Abdominal Pain
Nausea
Vomiting

And more seriously, muscle wasting and possibly kidney and liver problems. The serious side effect risks go up when the drug is used in combo with the statins, but it is with statins that it works. Again, why would one take this drug.

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