NYTimes article tries to figure out why docs order expensive medicines (and leaves out the real reason for so much testing: Lawyers),
althoug they mention why sometimes we don't follow the experts "guidelines": Too many tests not available for those of us in rural practice. But another reason is that too often the cases mix up apples and organges. Let's take this snippet:
For example, one study found that generic diuretic pills that cost pennies a day worked better for patients with high blood pressure than newer drugs that could be as much as 20 times as expensive. Because hypertension affects tens of millions of Americans, this finding had the potential to save the health care system billions of dollars. But the finding never really took hold; the percentage of patients taking the cheaper diuretics barely increased.
Not mentioned: They mainly work in populations that retain fluid (e.g. the black population), they often dehydrate our patients and make them low potassium and weak, and the really important fact: That ten to twenty percent of our men get sexual dysfunction from the pills.
Similarly, the "pril" drugs can cause a nasty cough (an allergy that gives you a "tickle in the throat") in ten percent of the patients.. So a doc with a patient who is not too good at giving you history or keeping appointments might prefer to prescribe a "sartan" drug that has the same advantages without the cough, but costs three times as much.
Finally, if you live in an area where you can't keep an eye on the potassium, you might want to use the medicine with the least side effects: the "pine" pills (amlodipine, nifedipine). That is why I spend the extra money to send Sister Euphrasia in Africa this pill instead of the cheaper ones: I can't monitor her potassium or her BUN, and I don't have to worry she will collapse from dehydration in the heat.
One more item on the population: When I worked with Native Americans, most of our high blood pressure was diabetes related. So a "pril" (or "sartan") type drug was preferred, since these medicines slow the rate of renal deterioration from diabetes.
related item: What about taking a "statin".
the latest: they may cut your risk for cancer.
"...Among other functions, cholesterol helps to build and maintain cell membranes, and is essential to their proliferation. Therefore, when cholesterol production is limited, the ability of cancer cells to reproduce uncontrollably is diminished, scientists say. There has also been some experimental evidence that statins may increase the effectiveness of radiation therapy..."
Really? But early studies showed that taking them didn't lower the real death rate, because the decrease in heart deaths was balanced by an increase in deaths from other causes: in one large study the other cause was violence (suicide/homicide) and another big study the other cause was cancer.
Wonder if this is a population bias: careless folks who eat too much, smoke cigarettes, etc. are also those who won't take all those statin pills. Those who are obsessive/compulsive about their health take them and have fewer cancer risks.
and some people get very achy from taking them...although some studies suggest taking coenzyme Q10 might prevent this.(not completely confirmed).
So do I take statins? No. My mom got achy from them, so I presume I would too. And I hate taking pills. Besides, although my cholesterol is slightly high, my "good" cholesterol is high too, from all the fish and shrimp we eat.
I'm all for natural diet and exercize, but i had to shake my head about one California expert who was blaming all the weirdo problems of his mainly female patients on modern diets.
Uh, fellah, the ancient greek docs noted the problem 2500 years ago, which is why the word "hysteria" is based on the Greek word for uterus.
I've been in medicine for 45 plus years, and the dirty little secret is that women and raging hormones have to find something to blame. This year it's what ever this california doc is blaming (can't remember if it's high fructose corn syrup or preservatives). But before this it was low blood pressure, low blood sugar, evil yeast infections, etc etc.
Reality check: I have spent part of my life overseas, so know my neurosis is my own. True, it is better controlled when I eat correctly, but it was still there when I was eating "fresh" and natural foods, be it in rural Africa or the rural Philippines.
Yet I do suffer from low blood sugar (and have the GTT to prove it). And fibromyalgia (mild) and mild depression/PMS symptoms. And when I ate at McDonald's with my kids, or ate at a salad bar (that uses sulfites to prevent the lettuce from turning brown) I know that later that day I would get a bit jittery and if I scrached myself, I would leave a hive (this is called "dermatographia).
So what does this mean?
It means that one of these days humans will figure out these things, and all we neurotic women will be able to control our bodies and not vice versa.
For me, it means watch my diet, and take antihistamines before going to fast food places.
The bad news is that too many "neurotic" women become obsessed and plan their life around their diet etc.
And I wonder why no one has noticed that birth control pills are part of the problem? I had terrible PMS and ovarian cysts, but when I was on the pill, I was worse. And when they gave me hormones I could tell: Testosterone made me feel great ("hairy, happy and horny") while when I was on the GRNA antagonist to block hormones, I cried for three months.
that last hormone is used not only for endometriosis but in larger amounts for prostate cancer, so I used to warn my male patients...anti depressents help a bit, but the best part is telling them that the "down" felling was normal.
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