Thursday, June 26, 2008

If you want to find out the 8 drugs doctors would never take....ask them!

I recently blogged about a particularly annoying article called "8 drugs doctors wouldn't take" that originally appeared in Men's Health and surprisingly appeared on MSNBC, which is usually pretty reputable. There were many annoyances about this piece including incorrect information and re-hashing negative data, much of which has been found to be incorrect. However, the most annoying thing about the story is that it implies that physicians were surveyed about medications they had concerns with, and in fact, I don't think ANY physicians were even asked!

In the orginal Men's Health article, they state:
"Of course, plenty of M.D.'s do know which prescription and over-the-counter drugs are duds, dangers, or both. So we asked them, "Which medications would you skip?" Their list is your second opinion. If you're on any of these meds, talk to your doctor."

Yet there is no mention of how many physicians they asked, how they chose these physicians, etc? In the article there are eight quotes/recommendations by five "experts," three of which came from Philip Rodgers, a Pharm.D (this is no disrespect to Pharm D's who have a great knowledge of medications and their side effects, but article is not titled "8 drugs no Pharm D would ever take").

That last sentence particularly irks me (and many of my colleagues) as well. To sell papers/create buzz, the media reports scary (and in this case, not entirely true) stories about dangerous medications, creating unnecessary worry for patients and headaches for physicians burdened with phone calls after each story hits the press.

I have given my opinion on the safety of the 8 drugs mentioned, but upon further reflection I thought, "What would real doctors say about these medicines?" So, unlike the article, I asked them.

Using Sermo, a physician only social networking site (you must be a licensed physician to join), I posted a question to its 23,000 physician members.

For all of the following medications, please respond whether in an appropriate patient you would prescribe the medication without reservation, with some hesitation due to safety concerns, or would never prescribe the medication due to safety concerns.

Here is a link to the results. After about a day, I got responses from 59 actual physicians. There was overwhelming dissatisfaction with this article, and substantial disagreement with the articles "findings". For all but Ketek, only a few doctors out of the 59 said they would never prescribe these medications. For Advair, 3/4 said they would prescribe without reservation, 1/4 with some hesitation and only 1 said never. For the much maligned Avandia, 2/3 would prescribe without reservation, 1/4 with some hesitation, and only 6/55 physicians said they would never prescribe. Even Celebrex, the Vioxx cousin, though doctors were split on no reservation and some hesitation, only 4/58 said they would never prescribe it. Virtually every doctor said they would prescribe Prilosec and Nexxium without reservation, with only 1 never prescriber.

This is certainly not a scientific survey. However, it is far more scientific then the Men's Health article, asked actual physicians, and is much more reflective of the collective medical wisdom.

Doctors, I hope you will refer patients to this post when they come in asking about the article. Patients, please don't believe everything you read regarding the dangers of medications, especially what most physicians would and would not do.

Special thanks to all my colleagues on Sermo who responded to the question. (Since the survey is still open, I will post the final results on this blog in mid-July).


dennisharrison said...

Somehow the concept of "informed consent - I mean real, true honest to gnodness informed consent" needs to be adopted into the medical community. Then when patient and physician discuss, then consent (I do that very carefuly after getting my Vioxx injuries - and I look on the Internet, as until the time that the drug companies are truly trustful, infomred consent cannot happen - but when it does, the physicians, and consumers, will then have some bottom up influence on thos esame drug companies. Enforcement needs to come from bottom up, and top down (and sideways - like an FDA with proper resources and independence).

You bring many good points to the table - thank YOU!

Dennis Harison

Are you also one of the disgusted, confused, and worse...litigants who feel that you have been boxed in to the MERCK "settlement" - and there are many ways.... Are you really hoping to find some compassionate individuals to dialogue with, an especially those in a similar or exact situation. then read on....
Vioxx Settlement - a group to relate to...heart - mi - stroke - bone - spine


Mass Tort reform “hawks”, as well as many trial attorneys appear hopeful that the MSA (Master Settlement Agreement) is a “model”. Rather than perform their jobs as they were trained, they can convert much of it to mere paper pushing and administration; with interests of their clients being secondary to their own – there has been much written about that. However, surely their intellectual capacity ought to recognize that a rigorous, or at least a reasonable and fair set of standards should be the rule.

There is a VIOXX EDUCATION PLAINTIFF EDUCATION GROUP (VPEG) for Vioxx Plaintiffs (now 340 and growing people). Regardless of the “settlement” official position - "things are not as they always appear...", the group REMAINS very, very relative and is gaining increasing “name brand recognition”. VPEG concerns, etc., need to be dealt with, and VPEG is becoming one of the lynchpins in converting a very unfair private settlement to what it should be…

VIOXX victims - we know you shall gain no comfort with the arrogant anti civil right violation HAWKS, also apparently MANY of your attorneys, and certainly not Merck… but there is a group of individuals in a similar situation and KNOW what you are going through. In some ways they are on the leading edge of knowing what the heck is going on and how Vioxx is being used by the MASS TORT LITIGATION REFORM hawsks who wish to pound the MASS TORT system to the ground, without a care in he world of legal fairness or your legal rights.

Whether - whether an "opt-in" who was also "boxed-in" -or- and "opt-out" who Merck is trying to "box-out"; if you are a vIOXX Plaintiff and wish to become part of a dialogue of nearly 350 individuals and growing, WHO CERTAINLY HAVE NOT GIVEN UP and are a bunch of decent, compassionate, human beings - all damaged by (allegedly…) Merck, in the VIOXX debacle...if you are a Plainitiff feel free to submit a request to join the VIOXX PLAINTIFF EDUCATION GROUP (VPEG) - at:

Dennis Harrison

p.s. – there is another, active litigation case in re to (alleged…) bone and spine healing problems - another group will be set up in June for that specific issue. It is not directly affiliated with this one, but will be started by one of the members (name above) who has been actively involved in the allegations of bone and spine problems (not a lawyer, but a pro se litigant). What is important to note that VPEG is increasingly aware of not only the major unfairness of the private “settlement”, a great place to dialogue and find people in your situation, but also seeks synergies with other (alleged…) shoddiness within Vioxx and across Merck “product” lines – PATTERNS and CONSISTENCIES of MERCK behavior are becoming increasingly known and relevant…

Anonymous said...

So, in response to an unscientific survey in Men's Health magazine, you conduct and publish your own unscientific survey. Did you bother to calculate whether your 59 respondents represented a statistically significant number? What is the point of mentioning that Sermo has 23000+ members if only 59 responded. N=59, not 23000. That by itself seems to be a cheap attempt to augment the perceived validity of your unscientific survey to the casual reader. Your survey, like the article you are commenting on, represents nothing more than an opinion piece and it is disingenuous to represent it as anything but, particularly when criticizing a publication’s misrepresentation of an opinion piece as a survey.

Now, as for your actual “findings.” I understand that the article you are commenting on is specific to the subject of doctors’ opinions of drugs, but I would like to look at this from a broader perspective. Is it really a surprise that the doctor’s in your survey don’t have a problem prescribing proven unsafe drugs? Firstly, pharmaceutical sales reps don’t typically visit doctor’s to warn them about the dangers of their employers drugs once they have been determined via statistical modeling to be unsafe or worthy of concern. Secondly, if doctors are routinely prescribing these drugs, wouldn’t it introduce sever cognitive dissonance to recognize that the drugs were unsafe and the action of the doctor exposed patients to risk. Thus, it would be more intellectually comfortable to down play the risk of the drugs overall than to accept one’s own involvement in the distribution of a dangerous drug. Thirdly, a physician is hardly an expert on pharmaceuticals (methods of action, safety profiles, etc). Funny that you are dismissive of a Pharm D…I’d trust a Pharm D’s opinion of drugs any day over an M.D. Where does an M.D.’s drug education come from? In practice, almost all of it comes from commission-paid undergraduate-degree holding pharmaceutical sales reps.

This brings me to my final point, and I do earnestly hope you answer at least these questions. In your commentating on the media’s reporting of medical issues, you yourself are behaving as a journalist. Therefore, a little bit of journalistic standards are in order regarding disclosure. A quick perusal of your blog demonstrates a common theme of defending the merits of drugs with maligned safety profiles. I would love to see you answer the following questions in the sake of disclosure:
• I have seen you listed as faculty for GWU School of Medicine. How much of your research is now or has been funded in part or in whole by pharmaceutical manufacturers?
• Are you full time faculty or do you currently practice internal medicine as well? Have you prescribed any of the medications you have defended on your blog? Have you potentially dismissed patient’s reports of side-effects for any of the drugs you have defended?
• What have you received in the past in the way of compensation or bonuses, cash or material, from pharmaceutical manufacturers? We know you’ve at least gotten some desk calendars and pens, but what else?

In conclusion, perhaps you can explain why you trust the research coming from a for-profit industry over the statistical analyses performed on obviously underreported data from the FDA or citizen advocacy groups. I don’t understand why you would give greater credence to the industry, but I suppose your answers to the previous two questions might elucidate that.

Anonymous said...

I am just a layperson, so I could be wrong, but aren't their comments on Prilosec and Nexium lacking logic?
They say that stopping acid production may have risks - like infection or low calcium absorption. Then they recommend Zantac instead. But Zantac also reduced acid even if it works in a different way. So wouldn't it have the same problems? If the cause of all these problems is the reduction in acid, does it really matter how it is achieved?

Also, as a normal weight female with very stubborn reflux laringitis (not sure about spelling...), I found the universal advice to lose weight pretty annoying. Yes, I understand statistics and I know that weight is a significant risk factor for the acid reflux. But the article doesn't say "if you are overweight, then lose weight". It says lose weight as a universal advice. Well, I weight 125 pounds, and while losing 5 would certainly help me look better in my size 5 skirts (and I am working on it), I doubt it very much it'll make a difference in my reflux problem. Especially given that my weight tends to fluctuate a bit between 120 and 125 pounds, and I haven't noticed much difference.

Dr. Matthew Mintz said...

You are correct on both fronts.
There main "claim" is that Prilosec/Nexium were linked to heart concerns, which were simply not the case. They go on to mention other concerns, which have a little more data behind them, mainly pneumonia. However, this is usually seen only in hospitalized patients, and not the average person with GERD or heartburn. Also, as you mentioned, it is the acid supression, not the pill, so it is unclear why Zantac is necessarily a "safer" choice.
Regarding weight loss, for someone with a normal weight, weight loss will unlikely improve reflux symptoms

Dr. Matthew Mintz said...

As for the prior response,
I will be the first one to admit that my survey is by no means scientific or conclusive. I also don't discount Pharm D's who are both knowledgeable and valuable. The point is that the subject of the article was 8 drugs doctors would never take, and they really never asked any doctors. Their list did not jive with my clinical experience and seemed to simply re-hash potential concerns that have been out there in the media before. Though not entirely scientific, I would hope that patients would be reassured that when actually asking a community of physicians, the ones that responded in general greatly disagreed with the list, with the exception of Ketek. I will soon post the final tally of my Sermo post.

Provillus hair regrowth treatment said...

Thank you for the over all post and I request to tell about the 8 drugs.