[e-drug] please be a little moderate.... (2)

e-drug
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E-DRUG: please be a little moderate.... (2)
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Dear friends,

I agree, fully, the case of aspirin is always the one I refer to in my mind and in discussion with other colleagues whenever a new scandal about a drug arises. And yet I use aspirin in all my diabetic patients both in primary and secondary prevention as they have an extremely high risk of cardiovascular disease, which kills some 70% of them and shortens or cripples them in their ordinary life and make it a misery for many years.

I also behave exactly in the same way as Bernhard does and I have no doubts that the majority of other doctors do. Maybe many of us unfortunately can be conned by the drug reps (as we call them in England) or the "detailers" (that's how I think they are called in North America). But this is because most doctors are overwhelmed by clinical work and have no time to look at the evidence in academic papers or, unless they work in academia themselves, might not have the technical knowledge of statistics that is necessary to understand the majority of published literature.

I think most doctors are generally altruistic folks, even if we have our own vested interest as one of the main things or pleasures that make us tick in life is to make our fellow human beings better, when we can. And one of our greatest sorrows is when we are unable to do that. Or when we have made some dreadful mistake which all of us do sooner or later...

Please, please remember this. Do not slender us because of some rotten apples. Beside, many doctors, luckily, are astute enough te recognize who they are.

Sometimes, I have felt so frustrated, unfairly treated and so deeply sorry by stories which have appeared in the forum (especially the ones which have been copied from the lay press without checking the original medical literature). The only reason for me not speaking up was lack of time, although I did on occasions as I am doing now.

Last thing: whenever I prescribe a drug that a patient has never used before, not only I talk him/her through all the major side effects and instruct them on what to do, but also remind the patient that no drugs on earth come without risks (my example is always aspirin, which is normally seen as innocuos by patients).

Foods don't come without risks either, or insect stings, or inhaled substances. How many people killed by anaphylactic shock from peanuts or bee stings... Tens of thousands -literally.

Just a curiosity, I once had a patient who literally terrified me, who developed anaphylaxis from the paper of the magazine she was reading while I was doing an oral glucose tolerance test on her.

I am very grateful to Bernhard and I hope that our feelings be shared by other doctors in the list.

Yours,

Valeria

Dr Valeria Frighi
Oxford Centre for Diabetes, Endocrinology and Metabolism
Churchill Hospital
Oxford
OX3 7LJ
UK
Tel # 44 1865 857300
Fax # 44 1865 857311
valeria.frighi@doctors.org.uk

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E-DRUG: please be a little moderate.... (4)
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dear E-druggers,

As a clinician who has worked both in the West (UK, Belgium) and a developing country (India), I can understand the feelings of Dr. Frighi and others who are devoted to the welfare of their patients.

However Society forms its opinion based on collective experience and evidence. How does one explain the following facts?

1. Eleven drugs (such as metamizole, droperidol, cisapride) internationally banned or discarded are being prescribed by doctors in India even when safer and far more efficacious alternatives are available?
No doubt that drug regulator has failed in his duty but why should doctors patronise such products. It is certainly not because of ignorance. The list of such discarded drugs is listed in MIMS INDIA each month, has been reproduced by several newspapers with huge circulations and has been a subject of discussion on several TV programmes. Doctors patronise because they are patronised by producers.

2. Due to non-application of product patent in India so far, each molecule has several branded formulations. Our study has shown that more expensive brands (some times 600% more than equivalents) sell far more than less expensive brands even when the producers have equivalent credibility. This happens because producers use excessive profits to give incentives to doctors. Naturally doctors accept such favours; otherwise the sales will not go up.

3. Doctors are involved in large-scale manufacturers sponsored drug trials without mandatory regulatory approval and even more important without proper, valid, informed consent from poor, illiterate, female subjects. Examples: Letrozole use in infertility, erythromycin pallets use for contraception, just to give two recent examples. Why do they do so?

I am not suggesting that all doctors receive incentives but many do. No wonder Indian medical profession today is one of the least respected professions.

Dr. Chandra M. Gulhati
Editor, MIMS INDIA
(Monthly Index of Medical Specialities)
e-mail: indianmims@yahoo.co.in
seeemgee@yahoo.co.uk