I’ve been on Plavix since my CABG in 1999. In 2005, I also received a Cypher DES. My cardiologist, in whom I have utmost confidence, recommends staying on Plavix “forever” to minimize the risk of a clot forming. For a drug that’s been around as long as this one has, it’s hard to understand how there can even be a controversy.

Anyone who would would let a TV commercial change their medication regimen is not someone who should dictate public policy. Anyone would change their parent’s medication based on a TV commercial is not a good decision maker.

Freedom means the right to make bad choices. All choices about therapy come with consequences.

There are good studies about when patients need Plavix. Post stent is a definite indication. The question that has newly arisen is for how long? It was initially approved by the FDA for 3-6 months post stent. A study recently published in JAMA suggests Plavix needs to be taken for 2 yrs post medicated stent (Cypher, TAxus). Bare metal stents dont seem to need it past the usual 3-6 months but most pts dont get bare metal stents, they get medicated stents. This study only followed pts for 2 yrs. What about 3 yrs? or 4? We just dont know yet

Plavix is not indicated for cardioprotection in patients with just risk factors for cardiovascular disease. The CHARISMA trial proved this to me. Pts risk of bleeding was increased but there was no benefit of decreasing cardiac events. In this trial the company and many cardiologist will tell you in pts with cardiovascular disease (CAD, PVD or cerebrovasc disease) that they need plavix too. But the statistical analysis was flawed and when done properly shows no benefit of plavix in these folks.

“This is why the lawyers are good at manipulating the general population.”

You must mean the defense lawyers, since doctors win the majority of malpractice cases. Who knew so many juries were rendering mistaken verdicts for the physicians?

Um… It isn’t just lawyers. It is the media, advertisers, salesman, etc. Critical thinking is something that is sorely lacking in the general population.

I often shock physicians by asking about whether this or that study is truly representative – and I have even been known to do a citation analysis!

The average person, heck, even the average educated person wouldn’t look at how often a given author is cited by his/her peers. Yet, if we want people to be “responsible” for their own medical care, they need those skills. Just because such and such doctor says this in this paper doesn’t mean it is so. Was it replicated? Is there more than one school of thought on how those results could be interpreted?

I think it would be better if we had a class of practitioner who worked as a true patient advocate to help explain all the benefits and risks associated at the patient level. Since good nurses are patient care experts, they fit the bill so that doctors can concentrate on what they are supposed to do, namely diagnose the problem – even if it is on the long-tail.

Pax,

MLO

I agree. It seems that people are so easily persuaded that these medications are the way to go. They don’t look into whether maybe they’ll be worse of or at more risk by taking the meds. Very intriguing.