Comments on: Plavix, lawyers and externalities

By: Surefire Guy

Surefire Guy — Thu, 17 Apr 2008 14:57:07 +0000

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.

By: Carrie James

Carrie James — Tue, 03 Apr 2007 12:51:51 +0000

In reply to your reader who wrote that her mother had just had 2 stents put in and is now on Plavix – I would say you have very good reason for concern. I lost my dear mother two weeks ago today. She too had just had stent surgery (six months ago), but otherwise was a youthful enthusiastic 71 year old. One of her post op meds was Plavix. Then one day while paying for a prescription at the pharmacy she had what is thought to be a stroke, fell straight back, fractured her skull and crushed her cerebellum. She died four days later. I now have very big questions about the role of Plavix in her death.

Carrie

By: MLO

MLO — Mon, 12 Feb 2007 18:47:54 +0000

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

By: lawrence

lawrence — Wed, 07 Feb 2007 04:10:56 +0000

no I think he meant
“This is why the lawyers are good at manipulating the general population.”

By: CJD

CJD — Mon, 05 Feb 2007 18:52:19 +0000

“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?

By: MLO

MLO — Mon, 05 Feb 2007 14:05:27 +0000

This person’s comment is part and parcel of what is wrong with our educational system. How many people actually know how to read and evaluate a study? To even understand the likelihood of a 1%, 5%, or even 30% chance? The numbers who play the lottery thinking they will win show very few understand even the basics of chance.

Most people never learn critical thinking. Every drug has side effects. The question is whether those side effects outweigh the benefits of using the drug. This is where it is so important for people to learn how to read and understand the statistics behind drug trials. This is difficult when they don’t know that 1% is a very small number. They become convinced they are in the 1%. (Of course, some are.)

Now, I’m not naive enough to believe well-structured unbiased studies come out of drug companies, but there are some things that can be gleaned even from a bad study. Reported incidences of side effects are a reasonable thing to go by. Of course, if it is unreported, that is another story. (Personal Opinion: Drug companies who cover up should be put up on fraud charges and if death occurs, the officers of the company should be the ones up on negligent homicide charges.)

Perhaps it would be good to design patient handouts for the drugs that are being given that are actually written in language that the average patient can understand. It should spell out that when 100 people took this drug for your problem, only 1 person told us about this side effect. With the specifics being written in. Most drug inserts are written at about an 11th grade level. I’ve taught college students to write. Trust me, reading comprehension is not all that common.

Whether you like it or not, the average patient should not be considered to have a reading comprehension above that of a 4th grader. This is why the lawyers are good at manipulating the general population.

Pax,

MLO

By: TerryS

TerryS — Fri, 02 Feb 2007 17:53:13 +0000

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.

By: ang

ang — Thu, 01 Feb 2007 06:52:40 +0000

for people who believe the sky is falling, they need a little reassurance and then some education. a blog may not be a good format.

By: Erik

Erik — Thu, 01 Feb 2007 01:01:46 +0000

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.

By: paul

paul — Wed, 31 Jan 2007 16:19:26 +0000

I ve been prescribing the drug for several yeears on hundreds of patients. I do believe the data from those randomized studies. when used in proper way for certain indication, I think the drug is trustworthy.