by Tony Cusano | Dec 16, 2018 | Public
An expert consensus statement such as this one recently released by the American Heart Association about a topic with such incomplete science should include a full transcript of all the deliberations in order to allow physicians and the public to judge the logic and factual accuracy behind the consensus statement.
Much data for performing a full scientific evaluation of these medications remains uncollected. In that setting it is not appropriate for experts to make a “scientific” statement that does not fully describe the derivation of the statement.
Statins, like any medical therapy, should only be used after shared decision between a patient and doctor after they fully discuss the benefits, risks, alternatives and unknowns of the treatment planned.
If you need help collaborating with your doctor to make medical decisions, we can help. Contact us for a free consultation.
by Tony Cusano | Nov 17, 2018 | Public
Many new and promising medications have been approved by the FDA over the past few years. While these drugs offer novel benefits for difficult diseases like Diabetes Mellitus, heart disease and cancer, the science behind them is incomplete.
A recent plea by an expert physician for his colleagues to use a new type of diabetes drug reveals the danger of biased emotions in making medical decisions to use such new drugs.
1) This physician has disclosed significant financial ties to the pharmaceutical industry
2) He states real facts about these drugs, and those facts indicate that for now the drugs should be available in every physician’s armamentarium for treating patients with DM.
3) The bias is to loosen the criteria used to decide on when to use them. Their serious adverse effects are likely more common than reported, as is usually discovered once drugs tested on limited numbers of subjects are used on larger numbers of patients in less rigorously controlled community practice settings.
Additionally, there are unknown adverse effects that are likely to be discovered as they are used for longer periods than the initial testing covered.
Finally, although they were effective as tested, the effectiveness was in a small minority of all patients who received them. Their benefits only slightly outweighed the risks.
In this situation, each decision must rigorously account for the balance of benefits, risks, alternatives and unknowns. There are patients who should get them based on their situation without more established alternatives, but those patients should be carefully chosen, and be fully educated about the BRAU that goes into the decision.
These drugs may someday be widely used, or they may have a niche use, but enthusiasm is neither scientific nor disciplined medical practice.
It has no place in medical decisions.
Be sure to collaborate fully with your doctor to make a shared decision when he or she offers a new medication for any condition.
by Tony Cusano | Nov 11, 2018 | Public
This harrowing five-part story adapted from ‘The Digital Doctor’ by Robert Wachter describes a near disaster due to a medication error augmented by a high-quality hospital’s Electronic Health Record. It starkly reveals the risks of medical care in the digital age. Too much system noise and overwhelmed caregivers make even routine decisions and tasks take on a high level of risk.
Vigilance is required at every turn. If you feel that you are overwhelmed managing a hospital episode for yourself or a loved one, or in keeping track of the complex facts of your medical care, we can help.
by Tony Cusano | Sep 20, 2018 | Public
This very well written review of scientific issues regarding complementary and alternative medicine reminds us of the challenges in making good medical decisions when medical science is incomplete.
The author points to one study of an asthma remedy that improved breathing symptoms without changing lung function. That could lead to fatal consequences,
Yet, as author Andrew Solomon says In this wise and humorous story of how exorcism can cure depression, “for depression, if I can stand on my head and jump up and down three times and feel better, that works.”
Conditions that involve less pathology than symptomatology are perfect for traditional remedies. But seemingly harmless remedies that relieve symptoms without improving the underlying pathology can be very dangerous.
We encourage you to take charge of your health care. We also advise rigorous evaluation of the benefits, risks, alternatives and unknowns of any treatment, whether the science behind it is rigorous, or weak.
We can help you find information or sort out the information you have.
Call for a free consultation.
by Tony Cusano | Sep 17, 2018 | Public
A large and rigorous study to look an the question of whether aspirin makes sense for older people to prevent cardiovascular events raises serious questions about its benefits and risks.
The study showed more risk than benefit, and found more death from cancer in those using aspirin. This raises great concern that previous positive studies were statistical flukes.
Unfortunately, The way medical statistics are used by medical scientists leads to most medical studies turning out to be wrong.
This is another spectacular example of why you should make a careful and collaborative evaluation of the benefits, risks, alternatives and unknowns of every medical decision.
The use of single chemicals to alter the human body, Even those found in natural sources like willow bark and other traditional medicinal plants which contain the main ingredient of aspirin, has some merit, but may make little sense for many people.
If you want to learn more about how to evaluate medical studies, or to collaborate with your doctor better to make good medical decisions, we can help.
Call is for a free consultation.
by Tony Cusano | Sep 9, 2018 | Public
Many people have developed type 2 Diabetes Mellitus (the kind that does not usually need insulin). The best treatment for it is weight loss through diet and exercise. The mainstays of drug treatment over the past decade or so have been Metformin to improve insulin efficiency in the body, and one form or another of sulfonylurea medications that increase insulin output by the pancreas. These treatments are variable in their success, though the variability is largely due to dietary indiscretion and inadequate exercise.
A few new types of medications have come along, and all successfully reduce blood sugars. Two of the new classes seem to prevent cardiac events that are so common in diabetes, although the true extent of the benefit to risk rations has not been fully elucidated.
The problem with these new medications is that they have only been on the market for a few years, so lots of unknowns still exist. A new warning from the FDA emphasizes one of those that has been recently uncovered by its post marketing surveys (what I like to call the phase 5 safety trial).
I cannot emphasize enough how significant this risk is. Although not common, the severity is so high that no one should take the medication unless they absolutely need to, and all the alternatives have been considered.
This new warning about a very heavily promoted medication that seems great but has only marginal benefit over older medications while carrying significant risks and unknowns serves as another reminder that it is critical to take charge of your own care by collaborating with your doctor on important medical decisions.
We can help you collaborate better. Contact us for a free consultation.
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