"Are We Overtreated and Underinformed?" | Arthritis Information

 

 

I always understood your point, I was simply trying to bring up another consideration -- health care costs.  Perhaps, I didn't convey well the point I was trying to make -- its day three of a heat wave here, and my brain is zonky.

 

I read that a big chunk of health care expenses was for chronic diseases, and I think, if I recall correctly, like 50% are preventable diseases.  A health insurance news nerd, that was sorta exciting to me cuz I thought wow, if we get a handle on that, we could lower health care costs and provide access to health care to more Americans.  I mentioned this to my doc, and he smiled and said, yeah, but how are you going to get people to change behavior and habits?  A slight oversight on my part.  I have no control over what meds the authors chose to use as examples in the article (they mention a toe fungus one, too, so maybe that wouldn't have touched as many nerves?), but I still think the overall premise is worth considering.  I will probably read the book they recommend at the end of the article, too.




Someone with a child diagnosed with JRA, like most people, has a strong interest in health.  We all have an interest in health of children and adults I would think.Crestor news:
http://uk.reuters.com/article/allBreakingNews/idUKLV161720080831?rpc=401&pageNumber=1&virtualBrandChannel=0

If studies are showing they don't help adults.........
[QUOTE=Suzanne]Crestor news:
http://uk.reuters.com/article/allBreakingNews/idUKLV161720080831?rpc=401&pageNumber=1&virtualBrandChannel=0

If studies are showing they don't help adults.........
[/QUOTE]

When Crestor first came out, we talked with my husband's cardiologist about it.  He said that he does not prescribe it for his patients; he doesn't like what the studies have shown.  He kept my husband on Zocor.
For the sake of the kiddies, let's hope Zocor is the first to hit the market with a fruit-flavored suspension..... [QUOTE=Suzanne]For the sake of the kiddies, let's hope Zocor is the first to hit the market with a fruit-flavored suspension..... [/QUOTE]

There are adults who require liguid suspensions too.Jasmine. Lipitor and Zocor are all statins and if you come to a hospital...chances are you will not get put on the statin you take at home as many hospitals use one type. Our hospital happens to use zocor exclusively. I don't think there is much difference when it comes to action.

Many people are not properly educated when it comes to taking their statins. They should be taken at night to do the most good for your cholesterol.

Suzanne. I agree that lifestyle is important. Too many people think that popping a pill is going to increase their chances of survival. But then they continue to smoke, eat their bacon every morning and not excercise, drink soda all day and eat no fiber....etc.

I would like to see a study on what percent of our population actually has cholesterol levels that are genetically a problem versus how many people could do the same good with changing diet and lifestyle. I bet the actual number of people requiring a statin is very small. Actually, lorster, the statins are different.  Some statins have more severe drug interactions than others, depending on how they are metabolized. Studies have shown that the difference between nighttime and daytime dosing is not significant for many of the statins.  And yes, hospitals will typically not stock all of them, but most of us don't live in a hospital.  You'll be switched to the statin your doctor deems best for you upon discharge.

As for the diet-n-exercise vs. statin debate - I agree.  But it's not as easy to get someone to follow a diet and exercise regime, especially if they have other health concerns.  My father has severe back problems due to injury; in addition, he had an abdominal aortic aneurysm repair a few years back.  At that point, it's a bit late to try to fix issues with diet and exercise.  He did change his diet somewhat, but he can't do much exercise.  Even going to the mailbox can be excruciating, and when he was waiting for the aneurysm repair (delayed due to other problems) they didn't want him doing much of anything.  After the repair, he had to take it easy for quite a while, and his other problems were still there.

When my husband had his heart attack, he was not allowed to do much of anything for a few months, and his cardiologist specifically told us not to impose draconian diet changes.  And to be honest, our eating habits were not bad before the heart attack.  Very few sweets in the house; most meals consisted of some sort of lean chicken, 2 vegetables, and a starch (rice, baked potato, etc).
It is perfectly fine for you to defend the statins in order to make it feel ok to do that rather than adhere to a strict diet/healthy lifestyle.

Day versus night doses. This is the same example as susanne brought up. It may not be a significant difference, but there is a difference and that should be a consideration to people when taking this med.

And Jas, you seem to always want to have the last say on everything on this board. And let me add. There are actually people out there that are willing to make the lifestyle changes rather than just jumping on the statin wagon.

Doctors seem to throw this med to everyone that comes in with lipid profile problems. Do I smell big pharma here?Whatever lorster - I'm not going to sit and watch my husband suffer another heart attack waiting for the broccoli to kick in.  We did not eat a bad diet before, and we've certainly improved things in the past 8 years.  We go to the gym.  Neither of us is overweight (and he was not overweight at the time of the heart attack).  You can choose not to take meds - that's fine.

Are you overweight?  Go to the gym?  Eat junk food? 
http://www.medpagetoday.com/Cardiology/MyocardialInfarction/tb/10721Sorry, Lynn, but I must post after you.  I can't let anyone else have the last word. That's okay...I totally understand.  LOLJas, My husband is the perfect example of what you've talked about.  He had elevated choles, bad ratio, was slim, ate very healthy and exercised and was a non smoker.  He was a military officer and he had to be slim or else!  His lab values  were resistant to change.  No matter what lifestyle change he made, his cholesterol remained high.  After a year he was put on Zocor with amazing results.  There are the exceptions, not everyone who has high choles are obese and lazy.  I've seen many patients over the years that were slim and led a healthy lifestyle but had high cholesterol.  Of course I've seen many that were obese also. The one question I have are the recommended values for cholesterol too low?  Have the values dropped since the statins hit the market to sell more of them?  Anyone know?  Lindy   Suzanne makes alot of interesting posts!!!! [QUOTE=LinB]Jas, My husband is the perfect example of what you've talked about.  He had elevated choles, bad ratio, was slim, ate very healthy and exercised and was a non smoker.  He was a military officer and he had to be slim or else!  His lab values  were resistant to change.  No matter what lifestyle change he made, his cholesterol remained high.  After a year he was put on Zocor with amazing results.  There are the exceptions, not everyone who has high choles are obese and lazy.  I've seen many patients over the years that were slim and led a healthy lifestyle but had high cholesterol.  Of course I've seen many that were obese also. The one question I have are the recommended values for cholesterol too low?  Have the values dropped since the statins hit the market to sell more of them?  Anyone know?  Lindy   [/QUOTE]

I believe the recommendations were revised downward a few years ago, specifically for people with other CV risk factors (hypertension, previous heart attack, family history, smoking, etc).

I also know from personal experience that several friends and acquaintances have had high cholesterol levels and the first thing their physicians do, assuming no other risk factors are present, is to recommend exercise and diet modification.  If that doesn't help matters much, then perhaps a statin is added sometime down the road.  Same thing with hypertension - if it's just borderline high, most docs will tell you to try diet and exercise mods first.  If it is high, though, and/or there are other risk factors involved, then medication is used right away, with the instructions to also modify diet and exercise.  The meds can be eliminated down the road if sufficient improvement is seen from lifestyle mods.  Same thing with type-II diabetes.
Jasmine. What I'm saying is that doctors are all to quick to add a pill rather than referring a patient to a nutritionist or PT or cardiac rehab. We live in a world of pills. I'm not opposed to them, I just think they become the answer rather than diet, exercise. Between drugs like statins and antidepressants because people simply don't want to feel any emotion any more, it gets old. I'm not anti drug...I take two myself, I just feel that there comes a point that we become dependent on pills to get through our life. You work for a pharmacy company from what I remember. Naturally you are going to encourage them.

There are a group of people that simply cannot get along without their statins. but most people do not need them. they need to quit smoking, drinking, eating more fiber, exercise, reduce stress and so on. There are many very elderly people that got that way without the use of pharmacy. There is nothing more disturbing to me than to see a patient on a statin who smokes 3 packs of cigarettes a day.Let's not leave out my hubby LOL.

His only cardiac event (in fact, his only hospitalization in his entire life) was caused by Bextra.

When you are expecting your second child and something like that happens, it will change how you look at new meds and studies and marketing and samples and postmarketing and overtreatment and lack of information.

I refused a Bextra sample, because of what happened to him (it was a long time after his event before Bextra was pulled) and the dr. blew it off and said to the nurse, "Give her Vioxx then".  Two weeks later, Vioxx was pulled; then Bextra.


[QUOTE=lorster]Jasmine. What I'm saying is that doctors are all to quick to add a pill rather than referring a patient to a nutritionist or PT or cardiac rehab. We live in a world of pills. I'm not opposed to them, I just think they become the answer rather than diet, exercise. Between drugs like statins and antidepressants because people simply don't want to feel any emotion any more, it gets old. I'm not anti drug...I take two myself, I just feel that there comes a point that we become dependent on pills to get through our life. You work for a pharmacy company from what I remember. Naturally you are going to encourage them.

There are a group of people that simply cannot get along without their statins. but most people do not need them. they need to quit smoking, drinking, eating more fiber, exercise, reduce stress and so on. There are many very elderly people that got that way without the use of pharmacy. There is nothing more disturbing to me than to see a patient on a statin who smokes 3 packs of cigarettes a day.[/QUOTE]

I don't work for big pharma.  And if you look back at my posts (hell, just look at my tag line) I prefer low-tech interventions like fish oil.  My cardiac husband takes lots of meds, and zocor is the "newest" of them.  All the rest are old generics, tried and true.  He also takes fish oil and coenzyme Q10, both ordered by his doctor.  I've said repeatedly that we don't take newer drugs, unless there is absolutely no alternative.  Our doctors are of the same mindset.  They also believe in the low-tech approach first, but they also recognize that you don't always have months or years to see if diet/exercise have an effect.

And as for the smoker on statins - that's his/her choice.  Personally I think insurance companies should charge more for people with unhealthy lifestyles, not just smoking.  Haven't exercised in years?  Eat crap food?  Overweight?  Like to skydive/play hockey/etc?  Your premiums are higher. 
I guess I come from a different standpoint than many. I work on a medical floor. It is the only one in 100 miles so I see a good sampling of all medical patients in our area. I work as team leader most shifts so I get a good look at medication records every time I work. It is not uncommon to see a patient with 40 different meds available to them on their med records. I have a problem with this. There has got to be interactions going on. No one questions when a new med is added. Doctors don't have time to look at all the interactions between all the meds. Once in a while, the pharmacy will pick up on it. It is not uncommon to give a patient 30 pills with breakfast. I find this a disturbing practice. Maybe this is ok for all of you, but it is not ok with me. For someone to be on 5 different blood pressure meds and 4 different antidepressants is a problem. It is like the doctor forgot to discontinue one when prescribing a new one. This is the only thing I can figure out because who takes that many antidepressants and then we wonder why the patient is in with a psychotic episode and no blood pressure. People really do need to advocate for themselves and many do, but many just trust whatever their doctor tells them to do(big mistake as your doctor is not only human, but very busy and is capable of making mistakes) I'm so glad we have the ability to look up meds and see what they are capable of. If one BP med does not work, DC it and try another. I just do not understand why 4 or 5 meds would work and not interact in some way. And now many hospitals are using hospitalists so many patients never see their primary physician when in the hospital as an inpatient. Yes, they have the history, but they don't know the patient like the primary does. [QUOTE=Suzanne]Let's not leave out my hubby LOL.

His only cardiac event (in fact, his only hospitalization in his entire life) was caused by Bextra.

When you are expecting your second child and something like that happens, it will change how you look at new meds and studies and marketing and samples and postmarketing and overtreatment and lack of information.

I refused a Bextra sample, because of what happened to him (it was a long time after his event before Bextra was pulled) and the dr. blew it off and said to the nurse, "Give her Vioxx then".  Two weeks later, Vioxx was pulled; then Bextra.

[/QUOTE]

My husband had a full cardiac arrest while I was expecting our second child.  He was not expected to live long enough to leave the hospital.  When he did leave 8 days later, there was a 50% chance he would not live a year.  He has massive heart damage; his ejection fraction is half what it should be.  And every single day I look at him and give thanks to Big Pharma and all of the high-tech medical interventions that saved his life and keep him alive and well to this day.

P.S. other than an occasional tylenol, he had never been on any medications prior to his heart attack.  Sensible diet, moderate exercise, and a full cardiac arrest at age 42.

Thank GOD for Big Pharma.
Like I said, an event like that will change how you look at things.  So we agree on that! I'm an ER nurse, I am always amazed at the number of medications one person can be on. What do we expect though when a person goes to 5 different specialists for different problems and the left hand doesn't know what the right one is doing? As for statin drugs, every drug out there has bad side effects that can cause harm or may not be effective for everyone. We see a lot of that here, Enbrel works for some, Humira for others and so on. In the US the FDA is supposed to know all there is to know about every medication they OK. There are some medications that according to the FDA didn't have bad side effects until after being on the market for several months to a few years. Lets say that someone here posts a topic about RA medications and how statistically this one particular one is no better than taking  a sugar pill, but I'm taking that medication and it's working for me. Am I going to stop taking it because of what someone else thinks about it, nope. [QUOTE=SnowOwl] Well, I'm not sitting here shaking my fist and shouting, "CURSE YOU, Big Pharma."  [/QUOTE]

Snowowl, I do not have an issue with pharma. just polypharmacy. There is a point at which people need to stop and look at how much they are taking and decide if it is all absolutely necessary or is some of it actually causing more harm. There are some amazing meds out there that if were not available to some, those people would not be alive. Take insulin for example. One of the best inventions ever. Antibiotics are another. But for someone to be on multiple same med, is wrong. A patient goes to see multiple providers and pretty soon, they are on lots of meds they may not need.
Copyright ArthritisInsight.com