Doctor or Patient Incharge?: Example of Medical Paternalism

Monday, April 12, 2010

Example of Medical Paternalism

One such example of medical paternalism that most people are familiar with is the Gardasil vaccine. The governor or Texas, Rick Perry, mandated that girls should be vaccinated. It was suggested that even though he was attempting to do something beneficial, he had ties to the Merk company. People were outraged by his actions. So if something is beneficial to some patients, should patients be given a choice or simply given something without knowing potential side effects? Should it be up to the consumer to decide?

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Consumer Report

WHAT YOU CAN DO

Until the nation’s drug-safety system is adequately reformed, the following guidelines can help you protect yourself:

• In general, if you’re taking any of the 12 high-risk types, don’t just stop, but ask your doctor whether the risks outweigh the benefits in your case and whether other options may be right for you.

• Don’t pressure your doctor to prescribe a drug, particularly a new one, unless other options haven’t helped and there’s strong evidence that you need it.

• Ask your doctor whether nondrug treatments can achieve adequate results. If not, might a lower dosage suffice, particularly combined with nondrug therapy?

• For a new drug, ask whether studies show that it’s more effective and apparently safer than older options. If not, older ones with longer track records may be a better bet. Older drugs also tend to cost less.

• Ask your doctor or pharmacist for a list of the drug’s known adverse effects. Supplement that information by consulting unbiased sources such as Consumer Reports’ Consumer Drug Reference, Consumers Union’s Web site (www.CRBestBuyDrugs.org), this site and www.ConsumerReportsMedicalGuide.org), or the National Library of Medicine’s Web site (www.nlm.nih.gov/medlineplus/druginformation.html). For the latest updates on drugs’ adverse effects, go to the FDA’s Web site (www.fda.gov/medwatch/safety.htm).

• Report any serious drug reactions to your doctor, or download the form from the FDA’s Web site, www.fda.gov/medwatch/report/consumer
/consumer.htm and bring it to the doctor or file it yourself.

• See our vital information to help you weigh medical treatments--both benefits and risks.

Consumer Report Drugs Pateints Should Be Aware of Potential Side Effects

DRUG	USED FOR	MAY CAUSE	RECOMMENDATION
Celecoxib (Celebrex)	Pain and inflammation.	Increased risk of heart attack and stroke. (Other NSAIDs may have similar risks, but current evidence appears stronger for Celebrex.)	Use only if other pain relievers don't help. Avoid it, especially at higher doses, if you have elevated risk of heart disease.
Estrogen alone (Premarin and others) or with progestin (Prempro and others)	Menopausal symptoms and postmenopausal osteoporosis.	Increased risk of breast cancer, heart disease, stroke, and blood clots.	For menopausal discomfort, use only for short-term relief of severe symptoms if other steps, such as exercise and relaxation, don't help. For osteoporosis, use only as last resort.
Isotretinoin (Accutane)	Severe nodular acne.	Birth defects, depression, psychosis, and suicidal tendencies.	Use only if less aggressive treatments don't help. Don't use if you are pregnant or may become pregnant. Have moods monitored closely by doctor.
Malathion (Ovide)	Head lice.	Flammability of hair and neurotoxicity.	Use only if other insecticides (Nix, Rid) don't help.
Medroxy-progesterone injections (Depo-Provera)	Contraception.	Irreversible bone loss.	Don't use if you've had blood-clotting disorder or unusual vaginal bleeding. Discuss alternatives with your doctor.
Mefloquine (Lariam)	Malaria prevention for travelers.	Disorientation, severe anxiety, paranoia, hallucinations, and depression.	People who've had psychological problems should use alternative: doxycycline or atovaquone/proguanil (Malarone).
Rosuvastatin (Crestor)	Elevated cholesterol levels.	Muscle breakdown, kidney damage. (Other statins may have similar risks, but current evidence appears stronger for Crestor, especially at high doses and in Asian-Americans.)	Use only if other statin drugs with longer safety records don't help.
Salmeterol (Serevent)	Asthma.	Increased asthma-related deaths; risk may be higher in African-Americans.	Use only with adequate doses of an inhaled corticosteroid, and only for prevention.
Sibutramine (Meridia)	Weight loss.	Increased blood pressure and heart rate; heart-rhythm abnormalities, heart attack, cardiac arrest, memory problems.	Don't use if you have heart disease, hypertension, or other significant coronary risk factors.
SSRIs such as sertraline (Zoloft), and other antidepressants such as venlafaxine (Effexor)	Anxiety and depression.	Increased suicidal tendencies initially or after dosage changes, particularly in children and teens but possibly in adults as well. All antidepressants may have similar risks, but current evidence appears stronger for SSRIs.	Monitor mood closely during the first few months and after dosage changes.
Tegaserod (Zelnorm)	Irritable bowel syndrome with constipation.	Potentially dangerous diarrhea, other intestinal problems.	Use only if safer options don't help: Boost fluid and fiber intake, limit foods that trigger symptoms, exercise, and reduce stress.
Topical immuno-suppressants pimecrolimus (Elidel), tacrolimus (Protopic)	Eczema.	Increased cancer risk.	Use only if first-line therapies, such as topical corticosteroids, don't help.

Lists of major adverse effects are not necessarily all-inclusive. Sources: Medical
literature, FDA alerts, drug labels, and drug-safety consultants.

Monday, April 12, 2010

Example of Medical Paternalism

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Doctor or Patient Incharge?

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Consumer Report Drugs Pateints Should Be Aware of Potential Side Effects