When a cardiologist recommended a drug to my, at the time, 91 year old mother and I was there and asked "What side effects does it have". He said.. are you ready? READY? "NONE" Yep that's what he said. I was shocked but not nearly so as when his next line was after I inquired again "If I tell …
When a cardiologist recommended a drug to my, at the time, 91 year old mother and I was there and asked "What side effects does it have". He said.. are you ready? READY? "NONE" Yep that's what he said. I was shocked but not nearly so as when his next line was after I inquired again "If I tell my patients all the side effects they won't take the medication"
I am glad Dr. Cifu sits and talks to his patients but again he offered (in this writing) no alternatives other than pharmacological ones. Maybe he offers other things but if it was a routine practice I doubt he would not include it in his writing.
Perhaps he and Mandola will team up and discuss their experiences with recommending non-pharmacological interventions to their cardiac patients. One also has to examine why insurance doesn’t cover such interventions, or even the time needed to go over them with patients. 15 minute intervals seem pretty standard for most types of appointments and that’s not the doctor’s fault. To really help patients with lifestyle interventions requires far more time than that.
I was aware in the past that if a doctor changed a medication for a patient they were reimbursed more (by Medicare) but I am not sure that is still the case
If you're implying it's common for doctors to change a medication for Medicare patients to increase reimbursement rather than because it was clinically indicated, that's a damning claim, and IMHO opinion, should only be made if you can prove it with credible evidence, which you failed to provide. Doctors have to know not only medicine, but billing practices or they risk losing money, and it's just crazy (see Medicare billing below, and that's just one of many they deal with). As for your comment below, I know why people don't trust Pharma. As I first stated, there's a lot they do that I don't like, and both drug research funding and the FDA need to be reformed. But it's not an easy problem to solve, given that such research is tremendously expensive, unless you want your taxes to increase proportionately so the government can fund it. I haven't heard any solutions from you, unless you're suggesting we should just eliminate medications. In that case, my husband would be in much pain and unable to function. He has psoriatic arthritis (PsA) through no fault of his own (autoimmune diseases run in his family), and he exercises more than anybody I know and eats healthy. But his inflammation was sky high, which is bad for the entire body, not just joints, and he experienced pain and loss of function. Since starting a biologic (a monoclonal antibody), his inflammation is in the normal range, his pain is gone, his grip strength is back to normal, and he's no longer experiencing joint degeneration. There are may other diseases besides PsA for which medication is the only efficacious intervention. So speak for yourself; as I said before, I wouldn't want to live in a world with no medications. There may come a day when you will be unable to survive and/or function without medication but you can always refuse to take it because you don't trust Pharma.
I didn't provide a link, you are correct, because I didn't state it as a fact. I said "I believe" not I am sure. I said that because I worked in health care and heard it many times in the office!!
I think we need to go back to a cash pay system so that people can make the final decision on what to do.
Some people needs meds I agree but how can you reconcile the fraud (that I provided links for) and their benevolence?
Has he ever tried turmeric, capsaicin, massage therapy or fish oils to help? Has any doctor suggested that? How about not just eating healthy but an elimination diet to see if there are certain things that make it better or worse?
I forgot to mention he stopped the turmeric after reading about the study below. He doesn't need another autoimmune disease! Many people seem to think "natural" remedies never have side effects, which is not true. In fact, many medications came from "natural" sources, and anything effective is also likely to have potential side effects.
Again I am not against medicines for those that need them. I am against not having informed consent about the risk and benefits. Diet, health. If we've learned anything these past few years it's we need ALL the information and to be able to decide for ourselves.
Well I would like to read that study but cannot. And what I did read it was one person who self identified. THAT is why I am SO supportive of patients knowing the "risks and benefits" for themselves because we are all different. This whole thread was started because the Doc made a general statement that the drug he was RXing was "generally well tolerated" but gave no risk or benefits (in his writing but maybe he did and didn't note it??) so that the patient could decide. THAT is what I was getting at.
I included another study below with 10 cases of liver injury. It's probably relatively rare, the same was with many meds, but there's probably no such thing as an effective treatment that has no potential side effects. They may also underestimate side effects of "natural" treatments, since there are usually no RCT's, and no organized reporting system as with meds, and people may not even realize an adverse event is from something "natural," because they think that's not possible. In any case, I agree with you completely that we're all different, and that patients should know the risks and benefits and decide for themselves. Given the background of the docs here and their frequent critiques, I would think they do discuss these with patients. They are all busy practicing doctors, so I don't know how they even find the time to write what they do. They probably don't want to write a book with every article. But maybe they'll read our discussion and somebody will write an article on that topic alone. Would be interesting.
AND those I linked are ONLY the five largest.
When a cardiologist recommended a drug to my, at the time, 91 year old mother and I was there and asked "What side effects does it have". He said.. are you ready? READY? "NONE" Yep that's what he said. I was shocked but not nearly so as when his next line was after I inquired again "If I tell my patients all the side effects they won't take the medication"
I am glad Dr. Cifu sits and talks to his patients but again he offered (in this writing) no alternatives other than pharmacological ones. Maybe he offers other things but if it was a routine practice I doubt he would not include it in his writing.
Perhaps he and Mandola will team up and discuss their experiences with recommending non-pharmacological interventions to their cardiac patients. One also has to examine why insurance doesn’t cover such interventions, or even the time needed to go over them with patients. 15 minute intervals seem pretty standard for most types of appointments and that’s not the doctor’s fault. To really help patients with lifestyle interventions requires far more time than that.
I was aware in the past that if a doctor changed a medication for a patient they were reimbursed more (by Medicare) but I am not sure that is still the case
We won't even talk about this article.
https://jamanetwork.com/journals/jama/fullarticle/192577
If you're implying it's common for doctors to change a medication for Medicare patients to increase reimbursement rather than because it was clinically indicated, that's a damning claim, and IMHO opinion, should only be made if you can prove it with credible evidence, which you failed to provide. Doctors have to know not only medicine, but billing practices or they risk losing money, and it's just crazy (see Medicare billing below, and that's just one of many they deal with). As for your comment below, I know why people don't trust Pharma. As I first stated, there's a lot they do that I don't like, and both drug research funding and the FDA need to be reformed. But it's not an easy problem to solve, given that such research is tremendously expensive, unless you want your taxes to increase proportionately so the government can fund it. I haven't heard any solutions from you, unless you're suggesting we should just eliminate medications. In that case, my husband would be in much pain and unable to function. He has psoriatic arthritis (PsA) through no fault of his own (autoimmune diseases run in his family), and he exercises more than anybody I know and eats healthy. But his inflammation was sky high, which is bad for the entire body, not just joints, and he experienced pain and loss of function. Since starting a biologic (a monoclonal antibody), his inflammation is in the normal range, his pain is gone, his grip strength is back to normal, and he's no longer experiencing joint degeneration. There are may other diseases besides PsA for which medication is the only efficacious intervention. So speak for yourself; as I said before, I wouldn't want to live in a world with no medications. There may come a day when you will be unable to survive and/or function without medication but you can always refuse to take it because you don't trust Pharma.
https://www.cms.gov/files/document/chapter1generalcorrectcodingpoliciesfinal11.pdf
I didn't provide a link, you are correct, because I didn't state it as a fact. I said "I believe" not I am sure. I said that because I worked in health care and heard it many times in the office!!
I think we need to go back to a cash pay system so that people can make the final decision on what to do.
Some people needs meds I agree but how can you reconcile the fraud (that I provided links for) and their benevolence?
Has he ever tried turmeric, capsaicin, massage therapy or fish oils to help? Has any doctor suggested that? How about not just eating healthy but an elimination diet to see if there are certain things that make it better or worse?
I forgot to mention he stopped the turmeric after reading about the study below. He doesn't need another autoimmune disease! Many people seem to think "natural" remedies never have side effects, which is not true. In fact, many medications came from "natural" sources, and anything effective is also likely to have potential side effects.
https://casereports.bmj.com/content/2018/bcr-2018-224611
Again I am not against medicines for those that need them. I am against not having informed consent about the risk and benefits. Diet, health. If we've learned anything these past few years it's we need ALL the information and to be able to decide for ourselves.
Well I would like to read that study but cannot. And what I did read it was one person who self identified. THAT is why I am SO supportive of patients knowing the "risks and benefits" for themselves because we are all different. This whole thread was started because the Doc made a general statement that the drug he was RXing was "generally well tolerated" but gave no risk or benefits (in his writing but maybe he did and didn't note it??) so that the patient could decide. THAT is what I was getting at.
I included another study below with 10 cases of liver injury. It's probably relatively rare, the same was with many meds, but there's probably no such thing as an effective treatment that has no potential side effects. They may also underestimate side effects of "natural" treatments, since there are usually no RCT's, and no organized reporting system as with meds, and people may not even realize an adverse event is from something "natural," because they think that's not possible. In any case, I agree with you completely that we're all different, and that patients should know the risks and benefits and decide for themselves. Given the background of the docs here and their frequent critiques, I would think they do discuss these with patients. They are all busy practicing doctors, so I don't know how they even find the time to write what they do. They probably don't want to write a book with every article. But maybe they'll read our discussion and somebody will write an article on that topic alone. Would be interesting.
https://www.amjmed.com/article/S0002-9343(22)00740-9/fulltext
I think, YES, we agree. Sadly this isn't the first time I've mentioned it and although I may be one ready I think the good Docs read the comments.
I also see that we came into this conversation as adversaries but after the "coffee talk" we aren't that different.
Have a great day!
YES, and I LOVE when that happens! Thanks for engaging! 🥰