8 Drugs That Doctors Would Never Take?
19 CommentsBy Ed Silverman // June 23rd, 2008 // 7:29 am
That’s the headline on a piece in the latest issue of Men’s Health, which usually spends time looking for erogenous zones and workout equipment. Now, though, the mag writes that it sifted through the Physicians’ Desk Reference and then asked some docs, “Which medications would you skip?”
Their list is supposedly your second opinion and if you’re on any of these, MH writes, talk to your doc. Okay, so which drugs? Here goes…Advair, Avandia, Celebrex, Ketek, Prilosec, Nexium, Visine Original and Pseudoephedrine. Want to know why? Look here for the explanation…
UPDATE: And look here for a response from Glaxo, which markets Advair and Avandia.
Dr. Sal Giorgianni
The following letter was sent to Men’s Health Magazine regarding this article, and I thought some of you might find it of interest.
To The Editor
Men’s Health Magazine
I read with interest your review article “8 Drugs Doctors Would Never Take” by Morgan Lord. The clinicians you interviewed provide some valuable insights about the medications mentioned. But a modest word of caution here, by taking these opinions and giving them the weight of “dogma” this article may be incorrectly steering men away from some very useful products. As I am sure you can appreciate, the medical community debates the appropriate use of medications all the time and the tendency for some docs. to choose a “drug of choice” or a “drug of non-choice” is more a personal matter based on their professional judgment and preferences. These personal-professional preferences for medications should not be considered right for every health care need any more than the personal-professional preferences of one car expert should be considered right for every car buyer. The fact of the matter is that all of the products in your article have merit and may be useful for some men and bad for others. To simply tag these, or any medication, as a No-Go for everybody is just not helpful to anybody. Personally, this doctor of pharmacy has no qualms about any of these medications when used properly and under appropriate supervision.
The best way for men to get the most appropriate medications for their individual needs is to have candid, regular discussions with health care professionals they trust. Individual medical needs, circumstances and preferences can then be taken into account and a rational selection of medications can be made. While I agree that for most folks the PDR makes great bedtime reading if you want to fall asleep fast, all that information and all those listings provide us with a very large armamentarium of products to help tailor needs and that choice and range of choices is to their advantage.
May I suggest the following medication selection advice for your readers; speak with your physician, pharmacist or other health care provider about your needs. Take a page out of the women’s movement playbook and become your own best health-care-advocate. Read up on areas of personal need, yes, including articles like this one do your own homework and ask questions. But above all – take charge of your health and use those doctors out there as your own health-care-coach…that is what they do best for you.
Lisa Van S
“Take a page out of the women’s movement playbook and become your own best health-care-advocate”!!!!!!!!!!!
I declined to take Ketek, risks outweighed benefits. Nice to see that Physicians agree.
M. Scott - Dunder Mifflin
Lisa, you should see new doctors. Never ever saw an Rx for Ketek.
Also, this is a crap list. Read #1 to start, very poor explanation and goes against asthma guidelines. So if your doc would rather prescribe off of scare headlines in the USA Today vs. clinical guidelines good luck. I make sure my doctor doesn’t read Men’s health.
Really you could go on and on with most of them - but can you really go out and get psuedophedrine or Ketek right now anyway?
Next list should put in Vioxx, Propulsid, Seldane and anything else taken off the market the last decade.
Lisa Van S
M.Scott,
The prescription of Ketek was prescribed to me before the Congressional Hearings and the Black Box. Ive learned a very important lesson,.. Investigate the Med, be an edeucated consumer.
Lisa Van S
M. Scott,.. Important note. Sales Reps were pushing Ketek as an effective treatment for Lyme Disease. Can one imagine taking this drug for four weeks!!!!!!!!!!!!!!!!!
M. Scott - Dunder Mifflin
Lisa, as you know there aren’t a lot of good effective options for Lyme disease. It seems as if your doctor was trying to help and present a new potential treatment option for a patient that continually comes back with complaints.
If you hadn’t heard of the potential problems with Ketek before Congress got involved you need to find a doctor that did. Since it was withdrawn, was it really necessary for Men’s Health to include it in an article?
I still think if you are healthy that it isn’t that big of a deal. I would take it for 4 weeks, but my liver is tougher than most.
Got to run, just burnt my foot on a Foreman grill. Need a CT scan.
anonymous
Let’s see: Celebrex is no more dangerous cardiovascularly than any other NSAID. They all have the same CV warning. As for GI, the whole reason Cox-2’s were developed was lower potential for GI bleed. All NSAIDs are hard on your kidneys if you take them long enough.
So, rather than point out that anti-inflammatories are not risk-free, and Celebrex is no more dangerous CV-wise than naproxen, the article steers you towards….acupuncture? There are many studies that show acupuncture is bunk. And I can’t see someone suffering from severe osteoarthritis getting relief from needles twice a week.
Let’s see: this should read–”One Hysterical Headline That Will Make You Buy Our Magazine!”
Justice in MI
The jury on Celebrex (and other NSAIDs) is still out. The big Cleveland Clinic study will tell us more.
Having the same warning (currently) only means we don’t yet know whether that will or won’t change. Meanwhile, any GI benefit for celecoxib (unlike Vioxx) turned out not to be significant.
No one ever claimed the Celebrex was more effective for OA than other NSAIDS. Of course, some pts will have had that experience, thus as others will do best with others. Overall, no significant differences.
Anyone want to wager a pen or something on the Celebrex CV outcome?
vince
The list seems pretty reasonable. A drug that increases the risk of death from the condition it is designed to treat is a drug most would stay away from. Despite the assurances od the c guidelines ;written by the best doctors money can buy.
Jaynesday
A different angle,
Why would Men’s Health publish such a story? Of course their first reason would be to sell more magazines. They would have to assume then that their customers might be concerned about the safety of the drugs that they take enough to give this consideration. The basis of the story is you shouldn’t necessarily trust the drugs that are prescribed to you, or maybe you shouldn’t assume that your own doctor would even take the drugs that are being prescribed to you (not saying that this is true).
Regardless of what drugs were recommended to avoid, I feel that the underlying concern is the more important issue. I’m stretching it I know but could this be a sign of the awakening of Mr.J.Q.Public?
Also, this is a lose form of “Consumer Reports for Drugs” which I personally would advocate. Let the consumer give a yea or nay (in a controlled manner, not by magazine)for the drugs/devices they use. Good drugs survive and the bad wither away.
CMC guy
If ones considers that most the alternative medications or life style changes suggested are less expensive could this simply mean these MDs surveyed don’t see the value in many of these medications? Shouldn’t generalize yet many docs can be “thrifty personalities” or just not up-to-date on drug comparisons so wouldn’t try for themselves as first choice. While in most cases would think it probably is best to take the iterative treatment approach, starting at the older/cheaper, at times individuals will see greater benefit from newer/more costly drugs that not seen with alternatives.
The article is correct that the PDR should be classified as a sleeping aid.
Justice in MI
For Jaynesday - As you probably know, Public Citizen/Health Research Group already publishes Best Pills, Worst Pills in both monthly and yearly volumes, on line and hard copy. My guess is that most, if not all, of the meds listed here are also on PC’s “do not take” list.
Therapeutics Initiative, which can be accessed on line, also has evidence-based assessments of many of the meds listed. They are based at the University of British Columbia.
And there are others, as Bob and others well know.
Wider point - Some will fault these organizations for one reason or another. But they provide an opportunity to hear what are clearly non-promotional assessments. From there, it’s up to each of us. (I personally take a couple of meds that PC says “don’t use.”)
M Helm, MD
I don’t generally think of Men’s Health as being an authoritative resource on much other than how to get cut abs in 8 weeks, so I’m not sure how much play this story will get. My list of drugs I won’t take includes some of the same, but the rationales given by the MDs quoted are a little sketchy - and in some cases not supported by evidence.
I think the pan of Advair (which should also have included Symbicort to be fair and balanced) was too simplistic, and gave information which is counter to what we know, and NHLBI asthma treatment guidelines for adults.
The accupuncture recommendation - while laughable - actually has at least one study which showed significant benefit for low back pain versus meds (can’t recall if it was NSAIDs or opiates). It doesn’t even have to be GOOD (classical Chinese) accupuncture. It seems that the prolonged interaction with a caregiver, and the BELIEF that it was effective generated nearly the same benefit as the classical Chinese approach, both accupuncture arms (classical and “random”) were at least as effective in pain relief as the meds.
J.I.M. I won’t wager a pen on the NSAID CV risk outcomes, but only because I buy my own. I’m thinking that the greater the difference between COX-1 and COX-2 toward the COX-2, the greater the risks will be see for CV events, but at the moment the jury is still out. With more than a dozen NSAID alternatives, not including acetaminophen and the oft-forgotten non-acetylated salicylates (the latter, for me would be the only agents I would use in bleeding/disordered clotting conditions), there are plenty of alternatives, and several approaches to avoid GI upset.
Too bad that the magazine didn’t take the opportunity to point out treatments which are uniquely beneficial. I’m thinking, inhaled steroids (alone) for most persistent asthma, saline irrigation and/or intranasal steroids for allergic rhinitis and nose problems, thiazide diuretics, and ACE inhibitors for CV risk reduction (throw in statins, aspirin, beta blockers, and maybe even ARBs too if you want - especially for the secondary prevention), CPAP for snoring, cognitive behavioral therapy with or without SSRIs for depression/anxiety, etc.
CMC Guy, I think you’ve got it right, and I’m probably one of those conservative MD types. Then again after my PhRMA experiences (and before medical school), I decided not to personally use any new medicines in the first two to three years after US marketing. If you think the PDR is bad, try reading (virtually)every word of Goodman and Gilman’s text. Katzung’s text is for those who only read the Cliff’s Notes.
It may have been a brave move for Men’s Health to publish this article, how much PhRMA ad revenue will they lose. Maybe Dr. Giorgianni can tell us if Pfizer is advertising Viagra there? If so, it is hard to see that going on much longer?
Dr. Sal Giorgianni
Dr. H
“I don’t generally think of Men’s Health as being an authoritative resource on much other than how to get cut abs in 8 weeks”
I’m sure few, if any, in health care think this…but they DO have a very broad and rather loyal readership and they WILL sway opinion, particularly in what I believe to be their key demographic, in this case I would say to the health detriment of their readership.
“It may have been a brave move for Men’s Health to publish this article, how much PhARMA ad revenue will they lose. Maybe Dr. Giorgianni can tell us if Pfizer is advertising Viagra there? If so, it is hard to see that going on much longer?”
I don’t think it brave at all - just a good read on the temperament of the public and what sort of material will drive non-subscribers to buy the magazine from the-rack. As to any ED-product ads, not sure if there are anymore in there, but if not I would be surprised. Again, the demographic, given the current “enhance your sexual experience” themes is what drives the ads buy decisions, not so much what the editorial is. If this logic prevailed in the ad-purchase and promotional response models there would hardly be any PhARMA or BIO ads in the likes of NEJM, JAMA or Lancet.
roccaas
Metformin instead of a glitazone?? How many people died from Glucophage every year: metabolic acidosis, contrasting dye procedures. It’s predecessor Phenformin was removed from the market after several deaths in the ’70’s.
The studies that MD’s used to Rx this medicine 10 years ago studied doses that were far smaller than those used in clinical practice.
Maybe you should try Oranase or another 1st generation Sulfonylurea’s so that if you get low blood sugar it will last for over 24 hours.
Beyond diet and exercise, if I was diagnosed today with Type 2, I’d consider the appropriate dose of insulin and skip all of the pills.
Dr. Sal Giorgianni
I have been following this story pretty closely. It has grown great legs. In the past few days it has been picked up by outlets. So anyone who thinks that sources such as this are not a factor in how patients think - please reconsider.
truthman30
Hmmm..
Just Two Glaxo Drugs out of the 8? ..
Not surprised at that..
I am surprised that Paxil or Zyprexa wasn’t on the list though…
Both are killers..
Larissa Surchin
I can’t believe the irresponsible nature of this article. While surely a couple of the drugs have some signficant issues, other drugs on the list are ludicrous. Check out this blog from a respected physician for a more balanced viewpoint: http://drmintz.blogspot.com/
Jane Hitchings
As pharm rep & a patient, I have become extremely disappointed by how the doctors have succumbed to practicing media based medicine. They should be practicing evidence based medicine. I am extremely cautious when I refer friends & family to doctors I call on. No doubt articles as irresponsible as this fuel the fire. However it is important as a patient to be knowledgeable about disease states that affect you, but a doctor should also be willing to educate themselves on the facts so when a patient asks a question about a drug or disease state they can answer with facts not with media headlines. Dr. Mintz is someone I would refer loved ones to. He does practice evidence based medicine, very few do. All patients have a right to see doctors that do, most are not aware their doctors don’t which adds to this snowball affect of misinformation.