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Thread: Ben Goldacre: What doctors don't know about the drugs they prescribe

  1. #1
    Abandon ship. Duckman's Avatar
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    Ben Goldacre: What doctors don't know about the drugs they prescribe

    http://www.ted.com/talks/ben_goldacr...=email#t-51240

    When a new drug gets tested, the results of the trials should be published for the rest of the medical world except much of the time, negative or inconclusive findings go unreported, leaving doctors and researchers in the dark. In this impassioned talk, Ben Goldacre explains why these unreported instances of negative data are especially misleading and dangerous.
    We all lead different lives.


  2. #2
    I didn't read the link yet but have done a bit of guinea pigging in my younger life and have to say that some commonly presented side effects such as palpitations and nausea and sleeplessness and lethargy are very likely due to the anxiety of the participants.....they are however still listed on the packets.

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    lone wolf survivalist.
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    GP's don't know anything about drugs, its just what the rep has on offer that week, your average pharmacist knows more about drugs than any GP ever will.
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    unleash my pharma powers! Daisysmum's Avatar
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    Seen it Duckman. But thanks for posting Dr G for me - academic eye candy.

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    Abandon ship. Duckman's Avatar
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    Remember. Big pharma are not board certified medical professionals. If a GP does not prescribe, s/he can be sued for professional negligence. If the medication turns nasty, you are then in the position of suing the pharmaceutical company in question. They can afford better lawyers than you can.
    We all lead different lives.
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    unleash my pharma powers! Daisysmum's Avatar
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    Quote Originally Posted by Duckman View Post
    Remember. Big pharma are not board certified medical professionals. If a GP does not prescribe, s/he can be sued for professional negligence. If the medication turns nasty, you are then in the position of suing the pharmaceutical company in question. They can afford better lawyers than you can.
    Hi, no maybe not, but every pharmaceutical company employs board certified medical professionals. I get job alerts for SanofiAventis, Astra Zeneca, and J&J to name but a few. I won't need them for a year or so but it helps to tailor courses to see what they are looking for.
    If I get your meaning correctly, if a physician or independent prescriber makes an error of omission or an error of commission they can be sued for professional negligence. If you make a claim for it to be successful you have to prove both negligence and causation. You cannot claim compensation just because someone has done something wrong. You have to prove that this has caused you significant mental or physical injury.
    Your final comment regarding suing the pharmaceutical industries, it has been done and successfully, but I'd make sure you have really good grounds and you've read the small print. I've had 2 adverse drug reactions but both were listed, it was a Dr in one case who messed up a drug algorithm...thrice, the other time the possibility of such adverse side effects was on the drug sheet. Only once have I ever had to yellow card a side effect.


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    Abandon ship. Duckman's Avatar
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    I meant there is an onus on the GP to prescribe.
    We all lead different lives.

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    Quote Originally Posted by hagrid View Post
    GP's don't know anything about drugs, its just what the rep has on offer that week, your average pharmacist knows more about drugs than any GP ever will.
    Quite true. In the case of some locums, it gets much worse. Our local pharmacist told me he regularly gets between 20 and 30+ calls in one day from the local surgery, if there is a locum on, wanting to know what drug, dose, and intervals is okay for the patient being looked at. Some of these locums, the pharmacist told me, look at the patient's history on the PC, then ring him to check it out and share the responsibility. Not bad for 350 a day, eh? (Figures given by the practice manager).
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    unleash my pharma powers! Daisysmum's Avatar
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    Quote Originally Posted by Duckman View Post
    I meant there is an onus on the GP to prescribe.
    But who is putting the onus on GP's to dish out pills? Did you see Dr Chris Van Tulleken in the two part documentary 'The Doctor who gave up Drugs' http://www.bbc.co.uk/programmes/b07w52tp

    I was a bit disappointed with his choices of target patients, in first year I was writing essays about anti-depressants only working successfully for some and having to point out the reasons. But it's TV, venturing into the land of 'Selling sickness' would cause an outcry.

    No, when Dr Chris (and, cards on the table if Dr Goldacre and Dr Van Tulleken, or his twin ever ditch their respective specialities and venture into the field of neurology, I may develop some very unusual auras and triggers), was sitting in as a GP he was getting hammered for antibiotics by patients who didn't 'feel safe' not getting them - like whiney kids at the candy stand in a supermarket. Sometimes he prescribed due to age or related comorbidities, sometimes it was the pressure of time, sometimes it was just sheer pressure. I don't know if anyone has read any of Theodore Dalrymple's books but in one he tells of a colleague who signed someone off for apparently no reason. He called the doctor to question why this apparently fit man was signed off. Seemingly when he had refused the man a sick line the man picked up his CRT monitor and threw it at him and next thing he was on top on him on the floor. Not bad for 350 a day...

    I personally don't trust pharmacists or doctors when it comes to drugs. I once had a hospital pharmacist dispense a prescription for antihistamines, these particular drugs stop my drugs from working, I know this from experience. I explained this. 'Oh don't worry it's just a little one'

    If you want advice about your drugs and the use of them from a health perspective find a pharmacist.
    If you want advice about what your drug does to your body, side effects, interactions etc. ask a pharmacologist.
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    unleash my pharma powers! Daisysmum's Avatar
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    Quote Originally Posted by oldkeith View Post
    Quite true. In the case of some locums, it gets much worse. Our local pharmacist told me he regularly gets between 20 and 30+ calls in one day from the local surgery, if there is a locum on, wanting to know what drug, dose, and intervals is okay for the patient being looked at. Some of these locums, the pharmacist told me, look at the patient's history on the PC, then ring him to check it out and share the responsibility. Not bad for 350 a day, eh? (Figures given by the practice manager).
    In defence of some locums, I've been to talks and lectures on polypharmacy where the patient has been on anything from 5 to 18 medications at the same time and we do have an ageing population. Whilst it is not always the case by and large the older you get the more drugs you will find yourself on, and the more often these things you are on drugs for require you to see a doctor. If you come in as a locum and you are allocated 10 minutes to see someone, even if you adored pharmacology at medical school, listening to the person's complaint/s is going to take up part of your time. For one drug I have seen GP's get out a BNF, fair enough that's what it's for: if someone is on a shed load of meds, some interactions may spring to mind, but the person who deals with them most regularly will be the local pharmacist. I doubt it is a case of dodging responsibility, but more like seeking advice from the best possible source available to assist the patient in the limited time given.
    I've heard as much junk from pharmacists as I have from doctors. My all time personal favourite is 'They are the same drugs honest' when trying to give me parallel imports or generics. I have Sanofi Aventis and Janssen Cliag on speed dial just in case the doctor is dragging his heels branding my script.
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    I don't trust modern medicines, too many side effects, I take the very minimum I can get away with.
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  12. #12
    All prescribing is pharmacy screened.....as such pharmacists are obligigated to report medicinal conflict to the prescriber.

    Off licence prescribing is rare and requires a DR with balls of steel to do so in 'the best interests of the patient'.

    Big pharma cannot run the studies required to achieve licensing for a new drug without involving medically qualified personnel.

    Generic medication is well policed when prescribed in this country. In rare cases some patients may have an allergic type reaction to the buffers or pigments/coatings used by individual manufacturers.

    Sure the MONEY is there for DRs ........BUT ......these higher functioning folk might take their talents elsewhere if it were not.

    We aren't talking about average Joe's here. .....they have to score very highly in academia AND work long hours with massive responsibility in a hard, apprenticeship type environment whilst expressing compassion and making accurate decisions.

    They could all apply their talents for better money elsewhere.
    Last edited by zendaze; 21-11--2016 at 01:18 AM.

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    Slightly off-topic rant at ignorantly thought out sentence....

    'In rare cases some patients may have an allergic type reaction to the buffers or pigments/coatings used by individual manufacturers.'

    Is that why so many of us with 'rare'
    conditions are fighting to get out scripts branded?

    You mess about with the usual drugs that you give someone with my condition you don't just get - don't you DARE remove this, I want people to understand- an 'allergic type reaction' - you get:

    loss of control - and that means seizures, and that can mean, losing your driving licence, job, time off work/studies, having to work in a different role, being viewed differently at work/studies, having to look for a new freaking job. Good control is beholden to all of us. Please don't anyone quote the Equality Act 2010 it keeps as many of us out of jobs as it supposed protects. Best thing you can hope for is that no-one ever buggers about with your meds and to avoid triggers.
    Faff around with our meds and you think we get ALLERGIC TYPE REACTIONS!

    Pharmacists and doctors don't live in the pill taking world they just hand them out and the 'allergic type reaction' post was synonymous of how trivial our situation is thought to be. My doctor is pretty good and he knows if he doesn't brand my script I will go elsewhere and I know where to get research and documentation to say I am better of on one type of medication.
    The latest MHRA guidelines divide anticonvulsants up into 3 types regards whether they should not be changed, not be changed after discussion with the patient and can be changed; it has made it confusing for doctors and patients alike especially if people are on drugs which cross groups and one can be changed but another can't; thus the change may increase the chance of interactions if the supply varies. If the drug is a time release the mechanism of release may also be different, causing different therapeutic spikes, resulting in ta dah seizures...
    That's one example of a disease model wants its drugs kept the same. Lots like it. Allergic reaction -
    https://www.prescqipp.info/appropria...pileptic-drugs
    Last edited by Daisysmum; 27-11--2016 at 06:57 PM.
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    'In rare cases some patients may have an allergic type reaction to the buffers or pigments/coatings used by individual manufacturers.'

    Is that why so many of us with 'rare'
    conditions are fighting to get out scripts branded? You mess about with the usual drugs that you give someone you don't just get - dont you DARE remove this, I want people to understand, a 'allergic type reaction' you get:

    loss of control with my condition and that means seizures, and that can mean, losing your driving licence, job, income(at worst), time off work, having to work in a different role, being viewed differently at work, having to look for a new freaking job. Good control is beholden to all of us.
    Faff around with our meds and you think we get ALLERGIC TYPE REACTIONS!

    Pharmacists and doctors don't live in the pill taking world they just hand them out and the 'allergic type reaction' post was synonymous of how trivial our situation is thought to be. My doctor is pretty good and he knows if he doesn't brand my script I will go elsewhere and I know where to get research and documentation to say I am better of on one type of medication.
    The latest MHRA guidelines divide anticonvulsants up into 3 types regards whether they should not be changed, not be changed after discussion with the patient and can be changed; it has made it confusing for doctors and patients alike especially if people are on drugs which cross groups and one can be changed but another can't; thus the change may increase the chance of interactions if the supply varies. If the drug is a time release the mechanism of release may also be different, causing different therapeutic spikes, resulting in ta dah seizures...
    That's one example of a disease model wants its drugs kept the same. Lots like it. Allergic reaction -
    https://www.prescqipp.info/appropria...pileptic-drugs

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    unleash my pharma powers! Daisysmum's Avatar
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    Oh stuff it if I managed to post it twice it might sink in.

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    Quote Originally Posted by Daisysmum View Post
    Slightly off-topic rant at ignorantly thought out sentence....

    'In rare cases some patients may have an allergic type reaction to the buffers or pigments/coatings used by individual manufacturers.'

    Is that why so many of us with 'rare'
    conditions are fighting to get out scripts branded?

    You mess about with the usual drugs that you give someone with my condition you don't just get - don't you DARE remove this, I want people to understand- an 'allergic type reaction' - you get:

    loss of control - and that means seizures, and that can mean, losing your driving licence, job, time off work/studies, having to work in a different role, being viewed differently at work/studies, having to look for a new freaking job. Good control is beholden to all of us. Please don't anyone quote the Equality Act 2010 it keeps as many of us out of jobs as it supposed protects. Best thing you can hope for is that no-one ever buggers about with your meds and to avoid triggers.
    Faff around with our meds and you think we get ALLERGIC TYPE REACTIONS!

    Pharmacists and doctors don't live in the pill taking world they just hand them out and the 'allergic type reaction' post was synonymous of how trivial our situation is thought to be. My doctor is pretty good and he knows if he doesn't brand my script I will go elsewhere and I know where to get research and documentation to say I am better of on one type of medication.
    The latest MHRA guidelines divide anticonvulsants up into 3 types regards whether they should not be changed, not be changed after discussion with the patient and can be changed; it has made it confusing for doctors and patients alike especially if people are on drugs which cross groups and one can be changed but another can't; thus the change may increase the chance of interactions if the supply varies. If the drug is a time release the mechanism of release may also be different, causing different therapeutic spikes, resulting in ta dah seizures...
    That's one example of a disease model wants its drugs kept the same. Lots like it. Allergic reaction -
    https://www.prescqipp.info/appropria...pileptic-drugs

    I find the refusal to listen to the person with the health problem (or the person looking after them) very difficult to manage. We haven't started on epilepsy meds yet as they still haven't made a diagnosis but I am gearing up for yet another battle when we get to that part of the process. Thanks for posting this, DaisysMum, I didn't know that it's the coatings that can sometimes cause a problem so that will be good for me to keep in mind if we hit any problems
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  17. #17
    Its still rare though.... Maybe I missed something along the way.....Good for you that you have an answer and solution and clarity on what you need. Oh right I see it ...I didn't check out the link......probably because its title is a bit general.

    I must have missed the post where you stated how much this affects you and where I personally attacked you.

    I do take offence that, once again, you are putting words in my mouth....I too consider myself an expert patient with regard to my own health issues and have come across many who are expert patients and yet more who clearly have a very good idea of what they need. I encourage and support this approach to life and medicine and empowerment.

    Maybe if I'd applied discretion and attempted to consider the OP's original post...............

    The reactions to generic medications ARE rare and no one is trivialising your condition except funders who continue to insist on reducing financial outlay......which means you have a letter to write to the appropriate body rather than bitching and biting at me.
    Last edited by zendaze; 27-11--2016 at 09:48 PM.

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    unleash my pharma powers! Daisysmum's Avatar
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    Reactions to generic medications are so very rare that for hiking up the price of a class one
    anti-convulsant Pfizer and flynn Pharma were fined a record amount; as nothing else would warrant the severity of their actions. Almost fifty thousand people on the medication couldn't be moved to a generic, hardly a 'rare' reaction - some 50,000 people loosing control of their medical condition. But then it depends on your definition of an ADR.

    No-one is bitching at you. I know where my knowledge and experience in this field lies, I just wonder given your sensitivities why you are attacking me for a post which was only meant to inform - I'm very glad Givingitthought managed to get something from it.

    GivingitThought please PM me if you need any more info, I haven't been on the forum due to exams and flat trouble.
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    Heavenly Creature cricket's Avatar
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    Do you have much/any research stats on contra indications of drugs?I have long been very concerned about this.More so than the coatings, as, with regard to quantity of product and effect of product, this seems a more seriously impacting health issue.I do not underestimate the issue with coatings though, as I accept allergens hitting the system of a reactor can be devastating.
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    Quote Originally Posted by cricket View Post
    Do you have much/any research stats on contra indications of drugs?I have long been very concerned about this.More so than the coatings, as, with regard to quantity of product and effect of product, this seems a more seriously impacting health issue.I do not underestimate the issue with coatings though, as I accept allergens hitting the system of a reactor can be devastating.
    Hi Cricket, any particular medication combinations that are worrying you?
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    Heavenly Creature cricket's Avatar
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    None specific at present as i did not give my son the pain/anti inflamatory nor the omniprazole.I helped him manage his knee ,ongoing ,problem.The new school has no stairs and we do minimal stairs at home.The drs thought i was unhinged when i said i thought the root cause was the very many concrete stairs and big rucksack loads at the old school and the jolt load on his knees.aggrravating it.We do massage too.Minimal discomfort I feel sure is better than meds which disguise the issue.The acid reflux was exam stress cured by space,rest, spoiling and end of exams.The doctor didnt even look them up,just said dont worry.If there is a more comprehensive and detailed reference guide than the BNF that is unbiased,not censored by the big pharma companys, I would much appreciate it if you would let me know.
    Quote Originally Posted by Daisysmum View Post
    Hi Cricket, any particular medication combinations that are worrying you?
    I also worked with special needs kids in the past on 6 or 7 different drugs/day and worried about it all.No one seemed to care about the mix.

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    Quote Originally Posted by cricket View Post
    None specific at present as i did not give my son the pain/anti inflamatory nor the omniprazole.I helped him manage his knee ,ongoing ,problem.The new school has no stairs and we do minimal stairs at home.The drs thought i was unhinged when i said i thought the root cause was the very many concrete stairs and big rucksack loads at the old school and the jolt load on his knees.aggrravating it.We do massage too.Minimal discomfort I feel sure is better than meds which disguise the issue.The acid reflux was exam stress cured by space,rest, spoiling and end of exams.The doctor didnt even look them up,just said dont worry.If there is a more comprehensive and detailed reference guide than the BNF that is unbiased,not censored by the big pharma companys, I would much appreciate it if you would let me know.I also worked with special needs kids in the past on 6 or 7 different drugs/day and worried about it all.No one seemed to care about the mix.


    It's the mix that I find difficult to deal with in general, Cricket, not specifically meds but life in general! My son has 'complex needs' several of which we still don't have a diagnosis/reason for. He isn't treated holistically which causes enormous problems. The doctors we see know a lot about their own 'bit' but not so much about the other 'bits' and the way they interact/affect one another. All of his problems are neurological in origin so it's impossible to tell where the edges are for the different conditions he's been diagnosed with. Everyone we see seems to just do the minimum they can get away with and then try and refer him on to someone else or discharge him without any real progress being made (in my opinion). I find I have to know more than the doctors in order to insist things get done and that's hard! I read as much as I can but I'm so worn out and my own health is starting to suffer now so it's getting tougher. Unfortunately I think a lot of parents with kids with special needs get so tired of having to fight for every single thing they need, on top of the hassles you get day to day from other people and the difficulties of raising a child with problems that they just conk out (I know I have! Lol). We need very strong coffee on prescription

    I hope your son is doing a bit better now. I do think kids are under ridiculous amounts of stress these days (and so are a lot of parents! ).

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    Quote Originally Posted by Daisysmum View Post
    Reactions to generic medications are so very rare that for hiking up the price of a class one
    anti-convulsant Pfizer and flynn Pharma were fined a record amount; as nothing else would warrant the severity of their actions. Almost fifty thousand people on the medication couldn't be moved to a generic, hardly a 'rare' reaction - some 50,000 people loosing control of their medical condition. But then it depends on your definition of an ADR.

    No-one is bitching at you. I know where my knowledge and experience in this field lies, I just wonder given your sensitivities why you are attacking me for a post which was only meant to inform - I'm very glad Givingitthought managed to get something from it.

    GivingitThought please PM me if you need any more info, I haven't been on the forum due to exams and flat trouble.

    That's very kind of you, DM, thank you. I'm re-reading the stuff you sent me a while back; it's very useful and is making more sense as I get my head around things and figure out what is going on (I find it really helps me to read a bit, then watch my son and see how much of it rings true, then re-read and so on). I will give you a shout if need be, thanks. I hope your exams went well and your flat troubles got sorted
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    unleash my pharma powers! Daisysmum's Avatar
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    The flat issues are sorted now. Thank god, I've just got to move to the new place - which is actually Halls, where I left but a different room. More expensive but a whole lot less hassle.

    One thing GivingItThought , I'm assuming when you are talking about 'doctors' you mean the specialists dealing with your son's complex needs. There are a lot of the guys on the epilepsy forums complain because their neuros aren't specialists in the field, you are a lucky bunny if you have an epilepsy specialist - funding and cuts etc.
    I look up my neuro's published work (did it to the last one too), very little of this one's work is on epilepsy and epilepsy is a broad field, neurology even more so. I'm in good hands if I have a stroke though. I'm actually getting a new on in January - more papers to look up For those of us who are controlled and have a relatively boring diagnosis, it is very much 'When was your last seizure?' 'Any issues with side effects (if they remember)?' and the rest of the time is spent trying to stretch the appointment out to something resembling can be bothered but best keep her in the system as its a transient condition - remember 2012 when they tried keppra - whoah! Basically, I guess what I have is about as interesting as a cold to a virologist; its a pain in the butt and it still has to be managed but it isn't anything to write an award winning care study on.

    For anyone with anything that is atypical to the normal presentation, it must be a an interesting learning curve even for a specialist in an area where there is so much scope for dysfunction. Neurology takes in the central nervous system the peripheral nervous system and the muscles they control.

    'I find I have to know more than the doctors in order to insist things get done and that's hard!' - I really feel your pain. I started out with a letter from a hospital that I couldn't make head nor tail off. I Googled individual words and it sounded horrific, basically, I was too scared to go to the doctor, I thought I was meant to understand this and it was some kind of death sentence.

    Eventually I got the courage to discuss it with my neurologist and she said 'oh it's just the way your brain is made, that's all they are describing. Ignore it.'

    I've read countless posts from freaked out people after reading letters from doctors that seem to be little more than justifications of years spent slaving over medical books resulting in an inability to write in plain English.

    Let me know if you need anymore info on anything. Probably best to use my uni email, PM me if you need it again.
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