Who cares about patients?

As  sort of follow-up to my earlier post, Pulse magazine, this morning, says:-

“Making GPs work longer and pay more for their pensions is one step too far from the health secretary.”

That is, making them work until 65, instead of 60. Hmm . . .

(I’ll ignore the fact that it should be “…by the health secretary.”)

It does rather make me wonder – and I know that Pulse is a magazine aimed at GPs, not patients – why none of Lansley’s measures aimed at fucking with the lives of patients has attracted the slightest ire.

Or could it be – and I ask this in all seriousness – that the patients don’t matter a hell of a lot? That we’re just a source of income?

Now I do know some GPs will be mortified by that suggestion, and justifiably so – but I also know some who appear to regard patients as a necessary bloody nuisance, to be endured.

Whatever the truth of the matter, it might be nice to see a little thought given to our plight occasionally. Don’t you think?

But – you’ll love this – a Pulse contributor who writes under the name of Copperfield, and has an extremely jaundiced view of patients, is waxing wroth at his PCT’s restrictions on hospital referrals.

Not because it’s bad news for his patients, though it is, but because he resents the implication that he might refer people unnecessarily.

Priorities, eh? Don’tcha just love ’em?

5 thoughts on “Who cares about patients?

    • It’s approved for use in the EU. Whether NICE approved it for UK use before they were sidelined, I don’t know.

      Clinical Study Findings

      The European approval was based primarily on data from 2 pivotal, 1-year phase 3 trials of more than 3000 patients with COPD, showing that roflumilast significantly improved moderate to severe exacerbations and prebronchodilator forced expiratory volume in 1 second relative to placebo — an effect that was independent of concomitant long-acting β2-agonist therapy.

      Two supportive 6-month studies demonstrated that roflumilast significantly improved lung function relative to placebo when added to tiotropium or salmeterol — 2 commonly used bronchodilators.

      “What’s interesting about the data — in terms of the whole series of articles published in the Lancet — is that there clearly was an additive effect to other standard therapies used in COPD, suggesting that Daxas really would have some efficacy in exacerbation prevention,” said Dr. Shorr.

      “The main additional benefit of Daxas on top of what is already achieved with bronchodilators is to reduce the number of exacerbations, or flare-ups, which are the events that really concern the patients who experience them. For patients with COPD associated with chronic bronchitis and a history of flare-ups, Daxas can make a real contribution,” said Neil Barnes, MD, in a company news release.

      Dr. Barnes is a professor of respiratory medicine at Barts and the London Hospital in the United Kingdom. (But see above re company news release – involved with the company?)

      Note, though, that a significant effect compared to a placebo is hardly wonderful!

      In the US the FDA have some safety concerns, and have yet to licence it.

      On the basis that it’s not exactly a world-class breakthrough (in the way, say, Aminophylline was 30 years ago), and if there are safety concerns, personally I wouldn’t touch it just yet. Unless you’re desperate, wait a year – see if it kills anyone.

      http://www.medscape.com/viewarticle/724903 (above extract)

      This is more informative http://www.medscape.com/viewarticle/720010 The FDA’s main gripe, and it’s a valid one, is that Roflumilast hasn’t been tested against other COPD drugs, so there is no way of gauging its efficacy compared to what’s already in use (or the question of potentially dangerous interactions/conflicts). Fair enough – testing it against a placebo really tells you bugger all that’s useful. Take the placebo effect out of the equation and what you’re left with is that it might just possibly be better than nothing, and that’s really not good enough.

      I’m with the FDA on this one, and, based on the limited information available, I can’t understand why the EC approved it.

    • First-in-class drugs are often dodgy. Remember Vioxx, one of the first, if not the first, of the COX-2 inhibitors? It killed people and was withdrawn. Later COX-2 inhibitors were OK (though the class as a whole is prone to some very serious side effects).

      Then there’s Serevent. When I was prescribed it, it was getting a rep for killing patients in the US. Then they found out that when people had been prescribed it, they’d taken it instead of their normal meds (especially their steroid inhaler), when it’s intended to be an adjunct, not a replacement. Once that was figured out, the deaths stopped. Well, within reason – no drug is 100% safe, but we have to balance the risks against the benefits.

      Patients – especially COPD patients – should always ask, “Is this as well as or instead of?” when prescribed a new drug. The doctor should tell you unprompted, but might forget. The bottom line is that you have a duty to yourself to find out – so ask.

  1. Nice post about Pulse magazine’s take on GPs and patients. You’re right. Most doctors don’t give a hoot about patients. They’ve deluded themselves into thinking that making money for themselves is helping patients. I speak from experience having become disabled unnecessarily at age 50 because years earlier, doctors only masked symptoms rather than find the cause. Then they passed me around like a hot potato from one specialist and test to the next and no one was responsible for comprehensively analyzing results. Aren’t we glad everyone will now be able to get all the uninterpreted tests I did — now that we will all have health insurance!? Doctors and patients live in two separate worlds. It’s worse than the divide between how differently men and women perceive things.

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