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Drugmakers

Pura Vida said:
from USA forum

Drugmakers Pushed Aggressive Diabetes Therapy. Patients Paid the Price




https://www.medscape.com/viewarticl...sso=true&impID=3775117&src=wnl_edit_tpal#vp_1

your thoughts?
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That's the same as the Reuters article I put up in the thread 'I don't know where to start', isn't it? Or at least it starts the same way.

I think it's all desperately sad, people being so badly advised and treated seemingly just to make profit. I've no idea what the answer is - especially as I'm in the UK and so US health policy isn't something I'm really qualified to comment on - but I am very sure that the current situation in the US, and increasingly in the UK isn't it.
 
Drugs companies want to maximise profit. They are not on an altruistic mission to save people. They are the main resource that sets criteria for doctors to follow, and offer incentives that are nothing to do with keeping people healthy. Thus over the years "ideal" figures for such as blood pressure, cholesterol and blood sugar are reset lower and lower.

I can't speak for other countries, but in UK there is a system (QOF) where GPs receive cash incentives to prescribe certain drugs and procedures. This is as irritating to conscientious GPs as it is dangerous for patients. But "You can't serve God and Mammon" hence we patients cannot afford blindly to trust, or to obediently follow taking prescribed meds. It's not a happy situation, but it's what we have to deal with.
 
Outlier said:
Drugs companies want to maximise profit. They are not on an altruistic mission to save people. They are the main resource that sets criteria for doctors to follow, and offer incentives that are nothing to do with keeping people healthy. Thus over the years "ideal" figures for such as blood pressure, cholesterol and blood sugar are reset lower and lower.

I can't speak for other countries, but in UK there is a system (QOF) where GPs receive cash incentives to prescribe certain drugs and procedures. This is as irritating to conscientious GPs as it is dangerous for patients. But "You can't serve God and Mammon" hence we patients cannot afford blindly to trust, or to obediently follow taking prescribed meds. It's not a happy situation, but it's what we have to deal with.
Click to expand...
QOF payment is made by the NHS rather than the drug companies and is mainly based on outcomes rather than drugs administered.
https://qof.digital.nhs.uk/
 
It's an interesting story, but creates a lot of questions. Firstly, he was getting uncontrollable hypos, so how come he still had a driving license? Secondly, as a T1 who has to take insulin, I am all too familiar with hypos. Maybe they are different for insulin dependent T2s but his diabetic team should have been helping him control them, whether with a cgm with alarms or with a more relaxed hba1c target. His target was 7% (53 in UK units) and he was achieving 7.5% (58).

My feeling is that the diabetic care was lacking, rather than the "aggressive treatment".
 
In the UK:-
  1. "You can’t adverti.se prescription-only medicines (POMs) to the general public but you can promote them to healthcare professionals and others who can prescribe or supply the product." https://www.gov.uk/guidance/advertise-your-medicines
  2. NICE guidelines say, "For adults on a drug associated with hypoglycaemia, support the person to aim for an HbA1c level of 53 mmol/mol (7.0%)."
  3. NICE guidelines also say, "Consider relaxing the target HbA1c level (see recommendations 1.6.7 and 1.6.8) on a case‑by‑case basis, with particular consideration for people who are older or frail, for adults with type 2 diabetes:

    • who are unlikely to achieve longer‑term risk‑reduction benefits, for example, people with a reduced life expectancy

    • for whom tight blood glucose control poses a high risk of the consequences of hypoglycaemia, for example, people who are at risk of falling, people who have impaired awareness of hypoglycaemia, and people who drive or operate machinery as part of their job

    • for whom intensive management would not be appropriate, for example, people with significant comorbidities." https://www.nice.org.uk/guidance/ng28/chapter/Recommendations
  4. The DVLA requires people on drugs associated with hypoglycaemia to check their blood glucose levels before driving and every 2 hours during a journey. They are not allowed to drive if they have hypoglycaemia unawareness. https://www.gov.uk/guidance/diabetes-mellitus-assessing-fitness-to-drive
 
Dark Horse said:
NICE guidelines say, "For adults on a drug associated with hypoglycaemia, support the person to aim for an HbA1c level of 53 mmol/mol (7.0%)."
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Now I'm confused. Insulin is the ultimate hypo inducing drug, Why are T1s supposed to aim for 48mmol/mol (6.5%)?
 
Just to explain (sorry I don't know how to quote)

QOF payment is made by the NHS rather than the drug companies and is mainly based on outcomes rather than drugs administered.

It's the drugs companies that set the criteria for treatment. Thus for instance blood pressure readings that used to be considered within the safe range are now labelled "high" and therefore need to be treated by drugs.
 
Outlier said:
Just to explain (sorry I don't know how to quote)

QOF payment is made by the NHS rather than the drug companies and is mainly based on outcomes rather than drugs administered.

It's the drugs companies that set the criteria for treatment. Thus for instance blood pressure readings that used to be considered within the safe range are now labelled "high" and therefore need to be treated by drugs.
Click to expand...
It is NICE that set the criteria for treatment. Drug companies may have some input along with many other parties but they certainly don't set the criteria.
 
Outlier said:
Just to explain (sorry I don't know how to quote)

QOF payment is made by the NHS rather than the drug companies and is mainly based on outcomes rather than drugs administered.

It's the drugs companies that set the criteria for treatment. Thus for instance blood pressure readings that used to be considered within the safe range are now labelled "high" and therefore need to be treated by drugs.
Click to expand...

I would prefer a collaboration between drs., drug companies, and the FDA or NICE, etc. according to countries, on criteria, and anecdotal statistics.
 
Thank you, Antje - much appreciated.

I agree Erin - it would be so helpful if money incentives were done away with, and information was shared freely. How valuable this Forum is compared to the dodgy advice given by so many medics and organisations.
 
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