Aseem Malhotra. Are prescription drugs a waste of time?

[Guzzler]

A Radio 5Live discussion (50 minutes) on the overprecription of drugs and patient expectations.
The salient points for those of us with Diabetes starts at roughly the 35.00 mark.
Covers: the costs to the NHS, the importance of risk to benefit ratios, R&D and trusting the published data among other things.

This programme reinforces something that we here on DCUK forum learn very early on, to do the research to the best of our ability and to try to work with our HCPs rather than abrogating resposibility to them.

 

[Phoenix55]

Interesting that the onus is being put back on the individual to 'do the research'. I appreciate that many people go to their GP expecting that there is a 'pill for everything' and that somehow they have failed if they do not come out with a prescription, but GPs also need to keep themselves up to date and to sometimes spend a little time advising on life-style. Instead of rebuking me for not taking the prescription of metformin both of the GPs in my practice would have done better to check on how I intended to lower and manage my diabetes without medication. They would then have found out my objections to the suggested medication, that I was monitoring my bloods and reducing carbs, losing weight and keeping it off. I would have felt that I was being treated as a partner in my health not as another statistic, an 'awkward'. All professionals have to attend additional training and are expected to look at others in the profession who are trying something 'new' that is working and decide what they can apply to their own situation. Not everyone has access or knows how to use the internet to do the necessary research. They were brought up in a generation who were told to trust the doctor to know what was best, that is a heavy responsibility for a GP.

 

[Deleted Account]

Very interesting but ...

The emphasis on diabetes is Type 2.

Please be aware when you post on generic topics that there are people on this forum with different types of diabetes.
I appreciate 90% of people with diabetes have type 2 but there are another 10% of us who don't bite but have a different condition which, whilst it may have very similar symptoms, is treated differently.

I am very happy for this material to be shared in the generic topics (I genuinely find them interesting and as someone with diabetes, friends and colleagues assume I know about all diabetes). I just ask for the text (or tags) to mention the type of diabetes.

Thank you for reading my gripe. I hope it does not come across as harsh: it is not meant that way.

 

[Guzzler]

Interesting that the onus is being put back on the individual to 'do the research'. I appreciate that many people go to their GP expecting that there is a 'pill for everything' and that somehow they have failed if they do not come out with a prescription, but GPs also need to keep themselves up to date and to sometimes spend a little time advising on life-style. Instead of rebuking me for not taking the prescription of metformin both of the GPs in my practice would have done better to check on how I intended to lower and manage my diabetes without medication. They would then have found out my objections to the suggested medication, that I was monitoring my bloods and reducing carbs, losing weight and keeping it off. I would have felt that I was being treated as a partner in my health not as another statistic, an 'awkward'. All professionals have to attend additional training and are expected to look at others in the profession who are trying something 'new' that is working and decide what they can apply to their own situation. Not everyone has access or knows how to use the internet to do the necessary research. They were brought up in a generation who were told to trust the doctor to know what was best, that is a heavy responsibility for a GP.

I agree with you, it is what came across in the programme. There has to be a change of mindset on both sides of the consulting desk. As was pointed out by Aseem, Ionnides has been quoted as saying that less than 10% of published data currently can be deemed unbiased and based on properly conducted research. This is backed up by former editors of medical journals. So our doctors are at a disadvantage.
As patients we are not always in a position to do research to any meaningful depth (depends on i ternet access and savviness) so some of us are at a disadvantage. That is why I made a point of saying '...to the best of our ability'.

I get where you're coming from with the point about Metformin, I am in the same position wrt statin medication and I feel that the HCPs are just not listening. For me, I am not yet in partnership with my HCPs, I am being dictated to by them. But, let's say I had done absolutely no research on statins, I took them for one week and got side effects so stopped them and that should be a perfectly valid reason but we hear of people being told 'Take the statin or you will die!' regardless of side effects. I do not know why you decided not to take Metformin but your GPs should have had the conversation with you instead of just following 'the pathway'. This is one thing I do not understand, recently I read an OP where the member said they had taken Met for 2 years with ongoing gastric trouble, my immediate response was to ask myself 'Why on earth would anyone suffer that long with Met tummy side effects and not just make the decision to change treatment or discontinue it?' We're all different but saying nowt gets us nowhere.

 

[Guzzler]

Very interesting but ...

The emphasis on diabetes is Type 2.

Please be aware when you post on generic topics that there are people on this forum with different types of diabetes.
I appreciate 90% of people with diabetes have type 2 but there are another 10% of us who don't bite but have a different condition which, whilst it may have very similar symptoms, is treated differently.

I am very happy for this material to be shared in the generic topics (I genuinely find them interesting and as someone with diabetes, friends and colleagues assume I know about all diabetes). I just ask for the text (or tags) to mention the type of diabetes.

Thank you for reading my gripe. I hope it does not come across as harsh: it is not meant that way.

I thought carefully before choosing this part of the forum. As the programme is about over prescription of drugs in general (and does touch on statin prescription which is common to both T1 and T2) and advocates lifestyle changes as a possible adjunct or alternative to said then I think I made the right choice. I highlighted the point in the programme which touches on T2 but the programme is not about T2 specifically.

 

[Phoenix55]

This is one thing I do not understand, recently I read an OP where the member said they had taken Met for 2 years with ongoing gastric trouble, my immediate response was to ask myself 'Why on earth would anyone suffer that long with Met tummy side effects and not just make the decision to change treatment or discontinue it?' We're all different but saying nowt gets us nowhere.

Sometimes it is a question of confidence. Some people spend a lifetime in work which not only does not challenge them to think but actively discourages thinking. For them to challenge a professional in a position of power takes courage.
In my position I was diagnosed on an HBA1c of 6.6, just tipping into diabetes when a few years earlier I would have been advised to watch my diet. I was beginning to wonder about my inability to shift weight that was starting to creep upwards. A finger prick test at the surgery gave a result of 11+ after I had eaten breakfast. The Dn prescribed but said not to pick up the prescription until after Christmas. That made me suspicious, and for the first time in my life I went online to find out about possible side effects and was shocked at the figures I found. I have an hour journey each way to work and there is no-where to stop except for an emergency, a field gateway if the car breaks down. I bought a bg meter and almost immediately found that the large bowl of porridge with mincemeat was probably the cause of the high finger prick test. Add that to a sedentary lifestyle and it was not surprising that I had raised levels. I started exercising more, changed my intake of carbs and found that not only did the weight drop off but also within three months the HbA1c was down to prediabetic levels. GP agreed that I did not need the Metformin. Finding this website was an added bonus, members on here reassured me that I was doing the right thing and I am trying to pass that on.

 

[Guzzler]

Sometimes it is a question of confidence. Some people spend a lifetime in work which not only does not challenge them to think but actively discourages thinking. For them to challenge a professional in a position of power takes courage.
In my position I was diagnosed on an HBA1c of 6.6, just tipping into diabetes when a few years earlier I would have been advised to watch my diet. I was beginning to wonder about my inability to shift weight that was starting to creep upwards. A finger prick test at the surgery gave a result of 11+ after I had eaten breakfast. The Dn prescribed but said not to pick up the prescription until after Christmas. That made me suspicious, and for the first time in my life I went online to find out about possible side effects and was shocked at the figures I found. I have an hour journey each way to work and there is no-where to stop except for an emergency, a field gateway if the car breaks down. I bought a bg meter and almost immediately found that the large bowl of porridge with mincemeat was probably the cause of the high finger prick test. Add that to a sedentary lifestyle and it was not surprising that I had raised levels. I started exercising more, changed my intake of carbs and found that not only did the weight drop off but also within three months the HbA1c was down to prediabetic levels. GP agreed that I did not need the Metformin. Finding this website was an added bonus, members on here reassured me that I was doing the right thing and I am trying to pass that on.

Again, I agree with you. Atorvastatin has challenged my faith in HCPs. Type 2 dietary advice given by my DN has seriously dented my confidence in her ability to treat my Diabetes. This has led me to question my treatment wrt my other conditions and the drugs I take for them.

I have been asking myself if I could be one of those who are overmedicated and already managed to give up one of those medications without consulting a HCP. As was said at the beginning of the programme, it is advisable to have the conversation with your GP before stopping any medication but if my experience with Atorvastatin is anything to go by then for me the decision is mine and mine alone and I am responsible for any untoward consequences.

 

[Robinredbreast]

I loved listening to the programme, it was a very informative and a chilled out discussion from all involved

 

[zand]

Thank you for posting this. I found it to be very interesting and relevant to everyone, not just T2s.

 

[AloeSvea]

I loved the Tony chap, "I researched... and then I had a discussion with my GP". Too right. I see it as discussions with GPs too, when it comes to metabolic dysfunction, and dealing with it metabolically (called 'lifestyle').

I clocked the guy with type two coming on at 39.00. Having spent a few years in here off and on, it sounded VERY soft line! But, it's all relative, isn't it? Still good info.

 

[AloeSvea]

Great line - "Good health rarely comes out of the medicine bowl."

Too right!

 

[lindisfel]

Great line - "Good health rarely comes out of the medicine bowl."

Too right!

Too right it's a no brainer. But some of us like T1's and others don't need tablets or therapy from poor diet, smoking or over drinking etc.
D.

 

[KK123]

Too right it's a no brainer. But some of us like T1's and others don't need tablets or therapy from poor diet, smoking or over drinking etc.
D.

I can't imagine any diabetic smoking?????

 

[lindisfel]

Don't you believe it. I have heard of people with terminal lung cancer breathing oxygen and smoking at the same time.
I guess it's a quicker end if you go in a flash of light.
D.

 

[AloeSvea]

I can't imagine any diabetic smoking?????

I have friends and acquaintances with Chronic Obstructive Lung Disease, the old emphysemia (or however you spell it) who can't kick the addiction and continue to smoke. One in particular - yeah - we are talking about ways of dying at the moment! And yes, it is incredibly sad as all who love her do not want to lose her all too soon.

I also have a friend whose dad had T2D, who is prediabetic off and on (or so he says in the 'off' department but as he doesn't know what an HBA1c is or what his is at any given time I would hazard a guess he is still prediabetic), and eats a large bowl of oatmeal with grated normal sugar-sweetened chocolate over it of a morning, topped up with milk, with a cup of steaming milo with two teaspoons of sugar added to it. I was horrified watching him eat and drink it when I shared breakfast with him recently. (Did he have the info to the contrary? Re eating to get out of the prediabetic range. I am his friend! So yes. He is appalled by my high healthy fat diet and very open about critisizing me for it. He thinks I am killing myself.) I see him as currently addicted to the sugar, and we all know about chocolate.

Being susceptible to addictions is part of the human condition, as far as I can see. I see myself as a sugar addict on the wagon.

 

[AloeSvea]

Too right it's a no brainer. But some of us like T1's and others don't need tablets or therapy from poor diet, smoking or over drinking etc.
D.

Ouch!

There are some very interesting theories about the cause of auto-immune diseases.

None of us are responsible for where we are in the food environment. I tease my parents about putting ribena in my baby bottle back in the day, instead of delightfully protecting breast milk from my mother, but I reassure them I don't blame them because they had no idea they were giving me a dynamite dose of "poor diet". Who did back then? Except some wonderfully up-with-it folks, like the Yudkin family?

And re smoking and drinking, and addictions generally - how to blame humans for being human?

I like no-blame way of looking at disease.

 

[Angelofthemarches]

There is a theory that some type 2 diabetes has strong genetic precursors.

 

[Antje77]

I can't imagine any diabetic smoking?????

I still smoke (a lot) and I wish I didn't. Being diagnosed with diabetes doesn't mean you suddenly develop super powers that enable you to overcome a nasty addiction.
For the time being I'll just be proud that I managed to get my hba1c to 38 with a lot of hard work and that I kicked addiction to heroin and crack cocaine some 15 years ago thank you.

 

[KK123]

I still smoke (a lot) and I wish I didn't. Being diagnosed with diabetes doesn't mean you suddenly develop super powers that enable you to overcome a nasty addiction.
For the time being I'll just be proud that I managed to get my hba1c to 38 with a lot of hard work and that I kicked addiction to heroin and crack cocaine some 15 years ago thank you.

Hi Antje, I do apologise for sounding pompous (I wrote this a while back in response to someone mentioning smoking and without any real thought, I just replied whilst musing on the added health issues smoking might bring when you have diabetes). I am in admiration of anybody who has struggled to give up what is bad for them and is then able to do so. You have clearly done a brilliant job.

 

[Antje77]

Hi Antje, I do apologise for sounding pompous (I wrote this a while back in response to someone mentioning smoking and without any real thought, I just replied whilst musing on the added health issues smoking might bring when you have diabetes). I am in admiration of anybody who has struggled to give up what is bad for them and is then able to do so. You have clearly done a brilliant job.

Thanks, apology and compliment accepted!