4 ms·

That's true, and to some extent useful, as people are generally pretty bad at risk evaluation. At the same time, drugs with teratogenic effects "feel" like a s

That's true, and to some extent useful, as people are generally pretty bad at risk evaluation. At the same time, drugs with teratogenic effects "feel" like a special case. The risk isn't just to the patient, but to their unborn child. And pregnancy can be successfully avoided. I don't know where to draw the line, but at least based on a quick read of the linked article and a few related pieces, it feels like NHS and other government bodies (both UK and elsewhere) dropped the ball with this drug.

giantg2 3y ago
"The risk isn't just to the patient, but to their unborn child." Any reasonably adept provider should be considering the care for the fetus (assuming it isn't being terminated). The main problem in this case was the lack of disclosure. And those disclosure problems are widespread. Anti seizure meds specifically are tricky. If you are on these meds and plan to become pregnant, they all increase defect risks. While some have lower risks, the effectiveness of the drugs can be highly specific to the individual. Some individuals may be required to take the higher risk drugs is the current low risk standard doesn't effectively control thier issue.
- alistairSH 3y ago
  Absolutely. If seems like this drug should have been placed on the "high risk - don't take while trying to conceive" lists from the outset. And from what I can tell, it's only on that list in the US when being prescribed for migraine control (but not seizure control). This will sound callous, but sometime a person has to pick between managing their personal health and having a child. I have a friend who's on some nasty drugs and when faced with the choice between "go off drugs, relapse", "stay on drug, risk birth defects", and "stay on drug, don't have a kid" she chose the last option (correctly IMO, but it's definitely not my place to interject).
  - giantg2 3y ago
    "If seems like this drug should have been placed on the "high risk - don't take while trying to conceive" lists from the outset. And from what I can tell, it's only on that list in the US when being prescribed for migraine control (but not seizure control)." That's because they're doing the risk profile. Seizures pose a risk to the fetus too while migrains do not. So they aren't doing it based solely on risk, but on the overall risk profile including "rewards" or reduction in other risks.
    - alistairSH 3y ago
      Sorry, I wasn't clear - it sounds like they may have botched the risk profile - the article paints a picture where the real-world incidence/severity of defects is "high". But, they're selling clicks, and the patients are looking for money/support, so it's hard to know for sure. It certainly seems like there should have been a discussion between MD and patient here (similar to what my friend had with her MDs, albeit different drugs/condition).
Turing_Machine 3y ago
In the United States this medication has a black box warning about fetal damage. For those who are elsewhere, a "black box warning" is the most serious warning the United States Food and Drug Administration can require -- it's called that because they mandate that the manufacturer print the warning at the top of the package insert, surrounded by a black box to draw attention.

giantg2 3y ago

"The risk isn't just to the patient, but to their unborn child." Any reasonably adept provider should be considering the care for the fetus (assuming it isn't being terminated). The main problem in this case was the lack of disclosure. And those disclosure problems are widespread. Anti seizure meds specifically are tricky. If you are on these meds and plan to become pregnant, they all increase defect risks. While some have lower risks, the effectiveness of the drugs can be highly specific to the individual. Some individuals may be required to take the higher risk drugs is the current low risk standard doesn't effectively control thier issue.

alistairSH 3y ago
Absolutely. If seems like this drug should have been placed on the "high risk - don't take while trying to conceive" lists from the outset. And from what I can tell, it's only on that list in the US when being prescribed for migraine control (but not seizure control). This will sound callous, but sometime a person has to pick between managing their personal health and having a child. I have a friend who's on some nasty drugs and when faced with the choice between "go off drugs, relapse", "stay on drug, risk birth defects", and "stay on drug, don't have a kid" she chose the last option (correctly IMO, but it's definitely not my place to interject).
- giantg2 3y ago
  "If seems like this drug should have been placed on the "high risk - don't take while trying to conceive" lists from the outset. And from what I can tell, it's only on that list in the US when being prescribed for migraine control (but not seizure control)." That's because they're doing the risk profile. Seizures pose a risk to the fetus too while migrains do not. So they aren't doing it based solely on risk, but on the overall risk profile including "rewards" or reduction in other risks.
  - alistairSH 3y ago
    Sorry, I wasn't clear - it sounds like they may have botched the risk profile - the article paints a picture where the real-world incidence/severity of defects is "high". But, they're selling clicks, and the patients are looking for money/support, so it's hard to know for sure. It certainly seems like there should have been a discussion between MD and patient here (similar to what my friend had with her MDs, albeit different drugs/condition).

Turing_Machine 3y ago

In the United States this medication has a black box warning about fetal damage. For those who are elsewhere, a "black box warning" is the most serious warning the United States Food and Drug Administration can require -- it's called that because they mandate that the manufacturer print the warning at the top of the package insert, surrounded by a black box to draw attention.