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When I read this article to my wife (a physician) she was not the least bit surprised. She asked me why it was even news. She has spent the last several months

by JunkDNA 17y ago

When I read this article to my wife (a physician) she was not the least bit surprised. She asked me why it was even news. She has spent the last several months trying to convince patients that Tamiflu isn't indicated for people who are otherwise healthy because the benefit vs. risk is not really favorable. Many become very irate when presented with this information and demand the medicine anyway, on the grounds that "other doctors" are giving it out to everyone.

pragmatic 17y ago
So did she prescribe the drug anyway? Doctors are pressured by patients to prescribe pain killers, anit-biotics, etc. But isn't it up to the doctor to say yes or no?
- anamax 17y ago
  If it does no harm and the patient is paying for it, why not say yes? Note the "if the patient is paying" clause. MDs shouldn't be doing cost-benefit tradeoffs - patients should. Politicians shouldn't be doing cost-benefit tradeoffs either. (That's a statement against interest - my demographic group has way more say than other groups, so we'll be subsidized by politicians. And no, it won't be different this time.)
  - stavrianos 17y ago
    You're thinking of a pharmacist. MDs and politicians should absolutely be doing cost-benefit tradeoffs. I'd go so far as to say that's basically their job. I go to a doctor because they have skills and knowledge I don't possess. That doctors (being experts) so often don't apply their judgment, and politicians (often being charismatic amateurs) so often do is lamentable. Politicians should be required to be experts. Doctors should be (aren't they?) required to exhibit judgment on behalf of their patients. Expecting everyone to be able to exhibit the judgment of a professional in every field is so wildly implausible that I've obviously mistaken your meaning.
    - abstractbill 17y ago
      In my experience there's a difference between European and American doctors. I guess it has something to do with how much American doctors get sued, or how much American patients expect to be "in charge", or something like that. My wife and I are both from Europe originally, and going to the doctor in the US is sometimes really frustrating for us. We go with the idea that we're consulting an expert for their advice, but sometimes find them quite unwilling to make any kind of judgment call. Sometimes they just offer a bunch of options and say "pick one". When pressed for an opinion, they'll sometimes just hint in one direction or another. Compared to a British doctor, who will almost always confidently tell you exactly what he or she thinks should be done, it can be quite an unnerving experience.
      - travisp 17y ago
        Doctors are taught in American medical schools that they are supposed to provide all options to their patients and explain to them the cost benefits and not try to make or even bias their decision. I'm not sure if it's simply for fear of lawsuits or if it's coded in the law itself (although I think I read that it's the latter somewhere).
        carbocation 17y ago
        It is coded in the ethical principle of autonomy, which some would say is more important than either the fear of lawsuits or the laws of any particular country.
    - CWuestefeld 17y ago
      If the patient is paying, then why shouldn't he be making the decision? I'd certainly hope the MD would provide guidance in that decision, since it's the MD who knows what the costs and benefits are. But the MD knows neither the patient's marginal valuation of the costs, nor of the benefits. That is, he doesn't know how precious each dollar is to the patient, nor the fact that, e.g., he is resigned to his terminal illness but just wants to live long enough to see his daughter graduate. Since nobody else knows how much those things are worth to the patient, nobody is qualified to balance them. Most especially not politicians, who ought not to have a horse in the race at all. The availability of the treatments ought to be metered by the price of providing them versus the patient's (or the patient's contracted insurance provider's) willingness to pay (given an understanding of the treatment as guided by the MD). Period.
karzeem 17y ago
An ER doctor I was talking to recently said the same thing. He said the best thing you can say about Tamiflu is that if you give it at the very beginning of the illness, it'll shorten the illness by maybe 12 hours. He was annoyed that some doctors prescribe it as if it does something more.

by JunkDNA 17y ago

pragmatic 17y ago

So did she prescribe the drug anyway? Doctors are pressured by patients to prescribe pain killers, anit-biotics, etc. But isn't it up to the doctor to say yes or no?

anamax 17y ago
If it does no harm and the patient is paying for it, why not say yes? Note the "if the patient is paying" clause. MDs shouldn't be doing cost-benefit tradeoffs - patients should. Politicians shouldn't be doing cost-benefit tradeoffs either. (That's a statement against interest - my demographic group has way more say than other groups, so we'll be subsidized by politicians. And no, it won't be different this time.)
- stavrianos 17y ago
  You're thinking of a pharmacist. MDs and politicians should absolutely be doing cost-benefit tradeoffs. I'd go so far as to say that's basically their job. I go to a doctor because they have skills and knowledge I don't possess. That doctors (being experts) so often don't apply their judgment, and politicians (often being charismatic amateurs) so often do is lamentable. Politicians should be required to be experts. Doctors should be (aren't they?) required to exhibit judgment on behalf of their patients. Expecting everyone to be able to exhibit the judgment of a professional in every field is so wildly implausible that I've obviously mistaken your meaning.
  - abstractbill 17y ago
    In my experience there's a difference between European and American doctors. I guess it has something to do with how much American doctors get sued, or how much American patients expect to be "in charge", or something like that. My wife and I are both from Europe originally, and going to the doctor in the US is sometimes really frustrating for us. We go with the idea that we're consulting an expert for their advice, but sometimes find them quite unwilling to make any kind of judgment call. Sometimes they just offer a bunch of options and say "pick one". When pressed for an opinion, they'll sometimes just hint in one direction or another. Compared to a British doctor, who will almost always confidently tell you exactly what he or she thinks should be done, it can be quite an unnerving experience.
    - travisp 17y ago
      Doctors are taught in American medical schools that they are supposed to provide all options to their patients and explain to them the cost benefits and not try to make or even bias their decision. I'm not sure if it's simply for fear of lawsuits or if it's coded in the law itself (although I think I read that it's the latter somewhere).
      - carbocation 17y ago
        It is coded in the ethical principle of autonomy, which some would say is more important than either the fear of lawsuits or the laws of any particular country.
  - CWuestefeld 17y ago
    If the patient is paying, then why shouldn't he be making the decision? I'd certainly hope the MD would provide guidance in that decision, since it's the MD who knows what the costs and benefits are. But the MD knows neither the patient's marginal valuation of the costs, nor of the benefits. That is, he doesn't know how precious each dollar is to the patient, nor the fact that, e.g., he is resigned to his terminal illness but just wants to live long enough to see his daughter graduate. Since nobody else knows how much those things are worth to the patient, nobody is qualified to balance them. Most especially not politicians, who ought not to have a horse in the race at all. The availability of the treatments ought to be metered by the price of providing them versus the patient's (or the patient's contracted insurance provider's) willingness to pay (given an understanding of the treatment as guided by the MD). Period.

karzeem 17y ago

An ER doctor I was talking to recently said the same thing. He said the best thing you can say about Tamiflu is that if you give it at the very beginning of the illness, it'll shorten the illness by maybe 12 hours. He was annoyed that some doctors prescribe it as if it does something more.