by Tony Cusano | Jan 20, 2019 | Public
We all want to promote a healthy cardiovascular system to prevent one of the most common causes of death and disability we face as we grow older.
Doctors try to help by measuring risk factors and providing treatments to reduce the risks. While many medications are available to help, they also carry risks of toxicity, many of which such as muscle changes or diabetes are well known, while others such as cognitive decline or cancer risk are hinted at but not clear (keep in mind that nearly all the statin studies show more reduction of CV deaths and events than overall, leaving open the question of why the CV risk reduction did not lead to the same overall risk reduction).
Lifestyle approaches have always proven very helpful for risk reduction, but much more difficult to implement in the modern American socio-economic workplace and over-scheduled lifestyle environment.
A recent study of the difference exercise makes beyond simple weight control suggests but does not prove that it is better than statin therapy for reducing CV risk, though certainly we know it carries minimal risk compared to medications.
If your doctor has found that you have elevated risk factors for cardiovascular disease it’s critical to compare the benefits, risks, alternatives and unknowns of lifestyle change to the use of medications, and to share the decision on which treatment plan to undertake.
Insurers and the government currently apply enormous pressure on doctors to use medications to reduce CV risk. That certainly can help manage the overall health of the population they must manage. But any individual should chose the balance they want to strike by collaborating with their doctor to make a decision that honors their own values and goals. The study linked above shows that diet and exercise can provide an effective alternative to medication.
Exercise has many proven benefits, so regardless of your medical decision regarding CV protective medications, don’t let the false sense of security a trim physique or prescribed medication provide mitigate committing to it.
by Tony Cusano | Dec 30, 2018 | Public
The FDA recently issued a warning about the old and very commonly used antibiotics like ciprofloxacin.
The side effect is rare, but the loss ratio of aneurysm rupture is devastatingly large.
Anytime you need to make a medical decision, even one that seems as trivial as taking an antibiotic, be sure to fully understand the benefits, risks, alternatives and unknowns. And share your values and goals with your doctor so the decision is right for you.
We can help if you feel uncertain how to do that.
Email us, or call 203-692-4422 for a free consultation.
by Tony Cusano | Dec 16, 2018 | Public
An expert consensus statement such as this one recently released by the American Heart Association about a topic with such incomplete science should include a full transcript of all the deliberations in order to allow physicians and the public to judge the logic and factual accuracy behind the consensus statement.
Much data for performing a full scientific evaluation of these medications remains uncollected. In that setting it is not appropriate for experts to make a “scientific” statement that does not fully describe the derivation of the statement.
Statins, like any medical therapy, should only be used after shared decision between a patient and doctor after they fully discuss the benefits, risks, alternatives and unknowns of the treatment planned.
If you need help collaborating with your doctor to make medical decisions, we can help. Contact us for a free consultation.
by Tony Cusano | Nov 17, 2018 | Public
Many new and promising medications have been approved by the FDA over the past few years. While these drugs offer novel benefits for difficult diseases like Diabetes Mellitus, heart disease and cancer, the science behind them is incomplete.
A recent plea by an expert physician for his colleagues to use a new type of diabetes drug reveals the danger of biased emotions in making medical decisions to use such new drugs.
1) This physician has disclosed significant financial ties to the pharmaceutical industry
2) He states real facts about these drugs, and those facts indicate that for now the drugs should be available in every physician’s armamentarium for treating patients with DM.
3) The bias is to loosen the criteria used to decide on when to use them. Their serious adverse effects are likely more common than reported, as is usually discovered once drugs tested on limited numbers of subjects are used on larger numbers of patients in less rigorously controlled community practice settings.
Additionally, there are unknown adverse effects that are likely to be discovered as they are used for longer periods than the initial testing covered.
Finally, although they were effective as tested, the effectiveness was in a small minority of all patients who received them. Their benefits only slightly outweighed the risks.
In this situation, each decision must rigorously account for the balance of benefits, risks, alternatives and unknowns. There are patients who should get them based on their situation without more established alternatives, but those patients should be carefully chosen, and be fully educated about the BRAU that goes into the decision.
These drugs may someday be widely used, or they may have a niche use, but enthusiasm is neither scientific nor disciplined medical practice.
It has no place in medical decisions.
Be sure to collaborate fully with your doctor to make a shared decision when he or she offers a new medication for any condition.
by Tony Cusano | Nov 11, 2018 | Public
This harrowing five-part story adapted from ‘The Digital Doctor’ by Robert Wachter describes a near disaster due to a medication error augmented by a high-quality hospital’s Electronic Health Record. It starkly reveals the risks of medical care in the digital age. Too much system noise and overwhelmed caregivers make even routine decisions and tasks take on a high level of risk.
Vigilance is required at every turn. If you feel that you are overwhelmed managing a hospital episode for yourself or a loved one, or in keeping track of the complex facts of your medical care, we can help.
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