[NPInfo] re: Question from Dave

[Eric Doerfler]

I saw a number of people on Vytorin and Zetia whose numbers improved over a
reasonable short term. Albeit, most these people were not my patients,
rather belonged to some other provider. One of the reasons that's the case
is that I often don't prescribe newer agents for several reasons.
1) They often aren't covered by insurance. Up until recently, most of my
"straight" medicine pts were on Medicaid HMOs.
2) Samples dry up--what's the point of starting people on samples, then?
3) Most classes of most drugs have agents that have been around for years.
The FDA categorizes new drug approvals based on their expected impact.
Simvastatin was a "me too drug" as far as I was concerned. Now ezetimibe,
that was interesting, but not new. I mean hell, APPLES soak up cholesterol.
So...hmmm...

Anyway, I had been noticing some patients complaining of muscle soreness,
but CKs weren't elevated. But cripes, there're like a 1000 lipid-lowering
agents that have been on the market longer, so NOT change?

Now that I do that crazy alternative medicine thing, when I do prescribe
drugs, I just go with what's been around, what's cheap, and what has been
known to work. I mean you got yer pravastatin, yer atrovastatin, yer
lovaststatin, etc. And pectin, cholestyramine, omega-3s, and etc etc. 

I agree that "maybe we don't know" but we are allowing ourselves to be
dragged into this sort of thing. I know we are looking to therapeutic
alternatives to get pts better experiences with pharmaceutical treatments,
but I have to offer that maybe sometimes we get too excited by novelty. In
countries with socialized medicine, novelty isn't weighted as much as
expense and safety. 

Granted, when something that just intuitively "sounds right" comes along,
it's hard not to experiment. And in a sense, that is what we are doing--I
mean, how many Vioxxes have to occur before we start to admit that FDA
approval just means we've changed the experiment from a phase III to a phase
IV? Anyway, now I won't have to listen to those stupid "cholesterol comes
from that buttered ham...and your Uncle Sam!" anymore.
e.d.

Eric Doerfler, NP, MSN, CCH
Certified in Adult Primary Care & Classical Homeopathy
Consulting at
1521 Cedar Cliff Drive, Suite 203
Camp Hill PA 17011
717-761-6902
http://www.nightingale-project.com
Coming soon: www.altmedresearch.us



-----Original Message-----
From: npinfo-bounces at nurse.net [mailto:npinfo-bounces at nurse.net] On Behalf
Of Priscilla Merrill
Sent: Tuesday, February 12, 2008 6:32 AM
To: 'NP Info'
Subject: RE: [NPInfo] re: Question from Dave

What I recall from the studies was that the numbers DO go down but the Zetia
portion somehow invites more plaque formation than the statin alone.  They
are thinking the study wasn't a good one and the results inconclusive.
So you are correct in your statement, "maybe we don't know".  That sums it
up.

Priscilla

-----Original Message-----
From: npinfo-bounces at nurse.net [mailto:npinfo-bounces at nurse.net] On Behalf
Of David Mittman
Sent: Monday, February 11, 2008 9:24 PM
To: NP Info
Subject: Re: [NPInfo] re: Question from Dave

I think we all deserve to give a bit of time to all this. consensusI would
not start new prescriptions but if you were on these products and your
numbers dropped, keep taking until concensus is reached.  
Some common sense is needed here. If it did not work empirically, why did
people prescribe it? Don't tell me it was just marketing? If I had a patient
taking a med for 8 weeks and nothing was happening therapeutically, I would
switch to another pretty fast. Marketing works but not if the drug does not
work. Maybe it's all the placebo effect BUT if your cholesterol levels go
down is that bad? The real answer may be we don't know?
Anyway, please continue to let me know what you are doing?
Much thanks.
Dave


On Feb 11, 2008, at 8:09 PM, stephanie2u at optonline.net wrote:

> But why even bother to take a lipid lowering drug when its main 
> purpose is to reduce your risk of heart attack?
>
> They shouldn't have marketed it so aggressively if there was no proof 
> it could reduce morbidity or mortality.
>
> Stephanie Walker, FNP
>
> ----- Original Message -----
> From: GIN11153 at aol.com
> Date: Monday, February 11, 2008 3:10 pm
> Subject: [NPInfo] re: Question from Dave
> To: NPInfo at nurse.net
>
>>
>> I asked my cardiologist a few weeks ago what he's doing, as he and I 
>> both take it. He said he has no plans to stop taking it or to stop 
>> prescribing it. He said that it lowers cholesterol and triglycerides 
>> as it's supposed to do and said the hoopla is ridiculous . It was 
>> never marketed as a drug to prevent heart attacks.
>>
>> Gail Neuman RNC CPHW
>> student midwife and student nurse practitioner certified high risk 
>> OB/OB legal consultant Perinatal Nurse Associates
>> 801 N. Tustin Ave., Suite 305
>> Santa Ana, CA 92705
>> (714) 314-7070
>> (714) 838-1479 fax
>>
>> "God doesn't require us to succeed; he only requires that you try."
>> --_Mother Teresa_
>> (http://nobelprize.org/nobel_prizes/peace/laureates/1979/teresa-
>> bio.html)
>>
>>
>>
>>
>>
>>
>> **************The year's hottest artists on the red carpet at the 
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