who's responsibility pharmaceutical company or doctor?

[frank]

my wife was on a drug called niaspan and has been for ten years at the cost to me of 184 dollars a month. She went for her yearly visit last week and the doctor told her that a study has been conducted and that the niaspan has had not effect one way or the other. Over 10 years the drug has cost me roughly 22 thousand dollars. I wonder why someone is not held responsible for money spent to do absolutely nothing. I just get peeved when I think about all that money spent on nothing.

 

[zinger1457]

There is no guarantee that any drug will work so I would be more upset with the doctor. It would have to be an extremely incompetent doctor to keep someone on a drug for 10 years and not be able to determine that the drug was having no effect.

 

[harley]

Also, just because the study showed one thing doesn't mean it didn't have an effect on your DW. Unless, as zinger1457 says, the doctor was totally incompetent, maybe he did see an improvement in DW. Different people react differently to various drugs. All the study could say is that for X group of people this drug didn't make any more difference than a placebo. But it's a generalization.

Edit: But to answer the OP's questions, I would say the doctor is responsible. He/she is the one monitoring progress. Even if the studies say a particular drug is the answer to all of mankind's problems, if it doesn't work on the specific patient it should be discontinued and something else tried.

 

[athena53]

I looked it up and found that Niaspan is a niacin supplement meant to increase "good" cholesterol. I went in for my regular checkup a couple of weeks ago and when the doc checked over my list of supplements I take regularly, he commented on the niacin in the multivitamin and said that they now discourage the use of niacin in supplements because it might spike blood sugar. (My fasting glucose was 107 a year ago even though I have none of the risk factors for diabetes; haven't received results from most recent test.)

I have borderline high cholesterol and I'm wary as heck of Big Pharma's "solutions" to lower it. Statins gave me tendonitis and now I'm reading that fish oil supplements may not be that effective.

Bottom line: consumers have to question everything and research everything. It's too darn complicated to be left up to a doctor who spends 10 minutes with you and in the end, it's your money and your body.

Still, I'd do an occasional search on "Niaspan class action" because I bet there will be one. Just be aware that your share of any damages is likely to be enough for you and your wife to have a nice restaurant dinner. But stay away from steakhouses and the Cheesecake Factory, OK?

 

[Meadbh]

Physicians make decisions and recommendations based on information available at the time. I would like to know what evidence was available at the time your DW started taking the drug, and when the opposing evidence came to light. You may wish to do a literature search.

If my doctor recommended an expensive drug (or anything unusual) my first step would be to find out as much as possible about the risks, benefits and costs, so I could make an informed decision.

 

[rbmrtn]

Sad thing it is just niacin which buy for a few cents. It worked for them, they made a nice profit off of you. There were studies in the past to support it's use. It's been around for a long time

Here's an article mentioning the study, http://well.blogs.nytimes.com/2014/...-and-heart-health/?_php=true&_type=blogs&_r=0

The niacin did what it was prescribed for, it made your numbers look good. The study claims that making the numbers look good did not improve heart related issues. Maybe the relationship between lipid numbers and heart disease aren't understood.

 

[harley]

I didn't even realize the drug was Niacin. In this case I'd be really furious with the doctor. I've got very low HDL, and I (with my doctor's agreement) started taking an over the counter Niacin supplement. It raised my HDL from <25 to the mid-40s with no other changes in medicine or lifestyle. It costs me about $20 every three months at GNC. There's no reason for DW and you to have to pay so much for the prescription version. Especially since there doesn't seem to be any other active ingredients than the niacin. It sounds like you have one of the many docs that scratch the back of the back scratching pharmaceutical reps. I'd seriously consider changing doctors.

Of course, IMHO you should have been doing the research on this drug and should have been questioning the doctor on why prescription vs. OTC. So you and DW have some responsibility here too. But I'd still dump the doc, since I couldn't trust him/her anymore.

 

[ls99]

Many years ago a doc prescribed nisapan based on then available info on it and my personal parameters then. After researching the stuff, discovered slow release niacin is really bad for the body. In fact it stresses the liver as I remember. Can't remember all the gory details.

One must always read the "mechanism of action" and all the other disclosures of all meds prescribed, and must understand each word therein in the most restrictive context. Sometimes a magnifier is needed to find the really gory details. Skip the reading at you peril. It is written by lawyers and chemists and FDA reviewed, it is virtually all CYA. Especially black box disclosures. I refused the stuff. I have been taking Niacin for long time.

Recent doc visit, he said: we now practice evidence based medicine, and the the lowering of numbers does not change longevity outcome. As a joke, I said I am shocked, you mean previously the evidence did not matter? We are on good terms, he gave wry smile.

IIRC there has been meta-analyses of the famed and oft quoted Framingham study, much of which has been intentionally misinterpreted by the drug companies to enhance sales of crap. My understanding is that cholesterol is an effect, not a cause. Inflammatory functions are causes. My body, my choices as to what I put in it.

By the way I will continue to take niacin, it is cheap, don't care that the lower "numbers" do not change date of death. A disliked effect the niacin flush, I think is a benefit and good thing. It dilates small blood vessels in the skin, thus gives a kind quick flush to the skin. And thus helps having supple skin. YMMV.

As an aside I was an early vicim of Bextra, and various famous cholesterol meds. Having survived the experiments, I now do a lot of reading before accepting any med. even if I accept it, it is only for very short term. As I get older I may need meds, but they will be exhaustively researched. There may come a time when there will be choice to made. Put up with nasty side effects or exit.

 

[AllDone]

Here's an ungated editorial about the HIT trial which gives a pretty good explanation:
http://eurheartj.oxfordjournals.org/content/21/14/1113.full.pdf

 

[sengsational]

Niacin Extended Release is available both OTC, as a generic prescription (as of 10/2013) and as a brand prescription.

Sometimes it is less expensive to get as a prescription if your health insurance covers it.

But frankly, I'm not sure there's much room for blaming anyone since, with a little research and a discussion with the doctor, there's a strong possibility the OTC version would have been substituted.

 

[FIRE'd@51]

I find it astonishing that the doctor wouldn't have noticed that your wife's HDL wasn't rising when he did subsequent lipid tests after putting her on the drug.

 

[Maenad]

... the doctor told her that a study has been conducted and that the niaspan has had not effect one way or the other.

In case you want a factual response, I've spent the last 8 years working on combo pharma/med device products, so I have some pharma experience.

When a drug is developed, the company conducts a clinical trial of a certain number of patients (usually in the hundreds, if possible). If the results of that clinical trial show greater benefits to the patients than the risks of the side effects, the FDA will approve it. Continuing, long-term, large-scale studies are started after the drug has been released, to make sure that the risk/benefit analysis is still correct. Sometimes these later studies show less or no benefit, and doctors stop prescribing it. Sometimes the side effects are serious enough that the companies stop making it.

Niaspan was prescribed to your wife because the best knowledge at the time was that it was beneficial. Now we know it isn't so great. That's really it. A lot of people complain that drugs are released too willy-nilly, and then turn around and complain about some great therapy that's available in Europe that we can't get here. Well, that's the trade-off - take greater risks in releasing new products, or slow down progress.

It sounds like you have one of the many docs that scratch the back of the back scratching pharmaceutical reps.

Do you have any idea how illegal this is? Really? I can't give a doctor a pen - and I'm talking a plain Bic ballpoint - without breaking a law. This kind of behavior did take place at one time, but the federal government has been cracking down on it severely, and I don't know any salesperson that winks at it. They take it very seriously.

 

[athena53]

A lot of people complain that drugs are released too willy-nilly, and then turn around and complain about some great therapy that's available in Europe that we can't get here.

That was true of thalidomide, as I recall.

Thanks for your viewpoint. While I'm suspicious of trying to cure everything with a pill, I also appreciate the meds DH is on for his polycythemia which greatly improve the quality of his life. It's just important that you always do your on research and know what tradeoffs you're making with regard to effectiveness vs. side effects, costs vs. effectiveness, etc. and realize that new information may change your conclusions.

 

[eytonxav]

I would think the doc would have stopped your DW from using this drug unless it produced a noticeable improvement. Did she get any benefit from it based on her Cholesterol tests? If not, I think you have a legitimate complaint against the doc.

 

[Chuckanut]

Recent doc visit, he said: we now practice evidence based medicine, and the the lowering of numbers does not change longevity outcome. As a joke, v I said I am shocked, you mean previously the evidence did not matter? We are on good terms, he gave wry smile.

I

Yes. Often 'soft' outcomes are used to confused the public. A medicine will cause a positive response in some measurement, but there is no hard evidence that it actually extends life or improves the quality of life.

After reading the pamphlet of a cholesterol lowering drug, I noticed that while it almost certainly would lower my cholesterol, they had no evidence it would extend the lifespan of an otherwise healthy male. This was in the pamphlet published by the drug maker.

 

[MRG]

Medicines can cause many issues that are not intended. I was on atenolol, same dosage, for 20 years. Started feeling disoriented like I was going to faint. Turned out the ER docs didn't think my heart rate in the 35 bpm range was a good thing.

Spent a couple days under observation as they changed meds. Stuff happens, I would ask my DR.

 

[athena53]

After reading the pamphlet of a cholesterol lowering drug, I noticed that while it almost certainly would lower my cholesterol, they had no evidence it would extend the lifespan of an otherwise healthy male. This was in the pamphlet published by the drug maker.

I listened to a great podcast interview on cholesterol-lowering drugs (shortly after guidelines expanded to include about 50% of the population over age 45). The doctor they interviewed was pretty much convinced that all the drugs did was correct an abnormal lab result and that was no guarantee of better health. I'm not a doctor but, as I said earlier, it's my body and I'm not convinced that lowering my (borderline high, with a lot of good cholesterol) levels will make me any healthier.

And now I'm off to the Fitness Center. I've got a 38-mile charity bike ride on the weekend and need to stay in shape. Better (to me) than statins any day!

 

[rbmrtn]

I would think the doc would have stopped your DW from using this drug unless it produced a noticeable improvement. Did she get any benefit from it based on her Cholesterol tests? If not, I think you have a legitimate complaint against the doc.

I think we're missing the findings of the new study. Her number very like improved as expected ( the OP did not say ). The new study's conclusion is raising HDL with niacin did not improve risk of cardio events long term.

 

[Walt34]

A lot of people complain that drugs are released too willy-nilly, and then turn around and complain about some great therapy that's available in Europe that we can't get here. Well, that's the trade-off - take greater risks in releasing new products, or slow down progress.

That was true of thalidomide, as I recall.

I knew a guy who was a "thalidomide baby" - his right arm ended at the elbow and he did not have a right hand. Not an accident, he was born that way. His mother was in England during the pregnancy and took thalidomide during the term.

 

[ERhoosier]

Here's an ungated editorial about the HIT trial which gives a pretty good explanation:
http://eurheartj.oxfordjournals.org/content/21/14/1113.full.pdf

IIRC, the VA-HIT study (conducted back in the '90's) used treatment with gemfibrozil, not niacin. And the subjects studied were men with low HDL with normal-to-low LDL. Most folks do not have this blood cholesterol profile, and only men were studied. So the results prob do not apply to the general population.
Much more has been published on the topic in the last 15+ years since.

 

[Rick_Head]

Physicians make decisions and recommendations based on information available at the time. I would like to know what evidence was available at the time your DW started taking the drug, and when the opposing evidence came to light. You may wish to do a literature search.

If my doctor recommended an expensive drug (or anything unusual) my first step would be to find out as much as possible about the risks, benefits and costs, so I could make an informed decision.

But from reading your posts, I suspect you are in a better position than most of us to make that decision based on the results of your research? Don't some of us have to trust professionals (as long as they aren't "financial advisors")?

 

[athena53]

But from reading your posts, I suspect you are in a better position than most of us to make that decision based on the results of your research? Don't some of us have to trust professionals (as long as they aren't "financial advisors")?

There's a lot on the internet now. Medicine isn't an exact science and no two bodies are alike. My Dad has been on statins for decades with no side effects. After 6 months I had tendonitis. In addition to the commercial stuff put out by the manufacturers and the materials put out by the scientific community that may be harder to follow, there are plenty of other resources. I like HealthBoards for experiences from real people on just about anything. There are also chat boards for people with specific conditions. DH has learned a lot (and shared a lot of info) on one for a condition he has that's so rare that most docs see only a few cases in their careers. Thanks to the internet, he was able to track down a doc who was an expert in these cases and was able to fly to Maryland to meet with him at Johns Hopkins. It helped a lot when we were at a major decision point on medications.

As I said earlier- in the end, it's your body and your money. The doctor is only an expert consultant.

 

[Meadbh]

But from reading your posts, I suspect you are in a better position than most of us to make that decision based on the results of your research? Don't some of us have to trust professionals (as long as they aren't "financial advisors")?

I am a physician, but I don't trust physicians.

 

[redduck]

I am a physician, but I don't trust physicians.

It sounds as if you don't much trust physicians as a group. But, how about your own physicians--how much do you trust them?

 

[Meadbh]

It sounds as if you don't much trust physicians as a group. But, how about your own physicians--how much do you trust them?

I don't.