Whooping Cough in Europe

@Michael Hewett We had shingles and the pneumonia vaccines on the same day (different arms). The pneumonia one did give us uncomfortable times for some days but then gone. Have to have the 2nd shingles one in July. We have always been wary of having too many jabs but we did travel to Asia and South America and Africa a lot and so had to have some for the regulations.

 

It comes down to risk vs. benefit @Februarysgirl . The risk of a side effect might be considered by regulators to be worth taking if the benefit is control of or improvement in a serious life-threatening condition but not for something like weight loss which could (in theory at least) be achieved by other means. But you are right, the prescribing doctor should discuss the possible risks as well as the potential benefits with the patient.

 

@JennyJB Yes and no. If we're talking about a disease for which no treatment exists and people are dropping like flies, then risk vs benefit is a pressing issue. When it comes to a chronic condition where the majority of people have it under control with existing treatment options, which in the case of epilepsy includes a variety of medication, surgery and VNS implants, the question is more one of quality of life vs benefit. Whilst any tonic clonic seizure can be fatal, technically, epilepsy related death (which includes suicides) is considered rare, standing at approximately 1200 in the UK pa. From an objective point of view, there just isn't the same urgency. In this year's spring budget, £45 million was allocated to research for cancer, dementia and epilepsy and given such vast differences in the death statistics, I doubt epilepsy will be seeing all that much of it. What niggles me about the weight loss situation is that in the US, weight loss is an enormous, and therefore lucrative, market but if you put out a drug that has a long list of unpleasant side effects, you're not to get many takers. Tweak it here and there to reduce them and you're good to go. You don't need to take as much care when you have a captive market and it feels like they just can't be bothered.

Ultimately, whether it's better to put out a drug as soon as it's passable rather than postponing it to iron out some of side effects is an entirely subjective issue. The answer will be different depending on who you ask and what their personal circumstances are. I'm speaking from a point of view of someone who is currently not having too many problems but had a horrendous experience with medication in the past. In my case, it was psychiatric side effects that even after 6 months of starting, weren't subsiding (in most cases, side effects wear off once the maintenance dose is reached and is settled in). One day I'd feel complete and utter despair, the next I could feel a black, oily entity inside me, there were a couple of occasions where I was positive I was going to die that day but worst of all were the moments where I'd be preoccupied with what it would feel like to kill someone. The only thing that was preventing me was the thought that the consequences wouldn't be in my best interests, not any sense of right or wrong. I ended up leaving work because it was getting harder and harder to not go into the office kitchen, grab a knife and stab someone. Once I started coming off of the offending medication, the crazy started to wear off but the whole experience kicked off another round of depression and anxiety. In my depression logic, I decided that medication was causing more problems than the epilepsy itself so started to wean myself off of it. It didn't go well. I went back to a previous medication which hadn't worked perfectly but gave me the least amount of trouble. I can handle a seizure or two here and there if it means I get to have a relatively normal life although I know some don't agree, especially medical professionals.

I can't recall a prescribing doctor ever offering information regarding side effects. Once I had the internet, I'd research first hand experiences, and decide which meds to try based on those. To be honest, they're all much of a muchness. My cat has leukaemia (I promise this is relevant) and our vet had suggested a steroid. I looked it up online and only a few days ago a man won £700 because he wasn't warned about the side effects of it and had a psychotic episode for weeks. I have mixed feelings about this though since apparently it was mentioned on the patient information leaflet. He either didn't read it, or read it and decided to take his chances

 

My point was that if a drug will benefit some people (potentially many) to control a serious illness and only a small proportion will get the more severe side-effects, then it should be made available, but ultimately it's up to the individual, in consultation with their doctor, to decide whether to take it once it's approved. It's the job of the regulators to decide whether the benefit is overall worth the risk, and greater risk can be accepted for greater benefit. Whether the drug companies do enough research to provide them with sufficient information I don't know. Large-scale trials are expensive and can take a long time, during which people who possibly could have been helped by the drug won't get it unless they're in the trial. Thankfully it's not my job to decide.

 

There's a problem right there.

It's nigh on impossible these days to get to speak to a doctor. And even if you do, very likely you'll get a tactful but stock response that the treatment you've been offered is what is recommended in your circumstances.

I'm having the same battle now with blood pressure medication. Or I would be if I cared enough. I had 15 months of unfavorable situation which inevitably pushed my stress levels, and by extension my blood pressure, through the roof. So following a fairly routine follow-up, they checked my BP, and set me off down the 'pathway' (everything seems to be a pathway in the NHS now) leading to me receiving a text message saying a prescription was waiting for me at my usual pharmacy. It was Ramipril.

I collected it, but haven't taken it. I tried to contact the doctor. I wanted to discuss options for addressing the underlying issues before we decide if medication is the only option. I get a text message back. That's the treatment, it's up to me if I take it. No discussion.

 

Totally disagree, @Clueless 1 v2, drs. on he whole do not give stock responses, we want the best for our patients, although sometimes we are prevented from prescribing the best.
The pathways have been designed by experts, on the best available evidence, to allow GP's to start treatment of common conditions.

 

Why did they not want to take into account any of the background situation and underlying causes?

Why did they not want to even discuss it?

This is not a demonstration of wanting the best for their patients. This is a clear example of following a generic procedure.

Even if I'm wrong, failing to show any interest in explaining why I am wrong is just another example of not wanting the best for their patients. If they genuinely did, then they would want to explain to me why they believe I should take this medication, rather than sending a text message effectively saying take it or leave it.

EDIT: To be clear, I'm not saying this is ALL doctors. There is one very good GP that did an excellent job of looking out for me last year. In my experience it is most GPs. A friend of mine once summed it up perfectly. 'The NHS is actually really good, if you can get past the wall that is the GP'.

 

I bet you could.

I've thought the same about ours. I don't think it's that the individuals that work there are bad. I just think they're inside a broken system. If we take my situation as an example, I wonder how many people and how many minutes have been spent passing my case around, passing messages through multiple people. Like when the receptionist called me to pass on a message, and I had questions about it. She didn't know, she was the receptionist. So she had to type out my question in her words to go back to the doctor, who will then have to read it, read earlier notes to get it into context, then type out a reply.

It would be quicker to just arrange a five minute chat direct with the GP, I can ask my questions, he can answer them, we can come up with a plan, then I'll go away and leave them alone until something changes.

 

My comment was really aimed at your disdain for following pathways, which have clearly been shown to be the best way to treat common problems. Ramipril, for very good reason is the first choice for treating hypertension, in most people. That is what I would want.
Presumably when they started you on this, you had an opportunity to question it. If not then I agree there is a problem, but your opinion of drs., might not be encouraging a proper discussion [ sorry if this causes offence, it is not meant to ]

 

I have no disdain for 'pathways'. I just don't agree with the complete lack of flexibility or consideration for the individual human being that is the patient, and that is not just a statistic. The pathways might be the best for most people in most circumstances. I don't know. I'm not a doctor. But when someone wants to alter your chemistry, I don't think it's unreasonable to expect them to explain things properly and answer any questions the human patient might have.

Why? Is hypertension not a secondary effect of chronic stress, bad diet, lack of exercise, or other factors? Let's say a patient has piled on the pounds due to bad diet and lack of exercise, following a period of extreme stress and even a hint of depression, due to some other medical crisis, for example the discovery of malignant melanoma and the subsequent discovery of other abnormalities that warranted further investigation. Would a text message telling you to take ramipril still be the correct treatment, or would you want to work with the human being that is the patient to either help them figure out how to get themselves fit and healthy again, or explain why it's too late for that and medication is the only option?

My opportunity to question it comprised an online form was linked from their text message, where I was supposed to confirm that I understood the instruction.

I am always respectful to doctors, and indeed everyone I meet. My opinion of doctors is based on poor service. I don't even really blame the doctors. I think it's probably more the system they're in. Regardless, people don't generally try to interact with a doctor just for the fun of it. Most people go to see the doctor because there is something causing them serious concern. It doesn't take a genius to work out that when you tell a person that there's something wrong with their cardiovascular system and they're four times more likely to drop dead than if their stats were normal, but the medication to fix it can in some cases destroy the kidneys, potentially also causing you to drop dead, that person might want to discuss the matter rather than seeing cryptic, short text messages about standard pathways.