macgyver - 30 March 2012 08:56 AM
Coldheart Tucker - 29 March 2012 09:50 PM
Why are you doing this? Seriously. You have latched onto a minor comment of mine, misinterpreted it (nowhere did I say anything about Proscar or Avodart being approved by the FDA for prevention, that’s all on you), and are flogging it as if it somehow changes the larger issue. The point was that we don’t always get things right when it comes to drugs and their uses. Change what I said about Avodart and Proscar to Cox-2 and how it was originally thought that the drugs could be safely given to people with no danger of stomach irritation or other problems, only to have it discovered that Cox-2 drugs (more specifically Vioxx) do, in fact, cause various medical problems (some times fatal), and the point remains the same.
As for Avodart and Proscar and prostate cancer, I’m not going to dig for the links which I read on the subject when I was first prescribed Avodart, but there was, indeed, thought that by giving it to people who were at risk for prostate cancer it might reduce (which is different than prevent) their risk of developing the disease, but studies have shown that this doesn’t appear to be the case. And the reduced libido and impotence are really minor side effects when compared to the depression side effects (which are unrelated to any performance issues). Personally, I’d prefer to have the “roto-rooter” treatment instead of Avodart, but without insurance, I’m stuck taking the meds, and even with insurance, the doctors are loathe to okay the surgery. (They seem to think that the potential for “nerve damage” is somehow a worse outcome than spending ones days wanting to swallow the barrel of a gun for no reason other than your medication is screwing with your brain chemistry. Not to mention that as a result of taking another drug to improve the effectiveness of the Avodart, I’ve developed an ulcer, so I’m forced to take acid reducers and eat a very bland diet.)
Coldheart I’m sorry, I know its often difficult to read intent on a message board but no offense was meant by my comments. As a physician I was simply trying to make sure the information presented here was accurate since there are others who read these comments besides you and I.
Well, for starters, I have no idea if you’re a physician or a dog, what with this being the internet and all. (I could be Jimmy Stewart’s friend Harvey, for all you know.) As for accuracy, I don’t think that anyone who would take medical advice from random strangers off the internet is going to be swayed to rationality (or the correct decision) by anything you or I post here.
In general with a few exceptions, physicians should not use a drug to treat conditions for which it has not been approved especially when we are talking about preventative treatments. If a physician was giving it to you for this purpose I was simply trying to point out that it is not standard of care in the medical community to do so. It seems you were given the drugs to treat BPH though if I’m interpreting your comments correctly and that is the intended and approved use for them.
While random pill-popping and sleazy drug reps pushing medication which is ineffective or for uses that they know won’t do the patient any good are all bad, I can’t say that I find the concept of off-label use to be wholly evil. The method of drug testing and licensing in the US is lacking in many areas (for example, there’s no real long term follow up, so we’ve no idea how patients do decades later after taking a medication in many cases), and in my view, American doctors are entirely too cautious when it comes to serious medical issues. In the early 90s I watched a friend die from AIDS, and I became acquainted with the ACT UP movement and saw how doctors were often unwilling to try something, anything, to treat people. Certainly, one can understand the hesitation to experiment in cases where the disease isn’t fatal, but when you’re dealing with a medical condition which is terminal, throwing stuff against the wall to see if any of it sticks, doesn’t seem like a bad idea to me. Granted, there’s the risk of making things worse or shortening the patient’s life, but rarely does one find themselves close to death and thinking, “Yeah, I lived the right number of years, I don’t want to live any longer, even if I was healthy.”
PBS had a documentary about ebola in Africa and they showed the efforts by WHO to control the outbreak of the disease. During the course of filming, one of the African nurses came down with ebola. The African doctors elected to give the nurse a transfusion from someone who’d survived ebola (and thus had antibodies to the disease) in hopes of saving her life. They were forced to do this in secret, because the WHO doctors were opposed to this and would have stopped them. The nurse survived, and the African doctors tried the same technique on the other patients who had the disease. Something like 19 out of 20 of them survived (as opposed to a fatality rate of 50% or so). The WHO doctors still objected to this, despite being witnesses to its effectiveness. Again, caution should be the watchword when it comes to something like acne, but a nasty disease like ebola? I say go at it with everything you’ve got.
I realize that there’s legal litigation issues when it comes to such things, but France seems to have a decent model when it comes to experimental drug treatments. (Of course, they also have socialized medicine, and we can’t have that. Because if we did, it’d soon lead to us all being rounded up and put into camps so that the government could harvest our organs and sell them to space aliens as aphrodisiacs. 
)
I’m sorry to hear you’re not doing well with the treatment you were given. Depression is a very rare side effect with these drugs. In fact it occurs no more often in patients on the drug than in those who take placebo,
Actually, there seems to be a growing number of patients who are saying that the levels of depression are much higher than have been reported by the studies. I do know that the intensity of depression is far greater than anything I’ve ever experienced before in my life, by a wide margin.
but if you are having that problem you should make it clear to your physician that it is seriously affecting your life, and that you need an alternative.
Will not do me any good, I’m afraid. I have no health insurance and am reliant upon charity to pay for the cost of my meds, and the only thing covered is Avodart, so since I can’t afford to pay for better meds out of pocket, I’m stuck with what I currently have (I’m too young, it seems to get into any of the test programs, despite having a family history of BPH and prostate cancer.)
I mentioned the decreased libido and impotence because they are very common side effects. To the men who suffer from them they are not minor, especially if the reason they are on the drug is dubious ( ie. to try and reduce their chances of dying from prostate cancer). The “roto -rooter” procedure also known as a TURP is not usually offered as first line therapy for several reasons. Its invasive with all the associated risks of invasive procedures. It also comes with significant risk of urinary incontinence and impotence which can be permanent. It does not always relieve the symptoms and even when it does it may only be for a limited period of time, but when medications don’t work its an alternative worth considering assuming the person is a good surgical candidate. Only your doctor can determine that though.
At least one study has found that people treated with the TURP procedure are more satisfied with the results than folks are with medication. (Think I read about the study on Science Daily.)
You are correct that we “don’t always get it right about drugs and their uses” because of the simple fact that we never have all the facts about how things work. That same philosophy applies to virtually everything in life though, not just drugs. You can only act on the information you have at the time. We can chastise the makers of COX-2 inhibitors for selling a drug that caused a small increased risk of cardiovascular events but the fact is that they didn’t know that when they were developing the drug. The rationale behind COX-2 inhibitors was a good one. In theory and in practice a drug that targeted prostaglandins involved in inflammation but not the ones that protect the lining of your stomach should provide a significant safety improvement over more broad spectrum prostaglandin inhibitors like naprosyn, ibuprofen, and aspirin. Unfortunately the companies making these drugs didn’t realize that some of them slightly altered the finely tuned balance between thrombosis and thrombolysis that occurs continuously throughout our blood vessels. Altering that balance resulted in a higher rate of coronary thrombosis going to completion in patients who took these drugs and hence more heart attacks. Like I said though, you can only make decisions based on the information you have.
I think that after the news broke about the COX-2 problems, one of the makers was found to have covered up information about problems with the drug during testing. We clearly need a system with more transparency and better ways of following patients after they’ve been taking a drug for a long period of time.
And as somewhat related to the OP (though from the AAAS and not some glurgy email) It looks like the herb thyme might be better at controlling acne than prescription meds.
