Musings of a Dinosaur

A Family Doctor in solo private practice; I may be going the way of the dinosaur, but I'm not dead yet.

Monday, June 04, 2007

Here's What I was Talking About

Via KevinMD:
I have practiced medicine for 40 years. I have never prescribed a pill to lower blood sugar. I still see no reason to do so. If I am disadvantaging my patients, it's to a trivial degree at most. However, I know I am sparing them known and unknown hazards.

And I won't let you measure my blood sugar or the measure of its persistent elevation, the hemoglobin A1c. I don't care, and I won't care till there is compelling science that something meaningful can be done if it is elevated.
(Link to full article here.)

Hm; so Dr. Hadler doesn't bother treating diabetes, hypertension or hyperlipidemia. I'm sure his nephrology colleagues adore him for augmenting their dialysis practices with patients whose kidneys fail years earlier than they otherwise would. Likewise, his cardiologist friends are probably toasting his continued health, as are the vascular surgeons and ophthalmologists.

I don't disagree in principle with being a "late adopter" of new therapies, but to say that "high blood sugar" does no harm marks him as foolishly antiquated; one of those "good 'ole docs" I was talking about here.

(I'd love to hear Amy's take on this.)


At Sun Jun 03, 07:37:00 PM, Anonymous Anonymous said...

I was going to comment on there, but apparently I need to give out all my identifying information to the Disney Recycling Preservation Project and World Domination Company. Uhm sorry, no. They probably have it anyway, so it is just a matter of principal, but I have enough junk mail. Anyway, this is what I had to say.

I also beg to differ. My dad was diagnosed with Type 2 Diabetes. He brought it under control, with regular blood sugar testing, a better diet, and a drug.

He looks better, (not weight, but color and 'twinkle in the eye'), and he has better endurance on the job. He went in because he had symptoms. Lowering his blood sugar has reduced those symptoms, and his quality of life is better.

Regular high blood pressure will damage organs. I researched this thoroughly when faced with the possibility of going on a drug myself. If it wasn't that bad for me, why should I worry and why take a drug? I found out it was. I chose to exercise to reduce my blood pressure, and it worked, so I didn't need the drug.

Had I been unable to reduce my blood pressure, I would have taken a drug rather than sustain silent and irreversable damage to my organs that would eventually lower my quality of life and possibly lead to my demise.

I am a healthy person. I'm not afraid for my health. I'm with you about overuse of drugs in medical practice. But you overstate your case here.

Since you seem fairly ignorant of these particular details, and since your specialty does not involve being a primary care physician who must keep himself up to date on these kinds of everyday silent and chronic conditions, I hesitate to refer to you as an expert who can enlighten me on this subject.

At Sun Jun 03, 07:57:00 PM, Anonymous Anonymous said...

Anyone who has read Nortin Hadler's pieces about the back pain and the industry that has developed around its treatment knows that he is an extremely intelligent physician in his specialty. However, this time he has ventured too far away from his expertise and gone way off the deep end. It's a shame because people won't take him seriously anymore when he does comment on areas he knows about.

At Sun Jun 03, 10:56:00 PM, Blogger Dr. A said...

Would love to see his pay for performance, er, quality numbers... *cough*

At Mon Jun 04, 07:02:00 AM, Blogger scalpel said...

We know (from the Framingham Study, for example) that hypertension, diabetes, and hypercholesterolemia are risk factors for the development of cardiovascular diseases. Do we really know that buffing the numbers reduces the incidence of these complications in patients with these conditions?

I'm not so sure, particularly in the "mild elevation" category. Does the emperor have clothes or not?

At Tue Jun 05, 12:10:00 PM, Anonymous Anonymous said...

How many statins do you have to prescribe before you prevent a single cardiovascular event?

In any event, this guy says that Lipitor is made by Merck, which is not correct:

"Merck is faced with a class action law suit because its advertising allegedly suggests benefits from Lipitor for women when there is no supporting science."

Lipitor is a Pfizer drug. Merck makes Zocor, which is now, of course, generic.


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