Avandia – Round 2

Sorry for the downtime the last few days. I heard from my webhost that they got his by a “Distributed Denial of Service Attack” or something. I guess its all better now or something. It wasnt me! I swear! I thought I maybe pissed off the dipshit who published that Avandia study.. 🙂
Anyhoo.
Avandia questions are still coming in waves. We actually have doctors who gave us blanket statements to switch all of his/her patents from Avandia -> Actos.
Now my question about this:

1. Kickbacks? Oh, I think so.
2. Doesnt he/she know that the risks from Avandia are a class effect? So when GSK gets its head out of its ass and publishes a paper showing the exact same risks are present in Actos, what are we supposed to say? Your doctor is an idiot?
3. I thought that drug treatment was supposed to be individualized to the patients, you know, practice medicine. Sweeping mass changes of Avandia -> Actos sorta goes against that dont you think?
   Now for the doctors in the crowd: Is he doing this to prevent himself from getting sued? We all know that study isnt worth the paper to wipe my ass with, yet people are seriously freaking out about it and switching all their patients. Hell, lets switch them to all Metformin, because Lactic Acidosis isnt nearly as scary *sigh*.
   When are people going to realize that Rx medication is a controlled poison?

Comments #

Comment by Pharmer Jane on 2007-06-10 06:27:08 -0700 #

I haven’t gotten a single phone call about Avandia. I guess people in my area of the country don’t read the paper or watch the news.

Comment by David Mihalic on 2007-06-10 13:08:58 -0700 #

Completely agree! I’m using this publication hor’s (Nissen) study to teach my students how to pick apart of piece of shit study. Especially a metanalysis!
I’ve have only one issue with your rant’s though. I know why you are an angry pharmacist….you’re a PharmD working in retail!

Comment by DrRx on 2007-06-10 14:16:30 -0700 #

AMEN!!!! When will they see this is a ‘CLASS EFFECT’?! Anyone remember a little drug called Rezulin?! 😉

Comment by Ryan on 2007-06-10 16:46:14 -0700 #

My thoughts exactly. Nice post.

Comment by stlcopton on 2007-06-11 09:24:13 -0700 #

Actually, I think the lipid profiles of actos and avandia are quite different. Avandia had negative effects and actos actually had positive effects. Not sure though, can’t find the therapeutics notes…..

Comment by dave on 2007-06-11 13:28:35 -0700 #

people (medical and lay) often don’t realize that these rare fatal side effects are almost always a class effect to an extent. we saw the same thing when Vioxx went off the market: blanket change to Bextra, then to Celebrex after Bextra got the axe. Does Celebrex really have a significantly lower risk of heart attack/stroke than the other COX-2 inhibitors? Almost certainly not, but until someone rigs up a study showing as much, it stays on the market.

Comment by LD50 Rat on 2007-06-11 17:31:23 -0700 #

Though you won the lotto, and left for your own personal island.
Glad you are back!

Comment by LD50 Rat on 2007-06-11 17:31:45 -0700 #

Though you won the lotto, and left for your own personal island.
Glad you are back!

Comment by NocturnalDoc on 2007-06-11 19:08:33 -0700 #

As a doctor (hospice doc FWIW), I would guess worry about lawsuits is causing docs to switch drugs. As nice as the idea of sitting down with each patient for a long risk/benfit discussion is, it isn’t going to happen. There isn’t enough time in the day and the average patient doesn’t have that much mental finesse.

Comment by richard on 2007-06-12 09:15:38 -0700 #

idunno…your statement about it being a class effect…the same would go with the liver failure first seen with the first glitazone that was on the market.
in canada, my patients are too daft to understand what a crappy study is. they are all scared they are all going to die because the television told them they were going to die.

Comment by CardioNP on 2007-06-12 19:26:53 -0700 #

I had a pt ask me about the cardiac risks of continuing his Avandia.
Told him that the risks of a cardiac event from the medication were significantly LESS than the risk from his pack a day cigarette habit.

Comment by Drug Monkey on 2007-06-13 01:53:15 -0700 #

Risks from Avandia are a class effect? Really? Take a look and get back with me on that.
http://www.theheart.org/article/363479.do

Comment by DrRx on 2007-06-13 20:14:43 -0700 #

Hello, Can’t wait to hear you next rant…and most importantly…to get to see the comments I’ve posted as well as otheres, displayed brilliantly on your website….yeah I know…I’m a nag…sorry…

Comment by DrRx on 2007-06-13 20:15:10 -0700 #

Hello, Can’t wait to hear your next rant…and most importantly…to get to see the comments I’ve posted as well as otheres, displayed brilliantly on your website….yeah I know…I’m a nag…sorry…

Comment by RJS on 2007-06-18 11:52:26 -0700 #

That’s pretty absurd. Maybe the doctors are dumber as a group where you are? I’ve not seen or heard of any blanket switch orders, and I work in three different pharmacies every week, each of which has a distinctly different prescribing circle.
I don’t think I’d follow a blanket switch request if it were made, either. You want an Avandia -> Actos switch? You write a new prescription.

Comment by Grasshopper on 2007-06-19 07:32:35 -0700 #

Hi…just found your blog. Good stuff!!
You say what I’d like to say everyday at work.
I’m currently a relief pharmacist (read: can’t live with any of the crap jobs out there right now) with varied experience in hospital, home infusion and some retail.
Keep up the good work!

Comment by Grace with a sigh on 2007-06-20 06:37:58 -0700 #

The good part? Two dinners from GSK at Ruth’s Chris in ONE WEEK!

Comment by eli on 2007-06-21 21:19:39 -0700 #

A class effect? Read the PROactive study bud. Then tell me that it’s a class effect and that Actos doesn’t have cardio and metabolic benefits. There’s def some conflicts of interest within the study (somebody’s gotta fund em), but you can’t deny the significance of the results.
As for lactic acidosis…tell me…have you, EVER, personally, witnessed a case of lactic acidosis related to metformin? Didn’t think so.

Comment by DrRx on 2007-06-23 07:56:37 -0700 #

eli….
I believe, ultimately, it will be a class effect (lipid profile or no lipid profile….), remember, effects on lipid profile is just a surrogate marker….
As for lactic acidosis, I’ve seen 2 cases over 4 years with metformin, so it does happen!

Comment by DrRx on 2007-06-23 19:17:03 -0700 #

To Dave:
Though the updates to the comment section of this website are slow in coming thus making interactive communication pretty tough, I feel compeled to respond about the Vioxx/Celebrex issue. If you look at the affinities of celecoxib for the COX1 receptor versus the COX2 (where thrombaxane is involved, and the PRO-coagulant effect is seen) is significantly HIGHER than rofecoxib or valdecoxib. This makes celecoxib much “less” a COX2 inhibitor than the other 2 agents, and thus LESS likely to cause the thrombotic events that precipitated the mortality seen with the other more ‘selective’ COX2 inhibitors…. So I would definitely think celecoxib could not be lumped in with the other COX2 inhibitors in this regard.

Comment by The Blonde Pharmacist on 2007-06-24 10:00:24 -0700 #

Glad to see you back. I was kinda worried!

Comment by sms on 2011-02-15 09:27:13 -0800 #

i think everyone should have their heart tested before a doctor give any drug.
doctors dont tested your heart till after you had a heart attack

Comment by JustthePOA on 2014-07-15 22:11:07 -0700 #

I know that this is really really late, I just wanted to let you know that your “Distributed Denial of Service Attack or “DDoS” as it is referred to in the “hacker” community is an attack by, well, hackers. It basically means that they sent a shitload of information to your server and overloaded it, effectively rendering you offline for a couple of days. So, yes, you probably did piss someone off. Lol.