Calgarypuck Forums - The Unofficial Calgary Flames Fan Community - View Single Post - Street's Health Discussion. Volume 1 Issue 1

theg69 · 02-20-2013, 10:58 AM

I saw this topic and will add my two-cents.

1) Vit D- increasing evidence that in addition to increasing bone density, it contributes to skeletal stability and has found some benefit in reducing the morbidity related to falls in the elderly. I recommend 2000 units a day for everyone (including myself). Most docs are on it themselves. Some docs still order Vit D levels. I don't because 99% of patients are either deficient or severely deficient -> so NO, sunlight exposure is not an adequate means for achieving Vit D.
Calcium is trickier - because there is mixed evidence re: cardiovascular events. Most recent evidence is that there was no significant increase in heart related events but that being said, I tell patients to try to achieve optimal Calcium via their diet and only if they are not intaking adequate amounts, to supplement on top of that. I have only seen 1 patient with potential toxic levels of Vit D - he was taking 10,000 units a day. I am comfortable with going up to 4000-5000 units a day myself.

2) Antibiotics - I do not prescribe Abx that often to be completely honest. It is my pet peeve with the walk-in doctors that they do prescribe them too much. It is not because most of them are bad doctors but think of it this way, what is the easiest way to get a patient out of your office? In a broken medical system where people resort to walk-ins and rushed in and out of appointments, it takes a shorter amount of time to give a Biaxin prescription than it does to explain that it is viral and does not need any drugs. Some patients are to blame as well - I have many patients who get mad at me for not giving them anything. So to stem this epidemic, we have to fix our medical system (but not overworking GPs, who by the way are the most undercompensated compared to specialists) and educating our patient populations.

3) In terms of pharma and drug reps, there are many ethical and legal considerations now. They are not allowed to provide "free incentives" and any dinner they sponsor must have "educational value". I think this is a topic people not in the industry should withhold judgement because they most likely do not know the facts. I am neither pro or against pharma but they are a necessary evil. Yes, they can be biased, but they are the ones who do most of the R&D.
I have actually more of a problem with the generic companies who rip off the drug as their own without doing any research and development. They then give kickbacks to the pharmacies that prescribe them as well.
There are a few medications in which the generic has been shown to be not as effective (bisphosphonates and bone medications are one of them). Its to the point where one of the endocrinologists went to the extreme of saying to prescribe generics is to perform medical malpractice (not saying I agree with that though).
Yes, they do have their bias, but what sponsor or maker or their own product doesn't. The key is for physicians to evaluate the evidence and do their own research.
I have seen physicians who refuse to see drug reps and then decided that they needed to see them again. For what reason? Because they were getting so outdated in terms of their drug knowledge. Sometimes, we need to see what else is out there. People forget that we work long hours, and we still go home and read, study, and have to do research to keep up-to-date. For some physicians, they need to spend time with their family so that gets neglected.
That's my rant with pharma, i think they get so villified its silly. People forget that generic companies are arguably bigger pharma now with bigger profits.
Again, education is key to ensure the best care of patients.

02-20-2013, 10:58 AM	#58
theg69 Scoring Winger Join Date: Jul 2008 Exp:	I saw this topic and will add my two-cents. 1) Vit D- increasing evidence that in addition to increasing bone density, it contributes to skeletal stability and has found some benefit in reducing the morbidity related to falls in the elderly. I recommend 2000 units a day for everyone (including myself). Most docs are on it themselves. Some docs still order Vit D levels. I don't because 99% of patients are either deficient or severely deficient -> so NO, sunlight exposure is not an adequate means for achieving Vit D. Calcium is trickier - because there is mixed evidence re: cardiovascular events. Most recent evidence is that there was no significant increase in heart related events but that being said, I tell patients to try to achieve optimal Calcium via their diet and only if they are not intaking adequate amounts, to supplement on top of that. I have only seen 1 patient with potential toxic levels of Vit D - he was taking 10,000 units a day. I am comfortable with going up to 4000-5000 units a day myself. 2) Antibiotics - I do not prescribe Abx that often to be completely honest. It is my pet peeve with the walk-in doctors that they do prescribe them too much. It is not because most of them are bad doctors but think of it this way, what is the easiest way to get a patient out of your office? In a broken medical system where people resort to walk-ins and rushed in and out of appointments, it takes a shorter amount of time to give a Biaxin prescription than it does to explain that it is viral and does not need any drugs. Some patients are to blame as well - I have many patients who get mad at me for not giving them anything. So to stem this epidemic, we have to fix our medical system (but not overworking GPs, who by the way are the most undercompensated compared to specialists) and educating our patient populations. 3) In terms of pharma and drug reps, there are many ethical and legal considerations now. They are not allowed to provide "free incentives" and any dinner they sponsor must have "educational value". I think this is a topic people not in the industry should withhold judgement because they most likely do not know the facts. I am neither pro or against pharma but they are a necessary evil. Yes, they can be biased, but they are the ones who do most of the R&D. I have actually more of a problem with the generic companies who rip off the drug as their own without doing any research and development. They then give kickbacks to the pharmacies that prescribe them as well. There are a few medications in which the generic has been shown to be not as effective (bisphosphonates and bone medications are one of them). Its to the point where one of the endocrinologists went to the extreme of saying to prescribe generics is to perform medical malpractice (not saying I agree with that though). Yes, they do have their bias, but what sponsor or maker or their own product doesn't. The key is for physicians to evaluate the evidence and do their own research. I have seen physicians who refuse to see drug reps and then decided that they needed to see them again. For what reason? Because they were getting so outdated in terms of their drug knowledge. Sometimes, we need to see what else is out there. People forget that we work long hours, and we still go home and read, study, and have to do research to keep up-to-date. For some physicians, they need to spend time with their family so that gets neglected. That's my rant with pharma, i think they get so villified its silly. People forget that generic companies are arguably bigger pharma now with bigger profits. Again, education is key to ensure the best care of patients.