My wife works for a Leukemia BMT program and says they give this to a lot of their patients. In normal times there’s frequently a backorder of this steroid.
Steroids are nasty stuff; they make me extremely short tempered and give me severe mood swings. Some of them are extremely dangerous even over the short term, causing bone degeneration and other nasty side effects.
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True. I stand corrected.
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I cannot agree enough, if you are on or about to be on a ventilator, dexamethasone is very reasonable to try to modify the course of the illness. This is all it can do. It does not treat the infection, and for the love of all that is good and holy, it does not prevent anything except living a long and healthy life if used outside of medical guidance. The majority of idiots who took hydroxychloroquine were fine, for the most part it’s side effects are minor. Dexamethasone, and all the related glucocorticoids, are not low impact drugs. Taken as directed they have major, potentially life altering, side effects if not monitored very closely. Taken by DIY “they dont want you to know about this” facebook guided fools, these things will absolutely make you miserable, sick and potentially dead. Just don’t. Please.
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And yet you drink H2O and not h2o …
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And sometimes those idiots will harm not only themselves with it, but also their children.
With steroids used to treat arthritis the bone degeneration is sometimes so severe that vertebral fracture happens.
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Because you know, there are a lot of people taking steroids without a prescription. And if they are athletes got disqualified for doping.
The cream is used to heal some dermatitis and eczemas, but if used on the wrong one it will cause other skin problems, like dry skin and itches. And sometimes causes itches even if used on the correct skin problem.
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Since I haven’t lived in the US since I was four years old, I have to ask: just how broken is the US medical system? Can anyone get their hands on medication that is supposed to require a prescription just by asking? Are doctors so beholden to the whims of their patients that they prescribe anything and everything for any reason whatsoever, and if so, isn’t that supposed to be prohibited? As in: doesn’t a prescription for something the drug isn’t explicitly tested and verified for use against trigger some sort of check? Is there no oversight whatsoever?
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What is this word, “oversight”? /s
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No, it does not. The purpose of a prescription is it is the doctor making a professional judgement that a drug or therapy will be effective. The FDA does regulate the marketing of drugs (you can’t claim a benefit without explicit testing and verification). But doctors are free to do pretty much anything (assuming availability and capability). The technical term is “off label use” which is very common. Use of dexamethasone for covid patients, even in the ICU, would fall under this category.
Since almost no drugs are tested on kids, almost every drug prescribed for kids is an off label use.
I’m not sure where you live, but it’s very similar in Europe. " Is it off-label use of pharmaceuticals prohibited or regulated by the law? Sentence T-452/14 (Laboratoires CTRS vs Commission, paragraph 79) of the European Court of Justice answered the question, confirming that “ off-label prescribing is not prohibited , or even regulated, by EU law ” and that “ there is no provision which prevents doctors from prescribing a medicinal product for therapeutic indications other than those for which a marketing authorisation has been granted ”."
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That brings me back to the part where I asked if doctors are “so beholden to the whims of their patients that they prescribe anything and everything for any reason whatsoever”. The answer thus seems to be “yes”, seeing how the difference then seems to be whether doctors prescribe medications based on a combination of their proven effects, intended uses, the medical training of the doctor, medical ethics, and other relevant factors, or if their prescriptions are given on the grounds of financial motivations (keeping your job, maintaining a business, accumulation of wealth, etc.).
There have definitely been cases of doctors overprescribing medications here in Norway too, but most doctors are strict and careful in what prescriptions they give out (which is, for example, part of the reason why we have a very low level of antibiotic resistance here, as the threshold for prescribing antibiotics is quite high).
Not really. Unless you’re rich and have a “special” doctor.
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The answer is sort of yes. Many employed physicians are subject to performance evaluations, which are notoriously difficult in our field. The easiest way to do one is to distribute “patient satisfaction surveys” which play an enormously outsized role in determining bonuses and even retention. So how do you score great patient satisfaction? You give them what they want. It is terrible medical practice, but it is very very commonly done. And once that habit is established, it can be very hard to get out from under it. So yes, I could very easily see this being done. Disappointing, but there it is.
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TL;DR of the report/interview I caught on telly: This steroid was part of a “try everything we have in a trial as a shot in the dark is better than sod all”. Patients on a ventilator were found to recover slightly better with this than anything else i.e. one in eight more patients survived. Not a miracle cure, not a preventative, but a boost to the odds of survival. Survivors will still face months, if not years, of rehab.
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I guess my experience is very different. Maybe it’s the State I’m in. If anything, I find it exceedingly difficult to get the kind of medication I may want. Or, I will get a very small amount of something with no refills requiring repeat visits to get more.
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There are multitudes of confounding variables in this. Honestly, at least in my experience, it takes longer to not prescribe than to just give what they want. If you are in a job where you have to see ridiculous numbers of patients to make you income, you take the path of least resistance. I have lost patients over this issue. I have pointed out before, I am senior enough (and productive enough) that I can laugh it off, but someone starting out, or under pressure to “move the meat” would see no reason to put up a fight, and every reason not to.
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Yay, capitalism. Anyway, I’m not questioning what you’re saying - you’re clearly the expert here and I’m not. My personal anecdotes are not data, etc, etc. Thank you as always for your insights and what you do.
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Eh, we are both relating anecdotes. I am pretty sure there is no definitive data on “off label prescribing due to patient pressure,” although the whole hydroxychloroquine fiasco would give circumstantial evidence for it being a big problem. I would also point out the sociological breakdown. The folks most outraged at not having their whims respected tend hard toward well-off white moms, in my practice anyway. but absolutely, YMMV.
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They are regulated in the sense that they must be prescribed by a doctor, but a doctor determines if it is a reasonable use, once it has passed FDA approval. There is some oversight beyond that, but it is mostly tied to specific drugs of abuse, but even that is underdeveloped. The real issue is the ease of doctor shopping. Only a small percentage of docs will go along with prescribing these things, but once someone gets the prescription, they can spread the word.
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Well… that sounds remarkably like academia… Depressing.
Also, just to the general conversation here… I find it uber-weird to go and ask my doctor for a particular drug that I THINK I MIGHT need. Like, if they prescribe me a drug, I take it, cause I assume they know what they are talking about… but why the hell, as a patient with no medical degree, assume I know about drugs?
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