I was a very naughty patient and, after taking Atacand for 135/75 blood pressure (benign essential hypertension was the description) for a number of years on my doctor’s prescription, decided to do a little experiment. That is, I cut back on it gradually, monitoring my BP every day. No change.
I eventually got to no Atacand at all and have been there for the past four years, during which time the BP has remained the same as when taking the drug. Now, whether the BP is going to kill me is perhaps a separate question (I seem to be in excellent health at 65) but the Atacand doesn’t appear to have made much difference at all — except for the $600/year it cost me, even after insurance had picked up on some of the expense.
I began to grasp how helpful self-experimentation could be when I discovered that tetracycline, an antibiotic that my dermatologist had prescribed, did not reduce my acne. When I told my dermatologist about the research that revealed this, he said, “Why did you do that?”
Had this person’s doctor told him that Atacand might not work? Clearly not. Did the doctor even know that Atacand might not work? Apparently not, since there was no doctor-guided attempt to find out. Perhaps the doctor who prescribed Atacand would defend himself by saying, lamely, that all he knew is what the drug company told him. I wonder what the drug company knew.
How much money could be saved by stopping the prescription of drugs that turn out not to work? Should all drugs come with a label that says the fraction of patients for whom this drug doesn’t work? It is a warning that is truly needed.
Thanks to Rajiv Mehta.
Why would one worry about 135/75?
https://www.spacedoc.net/does_treating_high_blood_pressure_do_any_good
dearieme, that’s a good point. so there were three things wrong here. 1. no medicine needed. 2. medicine didn’t work. 3. doctor didn’t care whether medicine worked. Perhaps four: 4. drug company didn’t reveal that medicine often failed. What a system.
I wonder if part of the problem is that most people are not sophisticated and disciplined enough to accurately measure their own blood pressure once or twice a day in order to really nail down the effects the medication is having on them.
If a doctor instructs all of his patients to self-evaluate in this way, he can be sure that a large percentage will not do it properly. If somebody screws up and is hurt as a result, would the doctor be open to charges of malpractice? If the doctor tries to pick out who is likely to comply, will he be open to charges of racism or classism? Perhaps there is a kind of rule utilitarianism at work; the simplest and most effective course of action for the doctor is to just prescribe the medication to all patients who are above age X and blood pressure Y.