October 14, 2013

October 14, 2013
5 Questions to Ask Your Doctor
Before You Fill That Prescription

Welcome to another day in my life. Today is Monday and I hope you had a beary safe and great weekend. It was a very busy weekend for Dab the AIDS Bear and me.

Sooner or later, everyone living with HIV ends up having to take at least one medication - and usually more than one. But do you know the questions you should be asking your pharmacist before you fill a prescription?

1. Why am I getting this drug?

Place the emphasis on the "I" when asking this question. Your doctor should consider your personal risk factors when prescribing a drug, not the previous patient he treated who may have been helped enormously by the medicine but also may have been far sicker to begin with. If you're considering a cholesterol-lowering statin, for instance, ask, "Has this drug been shown to prevent real clinical events like heart attacks or strokes in patients my age and gender with a cholesterol profile like mine?" Ditto for bone building drugs, which are being given more and more frequently to those with some bone loss, called osteopenia, but not full blown osteoporosis. Ask "Will this drug prevent fractures in those with bone measurements like I have?"

2. What are the risks versus the benefits?

Your doctor should be able to tick off the side effects of any drug she's prescribing as well as serious adverse events associated with the drug and how commonly those occur. You should also have a clear understanding of the benefits. Even in severe cases of depression, antidepressants significantly help one third of patients who take them, mildly help another third, and don't do much good for an additional third information that has become known in research studies but isn't featured prominently on manufacturer's websites.

3. Is there an older drug or a lifestyle alteration that works just as well?

Every time your doctor accepts a free lunch, a fruit basket, heck, even a ballpoint pen from a drug maker, you can bet that it's for a drug that's new, expensive, and still on patent (which means there's no cheap generic available). There's no question that doctors are more likely to prescribe drugs that they're being lobbied on new ones being heavily marketed by pharmaceutical firms. The trouble with a new medication? We might not know its long term benefits or its track record for risks.

It's one thing if there's no other treatment available for your condition, but it's quite another if there are a lot of other treatments that have stood the test of time. If your doctor can't make a strong case for why a new treatment may be better, take the older one. Ditto for lifestyle changes. For those with mild depression, exercise can work just as well as an antidepressant. Salt sensitive folks with high blood pressure may be able to reduce hypertension simply by lowering their sodium intake. And many of those with type 2 diabetes can reverse their condition by losing weight, increasing their activity, and cutting back on carbohydrates.

4. Will it interfere with other medications I'm taking?

While one fifth of Americans have taken three or more chronic drugs in the past year, many of them get their prescriptions from different specialists who are supposed to check for medication interactions but often do not. Pharmacies also alert you to dangerous drug drug interactions, but this may not happen if you don't get all your medications from the same place. Also, it's important to factor in all those over the counter medications you may be on like acid blockers, allergy medications, or pain relievers.

5. Has this drug been shown to prevent real clinical events?

You might think that any drug approved by the FDA would have to meet that criterion. But that's not the case. The diabetes drugs Avandia and Actos, for example, were approved "to help improve blood sugar control in adults with type 2 diabetes." These drugs don't, though, actually prevent heart disease, the leading killer of diabetics.

It's not enough to show that a drug lowers blood sugar; does it in fact improve clinical outcomes and not cause harm? There was a study published two years ago showing that Avandia was associated with an increased risk of heart attacks and deaths from heart disease. The experts who spoke with U.S. News would like to see the FDA approve only drugs that clearly show a benefit to the patient, rather than just improving lab test measurements like cholesterol, blood sugar, and bone density scores. Your doctor should be able to explain why you're taking this drug right now. Will it make you feel better? If not, will it prevent something bad from happening in the future? How big is your chance that you'll actually have that bad outcome if you don't take this drug?

Hope these tips will help you make sure you are taking only the medications which will really help you and not complicate living with HIV or other chronic illnesses. Have a beary safe and great day!

Until we meet again; here's wishing you health, hope, happiness and just enough.

big bear hug,

Daddy Dab