May 2017 – B4 U Consent

I didn’t think neratinib was getting through. As much as I want more flexibility in prescribing and a more moderate drug approval pathway, why does it have to be neratinib?

Despite very modest clinical benefit, a lot of toxicity and a broad label, this morning’s FDA panel voted 12-4 in favor of more options for cancer patients. The panelists did seem to take patient selection seriously, though it’s unclear how that will pan out when Puma is loose in the market. What I’m curious about is whether patients will demand it, whether the patient representatives Puma paid to speak – the what-if-Mommy-dies, I-want-to-do-everything-to-fight-this types – are representative of the overall population. Continue reading “The Puma Panel” →

While we’ve been worrying about nuclear war and rising global fascism, a post on KevinMD last week reminded us of a persistent and no less real danger: patients who ask for shit. The blog’s author draws a line between “patient-centered care” and “patient-dictated care”, the latter of which entails the physician sighing mightily yet rolling over at any patient request. What choice does he have, really? He’s just trying to keep the lights on in this crazy world.

The example given is antibiotic abuse, that old workhorse – just as scary and describable as it was in that 60 Minutes episode back in 1998. Can You Believe this Asshole Wants Antibiotics for a Cold?! has been kicking around at least since I was in high school, and despite its wear, it won’t die as the catchall justification for why physicians must remain the keepers of the knowledge. They are the rare, anointed ones, elevated by the combination of intellectual superiority and moral purity; they alone understand the dangers of antibiotic resistance. Continue reading “New Threat: “Patient-Dictated” Care” →