Doctors Face Dilemma Over Prescribing Avandia
ROBERT SIEGEL, host:
From NPR News, this is ALL THINGS CONSIDERED. I'm Robert Siegel.
MICHELE NORRIS, host:
And I'm Michele Norris.
And, today, many doctors find themselves facing a difficult question. That's after a Food and Drug Administration advisory panel issued a ruling yesterday saying essentially two things: that the diabetes drug Avandia does increase the risk of heart attacks but that the drug should remain on the market. So it now falls to doctors to field anxious calls from their patients and to decide, when do the benefits of taking Avandia outweigh the risks?
I'm joined now by one such doctor. His name is Daniel Einhorn. He's the president of the American Association of Clinical Endocrinologists, or AACE. He's also a clinical professor of medicine at the University of California San Diego. Dr. Einhorn, thanks so much for being with us.
Dr. DANIEL EINHORN (President, American Association of Clinical Endocrinologists): My pleasure.
NORRIS: Now, what are you hearing first from your patients?
Dr. EINHORN: Well, they may ask specifically, should I continue the medication? And what I'll say in that situation is if you feel the least bit of discomfort, lucky for all of us in 2010 there are many alternatives. And so, you need not suffer any concern about the medication, even if the concern is remote and not firmly established, there's no reason to take a medicine that you or your friends or family are worried about. We have lots of alternatives.
NORRIS: Well, given the serious health questions that were raised, as a physician who's always thinking about the well-being of your patients, would you advise them to move off Avandia?
Dr. EINHORN: I have personally not requested patients to discontinue Avandia, remembering that the events that are being described are very rare. If someone is on Avandia doing well, there is no call to withdraw it, at least not at this point. Remember that the FDA has not made a final ruling.
If you're not on Avandia and need to be treated for diabetes, there are many alternatives. And a doctor today would not likely choose to start Avandia, given the serious health questions that were raised and not resolved. I don't believe there are going to be very many new prescriptions for Avandia written, certainly not for new starts in people with diabetes.
NORRIS: So you won't be writing new prescriptions for Avandia, but someone comes into your office and they say, Dr. Einhorn, I'm not sure I understand this. I mean, you're not writing new prescriptions and yet you're advising me to continue with a drug that you obviously are not completely comfortable with.
Dr. EINHORN: Every time you change a drug, for example, let's say we would now pick a drug that we think has a better safety profile. In this specific individual, that drug may have issues that you're not having with Avandia. So if you know that a drug has been successful and well-tolerated, there's a good reason to not automatically withdraw that drug, unless there's a very strong safety signal because every change has its own risks.
NORRIS: I want you to reach back in your mind if you can, before Avandia came under this investigation by the FDA. How was the drug viewed before the FDA started looking at its safety? How was it used in your practice and how did people view it?
Dr. EINHORN: The class of drugs which include Avandia, they were viewed with a great enthusiasm. I had the privilege of being part of an NIH panel that really raised the question, should everyone with Type II diabetes, indeed should everyone with insulin resistance be given one of the drugs in this class? And I went through the evidence showing all the multiple studies that really showed what great benefits should inure from these drugs.
I thank my lucky stars that I did not suggest, therefore, give everyone these drugs 'cause now we see that we can't always predict the benefits or ultimately the risks of every drug. And we need to follow them for as long a time as possible in as many people as possible and be very critical about our observations. And even a drug that seems safe and seems promising may let you down in the long run.
NORRIS: Dr. Einhorn, thank you very much.
Dr. EINHORN: My pleasure, Michele, thank you.
NORRIS: That's Dr. Daniel Einhorn. He's president of the American Association of Clinical Endocrinologists, or the AACE, and medical director of the Scripps Whittier Diabetes Institute.
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