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What Doctors Don't Tell You

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July 2018 (Vol. 3 Issue 5)

Should we tell the patient?

About the author: 

Should we tell the patient? image

There's a new game being played by heart specialists at the moment

There's a new game being played by heart specialists at the moment. It's called 'Shall we tell the patient?' and it all started when a major trial discovered that valsartan, an angiotensin receptor blocker, dramatically increases the chances of heart attack among hypertension patients. Compared with the drug amlodipine, it raised the risk by 19%.
A patient of one of the doctors who conducted the trial got to hear about the findings, and said, not unreasonably, that this was essential information that should be revealed before starting valsartan therapy. And, irony of ironies, the patient just happened to be a doctor.
Now, a 19% increase is substantial, and it seems to be worth mentioning to the patient. Not if you're a doctor, it appears. After all, they say, the drug candesartan was discovered in 2003 to increase the risk of heart attack by 36%, and nobody bothered mentioning that to the patient. In another trial, the same drug increased the risk of fatal heart attack by 10% among the elderly, but doctors described that risk as 'non-significant'.
In an editorial in the British Medical Journal, Subodh Verma, a scientist at Toronto General Hospital, asks: "Has the time come for clinicians, scientists, pharmacologists and ethicists to review the unexpected effects of angiotensin receptor blockers on myocardial infarction (heart attack) and determine whether this should be part of the discussions between doctors and patients when starting treatment?"
Ethics tells us that the answer has to be a resounding 'yes' - but perhaps the deaths of patients has become non-significant.


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