Should Doctors Consider Body Size When Prescribing Drugs ?

Does a one-size-fits-all strategy works fine for many medications ?

“Children are the special case in which weight-based dosing is always required.

For adults, shouldn’t doctors take into account body size when prescribing drugs?

As a small female, I worry about getting the same dosage of antibiotics as men who weigh 100 pounds more than I do.”

Read the debate on ASK WELL, nytimes, 2018/06/08.

When clinical guidelines do harm

From Guideline to Order Set to Patient Harm


Clinical guidelines and standardized order sets are as integral to the practice of medicine in the digital age as the stethoscope and the chest x-ray. Rigorously developed guidelines and order sets aim to bring the most current, evidence-based medicine to the bedside and decrease unwanted variability in health care delivery. The JAMA Performance Improvement article in this issue of JAMA by Gupta and colleagues, however, illustrates the potential risks inherent in the incorporation of these tools into practice.1 In this case, a 58-year-old man with acute ST-segment elevation myocardial infarction (STEMI) was successfully treated with percutaneous coronary intervention (PCI) involving the right coronary artery but had bradycardia and complete heart block following the procedure. The patient was admitted to the coronary care unit, and the admitting physician placed orders via the electronic medical record using the “STEMI admission order set.” Within an hour of admission, the patient received medications, including atorvastatin and carvedilol, based on the order set. Over the next few hours, he developed dyspnea, bradycardia, and hypotension. This case demonstrates how a flawed guideline, incorporated into an inadequately updated order set, can undermine a physician’s intention and lead to patient harm.


Alex CanRant Unbelievable Story of DES

“I want to show you some of the stuff I’ve learned about what’s happening right now” says Alex

In this video published 15 Sep 2017, Alex unfortunately is mixing the use of DES for poultry, cattle, women, together with its side effects for up to three generations of people.
So, his dates are confusing and Alex’s very short summary of DES is quite one of his own.

Nevertheless Alex raises some very important questions here, and tells us not to take every medical/healthcare information for granted but to keep an open mind. So, we thank Alex for his time and effort in sharing awareness.

Check the links below to learn more.

More DES DiEthylStilbestrol Resources

Industry gifts to doctors linked to their branded and costly prescriptions, and should be banned

Influence of pharmaceutical marketing on Medicare prescriptions in the District of Columbia

Health care professionals who received gifts from the pharmaceutical industry not only wrote more prescriptions, but also more costly ones (including more brand name medications), than colleagues who did not receive such gifts.

2017 Study Abstract

Gifts from pharmaceutical companies are believed to influence prescribing behavior, but few studies have addressed the association between industry gifts to physicians and drug costs, prescription volume, or preference for generic drugs. Even less research addresses the effect of gifts on the prescribing behavior of nurse practitioners (NPs), physician assistants (PAs), and podiatrists.

To analyze the association between gifts provided by pharmaceutical companies to individual prescribers in Washington DC and the number of prescriptions, cost of prescriptions, and proportion of branded prescriptions for each prescriber.

Gifts data from the District of Columbia’s (DC) AccessRx program and the federal Center for Medicare and Medicaid Services (CMS) Open Payments program were analyzed with claims data from the CMS 2013 Medicare Provider Utilization and Payment Data.

Washington DC, 2013

Physicians, nurse practitioners, physician assistants, podiatrists, and other licensed Medicare Part D prescribers who participated in Medicare Part D (a Federal prescription drug program that covers patients over age 65 or who are disabled).

Gifts to healthcare prescribers (including cash, meals, and ownership interests) from pharmaceutical companies.

Main outcomes and measures
Average number of Medicare Part D claims per prescriber, number of claims per patient, cost per claim, and proportion of branded claims.

In 2013, 1,122 (39.1%) of 2,873 Medicare Part D prescribers received gifts from pharmaceutical companies totaling $3.9 million in 2013. Compared to non-gift recipients, gift recipients prescribed 2.3 more claims per patient, prescribed medications costing $50 more per claim, and prescribed 7.8% more branded drugs. In six specialties (General Internal Medicine, Family Medicine, Obstetrics/Gynecology, Urology, Ophthalmology, and Dermatology), gifts were associated with a significantly increased average cost of claims. For Internal Medicine, Family Medicine, and Ophthalmology, gifts were associated with more branded claims. Gift acceptance was associated with increased average cost per claim for PAs and NPs. Gift acceptance was also associated with higher proportion of branded claims for PAs but not NPs. Physicians who received small gifts (less than $500 annually) had more expensive claims ($114 vs. $85) and more branded claims (30.3% vs. 25.7%) than physicians who received no gifts. Those receiving large gifts (greater than $500 annually) had the highest average costs per claim ($189) and branded claims (39.9%) than other groups. All differences were statistically significant (p<0.05).

Conclusions and relevance
Gifts from pharmaceutical companies are associated with more prescriptions per patient, more costly prescriptions, and a higher proportion of branded prescriptions with variation across specialties. Gifts of any size had an effect and larger gifts elicited a larger impact on prescribing behaviors. Our study confirms and expands on previous work showing that industry gifts are associated with more expensive prescriptions and more branded prescriptions. Industry gifts influence prescribing behavior, may have adverse public health implications, and should be banned.

More Information

Risks awareness ref adverse outcomes of radical prostatectomy, radiotherapy and active surveillance

The accuracy of patients’ perceptions of the risks associated with localized prostate cancer treatments

2017 Study Abstract

To assess localized prostate cancer (PC) patients’ understanding of the differences in outcomes and risks of radical prostatectomy (RP), radiotherapy (RT), and active surveillance (AS), and to identify correlates of misperceptions.

Patients And Methods
We used baseline data (questionnaires completed after treatment information was provided but prior to treatment) of 426 newly diagnosed localized PC patients who participated (87% response rate) in a prospective, longitudinal, multicenter study. Patients’ pretreatment perceptions of differences in adverse outcomes of treatments were compared to those based on the literature. We used univariate and multivariate linear regression to identify correlates of misperceptions.

Approximately two-third (68%, n=211) of the patients did not understand that the risk of disease recurrence is comparable between RP and RT. More than half of the patients did not comprehend that RP patients are at greater risk for incontinence (65%, n=202) and erectile dysfunction (61%, n=190), and less at risk for bowel problems (53%, n=211) compared to RT patients. Many patients overestimated the risk of requiring definitive treatment following AS (45%, n=157), and did not understand that mortality rates following AS, RP, and RT are comparable (80%, n=333). Consulting a radiotherapist or a clinical nurse specialist was positively associated with, and emotional distress was negatively associated with better understanding of the risks (p<0.05), although effect sizes were small.

Prior to choosing treatment, the majority of PC patients poorly understood the differences in treatment risks. Greater efforts should be made to better understand why these misperceptions occur and, most importantly, how they can be corrected.

  • The accuracy of patients’ perceptions of the risks associated with localized prostate cancer treatments, Wiley Online Library, 28 September 2017.
  • Risk perception, slideshare, May 12, 2015.

Reporting side effects of medicines

EU Medicines Agency‏ survey on safety of medications and reporting of adverse drug reactions

This EU Medicines Agency survey, will take approximately 5 to 10 minutes of your time to complete. It will help understand the awareness of patients/consumers and healthcare professionals regarding the need and the way they can report adverse drug reactions (side effects). The results will be analysed by the European Medicines Agency and a report containing summary information will be provided to the European Commission (DG SANTE) and will be further disseminated publicly.

EMA launches survey to assess whether patients and doctors are aware of the arrangements for reporting of side effects – European Medicines Agency, the European Union agency responsible for the evaluation and supervision of medicinesEMA_News/status/905720311445893120, 7 sept. 2017.

Overtreatment is harmful, wasteful and common

Overtreatment Is Common, Doctors Say

Researchers surveyed 2,106 physicians in various specialties, from the American Medical Association (AMA) masterfile, regarding their beliefs about unnecessary medical care. On average, the doctors believed that 20.6 % of all medical care was unnecessary, including 22.0 % of prescription medications, 24.9 % of tests and 11.1 % of procedures.

2017 Study Abstract

Overtreatment is a cause of preventable harm and waste in health care. Little is known about clinician perspectives on the problem. In this study, physicians were surveyed on the prevalence, causes, and implications of overtreatment.

2,106 physicians from an online community composed of doctors from the American Medical Association (AMA) masterfile participated in a survey. The survey inquired about the extent of overutilization, as well as causes, solutions, and implications for health care. Main outcome measures included: percentage of unnecessary medical care, most commonly cited reasons of overtreatment, potential solutions, and responses regarding association of profit and overtreatment.

The response rate was 70.1%. Physicians reported that an interpolated median of 20.6% of overall medical care was unnecessary, including 22.0% of prescription medications, 24.9% of tests, and 11.1% of procedures. The most common cited reasons for overtreatment were fear of malpractice (84.7%), patient pressure/request (59.0%), and difficulty accessing medical records (38.2%). Potential solutions identified were training residents on appropriateness criteria (55.2%), easy access to outside health records (52.0%), and more practice guidelines (51.5%). Most respondents (70.8%) believed that physicians are more likely to perform unnecessary procedures when they profit from them. Most respondents believed that de-emphasizing fee-for-service physician compensation would reduce health care utilization and costs.

From the physician perspective, overtreatment is common. Efforts to address the problem should consider the causes and solutions offered by physicians.

More Information

Is advising people to take more exercise ineffective ?

Randomized controlled trial, 2002


Over the last 10 years ‘exercise referral schemes‘ have been popular even though the evidence for effectiveness of any one-to-one intervention in primary care is deficient. We report the results of a primary care based one-to-one intervention that compared the effect of two communication styles with a no-intervention control group on self-reported physical activity at 12 months.

In all, 1658 middle-aged men and women were randomly assigned to 30 minutes of brief negotiation or direct advice in primary care or a no-intervention control group. The main outcome was self-reported physical activity at 12 months. Secondary outcome measures included change in blood pressure and body mass index.

Intention-to-treat analysis revealed no significant differences in physical activity between groups. Brief negotiation group participants who completed the study increased their physical activity significantly more than controls. There was no change in body mass index in any group. The brief negotiation group produced a greater reduction in diastolic blood pressure than direct advice.

If patients whose health may benefit from increased physical activity seek advice in primary care, 20-30 minutes of brief negotiation to increase physical activity is probably more effective than similar attempts to persuade or coerce. However, blanket physical activity promotion in primary care is not effective. The most effective way of increasing physical activity in primary care has yet to be determined.

  • Advising people to take more exercise is ineffective: a randomized controlled trial of physical activity promotion in primary care, International Journal Epidemiololy, NCBI pubmed/12177026, 31 Aug 2002.
  • Featured image credit thechurchofalmightygod.

Should doctors prescribe physical activity ?

An Intervention to Increase Exercise Habits and Healthy Eating

About a quarter of men and a third of women in the United Kingdom describe themselves as physically inactive. The UK medical royal colleges and others have called for healthcare professionals to help tackle the problem, urging primary care professionals to lead the fight and to “question patients about their physical activity and exercise habits at every meeting.”

2017 Study Abstract

A healthy lifestyle is associated with improved quality of life among cancer survivors, yet adherence to health behavior recommendations is low.

This pilot trial developed and tested the feasibility of a tailored eHealth program to increase fruit and vegetable consumption and physical activity among older, long-term cancer survivors.

American Cancer Society (ACS) guidelines for cancer survivors were translated into an interactive, tailored health behavior program on the basis of Social Cognitive Theory. Patients (N=86) with a history of breast (n=83) or prostate cancer (n=3) and less than 5 years from active treatment were randomized 1:1 to receive either provider advice, brief counseling, and the eHealth program (intervention) or advice and counseling alone (control). Primary outcomes were self-reported fruit and vegetable intake and physical activity.

About half (52.7%, 86/163) of the eligible patients consented to participate. The most common refusal reasons were lack of perceived time for the study (32/163) and lack of interest in changing health behaviors (29/163). Furthermore, 72% (23/32) of the intervention group reported using the program and most would recommend it to others (56%, 14/25). Qualitative results indicated that the intervention was highly acceptable for survivors. For behavioral outcomes, the intervention group reported increased fruit and vegetable consumption. Self-reported physical activity declined in both groups.

The brief intervention showed promising results for increasing fruit and vegetable intake. Results and participant feedback suggest that providing the intervention in a mobile format with greater frequency of contact and more indepth information would strengthen treatment effects.

Why Some Prescription Drugs are More Dangerous than Illegal Drugs

Adam Ruins Everything – November 2016

Adam Conover explains that some doctors prescribe medicine drugs just as addictive and dangerous as street drugs.