Tom Frieden is a physician and director of the U.S. Centers for Disease Control and Prevention.
In the Los Angeles Times (6/18), CDC director Tom Frieden writes that “annual spending on healthcare in America totals nearly $9,000 per person,” but “on some of the most basic medical interventions, we’re failing.” He explains that undertreatment is an “even bigger” problem than overtreatment, as “some highly effective medicines for potentially deadly conditions aren’t being used nearly often enough.” Frieden cites treatments for high blood pressure, smoking, and high cholesterol, arguing that while “there are still many health problems we can’t treat effectively,” it is “tragic that we are not adequately addressing the ones we can.”
BLOGFINGER MEDICAL COMMENTARY by Paul Goldfinger, MD, FACC
Doctors are sometimes criticized for over-prescribing medications. My mother used to call them “pill pushers.” Sometimes doctors will give treatment when there is no evidence that such therapy actually works. An example would be giving a penicillin shot for a cold.
Another example is when someone is bitten by a tick, so they might insist that their doctor give an antibiotic right after the bite, but that is not standard care.* Physicians will sometimes do what patients request even if they know that the treatment won’t help.
But in this report, Dr. Tom Frieden of the CDC (Centers for Disease Control—a Federal agency) discusses the problem of under-therapy when a physician should give medication but does not.
When the statin drugs came out in the late 1980’s, there was great hope that the mortality of coronary heart disease could be reduced by using these cholesterol lowering medications. But we could ‘t be sure until a number of large scale clinical trials proved the benefit. Later, the American Heart Association and other professional organizations came up with guidelines for treatment with statins, giving physicians lab targets to achieve in the interest of saving lives.
But subsequently it became apparent that doctors were either not using the drugs when they should, or the dosing was inadequate resulting in failure to achieve target blood test results. What was even more startling was that cardiologists themselves were often failing to achieve target blood levels in their patients.
According to Dr. Frieden, the problem persists and includes treatment with aspirin for heart patients and effective lowering of blood pressure in those with hypertension, a condition that can cause heart failure and stroke. This is why practice guidelines make sense, but they must be written and judged by physicians and not bureaucrats. And it is why patients must pay attention to the treatments which are available that could reduce their own morbidity and mortality rates. Then they must queston their doctors about the possibiliy of under-therapy.
Here is a link to one of our recent articles on the treatment of high blood pressure, December 2013. http://blogfinger.net/2013/12/30/confessions-of-a-high-blood-pressure-doctor-part-iii-new-treatment-guidelines-from-the-jnc8/
You should read the brief report from the LA Times linked above for more information.
“target lesion” of Lyme disease.
*P.S.——- I may not be able to use the tick bite example for long, because a new trial is to be published in the New England Journal of Medicine in July, 2014, from Westchester County showed a preventive benefit of 2 capsules (or tablets) of doxycycline in reducing the subsequent risk of Lyme disease if taken within 72 hours of being bit by a deer tick, but the official recommendations currently say no antibiotics after a tick bite. Here is a link about that issue (below) —-PG
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