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Rare genital defects seen in sons of men taking major diabetes drug

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Re: Rare genital defects seen in sons of men taking major diabetes drug

#41
post #2

Metformin is the first resort in diabetes treatment. If it proves to truly increase birth defects by 40% that may have to change. It was my doctor's first resort for me, but the side effects were too severe and I stopped it. He vaguely mentioned that it would help if I lost weight, but made no mention of what actually resolved my diabetes, a low carb diet. I hope that becomes the first resort. Apparently around here…

> Metformin is the first resort in diabetes treatment

First resort for T2 diabetes. T1 diabetics have to go on insulin immediately, there's no other option.

Re: Rare genital defects seen in sons of men taking major diabetes drug

#42

Earlier quoted context omitted.

Prescriptions of diet and exercise are ineffective because many obese / type 2 diabetic people can't exercise self-control. That's why they're obese in the first place. It's way easier to take a pill than cut to 1500 calories a day for 2 years.

It is a harmful stereotype to label obese people as lacking willpower as you have done. Many obese people don’t have the resources (time, money) or tools (nutrition understanding) to improve their situation. Many have metabolic or familial history of obesity which has both physical and psychological (normalization) impact on their ability to control their weight. The former can be helped with diet and/or medication,…

Gp probably could have stopped after:

> Prescriptions of diet and exercise are ineffective

Which seems to be true. If any advice your doctor could give yields no measurable difference, is there really a point to giving it?

Re: Rare genital defects seen in sons of men taking major diabetes drug

#43

Earlier quoted context omitted.

Prescriptions of diet and exercise are ineffective because many obese / type 2 diabetic people can't exercise self-control. That's why they're obese in the first place. It's way easier to take a pill than cut to 1500 calories a day for 2 years.

It is a harmful stereotype to label obese people as lacking willpower as you have done. Many obese people don’t have the resources (time, money) or tools (nutrition understanding) to improve their situation. Many have metabolic or familial history of obesity which has both physical and psychological (normalization) impact on their ability to control their weight. The former can be helped with diet and/or medication,…

People weren't obese ages ago, and I am sure that's not because of better nutritional education.

It's a multifactorial problem.

Re: Rare genital defects seen in sons of men taking major diabetes drug

#44
post #42

Earlier quoted context omitted.

It is a harmful stereotype to label obese people as lacking willpower as you have done. Many obese people don’t have the resources (time, money) or tools (nutrition understanding) to improve their situation. Many have metabolic or familial history of obesity which has both physical and psychological (normalization) impact on their ability to control their weight. The former can be helped with diet and/or medication,…

Gp probably could have stopped after: > Prescriptions of diet and exercise are ineffective Which seems to be true. If any advice your doctor could give yields no measurable difference, is there really a point to giving it?

Agree, mostly. Primary care doctors in the US are often limited to 15-30 minutes per patient for routine matters. Referrals to nutritionists / dieticians and other expensive options often lack follow through, or aren’t offered in the first place because prescribing is so much easier. Medical professionals have a duty to arm patients with the information needed to make good choices about their health, but often shirk that duty due to inconvenience or these kinds of time limits. In a perfect world, access to medical professionals would be less scarce and at least the tools (nutrition info) would not be an issue. The medical system really isn’t designed for obese people on multiple levels in the US, and it isn’t designed for good long-term outcomes…yet.

Re: Rare genital defects seen in sons of men taking major diabetes drug

#45
post #43

Earlier quoted context omitted.

It is a harmful stereotype to label obese people as lacking willpower as you have done. Many obese people don’t have the resources (time, money) or tools (nutrition understanding) to improve their situation. Many have metabolic or familial history of obesity which has both physical and psychological (normalization) impact on their ability to control their weight. The former can be helped with diet and/or medication,…

People weren't obese ages ago, and I am sure that's not because of better nutritional education. It's a multifactorial problem.

People didn’t have McDonalds and cars ages ago. Barn-raising, (manual) farming, and hunting are hard energy-intensive work. Our calorie output required to survive dropped while the calorie inputs available cheaply dramatically increased. That is all part of “overcome metabolic efficiency.” :-)

Re: Rare genital defects seen in sons of men taking major diabetes drug

#46

> "...because tens of millions of people worldwide take metformin, chiefly for type 2 diabetes." In nearly all cases, T2 is preventable. That is, unlike T1, there are things an individual can do to not reach T2.

On a micro level, most cases of T2 are preventable. On the macro level, many aren't: food deserts have higher rates of diabetes and heart disease, and the people who live in those areas are frequently "stuck" there for socioeconomic and racial reasons. There are also subgroup susceptibilities in play: Asians and people with Hispanic backgrounds are disproportionately represented among American T2 diabetics[1]. Recent…

Thank you for the references.

Re: Rare genital defects seen in sons of men taking major diabetes drug

#47
post #2

Metformin is the first resort in diabetes treatment. If it proves to truly increase birth defects by 40% that may have to change. It was my doctor's first resort for me, but the side effects were too severe and I stopped it. He vaguely mentioned that it would help if I lost weight, but made no mention of what actually resolved my diabetes, a low carb diet. I hope that becomes the first resort. Apparently around here…

> made no mention of what actually resolved my diabetes, a low carb diet. I hope that becomes the first resort

Doctors know that if they compared "taking Metformin" to "eating a low-carb diet," the low-carb diet would win hands down. But that's not the comparison that's relevant for them, because it's not a choice they get to make. They have to choose between "advising someone to take Metformin" and "advising someone to eat a low-carb diet." The results of the latter are negligible on average.

Re: Rare genital defects seen in sons of men taking major diabetes drug

#48
post #27

Earlier quoted context omitted.

It is also beginning to be prescribed by many of the subscription medication/doctor businesses that are springing up, powered by VC cash and looking to build strong forward flowing subscription businesses. Their model is: - find areas that aren’t medically serious (speaking relatively, and in relation to life threatening - erectile dysfunction and male pattern baldness) - run people through online questionnaires - ge…

Do you see this as a bad thing? As someone who doesn't have any insurance, I'm extremely grateful for these. I don't want to have to go through the current medical racket where unless you pay a doc $300 you won't be allowed to purchase the medication you want. And then of course there's the follow up appointments, a "med check" where they can bill you $150 every 90 to 180 days just to hear you say, "yep, things are f…

In responding to your example first - to start with, I live and practice in a country where it isn't a choice between healthcare and food on the table. Beyond that, I believe that it is a basic human right to have free healthcare. The next bit is a bit more complex. I don't think it is right or sensible to advertise medications to people directly. The US is almost alone amongst industrialised/western countries in having prescription medications being directly advertised to consumers. From my time in the US as a medical student, I saw directly how that changed the patient-doctor relationship, and I don't believe in a positive way. So - I don't think it's right that there's a medical racket that fleeces you to see a doctor, but I don't think it's right that you decide your prescription anyway. On the other hand, it should (speaking of an idealised utopian world) be easy to get refills of medications that have been appropriately prescribed.

So here is where it gets interesting with the VC-backed Subscription healthcare model. I did a touch of consulting for one starting in Australia (well, it would probably be a stretch to call it consulting but I sat down with the founders as they were running through their spin-up process).

My concerns are that you can't just prescribe anything to anyone, and for the vast majority of prescription medications there are often side-effects that need to be monitored (some of which can be serious), as well as inappropriate prescribing. The 2 examples the company I was talking to were Finasteride as well as Viagra. Seperating these two out, my concerns with Erectile Dysfunction are that it could be inappropriately funnelling everyone into prescription treatment, when there is in a reasonable percentage of cases other psychological issues that are impinging on erectile function, and whilst it might be all well and good to get viagra to get to the end result, it is also missing the broader holistic picture of aiming to achieve better health.

For finasteride, there are a reasonable percentage of people who experience quite unwanted side-effects, from gynaecomastia to erectile dysfunction. Since the target audience is young men, these effects are often more psychologically concerning than the cosmetic issue they were trying to solve with a serious prescription medication and I was concerned about follow-up, referral and support in these instances.

I was able to be reassured by them that they had adequate safeguards in place and good clinical governance oversight to achieve good all round care and then we split ways. I have no idea if they have or are maintaining those protections; additionally I have recently heard they have been pulled infront of the regulators here in Australia for cutting a few corners so my suspicion is that the money and growth hacking has gotten the better of their product development.

Ultimately it is going to be an interesting bounce between both the regulation and the inevitable clinical disasters that will pop up. There's no doubt there is room for innovation in the space, and I feel that there is certainly a way to do it safely - ensure that, for certain conditions, you can answer a few questions, get your medication, and still have safe follow-up, and do this in a innovative way that reduces overall demands on a healthcare professional for a full sit-down (ie wrap up a bunch of the bullshit in algorithms and decision trees and take care of a lot of the back room stuff).

But after 9 years as a doctor and a health-tech founder, I am also convinced that there are a number of elements of health that just do not scale, at least not with anything like the technology we currently have (ie well developed expert systems - I am also fairly fundamentally convinced that the use of AI for diagnosis and the black-box internals is going to cause issues due to uncertainty over where the fuzzy edge lies)

So - TLDR: do I see VC driven subscription prescription as a bad thing? No, but also potentially yes

Re: Rare genital defects seen in sons of men taking major diabetes drug

#49
post #43

Earlier quoted context omitted.

People weren't obese ages ago, and I am sure that's not because of better nutritional education. It's a multifactorial problem.

People didn’t have McDonalds and cars ages ago. Barn-raising, (manual) farming, and hunting are hard energy-intensive work. Our calorie output required to survive dropped while the calorie inputs available cheaply dramatically increased. That is all part of “overcome metabolic efficiency.” :-)

The obesity epidemic is a lot more recent than barn-raising days. Even in the 90s people were considerably skinnier.

Re: Rare genital defects seen in sons of men taking major diabetes drug

#50
post #43

Earlier quoted context omitted.

People weren't obese ages ago, and I am sure that's not because of better nutritional education. It's a multifactorial problem.

People didn’t have McDonalds and cars ages ago. Barn-raising, (manual) farming, and hunting are hard energy-intensive work. Our calorie output required to survive dropped while the calorie inputs available cheaply dramatically increased. That is all part of “overcome metabolic efficiency.” :-)

> People didn’t have McDonalds and cars ages ago. Barn-raising, (manual) farming, and hunting are hard energy-intensive work. Our calorie output required to survive dropped

Not saying I know any better, but at it's face I don't buy this. The change in day-to-day activity doesn't feel like it would account for the difference from just the 80s to now.

> while the calorie inputs available cheaply dramatically increased.

This I buy much more, confounded with maybe the specifics of the nutrients available.

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