GLP-1 drugs: If you don’t prescribe them, are you a bad doctor?
Drugs like Wegovy and Zepbound are the rage. More are coming! Get ready for FDA indications of coronary artery risk reduction, dementia and stroke reduction and just less death in general. Indeed, it is remarkable to watch people drop weight and suddenly get their sugars under control.
As long as you avoid asking them about their GI tract and drug shortages, everything is wonderful. They have more energy because they are… well… lighter.
The super high copays are negated by drug company discount cards. Heaven help you when the six to twelve months are up.
The drugs are considered valid for a patient with a BMI of 30. I discovered something weird. When I look at people and think they are at an okay weight, they are not. These people of apparently okay weight actually all have a BMI well above 30. My eyes have been deceived. If I see someone under a BMI of 30, I start to worry they may have cancer. America!
So, basically every human should be on these drugs. The mainstream press and medical “throw-away” journals have picked up on this as well. The message is simple: “If your doctor doesn’t start you on these drugs, you have a bad doctor.” The message is being amplified by so-called thought leaders in medicine who say terrible things about people like me who say: “Can we go slow and let the rest of the population test out these drugs first. Maybe just for a couple of years?”
No! I am seeing Cardiologists initiate these drugs on my patients, turning over future prescriptions to me. This is not good.
I would love to be able to say, in another three to five years, “I was wrong. These drugs truly are miraculous.”
The problem is I’m old and I remember the drugs which were advocated for every patient that walked into my office. I remember drugs like Rezulin, PremPro, Oxycontin and others. I vividly recall confrontations with Aranesp/Amgen reps because I questioned their off label promotion of the drug for all patients with anemia (Google it). I remember the thought leaders talking down to me like I was a nervous parent afraid to put my child on the school bus.
There is so much money to be made on these GLP-1 drugs. People get killed for far less. Heck! Entire wars cost less!
I rarely prescribed the stimulants for weight loss but required the patients to come back every month to be weighed and BP checks. I printed out an information sheet for patients and of course they couldn’t have hypertension. It was expected they lose a minimum of two pounds a month and after 2 months initiation they had to comeback. No excuses.
Most patients would “eat through” the meds and never came back for weighings or med refills. I had very few that had success to get to ideal body weight but once down there, they kept the weight off for years after! I have to admit those patients were highly motivated. The patients who I sensed were “lackadaisical” I didn’t offer or refused the stimulant diet drugs. They usually left and got another physician.
I had one woman who asked me to maintain her on a lower dose of stimulant meds and I did so for years. It got so I had her come in for q6 month BP checks that were always normal as she was so compliant. She had been morbidly obese and the drugs worked for her and got her to ideal body weight. I have to admit, that is extremely rare and the only time I saw it in my practice. GLP1’s were just coming out when I was getting ready to retire and no way in Hades would an insurance company pay for it for a patient so I didn’t get experience with it. Kurt
More support for doing away with limiting prescribing power to physicians and “team members” who claim to be just as good. We should have la pharmacias, and let the CVS-Walgreens-et al dispense anything to any adult, and f**k ’em. Physicians can return to being paid consultants, and customers can gobble fistfuls of whatever the TV tells them to, and Big Pharma is happy. Win-win.
Ummmmm, until the malpractice suits start coming in for these people. They won’t have a “doc” to sue unless there is a
“supervising” physician in the loop. That poor bastid doc whose stupid enough to get into that environment will get slammed. If the powers that be allow them (N.P’s and P.A.’s) to be independent, they’ll have their arse’s sued off and malpractice insurance might soar so high for them they likely won’t be able to effectively practice. Too bad years will go by and many patients could be hurt by this. I don’t care as I’m retired from geriatrics. I wouldn’t mind seeing an N.P. or P.A. in the clinic I worked at as there is an M.D. behind them for backup. My experience when I practiced was they came to a doc when they had a patient issue they were uncertain with to discuss. That was a good relationship. Heck my N.P. shared exam rooms right next door to me and was very smart. Worked in oncology and pushed the cancer “poisons” for 8 years before she got her master’s. If other N.P.’s, P.A.’s supervising docs were unavailable in the group practice, they’d come up to my area to discuss situations. Was sort of a PITA but I felt honored they approached me with issues. 100% of the time is was stuff I had to put my “thinking cap” on and many of the patients ended up as legitimate direct admissions to the hospital. I can’t slam that. It was a good arrangement. Scheduling was notorious for giving tough cases to support personnel when they need to see docs but the docs schedules were crammed full to a “T”. I will admit most of these people should have gone to the E.R. and been admitted from there.