Re: serious question


Jason Johnson wrote:
I copied this sentence from the Hippocratic Oath:
"...I will keep [my patients] from harm..."

Doctor X prescribes statins to a patient.
During the following year, Doctor X does not conduct
any blood tests or urine tests to screen for signs
of Rhabdomyolysis which can cause kidney failure. It is
known that statins can cause Rhabdomyolysis.
The patient develops Rhabdomyolysis and loses the use
of his kidneys and has joint pain and muscle pain
for the rest of his life.
Please answer the following questions:

Did Doctor X keep his patient from harm?

No he did not.


Did Doctor X violate the Hippocratic Oath?

No he did not.


Do you believe that doctors that prescribe statins
should or should not screen them for signs of
Rhabdomyolysis?

Screening patients does not preclude them from developing side-effects.
You are testing after the fact. The doctor did not prevent anything but
only detected it earlier.
The only way for a doctor to prevent any side effects with any
medication is to not prescribe any medication. Once the medication is
prescribed then risk is assumed. It's a trade off and not against the
Hippocratic Oath. He may test today and find it normal and then the
patient may get it next week. If you test every 6 months how does this
help?
It didn't prevent anything. One would have to test everyday and even
then you did not prevent it from happening.


Before you respond, I suggest that you read this two
page report related to Rhabdomyolysis:

http://www.nlm.nih.gov/medlineplus/ency/article/000473.htm

The vast majority of people with muscle pain taking statins do not
involve rhabdomyolysis.
CK elevations are not specific for rhabdo. Many psychiatric cases
involve elevated CK's. Exercise can cause elevations in CK.
Hypothyroidism can cause elevations in CK. CK isoenzymes adds nothing
to specificity.
There are recommendations on how to deal with elveations of CK in
patients with statins.
Testing every several months does not preclude the patient from having
a severe case of rhabdomyolysis. The cases of rhabdoyolysis mentioned
in relation to statins have been diagnosed at the hospital and not at
the doctors office. The CK testing done routinely are for the more
common muscle problems of a chronic nature. You can have muscle
problems and not have elevations of CK. David mentioned to you that
there are no specific and sensitive tests for statin induced myopathy.

.

Relevant Pages

  • Re: serious question
    ... Doctor X prescribes statins to a patient. ... of Rhabdomyolysis which can cause kidney failure. ...
    (sci.med)
  • Re: serious question
    ... Doctor X prescribes statins to a patient. ... In my experience, doctors often prescribe medication ...
    (sci.med)
  • Re: serious question
    ... Doctor X prescribes statins to a patient. ... In my experience, doctors often prescribe medication ...
    (sci.med)
  • Re: Statins and muscle damage
    ... Rhabdomyolysis as a direct result of taking statins. ... Doctor X prescribes statins to a patient. ...
    (sci.med.cardiology)
  • Re: Statins and muscle damage
    ... Doctor X prescribes statins to a patient. ... of Rhabdomyolysis which can cause kidney failure. ...
    (sci.med.cardiology)
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