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CUBA IS THE FUTURE FOR LATIN AMERICA AND PERHAPS THE WORLD

CUBA IS THE FUTURE FOR LATIN AMERICA AND PERHAPS THE WORLD On my way out of Cuba, from La Habana, on COPA airlines flight to Panama, I w...

lundi 1 septembre 2014

DOCTORS AS PATIENT ADVOCATES

It was interesting but not unexpected to read that as many as 75% of all patients and 50% of individuals with chronic illnesses fail to adhere to prescribed medical regimens.
Many reasons have been debated about, but the possibly most important cause does not receive much attention: Inadequate Clinical Explanation about the rationale of the medication being prescribed.
If the Physician clings on to not having time as an excuse, he can be sure that he would end up blaming the patient for not taking the medication, and certainly not himself for not having educated the patient, having tried to build up a relationship and clarify the reasons for prescribing, not overemphasizing its benefits while not neglecting its side effects.
Taking a Statin medication has its own context for example.
It is not the same as prescribing it for an isolated LDL elevation as for the prevention of an acute or fatal Myocardial infarction in a patient with Coronary syndrome.
If not fully explained and educated, a patient with no cardiac disease, with an isolated LDL prescribed a statin medication, may get the feeling that he is now covered and is shown to indulge in dietary indiscretions, and increasing his body weight.
In the second episode, a failure in the part of clinician education may result in the death of the patient, if he does not made to realize that Statin may increase his chance of being alive by a substantial amount.
The need to keep abreast of a rapidly changing biomedical world, is not emphasized enough, in an ambience of time, money and payment structures.
How many practising physicians, let alone mid level providers such as Pas, would know the following information and the tremendous impact it has on the populations they SERVE?
CYP3A5 is a protein found in abundance in liver and intestinal cells. It adds an oxygen molecule to various drugs to make them more water-soluble so they can ultimately enter the urine and leave the body. 80 to 90 per cent of the European-Americans have no CYP3A5, because they have inherited two dysfunctional copies of the CYPP3A5 gene. Normally, the absence of CYP3A5 is not noticeable, a very similar protein CYP3A4 acts on most of the same drugs. But for a few drugs, like Maraviroc (HIV) and Vincristine(Cancer), CYP3A5 seems to play a particularly prominent role in helping to remove them from the body. In those cases, the presence or absence of CYP3A5 would likely affect the amount of a drug in the blood stream. Initial studies that lead to the licensing of Maraviroc included mostly European-Americans.  When the drug is used among African-Americans, who are disproportionately represented in the population of HIV sufferers, one fact needs to be understood!
African Americans, close to half of the population have maximum levels of those proteins! Which would mean that certain drugs, in this case life saving drugs, would be cleared faster among African Americans than the European-Americans, with possible dire results.
Individuals who have practised Medicine as Doctors of Medicine, may choose to become Patient Advocates, to provide the best education possible for the patient, to help them manoeuvre through the maze of medical care. Good Luck to them!