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!
