September

Reminding all the guys out there that it's Prostate Cancer Awareness month. So be sure to get checked. And here's some special guests to say more.

Wednesday afternoon

I'm in line at the bank, and hear this conversation in front of me:



Teller: "Ma'am, I'm sorry, but we can't give you a cash withdrawal without any identification."

Ms. Deceit: "How about I just get the money today? I can come back tomorrow with ID."

Teller: "No, we need a form of identification before giving you the money."

Ms. Deceit: "Like I said, I left my purse at work, or I wouldn't be here in the first place."

Teller: "Well, you can certainly get it and return later."

Ms. Deceit: "Don't be silly. For that kind of trouble I might as well go to different bank. How about if I give you my cell phone number? You can call it right now, and I'll put my phone on the counter. When it rings that will prove it's me."

Teller: "We can't accept that. What we need is a photo ID and..."

Ms. Deceit: "A photo ID is easy. Don't you have a computer back there? I'll show you my Facebook page, so then you can see my picture and know I'm telling the truth."

Teller: "Ma'am, Facebook isn't an acceptable form of identification, and we'd also need to see..."

Ms. Deceit: "This is why I prefer online banking. Places with people in them, like this, just aren't customer-friendly."

(she leaves)

Phone calls

I'm with a patient. Mary interrupts me to say there's another doctor on hold, who needs to talk to me.


Dr. Grumpy: "This is Dr. Grumpy."

Dr. Call: "Hi, we have a mutual patient, Mrs. Memory."

Dr. Grumpy: "Hang on, let me pull up her chart... Okay. It looks like I haven't seen her since 2014."

Dr. Call: "Okay, you need to pull her driver's license. I don't think she's safe to drive."

Dr. Grumpy: "I really can't do that after 4 years without seeing her. Why don't you have her family call Mary to bring her in? I can see her tomorrow morning at..."

Dr. Call: "That's ridiculous. She needs to have her license cancelled today. Immediately."

Dr. Grumpy: "Why don't you call the state DMV? You can do it, too."

Dr. Call: "I'm very busy! I don't have time to do things like that! This is your problem!"

Dr. Grumpy: "I..."

Dr. Call: "Okay, since you don't seem to be able to, I'll take care of it. What is the DMV phone number?"

Dr. Grumpy: "I don't know it off the top of my head, but you can..."

Dr. Call: "I'll just have my staff do it. You're not very helpful."

She hung up.

"Stand back!"

Seen in a bladder-flow report:

All I need is a miracle

Aimovig is the first FDA-approved drug specifically developed to prevent migraines.

It’s getting a lot of press. Some articles talk about it as a breakthrough, some on how it shows the pharmaceutical industry is now focusing on migraine as a real disease, some on how it represents a new era in diseases that affect predominantly women, and many other spins.

Of course, it isn’t alone. There are 2-3 similar agents on the launch pads to join it in the next year.

From my daily office view, the phone calls (and drug reps) come in, and inevitably I hear it referred to as “the miracle drug.”

“I want to try the miracle drug.”

“I saw an ad for that miracle drug.”

“Someone at work told me about this miracle drug.”

Amgen, to their credit (not that the FDA would allow it, anyway), has NOT claimed it’s a miracle drug. The information they provide doctors is the usual glossy graphics surrounding dry statistics and obligatory legal wording. (Note - neither Amgen, nor their competitors, or anyone else, has paid me to write this post. These are my own thoughts).

People seem to need to think a drug is a miracle, in spite of all evidence to the contrary. This isn’t a slight against Aimovig - it’s human nature. Just as people thought of the Titanic as unsinkable (a claim never in reality made by her builders, owners, or officers) there’s a desire to believe human intelligence has somehow overcome a problem and cured it.

It’s not like Aimovig is the first drug to get that label, either. Botox is a miracle drug. So was Imitrex in 1992. Interleukin-2 in the 1980’s. Penicillin in the 1940’s. Willow bark in 500 B.C. (that's where Aspirin came from, people). And too many others to list.

Are these bad drugs? Far from it. But, like every other drug ever discovered, they have a lot of limitations. They work for some conditions, but not others. They ALL have side effects (if someone tries to tell you a drug or supplement doesn’t have any side effects, they’re lying). And, most importantly, humans are not a biologically identical group. No medication will work for everyone. If you read the stats on any med you’ll see that approval is based on a percentage of people who respond to it - and it’s never 100%.

There is absolutely no way to predict with 100% certainty who will - or won’t - respond to any given drug. For that matter, there’s no way to know who will - or -won’t - have side effects, or even which ones.

This is a trial-and-error crapshoot, people. We make decisions based on facts, but an educated guess is still just that - a guess.

There is no such thing as a “miracle drug. " And there never will be.

You won’t hear me, or hopefully any other reputable physician, ever tell you that a drug or surgery or whatever is guaranteed to cure you, or has no chance of harming you. Medicine is about as imperfect a science as there is.

If someone is making such a claim to you, run away. They just want your money, and don’t care about helping you.

I’m not knocking Aimovig. For some people it will be life changing. For others it won’t do a damn thing. Still others will have an unpleasant side-effect. The jury on it and its cousins is still out, and will be for at least 2-3 more years.

But don’t go into any treatment plan, for anything, thinking it’s going to be a miracle. There’s nothing wrong with being hopeful, but you can still do that and keep reality in mind. Because in this field, there are no guarantees.