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Old 08-03-2012, 03:20 AM
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alice md alice md is offline
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alice md alice md is offline
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Join Date: Sep 2009
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I thought that the whole point was to suppress the immune system. Autoimmune disorders are the result of an overly ambitious immune system.
Not exactly, it is the result of dysregulation of the immune system.
Patients with untreated HIV have autoimmune diseases and a very suppressed immune system at the same time.

The aim of treatment is immunomodulation not immunosupression.
Better and more targeted treatments are being developed for many autoimmune diseases, leading to more effective and less toxic treatment approaches.

Nutritional supplements are also being used, but unfortunately only in small and few studies, because it is very hard to fund such studies.
This is a true problem, for which no solutions have yet been found. If you want to test the effect (and side-effects) of a certain agent you have to give it to numerous patients, fully document every minor change in their condition and then have a relatively independent regulatory authority supervise this process. Doing this costs enormous amounts of money. For a medication it will pay back once it is approved and on the market, but you can't do that with a nutritional substance as no one is going to pay 10 times more for something he/she can freely buy in the market.

Also, when you are testing a new medication, you can know for sure that your patients are not getting it from a different source as well. When testing nutritional supplements, your patients may differ in their usual exposure to this substance in their normal diet.

Even small and innovative drug companies, find it hard to fund this process and usually sell their products (that passed successfully the pre-clinical and early clinical phases to larger drug companies).

The incentive to find new treatments for rare diseases (for which there is going to be a relatively small market, even if the medication is approved) is very limited.

I do believe that because of the extremely high expanses of the regulatory process there is a large incentive to "push" approval of medications.
So, it is possible that some less safe agents will fall between the cracks.
That is why I am personally more cautious with "better" agents that replace older drugs. (see the example of vioxx).

Also, drug companies have an incentive to find new indications for their medications, as it makes the patent longer.

I am very suspicious of pharmaceutical company funded studies in which there is a significant gap between what is written in the results section and the discussion.
The results have to be accurate and always are, but in the discussion section you can write what ever you want. Many physicians will read the abstract and at the most the discussion. Most will not bother to look at the small details of the results. No one can blame the authors of the paper for trying to find reasons for why their original hypothesis was correct (even if the results do not seem to support it). You can only blame those who don't read the full paper thoroughly as they should.

For instance: The results of two studies on cellcept in MG clearly showed no difference from placebo. The discussion section explained why it is effective and why the study failed to show this (this may or may not be true, but it requires that they do a new study to prove those points). The results section showed that one patient in the study group died of infection and none died in the placebo group. As this was only one patient it could have been a coincidence.
But, I personally was not going to take a medication with a significant side-effect profile, that did not show any effect over placebo in two (relatively large) studies.

The problem is not with modern medicine, but with the way it is practiced by some physicians.
Many physicians properly read the medical literature, have a good and deep understanding of their field of practice. Such physicians will honestly discuss with their patients, what is known, what is controversial and what is yet unknown. Such physicians will be ready to respect other opinions (including those of their patients) and will always be ready to learn.

There are other physicians who trust what is written in pamphlets given to them by drug reps. know better than their patients what is good for them (even if it is based on flawed clinical trials), treat their patients according to convenient guidelines and protocols (without thinking if those do or do not fit their individual patient).

As a physician, I try as much as possible to belong to the first group. As a patient I try as much as possible to find physicians like that to take care of me. And every time I was tempted to ignore my instincts and follow the advice of someone who belonged to the second group, I paid a significant price.

I can easily understand how someone with no medical knowledge, experience or understanding can reach wrong and sad conclusions regarding modern medicine in general and the entire health care system after encountering such physicians.

I can easily understand how he/she would be ready to believe any quack who treats him with human understanding and compassion.
I can also understand how he/she will develop a very black and white picture of the medical profession.
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