It's like those guys in Australia who downed those ulcer germs in pursuit of empirical SCIENCE

[foxfirefey]

Best GYN I ever had, a man, heard me complain about the Provera an earlier one had prescribed me and how I wasn't taking it again, EVER, and said "A lot of my patients complained about it. So I was curious, and I took a month of it to see what everyone was talking about. You're all absolutely right. I have never prescribed it since then. We'll try something else."

rikibeth has a hardcore doctor.

Comments

[lea_hazel]

Awesome.

[hatman]

That's a cool idea in the abstract, but I don't think I'd go to that doctor ever again.

1. Provera is hormone therapy for women. Men have different hormone levels to begin with. There's no way it would work right for him.

2. He wouldn't give it to a woman who didn't need it. You don't give people the wrong medication, especially when it's medication designed to mess with hormone levels. Taking that medication was a dangerous and stupid idea.

3. Any decent doctor should know that different people react differently to the same medication. Side effects will vary in severity and type. Making a decision about whether or not to use a medication for someone based on a single data point (even if it's personal experience) is poor practice. Even more so when that one data point is someone who should never have had the medication in the first place.

(I'm also wondering where he got a month's supply. Did he misuse a sample pack? Or did he actually write what is essentially a fraudulent prescription?)

"A lot of my patients complained about it. Clearly, the side effects are a major problem for a significant percentage of patients. So I stopped prescribing it." That's a good reason. That's good science.

"I took a drug that I should in no way have taken, and - surprise, surprise - it messed up my system. So I'm not giving it to anyone else ever again." That's... downright scary.

ETA: How would it seem if it had been, say, thyroid medication that he didn't need and then refused to prescribe to anyone? Or a certain brand/type of tampon?

[foxfirefey]

I think you're right in a lot of ways. On the other hand, from looking it up apparently Provera does have uses that suggest it might also be used for men in some cases: "Some doctors prescribe Provera to treat endometriosis, menopausal symptoms, premenstrual tension, sexual aggressive behavior in men, and sleep apnea (temporary failure to breathe while sleeping)." So, it is not necessarily too horrible for a man to take it, although there will undoubtedly be side effects from it. (Progesterone is also a component in male birth control options in development.)

I also think there's a different between saying "I've never prescribed it since then" and saying that you refuse to prescribe it for anyone. There are also a wide array of gentler alternatives that can be used in lieu of Provera, and somebody satisfied with them wouldn't need to use Provera.

In the context thread, there are many, many women talking about how their doctors don't listen to them on gynecological matters. I'm pretty sure the people who responded well to that quote weren't so much thinking that it proved Provera was bad, but that it represented a kind of breathtaking solidarity with the issues they have experience, from somebody who didn't have to take that step. I think that probably means a lot to women who are used to not being listened to in the doctor's office. Reliable birth control options are very problematic for many women and carry many undesirable side effects, but it's still their main burden to carry. Male birth control is still in its infancy.

[hatman]

I've certainly had my share of experiences with doctors who didn't listen and didn't understand. Like I said, I appreciate the idea in the abstract.

There also seems to be legitimate reason not to use the medication, or to try other options first.

When you get down to the mundane reality of it, though... It's still horrible medical and scientific practice. The fact that it's sometimes given to men (as an off-label use, if I'm reading correctly between the lines?) doesn't really improve things that much.

[foxfirefey]

It's only a bad medical practice--I don't really know if anything happening there is really in the realm of science? One anecdote does not science make! Unless you're referring to the discovery of Heliobacter pylori.

[hatman]

Bad science is the experiment he did. A single subject. A subject who (not being female and not being in need of hormone therapy) does not fit the parameters of the experiment. And then extrapolating from that to the general population of people who do fit the parameters.

OTOH... Hearing a patient complain about bad reaction to a given medication and responding to that with "Okay, then I won't give it to you. Actually, I've had a lot of patients with that reaction, which is why I haven't given it to anyone in years." is good medical practice. That much of the story, I'm all for.