Avandia: Nissen tells endocrinologists to shove it

Endocrinologists and diabetes specialists view Nissen’s study with skepticism. He lashes back:

“The diabetes specialists have a very big problem with cognitive dissonance,” he says, in that they have to justify why they have been prescribing Avandia. “A cardiologist tells them this drug is dangerous, and no doubt that there is some pushback. But I believe the results we have reported will stand the test of time.”

(via PharmaGossip)

Comments

Rob
By the way, “Ron” Lamberts is actually me, if you hadn’t guessed it. She read my previous Avandia story and wanted to get that perspective.
Rob (aka Ron)
Elliott
“lashes back” and “shove it”? Kevin, I think you need to tone down the rhetoric. The quote above may indicate some pique, some annoyance at the viciousness and personal nature of the attacks (like what YOU have been doing), but describing it as lashes back is over the top. Even if you think that quote is unwarranted, you lignore the more measured statements he makes.
YOU are the problem Kevin.
Rob
It was interesting being interviewed for this, as apparently Nissen had told the reporter that there “were no proven downstream benefits” to the drug. Now, I have to say that glycemic control IS a downstream benefit, and a statement like that is misleading at best. There is a HUGE benefit for a patient to have good glycemic control, and Avandia clearly helps that. It also preserves beta cell function. Nissen was probably thinking more in comparison with other drugs that control blood sugar, or he was focusing purely on cardiovascular benefit (aside from that gotten from good glycemic control).
As I said, the bias seemed clear in the statements I heard.
I don’t think your rhetoric is inappropriate when you consider Nissen said endocrinologists have “cognitive dissonance.” THAT is strong rhetoric and shows he feels he is far clearer thinking than others.
Since he is in such a position of authority, Dr. Nissen should choose his words more carefully. I am sure he could care less how you word your statements in your blog.
Elliott
Rob, I’m surprised that you’re willing to suggest that this is the right way to debate this. First, you have been more measured than Kevin in your criticism and certainly less personal so I would guess you understand the value of that. Secondly, you take issue with Dr. Nissen’s comments about glycemic control at a personal level when over at Orac’s you respectfully disagreed. What gives? Do you not respect Dr. Nissen, is that the bottom line?
Rob
I don’t automatically give him authority that he does not have. He is a cardiologist who has a lot of credibility in his own area, but not necessarily in diabetology. I cringe when I hear statements like “no downstream benefits” and feel he may have tunnel-vision. The only reason I prescribe the drug is for the downstream benefits.
I would not say that I take it at a personal level (at least I try not to). Orac did not attack my thoughts on this, but I do feel that this could very well endanger patients. I don’t like it when patients hear “this drug is dangerous,” when I am trying to control a disease that is far more dangerous than the drug could be. My frustration is not intellectual, it happens when I sit in the exam room with a patient who has sugars in the 400′s (which happened today) because she stopped her “dangerous” medication.
The rhetoric against the FDA, while justified in many ways (as I said on my blog), is not without consequence. I think academics like to have these discussions and it makes them feel important when it happens in public. I think pundits like to bash the FDA. Yet the patients and physicians trying to care for them are left having to answer the difficult question of what to do.
That is the source of my passion on this subject.
By the way, she corrected my name in the article – it now reads “Rob.”
Whew.
Elliott
“May have tunnel vision”? I think now you’re being too generous. He’s a cardiologist who works for the Cleveland Clinic whose claim to fame (and area of expertise) is CVD events with respect to pharmaeuticals. I think he is justifiably angry at the venom directed his way (including taxpayer funded hit jobs by Douglas Arbesfeld of the FDA).
Attack the analysis as weak. Rail at the media and your patients for overplaying it. Be a little annoyed at (what might be) Dr. Nissen’s grandstanding, but to suggest that he is dishonest or on the make to Takeda is crossing a line. That’s why I have much sympathy for Dr. Nissen.
Rob
OK, I’ll buy that. The best angle I can take is the one I know, which is in the exam room. I wish people would understand that there are others left in the wake of their “scientific” debates. I tried to do that in both my blog and in my comments.
Rob

Avandia: Nissen tells endocrinologists to shove it

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