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...in that nurse who actually takes the time to keep track of your needs. And you've already noted your appreciation for the doctor's willingness to take on an uninsured, sporadic-pay patient. Small blessings but worth counting, and you've duly counted them.
That said.
With all respect to the doctor and staff, it's incredibly difficult to practice good medicine today, and the pharmaceutical companies have done a lot to add to those difficulties.
To be fair to the many truly dedicated, altruistic people who WORK FOR big pharmaceutical companies, much effort is genuinely focused on doing the right stuff. It costs vast amounts of money and effort to make even tiny, incremental advances sometimes, and often the money and effort goes only into ruling out something that won't work. Helpful in a negative way, but it doesn't do much for the suffering patients, nor yet for Big Pharma's bottom lines. So it's not too surprising that they devote vastly more resources into finding new chemical therapies for terrible life-threatening scourges like baldness and premature ejaculation than on going down yet another doubtful path to a possible tiny step forward in the fight against chronic, life-threatening conditions that have a complex etiology and a welter of exacerbating factors that include behavioral and environmental origins.
OK. I've been fair to everyone, haven't I? Can I get on with it, now?
By and large, few of the new drugs is that much of an improvement over old drugs, in some cases, very old drugs. The new drug might offer a 5% chance of improved outcomes to some (but not all) patients with specific disease profiles, which may or may not match YOUR profile. Or it might offer an alternative to something that is known to have an annoying side effect on 12% of people who take it. (Of course, while it doesn't cause side effect X, as experienced by 12% of the people who take Oldavil, Newavil might very well cause side effect Y in 8% of the people who take it...)
The pharmacopoeia is getting too vast and complex for most primary physicians to manage effectively, and they grab for any help they can-- usually from (surprise!) Big Pharma, which spends vast wads of money on very helpful and important-sounding resources about all the Great New Drugs available. But they don't spend much on helpful resources comparing the effectiveness, side effects, tolerance, and other factors of Newavil versus Oldavil, because while Newavil might apparently result in improved outcomes for five percent more patients with fewer side effects in twenty percent of the people in the study, they don't always tell you this:
1. The "improved results" might not be all that impressive. That is, Newavil might have enabled five percent more patients to keep lower levels of LDL cholesterol over a two-year period, but the levels might not have been that MUCH lower.
2. The "fewer side effects" might mean something like this: Taking Oldavil, 47 patients out of 1000 experienced difficulty sleeping and night sweats. Whereas, taking Newavil, the only side effect worth noting affected thirty-six patients out of 1000, and it was painful constipation. Well, yee-haw.
3. There is a generic version of Oldavil that is available for $11 for a month's supply. Newavil, being a TERRIFIC IMPROVEMENT, and NEW, NEW, NEW!!! (and with a HUGE R&D nut to make up and a multi-million-dollar marketing campaign to support) costs $236 for a month's supply, and there is no generic.
But doctors don't always have all of this information available on all the drugs available for all the conditions they might be presented with. All they DO have is information that Newavil has a better rate of improved outcomes, and lower incidence of side effects than Oldavil, and so if a patient hasn't been responding as well as the doctor would like to Oldavil, why not try Newavil and see if that works. And here's a buttload of FREE samples, to help!
Sigh.
They try, they really do.
Most doctors, I mean.
But you're doing exactly the right thing, Shadow. Take it into your own hands. Research stuff. Use the Web. Assemble information, formulate a couple of key questions, and THEN get back to your doctor.
Especially for chronic vascular disease and the constellation of related problems that contribute to cardiac illnesses, good outcomes depend far less on medical professionals and far more on the patient being willing to educate themself, seek out and compare information, ask questions and make decisions and take charge of their own course of treatment (and take the responsibility, too-- don't hold the doc responsible if you make a fully informed choice that doesn't turn out well) and most of all, make the behavioral and lifestyle changes that contribute as much to success as many medicines.
Generally, when a new drug really IS a "miracle drug," we know it within a fairly short time, maybe five years or so. If a drug has been around three or four years already and it hasn't been on the cover of TIME or Newsweek and a bunch of medical journals and the pharmaceutical company hasn't split its stock three or four times, etc., it's not gonna solve all your problems. A very great many "new" drugs are, in fact, reformulations of existing medications with changes so tiny that the difference in effect for the patient is negligible. But it's enough to patent, and thus to continue making a big profit on.
So. Sorry not to be more encouraging. But I don't think we'll ever go back, even with national health, to the days when we could go to a doctor who would have only one or two possible therapies for what ailed us, get one prescribed with great confidence, and then either get better and think the doc was really great, or die and figure it was too much for medical science anyway. Those days are gone forever. We're on our own. Our health is in our hands. Professionals are (should be, anyway) there to help and serve us and get us access to what we need and provide information and give us their technical judgments. But we're the last line.
Hang in there. I like the stuff you write here. Keep it up.
diffidently,
Bright
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