FlowVoid @ FlowVoid @midwest.social

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2 yr. ago

The doctor prescribed a different medication for her. And doctors, not patients, ultimately get to decide which drug they prescribe.

I don't think her case is going anywhere. She is suing pro se, which means she couldn't find or doesn't want a lawyer to take her case.

Because the doctor prescribed a different drug.

Don't get your hopes up. She sued pro se, which means she couldn't find or doesn't want a lawyer to take her case. Either way, it is very unlikely she will win.

Doctors are expected to mitigate risks, too. Valproate-induced spina bifida is a real problem, and doctors share a responsibility to prevent it when it won't harm their patients. They share this responsibility because they previously tried making patients entirely responsible for mitigating their risk, and that approach has failed.

Nobody said the woman in the article "has to suffer". They didn't refuse to give her any medicine, they refused to give her a particular medicine. There are plenty of alternatives, and in fact the doctor in this article wrote the woman a prescription for a different medicine. But of course, some people only want what they can't have.

Despite what patients often think, doctors are not drug dispensaries. It's not their job - and never has been - to give patients the latest drug they read about online, or the drug that worked for their friend, or the drug that someone said "ask your doctor" about. If there is a less risky drug that can treat the patient, they will prescribe that instead of what the patient wants.

To take another example, vancomycin is an antibiotic of last resort. Bacteria have not yet developed widespread resistance to it, so it is reserved for patients who have antibiotic-resistant infections, like MRSA. If it is used too much, theoretically bacteria can finally develop resistance to it. And theoretically, people in the future with MRSA may suffer.

Next time you get antibiotics, try telling your doctor "No, I want a vancomycin prescription". You will be disappointed. They are going to give you what they think will get the job done without incurring unnecessary risks, for you or other people.

My guess is that the drug is valproate. It's used for headaches as well as epilepsy, though obviously other drugs can be used instead.

The problem with valproate is that it is causes birth defects in two thirds (!!) of pregnancies, including spina bifida in 10% of pregnancies.

The World Health Organization and the European Medicine Agency have issued statements/regulations against prescribing it to any women of childbearing potential. Plenty of American docs take a similar approach, regardless of religious beliefs. Just to be crystal clear, neither the WHO nor the EMA pay attention to Dobbs, the SCOTUS, or the GOP.

If you go to a doctor and demand a course of antibiotics for a viral infection, they have been trained to refuse. Because antibiotics do not treat viruses.

For that matter, if you actually do have a simple bacterial infection and immediately demand a last-resort antibiotic like vancomycin, doctors have been trained to refuse. Vancomycin may work on you, but using it may create bacterial resistant strains that will put others at risk. Resistance is especially a threat if you don't complete your course of antibiotics.

So doctors will offer you a different antibiotic instead, with less risk of creating a resistant strain. Even if you promise to complete your antibiotics, "you get what you get so don't get upset".

People have agency, but so do doctors. Doctors are not supposed to be dispensaries who simply give patients whatever they ask for. Doctors have the right to refuse to provide a prescription that is not in keeping with the standard of care, and offer a different prescription instead. You have the right to find a different doctor, or not see a doctor at all.

I'm quoting the World Health Organization and a European agency, neither are American health care.

This is a universal approach taken by health care in the US, EU, and across the world. Doctors in general are pragmatists, and only concerned with outcomes. Which means acknowledging that no matter how often patients say "Trust me", they know a certain number will have a bad outcome. The doctor's job is to reduce that number.

It's the same reason why doctors increasingly urge their patients to not keep firearms at home. Even when the patient says they can be trusted with a firearm. It's not a matter of trust, it's a matter of statistics.

Most people who take Viagra have hypertension, because hypertension is the main cause of ED. That doesn't mean Viagra is dangerous, but you shouldn't combine it with certain other drugs.

There is a world of difference between valproate and Viagra. Valproate causes birth defects and cognitive delay in 30-50% of pregnancies, which is astonishingly high. If Viagra caused permanent harm to even 5% of users, it would already be off the market.

Your link literally explains how to sue a doctor for malpractice after signing a liability waiver.

No waiver can claim that patients cannot sue their doctors for gross incompetence.

In most cases, this will involve collecting medical files, seeing copies of the waiver(s) signed by the patient, and proving medical malpractice or negligence by showing that:

The doctor in question deviated from an acceptable standard of care

The injuries came from that deviation

The damages came from those injuries

Which is straightforward in this case. The standard of care is not to give valproate to women of childbearing age except as a last resort, and valproate is known to have a very high risk of birth defects.

No, I don't get that. If a drug might result in birth defects, it should only be used as a last resort. And that's not just me or some random NY docs saying it, it's the WHO and European Medicines Agency

Viagra is pretty safe, as drugs go. Are you thinking of Vioxx? That stuff was taken off the market.

She's not pregnant, but doctors try to avoid long-term prescription of teratogenic drugs to patients who might become pregnant while taking them.

Another poster already mentioned the issue with Depakote, aka valproate:

valproate should be avoided, if possible, in women of childbearing potential because of teratogenicity

See also:

In 2018, the European Medicines Agency introduced new restrictions on the use of valproate in girls and women of childbearing potential to avoid exposure during pregnancy

And yes, valproate is also used to treat cluster headaches, so it could easily be the drug that the woman in the article can't obtain.

I can't believe it's not battery!

Liability waivers don't protect doctors against malpractice claims.

I don't think so. But if a med is not to be used in pregnant patients, then it's only used as a last resort for patients who could become pregnant while taking it.

Again, this is not about religious beliefs, it's standard CYA for health care providers.

In the case of valproate, there are even European regulations against using it in women during childbearing years.

I don't know, because the medication in question hasn't been identified.

But in general, if a medication causes any birth defects (or, more often, miscarriages) in lab animals then it won't be used at the equivalent dose in pregnant patients. It would be unethical to try to find out what it does to a human fetus.

I just noticed this in the article:

Where are we drawing the line here? Are hospitals going to require someone to share a pregnancy test

Nearly all hospitals have long required pregnancy tests for some things, like getting a CT scan (which involves radiation exposure). And if the test is positive, the doctor is supposed to consider alternatives.

That's not how it would play out in a malpractice case.

Lawyer: You recommended my client take a medication that causes birth defects, when you could have recommended a medication that doesn't cause birth defects. Because of that, her child has birth defects.

Doctor: Yes, but she said she didn't want children.

Lawyer: Have you ever heard a woman say she didn't want children, who later went on to have a child?

Doctor: Yes, it happens sometimes.

Lawyer: So birth defects are a foreseeable result of the medication you recommended, even in women who say they don't want children?

Doctor: ...

That's unlikely to make a difference in court. Doctors are responsible for recommending the least risky treatment options. They aren't supposed to leave everything up to the patient.