"Mr. Graedon," she wrote, "You have no idea what it's like to have hot flashes. It gets so bad that sometimes I just can't stand it. They're so unpleasant and they upset my life so badly that I'm willing to take a risk and use estrogen for a limited period of time. And I don't think you have any right to tell me not to."
And she's absolutely right. She's looked into the available evidence about possible risks and weighed the risks against the benefits and has made the choice that's right for her. She made the right choice because she went to the trouble of really informing herself.
Many doctors act as if choosing a drug is always the doctor's decision.
And they're taught to think that way. It's not easy for doctors, because to support their clients to be self reliant health consumers, they have to unlearn some really deep-seated elitist attitudes. But some doctors are really working at it, they're really trying to share their knowledge and their uncertainties.
I got a call the other day from a man who was in great distress. He had a skin condition that had been bothering him for three years. "It's unbearable," he said. "it's gotten to where it's preventing me from working. It's really painful. I've gone the whole route of symptomatic treatment, and now my doctor's suggesting that I consider going on methotrexate."
Well, my immediate reaction was, "My God, you're kidding! Methotrexate? For a skin condition?" Because methotrexate is a very potent antimetabolite with massive side effects. It's normally used only in cancer therapy.
And he said, ''Well, my doctor explained it in great detail, and I've been reading up on the side effects. I think I understand what the benefits are and what the risks are.
''My doctor told me to take ten days and talk to anybody I could find—other doctors, anybody—to try to get any other suggestions or any other advice. That's why I'm calling you, to find out what you think about the use of methotrexate for my condition."
I'll tell you, I was impressed by the way that doctor was taking the necessary time and giving the necessary information and support to help that fellow make his own decision about using a drug. I really had a sense that they were working as partners. And the doctor made it very clear that if the caller decided not to try the drug, he would not be insulted, and he would continue helping him in the best way he could.
We need more doctors like that.
Yes. And it doesn't matter whether the drug under consideration is a very potent one like methotrexate or a widely used and relatively safe one. The doctor should supply the information and describe the alternatives, and the layperson should make the final decision.