8 ms·

The drug has several non-minor side effects, is prohibitively expensive, and is the same as the treatment for someone who already has the virus. I for one think

The drug has several non-minor side effects, is prohibitively expensive, and is the same as the treatment for someone who already has the virus. I for one think it's improper to prescribe a drug with these nephrological side effects to a large number of otherwise healthy individuals, not even accounting for the cost.

deleted 7y ago
[deleted]
agentdrtran 7y ago
Where did you go to med school?
- hcurtiss 7y ago
  What a snide reply. Is it necessary to be a doctor to have an opinion on healthcare policy?
  - deleted 7y ago
    [deleted]
  - jfengel 7y ago
    They were speaking of medicine rather than policy, and getting it wrong. PReP is not the same course as treatment, and prophylaxis is always a thing given to healthy people rather than sick ones. The side effects are considered manageable: you watch for signs of liver problems and you don't give the drug to people prone to them. I'm not a doctor but I can read the prescribing information[1], which they don't seem to have done. [1] https://web.archive.org/web/20161221124917/http://www.accessdata.fda.gov/drugsatfda_docs/label/2016/021752s047lbl.pdf https://web.archive.org/web/20161221124917/http://www.access...
    - hcurtiss 7y ago
      Arguing the facts is totally good. And you may very well be right (I don't know anything about the subject). But attacking the commenter's position because he/she is not a doctor (like you are not a doctor), struck me as poor form.
      - jfengel 7y ago
        You're correct about that. I apologize.
  - shawnz 7y ago
    Would you feel comfortable as a layman arguing with people who have been studying the topic for a decade about the tradeoffs involved?
    - hcurtiss 7y ago
      Of course. In many circumstances, the experts don't even agree. It's incumbent on me to inform myself, and I can lean on those very experts, but I'm not at all comfortable ceding how to weigh those tradeoffs to the people who identified them scientifically.
      - shawnz 7y ago
        I'm not necessarily saying you ought to cede to the experts, I'm saying you ought to do the research they have already done if you expect them to take you seriously about changing the way they do their jobs. Obviously it's not breaking any laws to post an uninformed opinion on the internet, but what is going to be accomplished by it?
- mbrameld 7y ago
  Attack the message, not the messenger.
jdietrich 7y ago
If it weren't for Gilead's legal efforts to extend the patent on Truvada, it'd be a dirt cheap generic by now; it already is in many countries. You might think it's improper, but the evidence says otherwise - PrEP is safe, well-tolerated, marginally cost-effective at proprietary prices and clearly cost-effective at generic prices. One of the fundamental principles of modern medicine is informed consent. Patients have the right to make their own decisions about their treatment based on their own assessment of the risks and benefits. PrEP is an incredibly compelling proposition for a lot of patients. https://www.who.int/hiv/topics/prep/en/ https://www.who.int/hiv/topics/prep/en/
- verulito 7y ago
  I think PrEP is great and I don't think we do a great job of getting it to people for whom it makes sense. That being said, the CDC has an excellent position on who should be getting it and that's not a lot of people. PrEP is well tolerated given it's known side effects but conservative medicine dictates that we don't prescribe medications unless we have a measurable benefit and that's not a large group of people. A homosexual male who has lots of unprotected sex with strangers should probably be on it. A hetereosexual mostly monogamous person probably shouldn't be. A big factor here is that the prevalence of HIV in the US is low, at .34%. Globally it's a bit higher at .48%. It is also often not that contagious. That being said, under the right circumstances it could be so it's real important to be aware of the risk factors.

deleted 7y ago

[deleted]

agentdrtran 7y ago

Where did you go to med school?

hcurtiss 7y ago
What a snide reply. Is it necessary to be a doctor to have an opinion on healthcare policy?
- deleted 7y ago
  [deleted]
- jfengel 7y ago
  They were speaking of medicine rather than policy, and getting it wrong. PReP is not the same course as treatment, and prophylaxis is always a thing given to healthy people rather than sick ones. The side effects are considered manageable: you watch for signs of liver problems and you don't give the drug to people prone to them. I'm not a doctor but I can read the prescribing information[1], which they don't seem to have done. [1] https://web.archive.org/web/20161221124917/http://www.accessdata.fda.gov/drugsatfda_docs/label/2016/021752s047lbl.pdf https://web.archive.org/web/20161221124917/http://www.access...
  - hcurtiss 7y ago
    Arguing the facts is totally good. And you may very well be right (I don't know anything about the subject). But attacking the commenter's position because he/she is not a doctor (like you are not a doctor), struck me as poor form.
    - jfengel 7y ago
      You're correct about that. I apologize.
- shawnz 7y ago
  Would you feel comfortable as a layman arguing with people who have been studying the topic for a decade about the tradeoffs involved?
  - hcurtiss 7y ago
    Of course. In many circumstances, the experts don't even agree. It's incumbent on me to inform myself, and I can lean on those very experts, but I'm not at all comfortable ceding how to weigh those tradeoffs to the people who identified them scientifically.
    - shawnz 7y ago
      I'm not necessarily saying you ought to cede to the experts, I'm saying you ought to do the research they have already done if you expect them to take you seriously about changing the way they do their jobs. Obviously it's not breaking any laws to post an uninformed opinion on the internet, but what is going to be accomplished by it?
mbrameld 7y ago
Attack the message, not the messenger.

jdietrich 7y ago

If it weren't for Gilead's legal efforts to extend the patent on Truvada, it'd be a dirt cheap generic by now; it already is in many countries. You might think it's improper, but the evidence says otherwise - PrEP is safe, well-tolerated, marginally cost-effective at proprietary prices and clearly cost-effective at generic prices. One of the fundamental principles of modern medicine is informed consent. Patients have the right to make their own decisions about their treatment based on their own assessment of the risks and benefits. PrEP is an incredibly compelling proposition for a lot of patients. https://www.who.int/hiv/topics/prep/en/ https://www.who.int/hiv/topics/prep/en/

verulito 7y ago
I think PrEP is great and I don't think we do a great job of getting it to people for whom it makes sense. That being said, the CDC has an excellent position on who should be getting it and that's not a lot of people. PrEP is well tolerated given it's known side effects but conservative medicine dictates that we don't prescribe medications unless we have a measurable benefit and that's not a large group of people. A homosexual male who has lots of unprotected sex with strangers should probably be on it. A hetereosexual mostly monogamous person probably shouldn't be. A big factor here is that the prevalence of HIV in the US is low, at .34%. Globally it's a bit higher at .48%. It is also often not that contagious. That being said, under the right circumstances it could be so it's real important to be aware of the risk factors.