I really enjoy listening to smart people. But I loose confidence in my doctors, when I hear a migraine expert state, that doctors are heavily influenced by big pharma when they choose my medication.
For the time being, I am listening to interviews from the World Migraine Summit.
There are many small gold nuggets in the lectures at World Migraine Summit. It is a series of lectures / interviews, running from March 18, 2020 and eight days ahead. There are more than 30 speeches, all by excellent speakers and researchers in migraine. The headline here is one of the gold nuggets I have especially noticed! I quote verbatim further down, because the videos are removed after a short time.
Dr. Robert Cowan from Stanford University in California made many interesting statements. He believes that many of those with chronic migraines have a small leak in the membrane that surrounds the brain and spine (subclinical IIH). Then the pressure (or the chemical content in the cerebro-spinal fluid changes in the ‘bag’ ) and it causes migraines.
But instead of checking the cerebro-spinal fluid (CFS) , doctors provide plenty of acute and preventative medicines – without great success, and perhaps with MOH (medication overuse headache) as a result. And, said the good doctor, doctors are heavily influenced by ‘big pharma’ in terms of which medicine they should / will prescribe. I understand, that it does not sell medication to patch the perforation of the membrane around the brain and spinal cord.
But shouldn’t doctors focus on the well being of the patient?
Quote from the first minutes of Cowan’s interview: Most physicians are not trained in headaches and are heavily influenced by big pharma in which medications to prescribe.
Such a change in the CFS may be a frequent cause of chronic migraine, said Dr. Cowan. But he did not follow up on it and glazed over the fact that MOH (medicine-overuse headache) is often a consequence of many migraine days. The closest he came to it was that we wake up after a long night’s sleep with medicine withdrawals because we have taken too many painkillers. He, on the other hand, carefully told that non-migraineurs with e.g. back pain, are not getting MOH. So they do not get the withdrawals. Funny, really.
Dr Cowan collects large datasets and searches in the data for groups of migraineurs who have common traits. Once such groups have been identified, it may be possible to tailor the migraine treatment accordingly. That is a perspective I fully support.
Also, try clicking on the link to BonTriage.com. A huge survey pops up. I tried to answer, but when I got to the end I was ousted – maybe because I didn’t live in the US. But the questions were interesting and should be on the tip of the tongue of any neurologist treating migraines.
The influence from Big pharma was also clearly demonstrated, when the definition of chronic migraine was changed in 2018 – just in time to make the clinical test results for CGRP antibodies look better.
Dr. Cowan’s opinion on doctors’ choice of medication makes me unsure whether I (and all the other migraineurs and patients with other diseases) are really receiving the best possible medical treatment.
That uncertainty should not be found. The primary task of the physician is to think about the well-being of the patient.
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