What to do about problematic medication taking?

Bill Polonsky: We know that about 30% of all the prescribed medications in the market do have what’s called a black box warning. They potentially have quite significant and serious side effects, potentially.

And yet, all those medications are still prescribed. Well, what’s going on? Are these people evil who are prescribing this? Well, no. It’s that individual is prescribing it, that physician, whoever it might be, believes, as he’s recommending this medication for you to take. That the benefits, the pros, outweigh the potential negatives. And you as an individual patient may or may not agree with that, but it’s important to have that conversation because if you trust your physician, you might believe he actually knows enough to be making a reasonable recommendation.

And that’s why the last point in this slide, that’s why these points 1 through 5, are in this order. It’s only after doing 1 through 4 we want to be able to, again, respectfully offer new information.

First, We want to address the reasons why taking these medications might be necessary, it’s called perceived necessity, and that means talking about the pros. We meet people all the time and say, yeah, my doctor told me to take this stuff called Januvia or put me on insulin, but I don’t really know why I’m taking it, and I don’t know what it’s supposed to achieve.

And again, there’s been lots of studies showing that many people aren’t convinced that taking their medications are helping or accomplishing much because they can’t feel it.

So are we helping people believe that medications are potentially valuable and can accomplish something? And at the same time, we wanna talk about people’s perceived concerns.

So that people have told us about their suspicions about these meds. You know, “Well, my grandmother, you know, I remember a doctor put her on insulin, and all of a sudden, she began having trouble with her eyes and kidneys. And now you want me to take that stuff? I don’t know.”

We want to be able to talk about that. Well, you know, probably it wasn’t the insulin that did it to your grandmother. It was the fact that there had been no interventions to help her get on any medications for decades. That was an issue. That people have understandable concerns that are worthy of being discussed.

And we know we can address many if not most of them. And by the way, sometimes you can address these pros and cons together. And I’ll tell you my favorite way to do that.

One of my favorite examples is sometimes I’ll meet someone who says, “Well, you know my doctor. I’m new to diabetes, and they recommended I take metformin. But I don’t know. I don’t know. I’ve heard bad things about that stuff.”

I go, “Yeah, there are some significant side effects to metformin you should be aware of. Let me give you an example. There’s some recent evidence that one of the side effects is it may reduce your risk of developing certain types of cancer.”

And people go, “Wait a minute, that’s a side effect?” “Yeah, just thought you should know. There’s also some mixed evidence that it actually might reduce your risk for certain forms of dementia over the course of years.”

“Wait, but that would be a good thing, right?”

“Yeah!”

So there are ways of providing new perspectives and talking about, I think, medications to help people be concerned as they should always be.

We can empathize with the fact that most of us would prefer to be taking less or none, but to help them come to, with the right information, with the right evidence, and the right knowledge, come to good conclusions on their own.

And again, we think if we can help people with the right meds and stay with them, we know we’re helping them to get to a safer place with their diabetes.

So I’m going to shut up and let you guys talk now. What do you think about those last points regarding how we want to leave this with folks?