Second pass at: When your prescriber and the evidence disagree — setting out what I have, and where I think it stops being reliable.
What changes if the standard account of prescriber is wrong? I ask because I have been treating it as settled and I noticed this week that I could not say why.
Working through the consequences rather than the evidence, since others here are better placed on the evidence.
The opening post is the version of this I will quote in future. One addition.
How to ask for what you need: rather than "should I take this", frame it as "I understand the evidence for this shows X benefit in people with my condition; would it be suitable for my specific situation?" That invites clinical reasoning rather than yes/no.
Prescriber is a question about a distribution, not about a value, and treating it as a value is what produces the confident wrong answers.
The failure mode on prescriber is boring rather than dramatic. It is almost always the step everyone assumes was done correctly because it is too simple to get wrong.
Agreed, and I will stop repeating the version of this I had been repeating.
A question phrased as "what would you want to see before considering X" is answerable and is not a request for X.
Practical answer on prescriber, since the theoretical one is upthread: do the simplest check first, write down the result, and only then decide whether the complicated explanation is needed. It usually is not.
I have no financial interest in anything named in this thread and I want to say so before I comment on prescriber, because it is the sort of subject where it matters.
Bringing a record of symptoms with dates and severities makes an assessment materially easier and is the single most useful preparation.
Post #8 is the version of this I will quote in future. One addition.
A second opinion is a normal part of medicine rather than an accusation, and asking how to obtain one is a legitimate question.
It took me longer than it should have to see that.
Where I part company with post #10, and it is a narrow parting.
A pharmacist can answer a great many of the questions people save for a prescriber, faster and often better, particularly about interactions and formulations.
On balance I think that is right, and I would not bet much on it.
Before the thread moves on from prescriber — what is the sample size behind the claim? I am not being difficult; I have seen the same figure quoted from an n of four and from an n of four hundred.
Small correction to my own earlier position on prescriber. I had the units the wrong way round, which changes the conclusion by an order of magnitude and therefore changes it entirely.
Post #14 put the caveat in the right place and I want to underline it.
Bringing a record of symptoms with dates and severities makes an assessment materially easier and is the single most useful preparation.
The literature is thinner on this than the confidence in the thread implies.
The arithmetic in post #16 is right; the assumption feeding it is the part to check.
Where I have landed on prescriber, having got it wrong once in public: the direction is clear, the magnitude is not, and anyone quoting a precise magnitude has borrowed it from somewhere that did not measure it.
Useful. I had the fact and not the reason, which turns out to be the important half.
Source for the prescriber figure, since it was asked for. It is in the discussion rather than the abstract, which is why the version circulating is stronger than the paper is.
Reading the surrounding paragraph is worth the two minutes. The authors are more careful than their summarisers.
A question phrased as "what would you want to see before considering X" is answerable and is not a request for X.
Bringing a record of symptoms with dates and severities makes an assessment materially easier and is the single most useful preparation.
Somebody will have a better source than mine, and I hope they post it.
Answering the question post #19 raises rather than the one it answers.
The most useful reply I ever got about prescriber was a request to state my units. It sounds like pedantry and it has saved me twice.
The arithmetic in post #23 is right; the assumption feeding it is the part to check.
If you have been doing something the prescriber does not know about, saying so is more useful than not. Clinicians here consistently say they would rather know.
Not disagreeing with anyone above, just adding the bit I keep having to look up.
Post #23 and I disagree about the size of the effect, not about the direction.
What I can speak to on prescriber is narrow, so I will keep it narrow rather than generalising from it. Beyond that boundary I do not know.
Where you disagree, saying so plainly and asking for the reasoning is better than agreeing and not following the plan.
Not the answer, but possibly the question that gets there.
No disagreement from me. Posting only so the question does not look ignored.
Narrowing post #26, because the general version has more than one answer.
I would call the community position on prescriber likely rather than established, and I would be comfortable defending that hedge.
Clarifying indication: if a compound is approved for diabetes but you have obesity without diabetes, clarify whether your clinician considers this off-label use and what the evidence basis is.