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        Cluster Headache Help and Support >> Cluster Headache Specific >> Why the reluctance to prescribe oxygen?
        
(Message started by: georgej on Oct 25th, 2006, 7:30pm)
Title: Why the reluctance to prescribe oxygen?
Post by georgej on Oct 25th, 2006, 7:30pm
Well, once again, the oxygen thing.  I've read a couple more posts just today where a physician is willing to prescribe medications of some sort, but not oxygen.

I've never seen this addressed as a separate topic--forgive me if I'm retreading old ground here--but why the reluctance to prescribe oxygen?

I've seen speculation that perhaps it's because they're afraid people will blow out their lungs.

Or that they'll ignite their clothing accidentally, or blow themselves up.  

Or that they'll somehow have some sort of toxic reaction to it or poison themselves, or put themselves to sleep forever, or something or other.

Frankly, none of these make much sense to me--if a physician is willing to prescribe narcotics and some fairly dangerous prescription medications for CH, why not try oxygen to see if it will help a patient?  It's cheap, effective, and easily administered.  It's non-toxic, and has few side effects.

If someone could explain this to me, I would be most appreciative.

Best,

George
Title: Re: Why the reluctance to prescribe oxygen?
Post by Not4Hire on Oct 25th, 2006, 8:10pm
georgej said:

Quote:
It's cheap,


I think that sums it up...
Title: Re: Why the reluctance to prescribe oxygen?
Post by Giovanni on Oct 25th, 2006, 8:28pm
I believe that the liability issue is the reason that a lot of meds including oxygen are not prescribed.  If you blow yourself up, the doc will be sued.  They rather you suffer than to risk a law suit.  

My opinion.

John
Title: Re: Why the reluctance to prescribe oxygen?
Post by Richr8 on Oct 25th, 2006, 9:10pm
Ignorance?  Just because they are Doctors, doesn't necessarily make them among the best and brightest.  Money talks.
Title: Re: Why the reluctance to prescribe oxygen?
Post by Not4Hire on Oct 25th, 2006, 9:11pm
...respectfully disagree, John. The reason medical care is so expensive is not because doctors are greedy bastidges with a Mercedes to pay off (well, most of them), but that the LIABILITY INSURANCE which covers oxygen mishaps as well as bad drug reactions IS expensive. Another example of the condition of our fucked-up litigious society.

My take on this issue is that the drug companies have so subverted medicine for the profit THEY have at stake, that doctors are reluctant to HEAL people (which sort of takes away the market for drugs).

Fer example, flouride in the water damn near ruined the dentist bidness. There's kid's out there who have NO cavities. The dentists NOW make their money off folk who let their gums go to hell and narcissists who gotta have STRAIGHT *WHITE* choppers.

...guess I've ranted enuff for tonite. So how 'bout them Tigers/Cards?
Title: Re: Why the reluctance to prescribe oxygen?
Post by BB on Oct 25th, 2006, 9:47pm

You know why? Because its only recently that oxygen has been recognised as a treatment for CH, maybe only about 10 years ago and no one bothered to pass on that knowledge to all the GPs practising out there, but more importantly no one has pushed it through the medical and pharmaceutical board to have oxygen formally and legally accepted as treatment for CH.

Most GP would have graduated at least 10 years ago, or else they would still be working in hospital or in training as interns and not be seeing patients of their own.

As CH is so rare, most GP wouldnt even see one. I have worked as a GP for 10 years and never saw one until I married one! None of the other doctors in the medical centre where I work had seen one and there are 26 doctors there. Many of the neurologists had not seen one either unless they specialise in headaches.

When I took Daniel to the hospital for tests, none of the doctors in ER and Radiology knew or had seen CH !

So our knowledge of CH is of the maybe 15 mins we were taught at medical school more than 15 years ago and there was no mention of oxygen then, only triptans and pain killers.

Once a doctor is graduated , its up to the doctors to continue to learn and update his/her medical knowledge and skills. There are no real formal continuing education program required or provided. Therefore the doctors will only be interested in studying more about things that are common, things that they see and deal with every day like asthma and diabetes and heart diseases.

When they see someone with CH, they pull out the 15 plus years old treatment regime of triptans and pain killers as thats all they know. Until they become more educated, if they so choose.

In Australia , we have books such as the MIMS and the Mecks Manual that give suggestions to what treatments are recommended for different conditions and they are updated every 3 months or so, yet oxygen is still not listed as a treatment for CH.

Many drugs that are patented for one condition can be used for others in certain circumstances, such as Zyprexa can be used as abortive and maybe even preventive for CH but has not been patented for such use. These "atypical" usages for those drugs lie in the realm of specialists prescribing, not GPs prescribing.

In reality, I can prescribe Oxygen to anyone I like, but I am not covered by insurance at all for that as its not a " recognised" treatment for CH! If something happens to the patient using that oxygen I prescribe and they sue, my insurance wont even cover me and I will have to pay out of my own pocket and that can send me bankrupt overnight!

Specialists can do so as they have a different insurance structure.


Annette
Title: Re: Why the reluctance to prescribe oxygen?
Post by BB on Oct 25th, 2006, 9:56pm

One more thing is that Oxygen is not supplied by pharmaceutical companies but by private companies selling industrial and medical goods, usually Gas companies.

The demand for oxygen for CH is so low due to the rarity of the condition compared to other conditions that its not profitable for the companies to apply for medical/legal license to market or have it recognised as a medical treatment.

But then here lies another problem, if the Gas company applies for a License to dispense oxygen as treatment for CH, they will have to pay a hefty amount for that and the cost of oxygen will skyrocket.

The only way around this I believe is to push for education for the average GPs out there and to push for formal recognisation of its use for CH by the Medical and Pharmaceutical Boards.

Annette
Title: Re: Why the reluctance to prescribe oxygen?
Post by Not4Hire on Oct 25th, 2006, 10:12pm

on 10/25/06 at 21:56:14, BB wrote:
One more thing is that Oxygen is not supplied by pharmaceutical companies but by private companies selling industrial and medical goods, usually Gas companies.

The demand for oxygen for CH is so low due to the rarity of the condition compared to other conditions that its not profitable for the companies to apply for medical/legal license to market or have it recognised as a medical treatment.

But then here lies another problem, if the Gas company applies for a License to dispense oxygen as treatment for CH, they will have to pay a hefty amount for that and the cost of oxygen will skyrocket.

The only way around this I believe is to push for education for the average GPs out there and to push for formal recognisation of its use for CH by the Medical and Pharmaceutical Boards.

Annette



whoa! Annette...

I started to reply to your first post (about the ignorance of GP's to CH and the difference in insurance for GP's and TA-DA *specialists*) and then I saw your *amendment*...

I tinkin' y'all prove my *point*>>


Quote:
The demand for oxygen for CH is so low due to the rarity of the condition compared to other conditions that its not profitable for the companies to apply for medical/legal license to market or have it recognised as a medical treatment.


then you say:


Quote:
and the cost of oxygen will skyrocket.


...Dear Lord, preserve us from these predatory bastards...
Title: Re: Why the reluctance to prescribe oxygen?
Post by BB on Oct 25th, 2006, 10:25pm
Hello Not4Hire,

What we see as patients and users as expensive may still not be profitable in the eyes of the big companies.

The cost of Imigran ( Imitrex ) injections here in Australia to a patient is $125 per pack ( which has 2 refill of 6mg each ). Now that to us who need to use 2 or more per day for months is astronomical, yet you talk to Glaxo and they say there is such low demand for the drugs that its not profitable and so they have to jack the price up to cover their cost.


Annette

* Edited for spelling mistake  :P
Title: Re: Why the reluctance to prescribe oxygen?
Post by Not4Hire on Oct 25th, 2006, 11:06pm
aaarrrgh...


Quote:
yet you talk to Glaxo and they say there is such low demand for the drugs that its not profitable and so they have to jack the price up to cover their cost.  


How can this be said with a straight face?

(...and this is NOT a flame on you, Annette...)

"Low demand"? ...and every doctor's office I've been to has a GlaxoSmithKline poster in the examining room for Imitrex? And y'all see ads every fucking DAY on yer telly?  And how much does it REALLY cost them to produce this drug? I'm talking actual ingredients to fill a stinkin' syringe.... I have no idea but I'm pretty sure it's pennies...

please don't play the R&D card: that was paid for long ago.

sorry for being a cynic... no, I take that BACK: I fit some of the traits...


Quote:
Word History: A cynic may be pardoned for thinking that this is a dog's life. The Greek word kunikos, from which cynic comes, was originally an adjective meaning “doglike,” from kun, “dog.” The word was probably applied to the Cynic philosophers because of the nickname kun given to Diogenes of Sinope, the prototypical Cynic. He is reported to have been seen barking in public, urinating on the leg of a table, and masturbating on the street. The first use of the word recorded in English, in a work published from 1547 to 1564, is in the plural for members of this philosophical sect. In 1596 we find the first instance of cynic meaning “faultfinder,” a sense that was to develop into our modern sense. The meaning “faultfinder” came naturally from the behavior of countless Cynics who in their pursuit of virtue pointed out the flaws in others. Such faultfinding could lead quite naturally to the belief associated with cynics of today that selfishness determines human behavior.


..OK OK.. the part about the table and the pursuit of virtue I will admit...

...the price you quote for Imigran/Imitrex is OBSCENE... and sadly, paid every day by folks who suffer...


Title: Re: Why the reluctance to prescribe oxygen?
Post by BB on Oct 25th, 2006, 11:43pm


Actually it was only yesterday that I rang Glaxo and spoke to their Pharmaceutical Representative about obtaining imigran solution in a vial so that we can draw up what we need  and keep the cost down, as I know that the cost for the packaging is far more than the 0.5 ml of the solution inside.

Thats when I got told that the demand ( at least in Australia ) for the drugs is low so there is no vial available. If I want some then I will have to apply to the PDA for a private importing license to import it from overseas. Well, you can guess how much it would cost for that license.

The pharmacy where I fill the script showed me the cost for them to buy it in is $110, so they make $15 profit for dispensing. When I asked the Glaxo Representative, of course she wouldnt tell me the manufacture cost ( she probably wouldnt know herself ). My guess is though the actually cost to manufacture the drug is not high, but other cost such as patency license, tax, insurance, payment to company CEOs, etc would have been a lot.

I wonder if oxygen would go the same way if it was to be supplied by a ( Pharmaceutical ) company as a prescribed "drug" . I admit this is not my area of expertise but there are some indication that it might .

Annette
Title: Re: Why the reluctance to prescribe oxygen?
Post by chopmyheadoff on Oct 26th, 2006, 6:52am
@ annette

you go girl - that is the most comprehensive answer anyone could have hoped for.

@ not4hire although i agree that the drugs companies are robbing bastards i still think that the law of supply and demand applies.

as iv said before - why are paracetamol so cheap ?? because 15 trillion( a guess)  are munched on every day around the planet so they make profit by volume.

now to research a new drug specifically for a very rare condition . . and know that its usage is capped . . .

work it out yourself
Title: Re: Why the reluctance to prescribe oxygen?
Post by BB on Oct 26th, 2006, 8:26am

Correct me if I am wrong please Jonny, but isnt the medical grade O2 already dearer than the welder O2, and yet its the same oxygen, same bottle, similar regulator ?

Slap the word "medical" in front of it and all of a sudden the price jumps!  ::)

Annette
Title: Re: Why the reluctance to prescribe oxygen?
Post by AussieBrian on Oct 26th, 2006, 9:10am

on 10/26/06 at 06:52:25, chopmyheadoff wrote:
.... why are paracetamol so cheap ?? because 15 trillion( a guess)  are munched on every day around the planet so they make profit by volume....

Surprisingly, and regardless how effective a painkiller it is, paracetamol is not available to our American friends.  
Title: Re: Why the reluctance to prescribe oxygen?
Post by chopmyheadoff on Oct 26th, 2006, 9:20am

on 10/26/06 at 09:10:10, AussieBrian wrote:
Surprisingly, and regardless how effective a painkiller it is, paracetamol is not available to our American friends.  



:o what ????
[smiley=gocrazy.gif]

seriously ??  
Title: Re: Why the reluctance to prescribe oxygen?
Post by chopmyheadoff on Oct 26th, 2006, 9:23am
in that case change that to asprin . .

they have that . . . . right ??  [smiley=huh.gif]
Title: Re: Why the reluctance to prescribe oxygen?
Post by AussieBrian on Oct 26th, 2006, 9:42am
Aspirin versus paracetamol?  Surely, sir, you jest!

Nor would I put petrol into my seriously off-road diesel 4WD.  It's like spark plugs and anal thermometers - both very effective, just not interchangeable.
Title: Re: Why the reluctance to prescribe oxygen?
Post by seasonalboomer on Oct 26th, 2006, 9:53am
their is not a strong enough threat presented to the doctor of what will happen to them if they don't prescribe oxygen. imagine if you were able to bring along a very large, slightly hairy man, who we will call "Vinny" (apologoes for to the "vinny's" of the world) to your doctor appointment.

The doctor starts to use some bullshit answer after you've shown him the info on O2 as to why he doesn't think you need O2. You indicate a low level of patience, look over at your friend Vinny, who begins to massage his knuckles a little. You tell the doctor, -i'm not askin' I'm tellin-.

The doctor looks up, set back a little bit, and Vinny says, - i think what my little friend here said was that he's not askin' he's tellin. And the doctor suddenly finds ample reason why  the O2 prescription should be written, post haste.

Now, that's a fun story. But, lets say, we make sure the leading neuro's on Cluster make a plain statement and publish it. That the first, safest line of attack for an abortive treatment for cluster headache is O2 at 10-15 lpm and using a non-rebreather mask. If it is something that can be printed out, showing the "petition" of the best experts in the field, this becomes our "vinny" that we carry in with us.

Think we can get Goadsby, Diamond, etc.... to sign-on? Can anyone check?

Scott
Title: Re: Why the reluctance to prescribe oxygen?
Post by chopmyheadoff on Oct 26th, 2006, 9:54am
LOL true
but in this case the analagy is being used to demonstrate a cheap tablet that is so cheap because it is mass marketed.
Title: Re: Why the reluctance to prescribe oxygen?
Post by maffumatt on Oct 26th, 2006, 9:56am
At the pharmacy that I use a box of 5 vials cost $311.00, at Walgreens 3 blocks down it is $511.00. When I asked the pharmacist why it cost so much more there, he wouldn't answer. When I asked the pharmacist  where I get mine why Walgreens cost so much more he told me that "because they can charge that much."  I don’t give Walgreens any business at all. I understand making a profit, but when you charge $200 more for the same drug you can get 3 blocks away, that is making a winfall off someone elses misery and that is just not right.
Title: Re: Why the reluctance to prescribe oxygen?
Post by BB on Oct 26th, 2006, 10:05am

Matt, how many mls are in each vial ?

Annette
Title: Re: Why the reluctance to prescribe oxygen?
Post by maffumatt on Oct 26th, 2006, 10:07am
.5 ML, 2.5 ML per box.
Title: Re: Why the reluctance to prescribe oxygen?
Post by AussieBrian on Oct 26th, 2006, 10:13am

on 10/26/06 at 09:54:35, chopmyheadoff wrote:
... a cheap tablet that is so cheap because it is mass marketed....

And that's exactly what breaks my heart in that it's not only cheap  (thank you mass marketing)  and far safer than other low-grade painkillers,  but it remains unavailable to our American friends and goodness knows who else.
Title: Re: Why the reluctance to prescribe oxygen?
Post by BB on Oct 26th, 2006, 10:19am

Well, at $311 per 2.5 mls, that means 0.5 ml costs $62.20 , thats about the same as what we pay here, even more considering the exchange rate.

So even in the US where the demand would be a lot more than Australia, this hasnt really dropped the price at all for this particular drug.

:(


Annette
Title: Re: Why the reluctance to prescribe oxygen?
Post by maffumatt on Oct 26th, 2006, 10:23am
Why can a little local phamacy charge $311 and a nationwide chain charge $511. To me that sounds like price gouging.
Title: Re: Why the reluctance to prescribe oxygen?
Post by nani on Oct 26th, 2006, 10:31am

on 10/26/06 at 09:53:14, seasonalboomer wrote:
Think we can get Goadsby, Diamond, etc.... to sign-on? Can anyone check?


How 'bout Todd Rozen?
http://www.chhelp.org/mhni.html
Title: Re: Why the reluctance to prescribe oxygen?
Post by kcopelin on Oct 26th, 2006, 10:32am
Back to the O2...I fought for months to get it...and here ,in a nutshell, is the safety briefing I got
1. NEVER smoke while using O2 (dude-take a look at my clustermasx-how could I smoke?)
2. If the square knob (his technical term I swear) breaks off, well then, you got yourself a rocket with enough power to rip through the walls of your apartment and two aparments down.  You could definietly kill someone with this.
3. If you drive with O2, you could have a serious condition on your hands if there's a wreck and that square thingy breaks off (see above)

So the VA reluctance was in part due to the fact that O2 is a potential rocket.

Welding O2...ask Jonny....

PFDAN y'all
kathy
Title: Re: Why the reluctance to prescribe oxygen?
Post by wildhaus on Oct 26th, 2006, 10:38am

Quote:
Well, once again, the oxygen thing.  I've read a couple more posts just today where a physician is willing to prescribe medications of some sort, but not oxygen.
but why the reluctance to prescribe oxygen?


I am very happy I got, as first option,  O2 (can do) prescribed!!!!

I have never seen reluctance to prescribe oxygen!
so i cant answer......

Meds. were most of the time with reluctance prescribed!

I must be very lucky.......

Michael



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