CHEST Guidelines-Finding-Common-Ground

Finding-Common-Ground_chest

Pdf Summary

The document discusses the complexities of prescription practices and professionalism in the context of clinical medicine, specifically focusing on the prescribing of H.P. Acthar Gel for treating sarcoidosis. It emphasizes the importance of evidence-based medicine, which involves scientifically assessing therapies against objective standards while considering costs, especially when healthcare costs challenge affordability. The discussion highlights the lack of definitive evidence for the effectiveness of H.P. Acthar Gel over the more affordable oral corticosteroids for sarcoidosis treatment. <br /><br />Dr. Metersky, in a letter, questions the validity of claims regarding H.P. Acthar Gel's superiority and safety compared to oral corticosteroids, highlighting that no evidence in the searchable medical literature supports these claims. The authors argue for the necessity of demonstrating effectiveness before adopting new, costly treatments, criticizing the high cost of Acthar Gel—which can run up to $50,000 per month—when no additional benefit over traditional treatments is evident.<br /><br />The authors stress that while the FDA does not consider cost in its approvals, those responsible for healthcare payments must consider cost-effectiveness to determine coverage. This case underscores the need for responsible prescribing practices and adherence to evidence before implementing new therapies or guidelines. The article calls for ongoing debates to balance cost and effectiveness in medical treatment, asserting that failure to demand evidence for effectiveness is unprofessional and wasteful. It advocates for incorporating financial considerations into clinical guidelines and ensuring physicians demand evidence before recommending or prescribing high-cost treatments like H.P. Acthar Gel.

Keywords

prescription practices

professionalism

clinical medicine

H.P. Acthar Gel

sarcoidosis treatment

evidence-based medicine

cost-effectiveness

oral corticosteroids

healthcare costs

FDA approvals