ilovetech. it will take a while for all physicains and cardiologists specifically, to fully come on board. from my perspective, right or wrong, there may be somewhat of an ego issue, but i think it may be more a "healthy skepticism" until further action by FDA (less likely data from EVAPORATE). you have to realize that many cardiologists were prescribing fish oil when the older studies came out and purported to show no benefit. if you were a cardiologist who first prescribed, then took your patients off (i mentioned this had occured to me) and if you put the patient back on it now, with the slight chance of an issue arising from the FDA process (problem here is most cardiologist are not reading in detail what's going on with Vascepa so the issue is more real to them...AND... they have to rectify the previous neg outcome studies with this larger newer one), would you not be concerned you could possibly have to take your patient off the medication in the near future, flip flopping, and seeming not to know what you're doing. physicians know their decision-making affects the way their patients view them, so, if they change what they're doing multiple times, without being completely sure, the patient may decide to move on (idiot physician).
the day RI came out i mentioned it to a cardiologist and showed him the results online. he said the problem was that LDL's likely went up. when i then pointed out this was not the case, he was impressed, but still wanted to know more. this type of information, review and the understandig of it, with adoption, does not occure quickly across the board.
there's a dictum in medicine, never be the first to adopt a new treatment or medicine, and never be the last. the first part is that maybe the study can't be reproduced, was shotty in design or how it was carried out, needs to be analyzed and discussed, or even that many physicians are not trained due this well on their own. ..so they wait to get more information before they make a decisions. many lay people feel that RI, or any study published in the NEJM carries an official imprimatur. i can give multiple instances of papers in the NEJM that had real issues with design or conclusions based on data, and which were heavily heavily criticised. in fact, almost all studies have issues, esp when you're designing for human populations, no study can be perfect. if the treatment is groundbreaking enough, NEJM may publish even with major issues. cardiologists, who are very busy, often do not have the time to fully delve into all the issues themselves, but they do watch what other cardiologist do, follow with CME, and new treatments will filter slowly, or quickly, into their armamentarium.
the cardiologist who prescribed on the pt i spoke with is an older curmudgeonly doc. i would not have expected his name as the one who gave the V script. he is also a partner in a very large group, and we have multiple large cardiology groups. i doubt he is doing this alone, or that V has not been dicussed in his group for with collegues from other groups. he may be one of the first, but the others will follow, esp with FDA. docs will not want to be the last to prescibe, as waiting much too long may harm patients. docs may also want their patients to be able to afford the medication and FDA approval swill help with that.
here's a couple other things to put it into perspective. i have a close physician friend with heart disease and when i mention V to him he kind of poo poo's and doesn't want to hear about it in detail. maybe i'm not as smart, but bet you he'll be on in in less than a year.
initial V uptake by cardiologists is in the global warming stage. and what kind of arguement can you start with that issue, where there's lots and lot of cientific data. skeptisicim? sure... but 90degrees in alaska?
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