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Biotech / Medical : VVUS: VIVUS INC. (NASDAQ)
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To: Tunica Albuginea who wrote (9265)6/6/1998 1:53:00 PM
From: VLAD  Read Replies (2) of 23519
 
TA,

IMO, now that many PCPs realize that they may be risking a lawsuit for scripting out Viagra with no more than a PE, I think a good chunk of them will choose MUSE as the first choice in any patient with possible vascular organic ED. This means that even men who really are psychogenic but suspect organic vascular may be turned to MUSE as a first choice.

It should be interesting to see how the new Viagra weekly script data looks for the month of June.

IMO a competent physician has two choices when many of his clients request to try Viagra.

1)He can appease the patient and write a script after doing little more than a PE (even many were not doing a PE--just writing scripts after phone call requests).

or

2)He can explain to the patient that the following protocol must be followed for the sake of practicing good medicine and protecting him/herself from a malpractice lawsuit:
a)The patient must make an office call for a PE.
b)During that office call a thorough history must be taken and documented.
c)A blood and urine sample should be collected for a CBC/chem panel/UA to at least screen out other underlying disease which might be causing the ED.
d)A cardiac work up should be instituted. This step in no way should be considered to be overkill. If the patient has a heart attack the same evening as Viagra was taken and nitro is given by the paramedic or ER physician because there was no way of reasonably getting the history that the guy was on Viagra then the PCP can and will be held liable.

IMO, if the patient declines to do a)b)c), the PCP should decline any Viagra script even if it means losing the patient.

Now if the patient accepts a)b)c), but refuses d) then the PCP should offer MUSE as the first choice for ED patients refusing CV work ups.

I guess the bottom line is that the PCP can either require the CV work-up before scripting Viagra at the risk of pissing off and losing a patient. The PCP needs to decide if losing money is more important than practicing high quality medicine. The PCP must also decide if he/she wants to have the liability issue hanging over his/her head.

Regretably, the media has hyped Viagra as if it were no more dangerous than taking a new vitamin. This very hype has pressured doctors to appease their clients by rubber stamping Viagra scripts like they were giving away candy (in fact now that PFE has its free samples out in number Viagra is being given away free).

Vivus can not fight a manic psychology on a level playing ground.
In the final analysis it will be the malpractice attorney that will place the entire situation in its proper perspective. All in my slanted proMUSE opinion of course.
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