Dr James Schaller
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In any setting, if the Physicians Desk Reference is used for anything but pill identification and extreme basics, you need to flee from the pretend "expert" that dreams they know something about medicine.

I actually know a case where a pro-pain family doctor, is testifying for a state board acts as a self-appointed bogus expert in psychiatry and pain, actually quotes an old PDR as if it were some kind of heavenly text. Sad to watch. And a waste of tax dollars. He is used by 45 states and appears to be unethically making over 20% of his income as a professional witness. (Surprisingly, he is used by the Pennsylvania state medical board in more than one case).

So what is the true reality of the PDR?

If the PDR is a source of any authoritative statements in a lawsuit or your own medical care, there is a problem with the care being proposed as the "standard" in medicine.

Why? Let me explain simply.

The PDR is merely a drug's package insert. It is a FDA regulated article limited to merely the research submitted to the FDA—typically to get a product approved for sale to you. Sometimes the information is from research from after the drug is out and being used by patients--new issues or problems arise. Period. It offers little else!

Dangerous side effects I saw reported in research on Pubmed and Medline took many years to make their way into the lumbering PDR.

Further, the dosages suggested can only be those limited to those used in the original research. In other words, before the drug is used on hundreds of thousands of people.

So let's say you are a rapid metabolizer of a medication, or someone with fast or acute tolerance, which we call tachyphyllaxis or someone with very slow tolerance to a medication.

Well in those cases the so-called recommended starting doses are ridiculous, chemical battery, and cruel.

For example, one new anti-psychotic drug, Abilify, is listed in the PDR as a drug, which has doses of 15 mg, 20 mg and 30 mg. Guess what would happen if psychotic youth were given this PDR official dose?

If I gave that to kids with psychosis, I would have vomiting and stuporous patients. Continuing to follow the PDR would be cruelty. Depriving such children with severe aggression the excellent response to this medication would also be abuse. We could offer many other illustrations and examples.

In no way does the PDR describe nor purport to describe the standard of care. Half the prescriptions in the nation are written off label. In other words, doctors think of useful and helpful ways which have not been approved by the massive FDA, you know, the ones who shut down Canadian drug stores in the USA.

If a doctor fails to place patients on a medication for the non-approved PDR indication, but the custom is that most doctors do, the doctor is clearly outside the standard of care. Thus quoting the PDR as authoritative represents the failure to comply with half of the standard of care in the US.

Some doctors would testify that limiting oneself to PDR approved indications and dosage is quackery that should result in the loss of license, as a threat to the health of the public. Half the customary prescribed treatment would be missed by this doctor.

Feel free to read the foreword to any PDR to confirm the limitations and key comments mentioned above.

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