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Cake day: June 1st, 2023

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  • Doctors are expected to mitigate risks, too. Valproate-induced spina bifida is a real problem, and doctors share a responsibility to prevent it when it won’t harm their patients. They share this responsibility because they previously tried making patients entirely responsible for mitigating their risk, and that approach has failed.

    Nobody said the woman in the article “has to suffer”. They didn’t refuse to give her any medicine, they refused to give her a particular medicine. There are plenty of alternatives, and in fact the doctor in this article wrote the woman a prescription for a different medicine. But of course, some people only want what they can’t have.

    Despite what patients often think, doctors are not drug dispensaries. It’s not their job - and never has been - to give patients the latest drug they read about online, or the drug that worked for their friend, or the drug that someone said “ask your doctor” about. If there is a less risky drug that can treat the patient, they will prescribe that instead of what the patient wants.

    To take another example, vancomycin is an antibiotic of last resort. Bacteria have not yet developed widespread resistance to it, so it is reserved for patients who have antibiotic-resistant infections, like MRSA. If it is used too much, theoretically bacteria can finally develop resistance to it. And theoretically, people in the future with MRSA may suffer.

    Next time you get antibiotics, try telling your doctor “No, I want a vancomycin prescription”. You will be disappointed. They are going to give you what they think will get the job done without incurring unnecessary risks, for you or other people.


  • My guess is that the drug is valproate. It’s used for headaches as well as epilepsy, though obviously other drugs can be used instead.

    The problem with valproate is that it is causes birth defects in two thirds (!!) of pregnancies, including spina bifida in 10% of pregnancies.

    The World Health Organization and the European Medicine Agency have issued statements/regulations against prescribing it to any women of childbearing potential. Plenty of American docs take a similar approach, regardless of religious beliefs. Just to be crystal clear, neither the WHO nor the EMA pay attention to Dobbs, the SCOTUS, or the GOP.


  • If you go to a doctor and demand a course of antibiotics for a viral infection, they have been trained to refuse. Because antibiotics do not treat viruses.

    For that matter, if you actually do have a simple bacterial infection and immediately demand a last-resort antibiotic like vancomycin, doctors have been trained to refuse. Vancomycin may work on you, but using it may create bacterial resistant strains that will put others at risk. Resistance is especially a threat if you don’t complete your course of antibiotics.

    So doctors will offer you a different antibiotic instead, with less risk of creating a resistant strain. Even if you promise to complete your antibiotics, “you get what you get so don’t get upset”.

    People have agency, but so do doctors. Doctors are not supposed to be dispensaries who simply give patients whatever they ask for. Doctors have the right to refuse to provide a prescription that is not in keeping with the standard of care, and offer a different prescription instead. You have the right to find a different doctor, or not see a doctor at all.


  • I’m quoting the World Health Organization and a European agency, neither are American health care.

    This is a universal approach taken by health care in the US, EU, and across the world. Doctors in general are pragmatists, and only concerned with outcomes. Which means acknowledging that no matter how often patients say “Trust me”, they know a certain number will have a bad outcome. The doctor’s job is to reduce that number.

    It’s the same reason why doctors increasingly urge their patients to not keep firearms at home. Even when the patient says they can be trusted with a firearm. It’s not a matter of trust, it’s a matter of statistics.



  • Your link literally explains how to sue a doctor for malpractice after signing a liability waiver.

    No waiver can claim that patients cannot sue their doctors for gross incompetence.

    In most cases, this will involve collecting medical files, seeing copies of the waiver(s) signed by the patient, and proving medical malpractice or negligence by showing that:

    The doctor in question deviated from an acceptable standard of care

    The injuries came from that deviation

    The damages came from those injuries

    Which is straightforward in this case. The standard of care is not to give valproate to women of childbearing age except as a last resort, and valproate is known to have a very high risk of birth defects.










  • That’s not how it would play out in a malpractice case.

    Lawyer: You recommended my client take a medication that causes birth defects, when you could have recommended a medication that doesn’t cause birth defects. Because of that, her child has birth defects.

    Doctor: Yes, but she said she didn’t want children.

    Lawyer: Have you ever heard a woman say she didn’t want children, who later went on to have a child?

    Doctor: Yes, it happens sometimes.

    Lawyer: So birth defects are a foreseeable result of the medication you recommended, even in women who say they don’t want children?

    Doctor: …