Alvin B. Lin, MD, FAAFP
Dr. Lin is an associate professor of family and community medicine at University of Nevada School of Medicine and an adjunct professor of family medicine and geriatrics at Touro University Nevada College of Medicine. He also serves as an advisory medical director for Infinity Hospice Care and as medical director of Lions HealthFirst Foundation. Dr. Lin maintains a small private practice in Las Vegas, NV. The posts represent the views of Dr. Lin, and in no way are to be construed as representative of the above listed organizations. Dr. Lin blogs about current medical literature and news at http://alvinblin.blogspot.com/.
I'm often asked "what's the best medicine/treatment/surgery for x" where x equals some health condition. Too often, the answer is "they're all about the same.” In this day and age of medical technology, we know what broad category of medicine to choose, but the specific one best suited for that individual patient's genetic profile. Sure, we can swab someone's cheek for some basic ideals related to liver metabolism, but I can't tell you whether you'll respond better to fluoxetine or paroxetine.
I was reminded of this yesterday when one of my 90-year-old female patients admitted to some urge incontinence (as distinct from stress incontinence). We discussed the various pharmacologic options available to her as noted in a wonderful systematic review published earlier this week in the Annals of Internal Medicine. Bottom line, they all demonstrate essentially equivalent benefit with many anticholinergic side effects.
For an avowed car lover, it's like being asked to choose between Chevy, Dodge and Ford. They all make wonderful cars but I would be hard pressed to tell you that the Corvette ZR1 is better than the SRT Viper or the Ford Mustang GT500 (of course, if any manufacturer wants to convince me, I'm open to an evaluation!).
In the end, I gave my patient the same answer that I give everyone else and repeat over and over: the best medication is the one that you can afford and are willing to take as directed with the least number of side effects that will get you the benefit/outcome that you need. Her choice? Scheduled toileting since an empty bladder can't leak!
