Pharmaceutical Kickback?

[JonPalawan]

My helper's 22 year old brother Bryan recently fell and struck his head. He was taken to an ER, and immediately they started pumping an NSAID Ketesse into him at high rates. He never complained of pain. The maximum dose (all the drug information I read from the insert document) for healthy persons is 75mg/day, and they started him at 150 for the first two days, and 100 for the third and fourth days. They did blood work on him and determined low electrolyte and "acute renal disease". A contraindication states that the drug "must not" be administered to persons with "moderate to severe renal dysfunction". Bryan is now paralyzed, his only voluntary muscle control is for his eyes and perhaps some bowel and urination control. There is a plausible link: NSAIDs can cause kidney damage, the kidneys control blood sodium level, and low Na can cause brain damage. So here's my question: could kickback be the reason behind what appears to be an overdose of a potentially dangerous drug? The cost is $15.50 a pop, and he was given 15 doses over his four day confinement. Even the after-release instructions said he is to continue taking Ketesse at the rate of 25mg/day. Mysteriously, the release document did not specify that electrolyte and renal function be monitored, something that we are doing. We ignored the Ketesse recommendation. There was a recent effort to make the practice of kickback illegal, but the Philippine Medical Association successfully fought it off.

[chris49]

Jon. As you know I already gave a comprehensive answer to this exact same question posted back in August.

 

Since you are asking for a medical opinion, I can't give that. But I would like to see the post added to your previous topic for continued discussion.

 

You said at the time, severe head injury with LOC, loss of consciousness, with a negative CT scan.  Now since the individual is not doing well, we would have to consider the head injury as the primary cause, everything else secondary. And as for the electrolyte profile was this done on admission or sometime later, meaning dehydration could have occurred in the interim.

 

And as for kickback. Even if I suspect that, I am not going to say that here. What other meds were available and what was the primary medical problem being treated? Sub dural hematoma which would show up on a CT scan maybe a week later? Was a follow up CT scan done?. Does the patient actually have renal disease or just an electrolyte imbalance at that time?

Edited September 23, 2015 by chris49

[JonPalawan]

What other meds were available and what was the primary medical problem being treated? Sub dural hematoma which would show up on a CT scan maybe a week later? Was a follow up CT scan done?. Does the patient actually have renal disease or just an electrolyte imbalance at that time?

 

Sorry I posted topic two times. This has been very troubling to me and I forgot that I posted it already. Seeing a 22 year old with a state of mind of "surrender" is heart breaking.

 

Bryan complained of no pain, so no other med would be called for. Ketesse is solely for combatting pain, according to the insert. The neurologist we visited yesterday is certain that Bryan's current state is the result of low Na, and not all related to the initial injury. He is careful to not implicate his associates.

 

GFR - glomerular filtration rate is the best test to measure your level of kidney function and determine your stage of kidney disease. It is determined by measuring creatine level, and taking other factors into account. A calculator is at

http://www.davita.com/gfr-calculator/

Bryan left the hospital with GFR = 37, putting him at the middle of stage 3b: Moderate to severe loss of kidney function. Ketesse is contraindicated by moderate renal dysfunction.

[chris49]

I agree.

Was adequate hydration in the form of IV saline, being given at the same time?

In marathon running we have people who have taken up to 10 x 500 nurofen during a 3-4 hour event. We haveseen disturbances in renal function, but in young healthy individuals, this is correctable with a rapid infusion of IV fluid, even by mouth.

Head injury is complex in that the patient is given the minimal fluid for hydration, because of the secondary risk of cerebral edema.

Now your patient has 2 medical problems. Paralysis. What's the cause of that? There has to be something within the brain. And renal failure caused by electrolye imbalance, induced by the use of Kettesse, Dexketoprufen, per the previous topic.

You would need a lawyer to find a neurologist who was willing to give an opinion on the case in the form of testimony which could be used in court. Since this is not the USA, I can't advice that.

Jon, I don't know mate, as to your level of involvement and how far you want to go with it.

Edited September 23, 2015 by chris49

[JonPalawan]

Was adequate hydration in the form of IV saline, being given at the same time?

 

He was given continuous saline drip.

[expatuk2014]

My Late Mother-in-law was in Hospital on and off since Febuary because of a intestinal Growth.

they tried many different medicines , and in late July she couldnt eat or drink normally so was on a Dextrose drip

and also a Liquid food drip, the food drip was called Kabiven ( cost per bag 7,300 pesos ) after senior discount =( 5,200 pesos ) 

i bag =36 hours we were struggling to keep paying for this as you can imagine .

we were told there were was no other alternative liquid food ! we have a nephew who is a dentist who naturally new how things worked

and he told us he would ask some friends , sure enough there were cheaper alternatives !

And we persuaded the doctor to change the liquid food , our nephew told us the makers of Kabiven are being investigated by the US Drugs

people for their sales practices !

Not going to say it was the Kickback Thing but the Doctor was not happy !!

[Dave Hounddriver]

My helper's 22 year old brother Bryan recently fell and struck his head. He was taken to an ER

 

My first thought is "who paid and how rich are they".  There are many hospitals in Philippines where the first question asked is "How much money have you got and how much do you get each month"?  The medical treatment received is directly proportional to that number.  My experience with Philippine hospitals is that they won't give anything but the ABSOLUTE essentials  until funding is established so I cannot imagine them "pumping him full of" anything.  How reliable is your arms-length source, (as in not told to you by a wife, gf or relative)?

[JonPalawan]

Not going to say it was the Kickback Thing but the Doctor was not happy !!

This from a story at

http://www.mb.com.ph/doctors-hit-proposal-banning-pharmaceutical-firms-from-giving-them-promo-items/#!

titled "Doctors hit proposal banning pharmaceutical firms from giving them promo items" by Jun Ramirez July 27, 2014

"Another doctor from Makati Medical Center admitted that some of their colleagues are accepting substantial gifts from drug companies like trips abroad and gift checks but these benefits do not compel them to prescribe drugs manufactured by the gift-givers.

"He added that they did not take the long and difficult medical course to be subservient to the desires of drug manufacturers.

"He said prescriptions of drugs are based on their efficacy and financial capacity of the patients.

“ 'Why prescribe drugs that the patient cannot afford,' he asked."

 

[JonPalawan]

 

My helper's 22 year old brother Bryan recently fell and struck his head. He was taken to an ER

 

 How reliable is your arms-length source, (as in not told to you by a wife, gf or relative)?

 

I don't understand the question. What is "arm's-length source"?

 

[Dave Hounddriver]

I don't understand the question. What is "arm's-length source"?

 

https://en.wikipedia.org/wiki/Arm%27s_length_principle

 

I mean to ask, are you getting your information from an individual who does not have a dog in the fight?  Or to put it another way, is your information on what actually happened coming from someone who has no financial or emotional gain or loss from the information they are giving you?