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@AdrianHarrop Dear Adrian, I'm sure you wouldn't wish to encourage reckless prescribing. 1/ As with any drug, the harm:benefit ratio depends on indication, dose, time etc. Insulin is vital in Type 1 diabetes, and can be fatal in the well
@AdrianHarrop 2/ There is no comparison with menopause guidance nice.org.uk/guidance/ng23. The menopause is not a disease of oestrogen deficiency (but a kind of withdrawal from one normal level to another), there is a LOT of research. @NICEComms
@AdrianHarrop @NICEComms 3/ General pharmacological principle is to use the smallest dose for the minimum time.
@AdrianHarrop @NICEComms 4/ Open ended prescribing of a powerful drug with psychoactive effects requires proper shared decision making - here where there is an absence of good decision aids or evidence, for a much less well understood indication and harms:benefits
@AdrianHarrop @NICEComms 5/ Thus its important for us all to be clear thinking, and to address the evidence and uncertainty gaps - which is the basis of present differences in thinking/approach between 1ry, 2ndry & 3ry care.
@AdrianHarrop @NICEComms 6/ Some people might think it mischievious to deliberately muddle the (usually temporary & well researched) prescribing of oestrogens for women with menopausal symptoms with the (planned permanent & less well documented) prescribing of oestogens to natal male/ transwomen.
@AdrianHarrop @NICEComms 7/ I want to do right by all patients, with compassion and dignity. But when asking GPs to prescribe drugs for life (& more esp for new group of female-to-male adolescents), I think its OK to ask for & generate evidence. DOI Chair @HealthWatchUK
@AdrianHarrop @NICEComms @HealthWatchUK 8/ Also, in interests of transparency, DOI here at whopaysthisdoctor.org/doctor/58
