PCOS-MEDICATION Messages for July, 2002: Metformin Debate (was Re: Dianette)

Metformin Debate (was Re: Dianette)

From: Fergus (anonymous@obgyn.net)
Fri, 5 Jul 2002 03:16:45 -0700

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>----- Original Message -----
From: "Victoria" <anonymous@obgyn.net> To: "Multiple recipients of list PCOS-MEDICATION" <pcos-medication@mail.medispecialty.com> Sent: Wednesday, July 03, 2002 7:15 AM Subject: Re: Dianette

> Is what you are referring to as uterine cancer not the same as endometrial
cancer? That was my assumption, and if that was wrong, I apologize.

If uterine and endometrial cancers are the same thing, that's news to me. I thought they must be difference since they have different names.

> > Why any treatment? Surely the purpose of treatment is to achieve the
best > > possible result. I am not convinced that diet and exercise alone
achieve a > > better result than combining these sensible factors with Glucophage.
>
> There has been at least one head to head Metformin vs. diet/exercise that
showed Metformin prevented 31% of the time, 58% for diet and exercise. There was no test of Metformin with diet and exercise to find out if that beats each one alone. Theoretically that should be true, but who knows?

We should make the best decision we can with available information. If we have every reason to believe a combination therapy of metformin with diet and exercise will have the best result, that's what we should do, isn't it? Let's eagerly await further research that will settle your doubts about metformin with diet and exercise versus diet and exercise alone, but in the meantime, there seems every reason to conclude metformin is ideally part of the solution. I write ideally because not every woman can tolerate it, so sometimes it is forgone.

> > I know of an old man who smoked multiple times a day for 75 years. He
> > smoked cigars that smelled like burning tires and a pipe. He died at
the > > age of 96 of unrelated causes. Should we conclude that smoking is not a
> > health risk? Or is it more reasonable to interpret these anecdotes as
an > > indication that one person proves nothing?
>
> Kat Carney was being as an example. Not everyone who uses diet and
exercise to keep problems at bay is going to say so. Tis the squeeky wheel who gets the grease. If that's the case, then some of Dr. Glueck's studies may have to be thrown out, as others.

Yes, I understand that Ms. Carney was being used as an example. My response was, and remains, that such examples aren't necessarily useful. Do you believe the old man who I have used as an example is a strong piece of evidence that there are little or no dangers to smoking?

Who is Dr. Glueck?

> > Likewise, it's valuable to consider what helps most people the
> > most.
>
> True. Which is why I go back to the study I was talking about.

But the study is immaterial, IMO. It does not address my position, which is that metformin with diet and exercise is the best treatment.

> If we do have a subset of those who aren't IR, or Metformin doesn't help,
we would need to test for that, and provide alternatives. If the drug isn't effective for everyone, we need to provide options to people outside of Glucophage.

So how do we know that these people who claim they're not IR aren't IR? Is this just anecdotal?

> No. I made the statement because I've been publically accused before of
not being 'for Metformin'.

With respect, it doesn't seem to me that you are for metformin as a standard treatment of PCOS.

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