HJNO Nov/Dec 2024

POLITICIZATION OF COVID 14 NOV / DEC 2024 I  HEALTHCARE JOURNAL OF NEW ORLEANS phenomenally trained, phenomenally intel- ligent. They were the ones that were hesi- tant. They were getting pushed by the feds not to fill because they were fearful of their license and shutting their businesses down. The difference, as far as physician training, as the pharmacist do to a point, is we have the biochemistry, the physiology. We under- stand the process that goes on inside the cell as to its response to a particular insult. And, when I take all that into consideration, if you’re my patient and you come in with the high fever, the cough, all the things that COVID presented with, I’ll reach back in my brain to my first and second year of medical school, and I’ll pull all those things together, and then I’ll make a decision. Then, as a physician, I expect my prescriptions to be honored. If I didn’t have the training to pull back on those resources, then you could give me debate. But, until you’ve had that exact training that I’ve had, that Dr. Cole- man has had, that any physician has had, then please give us at least the benefit of the doubt that we are doing what we know is the best for our patient. Rep. Knox Yes, Sir and I appreciate that. I’m just trying to understand and maybe those who are watching may want to under- stand as well — why would they not fill the prescription? Coleman I think the pharmacists’ abil- ity to not fill up prescriptions is based on the idea that maybe if we write 1000 mil- ligrams, when we meant to write 10, then they would have the ability to stop and say, “I don’t think this is the right dose.” And that’s a good check and balance to have in there. Or, if they have some moral or reli- gious grounds, I think that there could be some of those on the abortion debate where they say, “I don’t want to fill this for some moral or religious reason.”Fair enough. But the off-label drug use question is one that came up in, I believe, one of these sessions earlier this year, and that’s a long-standing principle. So, the FDA approves drugs for a very narrow use. For example, I do cata- ract surgery, a lot of cataract surgery, and we use drops after cataract surgery to prevent infection, control inflammation, etc. None of those drops are approved for that purpose. They’re approved for other purposes, and then they’re repurposed for the use of con- trolling inflammation after cataract surgery. In ophthalmology, probably like 90% of the of the drugs that I use are not approved for the purpose that I’m using them. So that’s a long-standing principle which they would normally fill all that. I think because it did not go in line with the prevailing narrative, that’s when they said, “For a political reason, I’mnot going to fill these prescriptions.”And that’s where it’s so problematic, because if that’s the precedent, well, maybe they decide that they don’t like filling drops for cataract surgery one day because it’s off-label and they could stop that fromhappening, which would not be good. Rep. Knox So, if I am the patient and I have this relationship with my doctor, and I go to the pharmacist to get my prescription filled, where does that leave me when they decline to fill my … Coleman In a precarious situation. Abraham It leaves you in a very bad bind. Rep. Knox Yesterday, we discussed Budesonide. Is that something you all see as early treatment that has been successful? Abraham Yes, absolutely. Budesonide is an inhaled steroid, it was used in nebulization treatment, and it did work. Rep. Knox Does that work [because of COV- ID’s] inflammation? Abraham Exactly. That’s the reason it does work because of its anti-inflammatory component of being a steroid drug. Ste- roids, being anti-inflammatory drugs, if you wrench a knee, if you throw a shoulder out, you get a steroid injection because you got inflammation in that joint. In COVID, you had just significant and severe inflamma- tion in the lung field. Rep. Knox Can you explain or give an opin- ion as to why simple people like me did not hear more about this treatment and COVID as an inflammation-type disease, because from my appreciation, I akin it to a flu, a very serious flu, and therefore it’s infection and we should focus on that. I don’t recall, and I’m sure it may have been said, that there is an inflammatory side to this pan- demic that we’re experiencing as well. But I don’t recall hearing a lot about that side of this disease. Coleman It was top-down control of the nar- rative, and that did not go along with it. Abraham There were studies that would come out that I would catch one day, it would be up, that would go to that narra- tive — that there are good things that can be done with these particular off-label drugs. The next day, I couldn’t find it. Rep. Knox So, for inflammation, you would not have to social distance for that, correct? Abraham Yes, that’s correct. That’s a good point. Coleman Could you humor me for one sec- ond? You talked about the idea that there were some quacks, and I think that’s how a lot of people were portrayed for a while. I read this Michael Crichton quote, I thought he was a great author, but he wrote, “The greatest scientists in history are great pre- cisely because they broke with the consen- sus. There is no such thing as consensus in science. If it’s consensus, it isn’t science. If it’s science, it isn’t consensus. Period.” So, pretty much every great idea in science was come up with by a quack at some point until everyone figured out they were right.