![]() ![]() Chris Adigun, a dermatologist practicing in North Carolina who did not work on the study.įor one, the pills work only about half of the time and must be taken for up to six months, depending on how severe the fungus is, and Adigun says there's still a 2 percent chance for other side effects. "Just assuming is safe, let's prescribe it for every clinical diagnosis for onychomycosis doesn't translate perfectly into practice," says Dr. It would be better, Pandya says, to slash procedures that don't make economic sense.īut other doctors say it's not that simple. It becomes an insatiable cash-scarfing beast latched onto the end of your foot. Then, a toenail fungus is not just a toenail fungus. The cost to treat even minor nuisances can skyrocket. Insurance premiums hurt, even for cheap plans. This is part of the reason why health care is so expensive. These are dollars that could trickle back into our pockets on a societal level." ![]() Either our tax dollars or our paychecks as we pay more in premiums and deductibles increase. "These extra health care costs are coming from somewhere. The cumulative cost of all these decisions results in a needless burden on the health system, says Ankur Pandya, a health decisions scientist at Harvard University who was not involved with the study. "As soon as there are articles mention 'you should use this safe topical medicine,' doctors say, 'I am not going to put myself at risk.'" "The problem with this drug is that it isn't 'lifesaving' like cardiac medicine," he says. They want to avoid any potential liver injury and malpractice lawsuits. Under the influence of this misconception, Kanzler says both physicians and patients elect to use more expensive topical treatments, like a new drug called Jublia that costs thousands of dollars per nail and works about 15 percent of the time. Matt Kanzler, a dermatologist at Palo Alto Medical Foundation, tells Shots in an email. "I think that 'people' think that terbinafine is dangerous because their primary care doctors and even dermatologists have told them that!" Dr. That's the reason why doctors almost always order lab tests, so that people without a fungal infection wouldn't be taking that risk.ĭermatologists know now that the chance for liver damage from terbinafine is less than 1 in 100,000, and yet the message persists. Arash Mostaghimi, a dermatologist at Brigham and Women's Hospital and Harvard Medical School and senior author on the study. "Practitioners were uncomfortable giving it because of the consequences, and we unfairly discouraged a lot of people from taking it," says Dr. Considering that at least 10 percent of Americans have toe fungus, the health care system could be saving between $18 million and $90 million by skipping the testing, the researchers say.īut some people are reluctant to use terbinafine because there's a risk of liver damage, a fact that was emphasized when it came on the market decades ago.
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