I am a general physician and clinical pharmacologist at Wellington Hospital. I spend about half of my time as a hospital clinical pharmacologist, trying to educate the most junior prescribers how not to harm patients with very potent drugs. Sometimes I am successful. I also educate the next generation of prescribers via my role as a senior lecturer at OUW.
In my role as a general physician I frequently see frail elderly patients admitted with a “geriatric syndrome”, and have spent much of the last couple of years trying to pick apart the evidence around whether we are curing/caring or killing our patients by treating frail elderly patients with treatment regimens tested on 50yos with single organ disease.
In my spare time I do some work for PHARMAC, the Medicines Adverse Reactions Committee of the Ministry of Health, and the Standing Committee on Clinical Trials.
Why And What Does A General Physician Need To Know About MAbs?
Monoclonal antibodies are the “magic bullets” that many single organ doctors reach for when disorders such as many cancers, rheumatological disorders and others do not respond to traditional (small molecule) management.
Sadly for the general physician, there is no MAb available to manage multimorbidity, polypharmacy and frailty, so I won’t be revealing any new drugs not PHARMAC funded, but demanded by thousands!
Many patients present to general medicine with “undifferentiated illness”, and using a surgical sieve-like approach is the standard way to sift through the patient’s history, examination and investigations to arrive at a diagnosis. I will discuss several cases where the history was made more challenging due to the ghost-like presence of a MAb lurking in the corner of the room, largely unseen and forgotten until the penny dropped. I’ll cover some clinical pearls for generalists to take away for future Mab encounters.