Several months ago I panicked when I had to have a tooth removed and the oral surgeon (MD/DDS) told me that he was scared and that his malpractice provider wanted to make sure my informed consent was more “informed” then normally required for an extraction.

I called Rugerio and two oncologists at Harvard who study BRONJ. They helped me and the dental surgeon relax enough so that I went ahead with the extraction.
So far so good–no jaw problem.

The take away message from all this drama was no one really knows the etiology
of the problem. Therefore it is very difficult to find an answer. It seems to me that if a drug alters the remodeling of the bone the risk of jaw necrosis remains on the table.

RHUP20 may make bisphosphonates more palatable for people who fear esophageal cancer but it will make the drug company and doctors even happier because injections are given in doctor’s offices, pills are taken at home, and infusions are given in hospitals. The docs are being squeezed by HMO and Medicare so they need a way to get people coming into the office. Pills and infusions don’t cut it.

Zometa (about 2 thousand dollars per injection) goes generic fairly soon. Fosamax has received bad press. If I were on the lawyer/marketing team I would want a replacement drug in the pipeline to keep the income flowing.

I don’t think my reasoning is cynical. This is the way we work together to solve problems. Medicine is in the marketplace and it is there to stay. As long as we blindly hope for Dr Welby to start caring for us again we won’t be able to address our broken health care system.