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One out of every four people who take prescription drugs experience adverse side effects.

But that’s not the bad news.

According to a study released last month, almost 40 percent of those side effects cases are preventable, and in almost half of the preventable cases the wrong drug is prescribed.

The study also identifies three types of drugs that may produce the most common problems with side effects. And there’s a very good chance that one of those drug types is in your medicine chest.

 

 

Runaway train 

By some estimates, more than a million people each year are admitted to a hospital for treatment due to drug side effects. And while that’s bad enough, it’s considered a very low estimate of just how many side effects occur because most cases are not documented.

A study from Brigham and Women’s Hospital in Boston revealed some of the realities behind those estimates. The BWH team surveyed more than 1,000 outpatients who received at least one prescription over the course of 4 weeks. In addition to the result I mentioned above, researchers found that problems from side effects stemmed primarily from physicians who failed to respond to medication-related symptoms, and (to a far lesser degree) patients who failed to inform their physicians of the symptoms of side effects.

And while these troubling results are not really surprising (not to HSI members anyway), two comments made by the lead author of the study Tejal K. Gandhi, M.D., M.P.H., struck me as way off the mark in assessing the role of pharmaceuticals in healthcare, and the responsibility of doctors.

Failure to communicate 

In an absurdly simplistic defense of physicians, Dr. Gandhi told Reuters that it’s difficult for doctors to find out if symptoms are bothering patients “with these 10-minute appointments.”

 

Wait a minute. First of all, the length of an appointment is completely controlled by the doctor. But no matter what the length – 5 minutes, 10 minutes, 90 minutes – it’s the doctor’s responsibility to provide health CARE. In theory, a doctor knows what drug he’s prescribed for the patient, he knows the likely side effects, and if he exhibits what I would consider the very least amount of care, he would know exactly what questions to ask a patient in order to be certain that no unwanted side effects were taking place.

The study found that part of the problem lies with poor communication on the patients’ part. And while the patients are not necessarily blameless (it’s easy to imagine, for instance, a patient who purposely misleads his doctor for fear of unwanted hospitalization), it’s the doctor’s responsibility to be diligent in asking the right questions, and not settling for easy answers.

Of course, this doesn’t even touch on the subject of doctors who don’t really WANT to hear about adverse side effects when they’ve prescribed a drug manufactured by a pharmaceutical company that has wined and dined, and perhaps even provided them with “consulting fees.” (If you want to open that can of worms, see the 9/23/02 e-Alert “The Drug Salesman & The PhRMA’s Daughter.”)

Discourage me 

Dr. Gandhi also expressed dismay that the side effects of a drug might “discourage patients from taking vital medicines.”

Well I should hope that side effects WOULD discourage patients! Side effects are a drug’s way of saying, “Don’t take me!” And unless a drug has the potential of saving a patient’s life (such as chemotherapy might), it’s clearly foolish to take a path to improved health that only manages to put you on the path to another health crisis.

If Dr. Gandhi has any notion that reliable healthcare is available that doesn’t depend on pharmaceuticals, that wasn’t reported by Reuters.

3 least wanted

The data from the BWH study showed that three types of drugs pose the highest risk of side effects:

  • Selective serotonin-reuptake inhibitors (SSRI) – such as Prozac and Zoloft, prescribed to treat depression
  • Beta-blockers – such as Inderal and Lopressor, prescribed to treat hypertension, congestive heart failure, and abnormal heart rhythms
  • Non-steroidal anti-inflammatory drugs (NSAIDs) – such as aspirin and ibuprofen products, used to treat joint pain, headaches, etc.
And although all three of these drug types should be used with caution, it’s that third one that’s particularly worrying. Because not only are NSAIDs available without a prescription, but they’ve also been shown to contribute to liver and kidney impairment, painful gastrointestinal conditions, and an increased risk of hypertension.

Well over 3 billion prescriptions were filled in the U.S. last year. If the BWH data accurately represents adverse side effects nationwide, then hundreds of millions of patients suffered side effects.

You have to wonder – how many times does it have to happen before people really do become discouraged from taking “vital” medicines?


To Your Good Health,

Jenny Thompson
Health Sciences Institute

Sources:
“Adverse Drug Evens in Ambulatory Care” New England Journal of Medicine, Vol. 348:1556-1564, No. 16, 4/17/03, content.nejm.org
“Medication Side Effects Strike 1 in 4” Reuters, 4/16/03, msnbc.com

 

 

 

 

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Dr. Allan Spreen, Chief Medical Advisor

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