|
medpundit |
||
 |
 |
|
Thursday, November 06, 2003Doctors are giving their patients epilepsy drugs for depression and hot flashes and to help them lose weight. They use antidepressants to treat premature ejaculation and pain, and powerful antipsychotics for insomnia and attention deficit disorder. High blood-pressure pills are prescribed for headaches and anxiety; antibiotics are used to treat viruses. The use of antibiotics "to treat viruses" isn't an off-label use, it's an inappropriate use, often born of the difficulty of distinguishing a viral respiratory infection from a bacterial one, and succumbing to patient demand. High blood pressure pills to treat migraine headeaches refers to the use of beta blockers and calcium channel blockers to treat chronic migraine sufferers. It's true that the FDA hasn't approved the drugs for that specific indication, but they've been used that way for years, and they work. And, why would taking a pill every day for headaches be any more dangerous than taking it every day for high blood pressure? In fact, one could argue that the migraine sufferer sees a much more tangible benefit for his drug risk than the hypertension patient, since hypertension is asymptomatic. "Powerful antipsychotics for insomnia" refers to the use of antipsychotics for the elderly demented who often wander at night and have hallucinations. It cuts down on their hallucinations and gives their caregivers some peace. I haven't seen antipsychotics used for attention deficit disorder, so I can't comment on that one. Yes, anti-depressants are used for chronic pain and they're effective in helping to alleviate it because: 1) they work at the level of the pain receptors to decrease the transmission of pain and 2) chronic pain induces depression which in turn increases sensitivity to pain. Anti-depressants break the cycle. They also help treat premature ejaculation (especially the SSRI's) because one of their side effects is delayed orgasm. Again, there's no reason to think that taking a pill like Zoloft or Prozac once a day to delay orgasm or to dull chronic pain is any more dangerous than taking it once a day to treat depression. The Knight-Ridder series blames the problem on "tepid regulators" and "cavalier doctors" but they forget to mention the role of the press in the widespread use of medication for off-label purposes. They often aid and abet the pharmaceutical industry by publishing glowing reports of the latest research on the latest drug without ever taking the trouble to critique the data. They help create a demand for drugs that would not otherwise be there. But don't look for that admission anywhere in the series. It would require too much introspection, a quality which seems to be congenitally absent from journalists. Not that they would be any good at critiquing data, judging by this description of the methodology used in their series: To estimate how often patients are harmed by this practice, Knight Ridder reviewed the FDA's database of adverse drug reactions. The FDA estimates that only 1 to 10 percent of reactions are reported. Knight Ridder identified more than 800 reports filed during 2002 of serious reactions involving off-label prescriptions for its sample of 45 drugs. Experts say that means anywhere from 8,000 to 80,000 people probably were affected. That's quite a spread. But, in the world of Knight-Ridder, that bit of journalistic conjecture passes as scientific truth. Then there are the unexamined case histories. The first article opens with the story of a woman who developed a heart problem after having twins. She took terbutaline, an asthma drug, to stop premature labor for the last three months of her pregnancy. She blames the drug, even though pregnancy and delivery in themselves run a small risk of heart damage. In fact, she says she hates the drug, and she has a lot of animosity toward her obstetrician, too. However, at the end of the article, we learn that she wanted her babies so badly she went to the time and expense of in vitro fertilization to get pregnant. Can she honestly say that given the choice again, she would forego the medical treatment and elect to expose her babies to the risk of death by having them three months prematurely? The second article opens with a suicide tale. The doctor, a cardiologist, blames Prozac. So does the patient's family. They all say he wasn't depressed. But all too often in depression, the family is the last to know (or admit it.) And why would the cardiologist put the patient on Prozac if he didn't think he had at least a modicum of depression? Far more likely that the man committed suicide because he was depressed rather than because he took Prozac. The final article details the case of a young woman who died of Stevens-Johnson syndrome after taking the antibiotic Avelox for a respiratory infection. Stevens-Johnson syndrome is a severe auto-immune reaction that can be fatal. It can be associated with any drug, not just Avelox. It's one of the risks we take each time we take an antibiotic. What's more, it can be caused by a virus or a bacteria, too, so foregoing antibiotics for an infection doesn't protect you from getting it. To give you an idea of how many agents have been implicated in the syndrome, here's a partial list of drugs: * Fansidar-R * Sulfadiazine * Sulfadoxine * Sulfasalazine * Trimethoprim-sulfamethoxazole * Carbamazepine * Phenobarbital * Phenytoin * Acetaminophen (Tylenol -ed.) * Allopurinol * Aminopenicillins * Amithiozone * Amoxapine * Barbiturates * Cephalosporins * Chlormezanone * Clobazam * Diclofenac * Fluvoxamine * Hydantoins * Imidazole antifungals * Indapamide * Lamotrigine * Macrolides * Mianserin * Oxicam nonsteroidal anti-inflammatory drugs (NSAIDs) (eg, piroxicam, tenoxicam) * Propionic NSAIDs * Propranolol * Pyrazolone derivatives (eg, dipyrone) * Quinolones * Salicylates (aspirin - ed.) * Sertraline * Tetracycline * Tiapride * Trazodone * Valproic acid Note that the list includes old stand-by antibiotics like the penicillins and sulfas, and that it includes aspirin and Tylenol. And here's the list of infectious agents that have been associated with it: * Adenoviruses * Calmette-Guérin virus * Deep fungal infections * Enterobacter * Enteroviruses * HSV * Influenza * Measles * Mumps * Mycobacterium tuberculosis * M pneumoniae * Streptococcus pneumoniae * Syphilis * Typhoid fever Five of those agents - adenoviruses,enteroviruses,influenza, M pneumoniae, and Streptococcus - cause respiratory illnesses. The reporter may accept unequivocally that the young woman's death was the caused by her anitbioitic, but in truth there's just no way of telling. But then, they don't really care about the truth. They just want to prop up their themes that drug companies are bad, the FDA is useless, and doctors are "cavalier." posted by Sydney on 11/06/2003 08:16:00 AM 0 comments 0 Comments: |
|
