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    Thursday, October 19, 2006

    One Man's Poison: Shocking news today. Medicine is poisonous:

    Harmful reactions to some of the most widely used medicines -- from insulin to a common antibiotic -- sent more than 700,000 Americans to emergency rooms each year, landmark government research shows.

    Accidental overdoses and allergic reactions to prescription drugs were the most frequent cause of serious illnesses, according to the study, the first to reveal the nationwide scope of the problem. People over 65 faced the greatest risks.

    ``This is an important study because it reinforces the really substantial risks that there are in everyday use of drugs,'' said patient safety specialist Bruce Lambert, a professor at the University of Illinois at Chicago's college of pharmacy.

    Even so, the study authors and other experts agreed that the 700,000 estimate was conservative because bad drug reactions are likely often misdiagnosed.

    The study found that a small group of pharmaceutical warhorses were most commonly implicated, including insulin for diabetes; warfarin for clotting problems; and amoxicillin, a penicillin-like antibiotic used for all kinds of infections.

    ....Those age 65 and older faced more than double the risk of requiring emergency room treatment and were nearly seven times more likely to be admitted to the hospital than younger patients.


    This should surprise no one. Every treatment has its risks. Everytime a doctor prescribes a medication, he's weighing the risk of the medicine against the risk of the disease it's treating. That's why we don't lik to prescribe antibiotics for viral infections. Does this mean we should avoid amoxicillin, insulin, and coumadin? No. Amoxicillin made that list because it is the most commonly prescribed antibiotic. Coumadin, which inhibits blood clotting, made the list because it not only has a narrow therapeutic range, but its levels are easily influenced by other drugs and even diet. The dosage that works today may be overkill tomorrow if the diet changes or you take the wrong drug. Unfortunately, the most common use of coumadin is to prevent strokes in elderly people who have atrial fibrillation. It isn't the best age group for the drug since they are more liklely to suffer from polypharmacy not to mention falls. Oh, and the very elderly (over 75), also are intrinsically at greater risk of bleeding to begin with (bleeding ulcers, cerebral hemorrhages, etc.) Studis maintain that the risk of stroke in elderly patients with atrial fibrillation is greater than the risk of bleeding from their anti-coagulant, but I sometimes have my doubts. And insulin? Well, one of the prices we pay for adhering to strict guidelines for diabetes care is that we have more episodes of dangerously low blood sugars.

    So, it would seem we have somewhat of a paradox here, does it not? Practicing quality guideline medicine sometimes does more harm than good. It is important, however, to put these numbers into perspective. 700,000 injured people a year is an awful lot of people (it's more than the Iraqi war dead!), but as a percentage of emergency room visits and injuries, it's not so impressive:

    Over the 2-year study period, 21,298 adverse drug event cases were reported, producing weighted annual estimates of 701 547 individuals... or 2.4 individuals per 1000 population... treated in emergency departments.

    That translates into 0.24% of emergency room patients. They don't tell us how many people turned up in the emergency room with conditions that required treatment with those drugs, but I suspect the percentage of emergency room patients in that time frame who were in need of them drugs was far greater than those harmed by them.
     

    posted by Sydney on 10/19/2006 09:15:00 AM 2 comments

    2 Comments:

    Remember when, back there not so long ago, "chemicals" changed in the public's view from being benign and helpful substances, to threatenting and harmful? So today we have chemical pollution, chemical dependence, chemical poisoning, etc etc. How did I ever survive my Gilbert chemistry set? How did duPont ever sell the public on "better things for better living thru chemistry"? Tis a puzzlement in this, our sophisticated age.

    So now, I gather people are starting to understand that medicine - and even food - are also chemical.

    How nice. A healthy respect for how medicines actually work can't be all bad. It might even lead to more patients actually paying attention to the prescribing instructions. Whaddya think?

    John Fembup

    By Anonymous Anonymous, at 9:24 AM  

    I wish people had a healthy repect for all chemicals, including an understanding that the natural ones can kill you. Whenever I had a patient going overboard on natural treatments (I am not against all of them, BTW), I liked to point out that caffeine, heroin, morphine, cocaine, digitalis, Vitamin A and alcohol are all natural chemicals.

    I also find patient's perceptions of medications depends on if you call them "medicines," or "drugs"!

    By Anonymous dani, at 5:28 PM  

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