DON'T BE A FRIENDLY FIRE CASUALTY IN THE WAR ON DISEASE
Accidental death from prescription drugs, even when they are correctly given, is now the fourth leading cause of death in the U.S.
Before you pop another prescription pill, think carefully. Just because your doctor prescribed it is no guarantee you'll benefit from it or even emerge unscathed from the experience. That prescription pill could be hazardous to your health - and life. Ask Stephen Fried.
He wishes he could have read his own book, "Bitter Pills: Inside the Hazardous World of Legal Drugs," (Bantam Books, 1998), before his wife, Diane Ayres, go "floxed" from a bad drug side effect. Diane took a single pill of an antibiotic called Floxin for a urinary tract infection and a few hours later ended up in the emergency room with acute delirium.
Serious side effects happen often enough with Floxin, an FDA-approved drug, that those in the know refer to the experience, in a kind of grim flippancy, as getting "all floxed up." But for Diane, getting floxed up didn't end only with a flurry of medical concern and a battery of tests by hospital staff. Floxin triggered her genetic predisposition to neurological illness which then manifested as mood disorders and manic depression. These in turn required a series of "heavy- duty drugs" to undo, says Fried.
The experience was a deeply traumatic one for Fried and inspired him to find out how such an event could happen. it turns out it happens a lot. "An investigative journalist and exasperated husband, I am trying to find out if my wife was the victim of a pharmacological foul- up or just a statistically acceptable casualty of 'friendly fire' in the war on disease." By the time you finish reading Fried's chilling expose' of the world of prescription drugs, it's clear Diane Ayres' situation was not a foul-up but a friendly fire casualty, one of millions, in fact - business as usual in the world of legal drugs.
Fried learned that well over 100,000 Americans die every year from adverse reactions to prescription drugs and that drug side effects are a leading cause of death in the U.S. (See "The FDA's Skewed Policies," this issue, pp 104 - 105.) The worst thing that can happen to you when you take a legal drug is not that it won't work, but that you might drop dead, Fried Says. "The next worse is that your body is permanently damaged."
A little further down the list of drug-induced disasters is that you fall into that seemingly endless "cascade of prescribing" where you need a half dozen strong drugs to undo the side effects of the first one, and then a lot of time to recover from the effects of all of them, as Diane Ayres learned the hard way.
Let's enlarge our perspective a little and look at the scope of prescription drug sales and adverse drug reactions in the U.S. We're talking about an $85-billion-a-year U.S. market for pharmaceuticals, based on 1996 data. Coupled to this figure is a steady yearly rise in consumer prices for the top 500 prescription drugs at a rate that exceeds inflation.
The hidden cost of this drug "bonanza" is only beginning to emerge. New studies show that mistakes in drug prescribing and side effects from prescription drugs cost at least $76 billion a year (and could be as high as $136 billion, according to other estimates) in extra medical costs. The largest factor contributing to the additional cost is adverse drug effects requiring hospitalization. These mistakes may also double the risk of death.
Remember, Fried's data deals with correctly prescribed drugs; you have to add to this the costs and consequences of incorrectly prescribed medications. The misuse of prescription drugs, leading to injury and death, represents a "serious medical problem" that "urgently" requires attention, according to "Archives of Internal Medicine."
To put this in perspective, in 1994, the year this data was collected, Americans spent over $73 billion on prescription drugs. This averages out to $292 per person to buy the drugs and an additional $306 to treat the adverse effects of using these drugs. The math is simple: that's about $600 for every American man, woman, and child in the U.S.
A new study of 1,580 cases tracked at a single hospital over a year shows that adverse drug events (ADEs) were involved in 2.4 per 100 admissions, producing an additional hospital stay of 1.9 days, costing $2,262, and increasing the risk of death by 1.88 - a nearly twofold increase. Out of 91,574 patients admitted to a single hospital over a three-year period, 2.43% (2,227) experienced ADEs. According to the study, ADEs may account for 140,000 deaths per year in the U.S.
A six-month study tracking 4,108 admissions at two hospitals reported similar results. There were 247 ADEs among 207 admissions (some people had several ADEs), requiring an average of 2.2 extra days of hospitalization at a cost of $3,244 per person. For ADEs that were judged to be preventable, 4.6 extra hospital days per person were required, costing $4,685. The estimated average cost attributable to both types of ADEs for a typical 700-bed hospital is $8.4 million per year.
A third study indicated the types of prescribing errors doctors typically commit, based on data collected over a year from a 631-bed hospital. Pharmacists reviewed 2,103 prescribing errors and found that the error rate was 3.99 per 1,000 drug prescriptions. Among these, 12% of the errors involved overlooking patient allergy to the type of drug, 11% were due to incorrect dosages, and another 11% to using the wrong drug name.
In yet another study, researchers reported that about 30% of the prescribing errors were due to lack of knowledge regarding drug therapy, 29% to lack of knowledge regarding patient interactions with drugs, 17% to arithmetic mistakes, and 13% to using the wrong drug name.
The error rate was highest (5.89 ADEs per 1,000 prescriptions) for pediatric patients, followed by 5.05 for emergency-room patients, 4.5 for obstetrics-gynecology, and 3.5 for surgical patients. Prescribing an overdose was the most common error, accounting for 41.8% of all mistakes.
The pattern of damages, even deaths, created by dangerous drug interactions is already repeating itself in the case of Viagra, the impotence drug released in April 1998 by Pfizer, Inc., of New York. In its first month on the market, 1.7 million prescriptions were filled for the pill promising relief from erectile dysfunction.
Yet soon after, 16 deaths occurred in users of Viagra, presumably from fatal drug interactions. Specifically, drugs given for heart pain (angina), such as nitroglycerin-based nitrate drugs, seemed to produce the most dangerous interaction with Viagra. In fact, there are at least 41 different nitroglycerin formulations or nitrate-based drugs that are believed to make a deadly combination with Viagra.
With these facts in mind, it's easier to understand the shock, outrage, and urge to find an alternative that inspired Fried both to help his wife heal from the bad effects of Floxin and to write his book.
Fried also got a formidable political education in the course of his research. He began to see how and where the power is stacked up in the world of legal drugs and how little science and how much marketing and political influence have to do with medical care in conventional medicine. It's a power play on a global scale, Fried says.
Drug companies are merging and in turn buying firms that decide which drugs the HMOs will get, says Fried. The drug companies are controlling the flow of information about the medicines to doctors and the public; they're directing the allocation of funds for drug research and physician education; and they're going after the consumers directly in a massive advertising campaign to stir up interest in their latest products.
Fried's revelations are sobering. If you thought illegal drugs was the major drug problem, you'll look at "the other drug problem" - legal drugs - far more critically after reading "Bitter Pills." Passivity and lack of knowledge in the face of prescription drugs could cost you your life.
"Understanding drug reactions has been a way to explore what is wrong with the entire international pharmaceutical business - a $250 billion enterprise ($700 billion if you count all the other products sold by drug companies) that has managed to repel scrutiny more effectively than almost any other major industry, while remaining the world's most profitable industry through many changes in economic climate," says Fried.
Presiding over this global drug cover-up is the FDA, an agency responsible for "regulating 25% of America's entire gross national product and whose policies are the benchmark for world regulation of drugs and medical devices," says Fried. If this information is new to you, by the time you finish his report, your eyes will be wide open and you may feel angry enough to take political action. You certainly will think very hard before you automatically take that next drug.
The point is, his wife's bad drug reaction - it took her four years to recover from it - could happen to anyone who takes a prescription drug. One doctor told Fried that antibiotics, the second most commonly used class of drugs in the world, are improperly prescribed 40% to 50% of the time, due to wrong dose, wrong duration, wrong drug. "Apparently everyone in medicine knows this except the patients," says Fried. Now you do, thanks to Fried.
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