Friday, June 8, 2012

Prescription Drugs: Even More Deadly?

In the past I have blogged about Donald Light's important work on the risks of prescription drugs:

Now, here's journalist Jeanne Lenzer on the same issue in the BMJ (I am not sure if this link provides free access to non-subscribers):

Ms. Lenzer cites a new study that uses the FDA adverse reactions report database to calculate the estimates that in 2011, between 2 and 4 milion Americans suffered some sort of serious reaction of prescription drugs taken properly and in the correct dose, and 128,000 died. The latter estimate fits well with Don Light's earlier work that the annual death toll is conservatively estimated at 100,000, making it the 4th largest cause of death in the US. The new study also shows that 11% of the US population is taking 5 or more drugs, which every physician knows is a setup for dangerous drug interactions.

The top troublemakers on this list were anticoagulant drugs that caused dangerous bleeding. One was warfarin, which is an old generic and is not marketed by any company. But the other is one of the new kids on the block, dabigatran (Pradaxa), which is being heavily marketed because it's a new agent and supposedly a lot safer. Another big problem drug in this review is the antibiotic levofloxacin (Levaquin) which is so widely used in hospital as well as outpatient medicine that it's often jokingly referred to as "Vitamin L."

So why is this important? Well, we might ask the American Enterprise Institute. This conservative think tank recently announced a conference:

The idea behind this appears to be that regulations and restrictions are hampering drug reps' access to docs. This is of course bad because these drug reps are a wonderful source of up-to-date, accurate information. So it will no doubt seriously harm patients if these reps can't do their good deeds.

So we have to set up a scale to weigh the pros and cons accurately. On the one side we have to put the possibility that because industry marketing cannot reach some physicians, patients might suffer harm--despite many previous studies that all show that drug reps, when they interact with docs, always tend to downplay any risks of drugs. On the other side of the scale we can put 128,000 deaths per year due to our crazy, overboard overprescribing practices, much of it fed by industry marketing.

You can make guesses as to which way the scale will tip.

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