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Prescribed Killers

by Nancy Shute

Source: U.S. News Online 4/27/98

Big killers.gif (11434 bytes)You're more apt to die from prescription medication than from an accident, pneumonia, or diabetes. That's the unsettling news that last week came out of the Journal of the American Medical Association, which found that adverse drug reactions may be the fourth-ranking cause of death in the United States, right after heart disease, cancer, and stroke.

All drugs can harm as well as heal; doctors know that when prescribing. But even the researchers were surprised at the number of deaths, between 76,000 and 137,000 a year, plus 2.2 million serious nonfatal reactions. "We were shocked," says Bruce Pomeranz, a researcher at the University of Toronto who coauthored the article, which analyzed 39 studies conducted over three decades. The numbers are even more chilling because the researchers excluded cases where drugs were misprescribed or used wrongly. "It doesn't matter if you're getting the drug at the Mayo Clinic or in Oshkosh, Wis.," Pomeranz said. "It's not a question of quality of care."

Rarely reported

Adverse drug reactions come in two major types: the "too much of a good thing" effect, as when a blood-pressure drug lowers pressure too much; and unexpected reactions because the drug's mechanisms aren't fully understood. This includes liver damage caused by the painkiller acetaminophen (Tylenol?). One reason the JAMA numbers seem shocking is that adverse drug reactions are rarely reported: A death will be recorded as kidney failure, not as a drug reaction causing the kidney failure. (The authors used studies that had a researcher in the hospital recording data at the time of death.) Physicians are asked to file reports to the Food and Drug Administration, but most doctors, already swamped with paperwork, don't bother; in 1994, the FDA received notice of just 3,500 such drug-reaction deaths.

The notion of pills that kill is especially scary because drugs are so essential to modern medicine. Physicians, who are wooed by pharmaceutical companies from the moment they enter medical school, trust drugs as their primary treatment tool. They aren't above writing prescriptions just to hurry patients out of the examining room. People demand drugs even when they're useless, like antibiotics for the common cold, a viral infection. "We are really in love with prescriptions," says Raymond Woosley, chairman of the pharmacology department at Georgetown University in Washington, D.C. "We pop pills without thinking of the consequences."

Nobody's saying it's time to throw out the prescription bottles, but the risks could be reduced substantially if we put as much effort into reducing adverse drug reactions as we do into improving highway safety. At present, the FDA gets only $9 million a year to police drugs once they're in the marketplace, which is where many unexpected effects surface. It wasn't until the antihistamine Seldane had been taken widely, for instance, that it was found that it could cause heart arrhythmias if taken with antibiotics. The $81 billion prescription-drug industry is only now starting to look into why people metabolize drugs differently, depending on age, gender and ethnicity. And doctors and patients need to remember that the cure sometimes is worse than the disease.


This death rate is roughly equivalent of a Boeing 747 crashing every day of the year. Americans would never stand for that kind of wanton recklessness from the airline industry. Why is it that we allow the health care industry to get away with it? When is the last time you heard of someone dying because they consumed an herbal food supplement??? [Click here for 2009 statistics]


Related Links

Healthtouch Online
Information on drug interactions and essential questions to ask your doctor or pharmacist, from the Council on Family Health, a nonprofit health education group.
RxList
Entries on hundreds of drugs, with possible side effects and contraindicated interactions, plus links to pharmaceutical networks. This independent site is maintained by a pharmacist working at a major pharmaceutical company.
PharmInfoNet
Drug database organized by generic and trade names. Answers to questions about commonly prescribed drugs. Provided by a group of pharmacists and regulatory experts.
Mayo Health Oasis
Tips from the world-famous clinic on avoiding adverse food and drug combinations.

Related U.S. News Articles

Note: Because some of these articles are dated several years ago, they may no longer be available on the Internet.

Dangerous Drugs
What your doctor doesn't know about a medication's side effects could kill you. (1/9/95)
Behind the Pharmacy Counter
Just because a drug has been recalled doesn't mean patients aren't still taking it. (5/15/95)
Getting In Sync
Some drugs work best when administered to fit the body's schedule. (5/27/96)
The Big Pill Push
Doctors and pharmacists are under pressure to switch medications. Guess who pays the price? (9/1/97)
 

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