Tossing the Baby Out with the Bath Water

While I was doing the online equivalent of dumpster diving this weekend, I stumbled upon a number of tweets and questions surrounding the use of medications.  On the one hand, many people write into any number of health care forums (I participate on www.healthtap.com) and ask about possible drug-drug interactions regarding their regimen.  I find this a sad commentary as these questions should have been addressed by the physician at the time of prescription & re-addressed by the pharmacist at the time the medication was dispensed.  Unfortunately, in this day and age, we don't have time to go into detail with our patients as accountable care organizations force us to become more efficient at data entry under the guise of providing better care.

As a result, there has been a backlash by patients who've lost their trust in their doctors aka healthcare providers.  We're seen as pawns of Big Pharma, or worse, as salesmen pushing the latest medication on an unsuspecting population.  Selective serotonin reuptake inhibitors are now being blamed for suicides and homicides.  Yet, just two short decades ago, these very same SSRIs were considered a God-send as they were found to be useful in treating those with depression.  And if you think about it, who's more likely to commit suicide?  A depressed person or a non-depressed person?  So blaming SSRIs for causing suicides is like blaming cars for killing others while the driver was under the influence.

Don't get me wrong.  Many drugs have been pulled off the market just as soon as it was deemed the appropriate thing to do.  Some have required more time to uncover their risk given the small chance of something going bad.  A good example is the Food & Drug Administration's recent warning for heart rhythm problems in association with Azithromycin.  How ironic that it's taken this long after FDA approval in 1991 to uncover a link between Azithromycin use and heart rhythm disturbances in those w/QTc prolongation.  In fact, this link was first published last May in the New England Journal of Medicine.

So is this an isolated incident?  It's more likely a class effect as it's cousin, Erythromycin, has also been linked to heart rhythm disturbances.  And now, another family member, clarithromycin was just linked to increased risk of cardiovascular events in a study published last week in the British Medical Journal.  The point of my diatribe is not to classify this particular family of antibiotics as inherently & overwhelming dangerous and in need of being pulled off the market, but to point out how we must balance need for benefit against potential risk of side effects.  Surely, you shouldn't take any medication unless you need to do so.  By that same token, always ask your doctor about alternatives, side effects & interactions.  And find out what are the consequences of not taking the medication.  

If you're depressed such that counseling isn't enough, yet refuse to take any antidepressant out of fear that it might cause suicide/homicide, you just might commit some regrettable action even w/o taking said medication.  Likewise, if you're now afraid of taking any antibiotic (healthy skepticism is a good thing), then your risk of dying from said infection is greater than if you didn't take the appropriate medication.  So be sure not to rush your doctor for empiric antibiotics just a few days into a cough & runny nose (www.ChoosingWisely.org).  And be sure s/he knows every medication & supplement that you're taking.  Don't throw the baby out with the bath water.

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