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Medicines Kill 100,000 U.S. Citizens Each Year
Now for some real scientific medicine. A study in the Journal of the American Medical Association10 suggests that adverse reactions from properly prescribed(?) drugs are among the top causes of death in the United States each year. The authors estimate that more than two million adverse drug reactions (ADRs) occur yearly, 106,000 of which result in death. In 1994, they say, this would account for 4.6 percent of all recorded deaths, just behind heart disease, cancer and stroke. Deaths from adverse drug reactions therefore were ahead of pulmonary disease, accidents, pneumonia and diabetes. This study only counted deaths from drugs prescribed in a hospital setting. If you were to combine these results from a recent study (see "Hospital Infections Rising" in last month's column) that found 90,000 deaths per year from hospital-induced infections, one could easily place hospitals as the third leading cause of death in the U.S., ahead of strokes by about 45,000. The researchers suggest that deaths from ADRs have not changed much in the past 32 years. I'll let you do the math. 10. JAMA 1998;279:1200-1205.
Hold the Antibiotics
A study from Children's Hospital and Regional Medical Center in Seattle1 reports that antibiotics given to children suffering from E. coli infection may trigger complications that can result in the child's death. (The bacteria, E. coli 0157:H7, causes about 73,000 cases of food poisoning in the United States each year.) This study looked at the medical records of 71 children infected. Nearly half who received antibiotics contracted hemolytic uremic syndrome, a complication of the infection that results in kidney damage and blood cell destruction, a significant contributor to death. Among the children that were not treated with antibiotics, the rate of syndrome contraction was about eight percent. The connection to antibiotics, which has been suspected for some time, is thought to be due to toxins being released from the bacteria into the intestines after contact with the drugs.1 1. New England Journal of Medicine, June 29, 2000.
The U.S. Drug Enforcement Administration reports a growing pattern of recreational use of the drug methylphenidate (MPH) among pre-teen and teenaged children. MPH (street names "Vitamin R" and "R-Ball") is favored for its stimulant and psychotropic effects, and is among the top 10 controlled substances most frequently reported stolen each year. The pattern of abuse is found by examining data from emergency room reports, poison control centers, adolescent drug treatment centers, and school surveys. MPH is sold by prescription under the brand name Ritalin.3 3. Associated Press, May 5, 2000. Recreational Ritalin.
HIV Drug Mimics Infection
A spokesman for the National Institutes of Health says that a drug commonly used to treat HIV patients can easily fool a physician into believing the patient has a urinary tract infection. Indinavir (brand name Crixivan) tends to crystalize in the urine, causing flank pain and urethral burning. A high water intake is recommended by the drug maker to minimize the effect.4 4. United Press, July 14, 1997.
Antidepressants and Intestinal Bleeding
Spanish researchers report a statistical correlation between antidepressant drugs and intestinal bleeding. Actually, the danger appears to be taking the drugs with aspirin or other nonsteroidal anti-inflammatory drugs. The combination appears to produce a larger risk than the individual risks added together. The antidepressant drugs studied were selective serotonin reuptake inhibitors (SSRIs), a class that includes Prozac. The study involved 1,600 people with upper GI bleeding.7 7. British Medical Journal, October 23, 1999.
Study Reports Acceptance of Unresearched Drugs
Researchers from the University of North Carolina at Chapel Hill are questioning the casual prescription of serotonin selective reuptake inhibitors (SSRIs) to hundreds of thousands of children each year. "Our survey data suggests that despite a lack of research support, adequate training and comfort with the management of depression, SSRIs are gaining physician acceptance and becoming incorporated into primary care practice," said a university spokesman recently.8 He warns that it is not prudent to use these drugs for "school problems or nebulous behavioral problems." While SSRIs are approved for patients over 18 years of age, there is little scientific evidence that they are safe and/or effective for mental illness in children. These drugs, which include Ritalin and Prozac, are known to cause sleep disturbances and untoward behavioral changes in children. Nothing is known about their effect on developing nervous systems. They are frequently prescribed in the U.S. to treat children for hyperactivity and ADD, obsessive-compulsive disorder, aggression-conduct disorder and even bed-wetting. 8. Jerry Rushton, a researcher quoted by Reuters news service, May 1, 1999.
Estrogen Drugs Stimulating Ovarian Cancer
Researchers from the University of Southern California report that one of their studies suggests that a drug commonly used in postmenopausal women to prevent osteoporosis may encourage growth of ovarian cancer. The drug, an estrogen supplement called raloxifene, does not appear to affect breast cancers or the uterine lining. However, in a laboratory setting, ovarian cancer cells showed increased growth when exposed to the drug. Reference: Reuters, July 3, 2001, reporting on the work of Dr. Richard Paulson, an ob/gyn professor. The results varied widely according to geographical area as well as other factors. Independent drug stores warned customers less often, as did stores in lower income neighborhoods. In Denver, one dangerous combination was quietly dispensed more than half the time, while the vast majority of pharmacists in Indianapolis refused to fill the prescription.4 4. U.S. News & World Report, August 19, 1996.
Heartburn Drug Warning
The FDA has issued a warning about a drug commonly used for the treatment of nightİtime heartburn. Cisapride (also known as Propulsid) is believed to have caused at least 38 deaths from cardiac sideİeffects. The drug is also thought to interact unfavorably with a number of other drugs, and there is a long list of physiological illnesses that preclude its use. The manufacturer plans to send a letter to doctors asking them to use caution when prescribing the preparation.13 13. United Press, July 6, 1998.
Copper for E. Coli
British doctors report that when at least one harmful strain of e. coli bacteria comes into contact with copper surfaces, it dies within hours. Further studies are planned to test the effectiveness of copper counter tops in food preparation, and whether copper water pipes decrease the risk of water-borne contamination.14 14. United Press, July 6, 1998.
Did you think doctors prescribed a lot of antibiotics to their patients? Farmers give their animals eight times as many as the average person gets in the United States, according to a report from the Union of Concerned Scientists. The practice, which spurs livestock growth, is seen as contributing greatly to the problem of antibiotic resistance that has many health officials very worried.10 10. Reuters, January 8, 2001.
Salmonella Developing Drug Resistance in Cattle
A recent case of salmonella infection in a young boy is worrying health officials, because the strain turned out to be resistant to one of the very few antibiotics thought to be still effective against most bacteria: ceftriaxone (brand name Rocephin). The bacteria was also resistant to a dozen other antibiotics. Further tests revealed that the bacteria came from cattle (from the family's ranch in Nebraska), which had been recently treated with ceftriaxone. The case is documented in the New England Journal of Medicine.10 10. NEJM, April 27, 2000.
Birth Control and HIV
New research from Kenya again implicates contraceptive usage in the spread of the HIV virus, but this one is a little different. Instead of showing that birth control pills make a mother more susceptible to HIV infection, this study reports that women who use these drugs will transmit the virus more easily to sexual partners and to babies during birth. Lack of vitamin A also seems to be a factor. The researchers found that such women tend to "shed" HIV-1 viruses at a higher rate in cervical and vaginal secretions.4 4. Lancet, September 27, 1997.
Hormone Replacement Therapy
A review of 22 separate studies published in the British Medical Journal8 concludes that, at least in the short term, hormone replacement therapy (HRT) offers no protection from heart disease in post-menopausal women. Doctors have long thought that maybe they would and have prescribed accordingly. Now they have to rely on faith that maybe they help in the long-term. 8. BMJ, July 19, 1997.
British researchers at a meeting of the American Society for Microbiology13 warned that antibiotic treatment of acne is producing some very hardy germs that spread quite easily to other members of the population. They have found that the majority of acne patients on antibiotics harbor highly resistant bacteria on the surface of their skin. These can be passed on to others by casual contact. Acne patients treated with antibiotics are typically on the drugs for 8-10 years. "Long-term treatment with antibiotics is insane," one expert opines.14 13. American Society for Microbiology Meeting in Toronto, September, 1997. 14. United Press, September 29, 1997, quoting Marilyn Roberts, pathobiology professor at the University of Washington School of Public Health and Community Medicine, Seattle.
A study published in the New England Journal of Medicine1 suggests that Prozac taken during a woman's pregnancy can lead to premature birth and a number of other complications in the infant. This study of 482 pregnancies found that mothers taking the chemical were many times more likely to not carry their babies to full term. Also, many of the Prozac babies had other problems that while not life-threatening, required admission to special care facilities. Prozac is taken by 12 million people world-wide. 1. NEJM, October 3, 1996.
Prescribing Doctors Fail Drug Survey
The results of a survey7 of medical practitioners who regularly treat patients for angina were announced at a September meeting of the American Federation for Aging Research and Key Pharmaceuticals. Researchers wanted to know if physicians paid attention to labeling information changes of drugs they prescribe. In this case, they specifically queried doctors about isosorbide dinitrate drugs, a common treatment for angina. A year ago, the label and prescription information began noting that the drug was only effective for two hours. Three out of four doctors did not know about the new information, and most were under the impression that the medicine was good for 12 hours. Nearly all the doctors surveyed prescribe the drug regularly.8 7. Conducted by Yankelovich Partners, Inc. 8. United Press, September 5, 1996.
Misplaced Faith in the PDR
A study published in the Annals of Emergency Medicine1 concludes that the popular Physician's Desk Reference contains bad information that can cost lives. The researchers examined the advice for overdose treatment of the 20 most commonly prescribed drugs associated with deaths from overdose and found it outdated (up to 25 years old) and inadequate. Many times, the PDR does not mention treatments that could save lives and recommends harmful advice, considering current toxicology knowledge. For example, the PDR advises treatment of Elavil toxicity with physostigmine, a drug that many years ago was found to increase the risk of death in these cases.2 However, patients may be comforted (or not) by another finding of the group: They surveyed doctors and found that less than half had consulted the PDR at all in the past year. 5. AEM, February 1, 1997. 6. United Press, January 31, 1997.
Antibiotics and Birth Control Pills
Some antibiotics may interfere with the absorption of oral contraceptives leading to an increased risk of pregnancy, according to a Stanford University pharmacist. Also, breakthrough bleeding during the menstrual cycle may be increased by the drugs and metabolic changes can result in body temperature changes that work to counteract the action of the birth control pills.2
Painkillers Slow Healing
New research reinforces what many of us were taught in college decades ago: deadening pain resulting from an injury appears to interfere with healing. Research at the University of Medicine and Dentistry of New Jersey found that NSAIDs appeared to slow or modify bone healing after a fracture. Researchers administered Celebrex or Vioxx to rats with broken legs, and noted that most fractures had not fully healed after two months. When new bone formation did occur, it was often weak and superficial. The significant component appears to be the cox-2 enzyme (associated with inflammation and pain) blocked by these drugs. Researchers are starting to realize that the enzyme (and maybe the inflammation itself) plays an important role in healing.4 4. Journal of Bone and Mineral Research, May 2002.
Therapy Better than Drugs
A study8 from Vanderbilt University in Nashville suggests that cognitive therapy treatment may be a better way to manage depression than pharmaceuticals. The costs and effectiveness for both types of treatment were about the same over a four-month period, but the cognitive therapy appears to have a more permanent effect, with relapses occurring much less often. In the long term, cognitive therapy (which is somewhat slower to show results initially) appears to be much more effective, both clinically and economically. The conclusions of this study are expected to come as a big surprise to many psychiatric professionals who have strong faith in the drugs they prescribe. 8. Reuters, May 24, 2002.
Antibiotics in the Food Chain
More researchers are warning about the dangers of using antibiotics to enhance food production. Researchers from the University of Maryland School of Medicine have found, in the intestinal tracts of chickens, bacteria that are highly resistant to antibiotics generally considered to be the last remaining drugs effective against many infectious diseases. In addition, they have found resistance to what were thought to be very powerful drugs still under development. These germs are being found in animals raised on antibiotics, which are given in an effort to boost growth and 7. United Press, September 25, 1998.
"New" Theory: Fevers Are Beneficial
A new book, Evolution and Healing,1 promotes some "radical"2 health concepts. The authors, a psychiatrist and an evolutionary theorist instructor, say that fevers are an adaptation by natural selection specifically to fight infection; that treating fevers with aspirin may be doing the patient harm. The authors go on to say that "we should respect the evolved wisdom of the body," and make other statements reminiscent of a philosophy course at a chiropractic college, such as the need to know when to act and when to leave the body alone. The authors also note that modern medicine uses drugs mainly to treat symptoms instead of causes. In addition to some basic concepts taught to every chiropractic student, the book also explains a great deal about how modern lifestyles make us prone to problems such as heart disease and nearsightedness, and help to create deadlier bacteria and viruses. Virulence among pathogens, the authors say, will increase as populations become denser. Germs are less virulent if transmission avenues are few, since they will not reproduce if the host dies. But increased avenues caused by poor sanitation, sexual promiscuity, shared needles, confined living and working quarters, etc., allow much deadlier forms to survive and prosper. The authors base their theories on a large number of studies relating to various causes of illness.
Nursing Home Drugs
A study by the U.S. Inspector General of the Department of Health and Human Services paints a sorry picture of medical treatment in Texas nursing homes. This work reports that one in five residents receive drugs that are inappropriate for elderly citizens. Another 20 percent are getting at least two drugs with potentially dangerous interactions. The report was released by Senator Chuck Grassley of Iowa, who chairs the Senate Special Committee on Aging.14 14. Reuter, November 17, 1997.
Lowering Your Cholesterol Can Be Depressing
Psychiatrists often notice that their patients who are under concurrent medical treatment for heart problems are more prone to episodes of anxiety and crying. A study at the Henry Ford Hospital in Michigan is blaming their emotional instability on cholesterol-lowering drugs.3 Researchers are starting to associate artificial decreases in cholesterol levels with emotional stress. Statistically, such patients are more likely to die by murder, suicide, or some kind of traumatic accident.
More Calcium Channel Blocker Effects
Another study is warning about the hazards of calcium channel blockers used in the medical treatment of high blood pressure. Swedish doctors found a five-fold increase in the incidence of suicide among patients who used these drugs, compared to those undergoing a different course of therapy for their hypertension. The suicides are thought to result from depression induced by the CCBs.10 10. British Medical Journal, March 7, 1998.
A group of pediatric physicians in Rochester, N.Y. conducted a novel study on 383 of their child patients. They practiced what they term "judicious antibiotic use" in children with colds and other upper respiratory infection, i.e., the doctors didn't use antibiotics unless there were clear indications that the child might be suffering from an infection for which antibiotics were effective. The study involved children from infancy to age 12. About 25 percent received antibiotics. In many pediatric practices, most children with upper respiratory infections are given the drugs routinely. The study7 concludes that withholding antibiotics from these children did no harm; in fact, fewer children from the nontreatment group needed follow-up care. 7. Pediatrics, April 2000.
Drug Use on the Rise
Americans will be using about six percent more drugs in 1998 than the year before, according to estimates by the National Association of Chain Drug Stores. This figure is for prescription drugs based on sales during the first six months of this year. Increasingly popular new drugs that contribute to this trend range from Viagra to toenail fungus remedies. Analysts credit a number of factors, not the least of which is advertising, for this increase. Another factor is the availability of an array of new drugs going through an accelerated FDA approval. One 34İyearİold Manhattan resident went from taking only insulin for her diabetes in 1995 to her now 52 daily doses of 19 different drugs, many of which were not on the market last year. An average of 11 prescriptions will be picked up each year for every man, woman and child in America.4 I wonder who's been picking up mine for the past 25 years? 4. Associated Press, August 30, 1998.
The FDA is warning that recent studies suggest that steroid inhalers used in the medical management of asthma appear to delay a child's growth. The longİterm effects are not yet known, but many lung specialists and drug manufacturers are hoping that the children will experience a growth spurt later in life that will let them catch up. As it stands, though, current research indicates that during a year's worth of inhaling the drugs, a child will grow 1/2 to one inch less than expected. The FDA wants to put warning labels on inhalers recommeding the need for frequent height measurements.11 11. Associated Press, August 14, 1998.
In June 2001, Connecticut became the first state in the United States to pass legislation aimed at combating the growing abuse of prescription drugs among children in school. The unanimously approved law prohibits teachers, counselors, and other school officials from recommending psychiatric drugs for any child. The school can still recommend that a student be evaluated by a doctor, but it is the doctor who must suggest the mode of treatment. Many legislators are becoming alarmed at the number of children taking such drugs, which they see as an all-too-easy solution for parents, teachers or doctors who don't want to deal with individual situations. Some schools were even demanding that certain children be medicated before being allowed into the classroom. The federal Drug Enforcement Administration says that, in some elementary and middle schools, as many as six percent of all students are taking these drugs.7 7. Associated Press, July 17, 2001.
Elderly Deaths from Medication
A new study of hospital patients in Norway suggests that many elderly people are dying not from disease, but from fatal-side effects of their medications. The project determined that 18 percent of the deaths among the elderly patients studied were due, either directly or indirectly, to the medications they were given. This rate is much higher, say the researchers, than that for the general population. They suggest that doctors take more care when prescribing drugs for older patients with complicated conditions. Most of the deaths resulted from drugs used to treat cardiovascular disease (including circulatory problems) or asthma.15 15. Archives of Internal Medicine, October 22, 2001
FDA Considers Relaxing Drug Ad Restrictions
The FDA is trying to decide if it should allow pharmaceutical companies more freedom in advertising their prescription drugs. In 1994 manufacturers spent $250 million advertising prescription- only drugs; many of those ads were aimed directly at potential patients. Analysts say that amount could increase $1 billion a year if current restrictions (such as requirements to reveal side effects) are relaxed. It has been contended that an increase in such advertising will increase the pressure doctors are under to prescribe "trendy" medications at the expense of more conservative measures such as diet and exercise. It has already been established that doctors give in to such pressures rather easily, as evidenced by the widespread prescription of antibiotics for colds and flu to placate patients even though the doctors know better.1
Advisors to the FDA are expressing concern over signs that many popular nonsteroidal anti-inflammatory drugs are more dangerous than doctors and the public think. Most NSAIDs are believed to contribute to gastrointestinal problems. Forty-one thousand hospitalizations and 3,300 deaths each year are blamed on such side effects.11 The consumer group Public Citizen is asking the FDA to ban piroxicam (sold as Feldene), a more potent form of this class of drugs used to treat arthritis. According to FDA records, 299 Americans deaths have been linked to this one drug since 1982.
Researchers analyzing studies for the effects of cholesterol- lowering drugs on women with high cholesterol but no other heart disease risk factors have concluded that the drug therapy is useless.12 The regimen, which can cost as much as $1,000 per year, can produce many side effects (such as heart arrhythmias) without reducing deaths from heart disease related to elevated cholesterol levels. The long-term effects of the drug therapy are not known. The lead author even goes so far as to say that it may be pointless to even test the cholesterol levels of otherwise healthy women.13
Epileptic Drugs Demineralization
Scientists from the University of Washington were surprised to find that young men taking anti-convulsant drugs for epilepsy appear to lose a large amount of bone mass. They found that some in the 22 to 43 year age group had skeletal densities that resembled that of 70 year old men, with an accompanying four-fold increase in fracture risk. One researcher estimates that about half of persons on such medications are affected, but more research needs to be done to quantify the effects, as well as to follow the long-term effects.11
Psychotropic Preschool Drugs
A study published in the Journal of the American Medical Association7 reports that the use of psychotropic drugs such as Ritalin and Prozac is increasing at a dramatic rate. This work finds that from 1991 to 1995, such prescriptions increased by 50 percent, from 100,000 to 150,000, for children aged 2-4. In 1995, 60 percent of these youngsters on the drugs were age four; 30 percent were three; and 10 percent were two year-olds. The authors of the study are concerned with the trend, especially since there is little evidence to show the drugs offer more benefit than harm, and that the potential damaging effects on brain development have not been investigated. The FDA has asked the drug manufacturers to look into this.8 7. JAMA, February 23, 2000. 8. Associated Press, February 22, 2000.
Drug Dispensing Errors
An investigative report,11 stimulated by recent media attention involving the high number of deaths due to medical mistakes, attempted to quantify any such problem involving the dispensing of drugs at your local pharmacy. They found that no such data exists, primarily because pharmacies are not required to report errors to any authority (except in Georgia and North Carolina - those states require a report in the case of "significant" harm, and death). No industry-wide statistics are kept, as errors might be handled (and go no further) at any level including: the pharmacist; his/her manager; the store or corporate office; an insurance company; a complaint to the state regulatory agency; or, if litigation results, the court system.
North Carolina officials say that 36 deaths were reported in 1999, but believe that many more are never reported. The nonprofit Institute for Safe Medication Practices estimates that 2-3 percent of filled prescriptions are erroneous. Many pharmacists blame mistakes on ever-increasing workloads. In one case that went to court, the pharmacist was working 12 hours each day, five days per week. The AP report blames the increased workload on insurance companies for encouraging doctors to prescribe a pill instead of using a more expensive treatment that might require hospitalization or other physician-intensive attention.11. "Deadly Doses." Associated Press, February 12, 2000.
Antibiotic Resistance Fears Grow
The American Society of Microbiologists have called for a national program of research and education to raise awareness of growing bacterial resistance to antibiotics. A University of Alabama microbiologist3 says that the United States will "pay dramatically"4 if action is not soon taken. The problem is known to be growing, but no one really knows how quickly or to what extent. However, the U.S. Centers for Disease Control and Prevention estimates that at least $4 billion is spent each year treating antibiotic-resistant infections in America. The task force recommended a number of things that could be done immediately to at least lessen the problem, such as asking doctors working in intensive care units to wash more frequently and to choose organism-specific antibiotics instead of the shotgun-type, broad-spectrum varieties when possible. Another interesting recommendation was to ask patients to stop pressuring their doctors for antibiotics that they do not need (for example, treatment of viral infections), because many doctors apparently cannot turn them down, even when they know better! Some interesting facts:5
- Over 90 percent of staphylococcal strains are now resistant to penicillin and related antibiotics.
- Resistance in pneumococci, the most common organism in middle ear infections, is increasing rapidly. Resistance was extremely rare before 1987.
- Resistance to vancomycin, "the last weapon available against potentially deadly hospital-acquired infections"6 has increased 20 times in five years.
- A Shigella dysentery outbreak that killed 60,000 people in Burundi in 1990 proved to be resistant to most drugs that previously would have been effective.
- Almost half of all antibiotics made are used in farm animals.
Ulcer Patients Not Warned about NSAIDS
A study published in the Journal of the American Medical Association reports that most Medicare patients being treated for peptic ulcers are not warned about the dangers of taking over-the-counter nonsteroidal anti-inflammatory medications. Drugs such as aspirin and ibuprofen can create or increase the severity of ulcers and lead to increased hospitalizations or death from internal hemorrhage. Guidelines issued by the National Institutes of Health in 1994 recommended that doctors determine if their ulcer patients use NSAIDs and, if so, have them discontinue their use. However, this study says that there was no such change in clinical practice. Less than one third of patients are warned that NSAIDs could cause or aggravate their problem.1 1. JAMA, October 24, 2001.
NSAIDs and Miscarriage
A report in the British Medical Journal6 suggests a connection between nonsteroidal anti-inflammatory drugs (NSAID) and miscarriages. There has been little research on the subject, but this study concludes that there is a significant increase among women who took the drugs. The study involved more than 18,000 pregnancies, 1,462 of which involved NSAIDs. The researchers did not find any increased incidence of birth defects or pre-term delivery. 6. BMJ, February 3, 2001.
Super Aspirin Study Outcomes
For the past five years or so, pharmaceutical companies have spent hundreds of millions of dollars to prove that the new "super aspirins" (IIb/IIIa antagonists) are the new wonder drugs for heart and stroke patients. Unfortunately, each of the five major studies thus far suggests that, far from saving lives, the treatment is killing patients. The director of two of the studies estimates that up to 200 patients have died from the experimentation.10 The patient deaths appear to be related to excessive blood clotting, which is unfortunate, since the drug is supposed to work by blocking the clot mechanism. The prevailing theory of why so many patients die is that the body adapts to the drug's effects by lowering the clotting threshold. When blood levels of the drug become low (for example, just before the patient takes their next dose), clots form much easier than normal. So far, about 42,500 volunteers have participated in super-aspirin studies. Another study of DuPont's version (Roxifiban) is expected to recruit 2,000 more volunteers by the end of this year. 10. Associated Press, January 27, 2001.
A report in the journal Science suggests that drugs routinely used to anesthetize children may kill developing brain cells. Researchers from the Washington University School of Medicine found that developing rat brains are sensitive to toxic effects of nitrous oxide (laughing gas) and ketamine. The damage occurred at a time corresponding in humans to the sixth month of pregnancy through the second birthday. Angel dust (PCP) produced similar findings.6 6. Science, January 1, 1999.
Drugging School Children
Researchers from the Center for Pediatric Research in Virginia report that doctors appear to be overprescribing drugs to grade-school children.1 Attention deficit-hyperactivity disorder (ADHD) is thought to affect only three percent of children to the extent that medication is prescribed. However, this study finds that between 8-10 percent of children in second through fifth grades routinely take medication for ADHD. Among fifth graders, one of every five white males is taking ADHD medication. Most experts seem to think that doctors are misdiagnosing these children. 1. American Journal of Public Health, September 1999.
Painkillers and Heartburn
New research from the University of Georgia suggests that nonsteroidal anti-inflammatory drugs (NSAIDs such as aspirin, ibuprofen and others) may increase the likelihood that a patient will suffer from heartburn. Researchers compared 12,500 Medicaid patients who regularly took such drugs with a similarly matched group that didn't. Patients on NSAIDs were twice as likely to have been diagnosed with gastroesophageal reflux disease.8 Many NSAIDs have been associated with a number of gastrointestinal disorders and are blamed for the deaths of 16,500 Americans each year.9 8. Presented to the American Association of Pharmaceutical Scientists meeting in New Orleans by Jeffrey Kotzan, November 17, 1999.
Pain and People Killers
Swiss researchers report3 that painkillers are probably killing 2,000 patients each year in the UK. Nonsteroidal anti-inflammatory drugs (NSAIDs) are causing bleeding ulcers responsible for most of these deaths, they say.4 NSAIDs appear to block a coenzyme (COX-1) that protects the stomach lining. This research suggests that about one in 1,000 patients who take these drugs for at least two years will die from them. 3. Pain, March 2000. 4. Martin Tramer, et al., University Hospital, Geneva.
British researchers are starting to express reservations about the new "super-aspirin" COX-2 inhibitors.18 They suggest that these, as well as other anti-inflammatory drugs, may actually worsen conditions over the long haul. Rat studies show that although they relieve initial symptoms and inflammation, no benefit is seen in the underlying disease process in conditions for which they are often used, such as arthritis. In testing the drugs on rats for their effect on pleurisy, their experiments suggested that these drugs led to an unusually large increase in inflammation in a later stage of the disease process. 18. Nature, June 1999.
Placebos for Depression
A study in Prevention and Treatment12 concludes that for many anti-depressive drugs the placebo effect is the main curative agent. Researchers analyzed data from 19 randomized, placebo-controlled studies and found that while 25 percent of any improvements seen could be attributed to pharmacological effects, 75 percent of a given patient's recovery was attributed to the simple fact that the patient was taking a pill -- any pill. Even the 25 percent improvement credited to the medication may be suspect, however, as the researchers speculate that for some patients, drugs may enhance the placebo effect because the patients "could tell by the side effects that they had taken something," thereby enhancing their faith in the medication. 12. Prevention and Treatment, July 1998.
Drug Rush at FDA
Concerns are mounting that the FDA is too quick to approve new and exciting drugs for distribution in the marketplace. Over a period of 10 months ending last July, nearly as many drugs have been pulled off the market as had been during the entire previous decade, because of dangerous side-effects. Insiders say that the FDA is under political pressure to speed up approvals; that safety problems that arise are ignored; and that inspectors should "give the drug company the benefit of the doubt."13 Many of the drugs suddenly removed from the market this past year had prompted warnings from experts before the drug was approved. The FDA maintains that the current system is working, though, since drugs are quickly pulled off the market as soon as it is obvious that they are killing people. 13. Associated Press, July 10, 1998, quoting Elizabeth Barbehenn, a former FDA employee who spent 13 years monitoring experimental drug safety.
Accidents and Anxiety Treatments
Common anti-anxiety drugs seem to be contributing to the frequency of automobile accidents, according to a new study published in the British Medical Journal.14 This research finds that people taking drugs such as valium are more than twice as likely to be involved in an accident, and more than three times as likely if they are under 45 years old. These findings apply even if the patient does not feel drowsy after taking the drug. The study looked at drugs taken for anxiety, other stress-related disorders, and muscle spasms. 14. BMJ, October 31, 1998.