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Some of the Challenges with Pharmaceuticals


Wellness Corner - June 2016
Some of the Challenges with Pharmaceuticals

Nowadays, when watching TV, the prescription drug ads can be pretty overpowering. A nice shot flashes of a happy person obviously benefitting from a medication. The voice-over recites a list of horrendous side effects the drug could cause, followed by, “Consult with your doctor.” The question arises, “Why in the world would anyone want to take something that might do all of that to them?” 

Medication side effects are no small issue. A study just published in the May 3 British Medical Journal cites medical errors as the third leading cause of death, behind cancer and heart disease. This is not only medication reactions, but it gives some perspective on the intensity of the problems with our high-powered, fast-paced medical system.

The Medical Perspective

Despite increased attention to adverse effects from medication, providers tend to consider most common pharmaceuticals as generally safe. The drug inserts will list percentages of people in the clinical trials who had certain side effects (usually less than 10%), with the thinking being that the other 90% won’t experience the problem.

Some types of reactions and factors which influence whether someone is likely to get unwanted side effects: 

• immune system/allergic reactions to the drugs.

• toxicity to a substance within the medication. 

• dosing – higher risk with higher dosing; any substance causes problems at a high enough dose.

• genes – enzymes are the key to metabolizing medications. There is variation for the genes which code for enzymatic activity. Some people lack an enzyme or have a diminished response, which makes the drug build up and cause problems.

• use of multiple medications – many medications follow the same pathway to breakdown. If these drugs are taken at the same time, the enzymes get backlogged and metabolism slows.

• age/body size/gender – all of the variations of the human body affect how we can react.

Risks vs. Benefits

While the Hippocratic Oath enjoins the medical practitioners to “First do no harm,” the reality on the ground is more complex. Not acting when someone is suffering can also be seen as “doing harm.” Most procedures or decisions involve balancing the risk from taking that pill or doing the surgery and weighing it against the potential benefit. For example: In an aortic aneurysm, as the size increases over time, the risk of rupture goes up. When the risk of not acting when an aneurysm hits a certain size becomes greater than the risk of the surgery, usually the operation is recommended. The deciding factor is the balance between risk and benefit.

Risks of Contraception

An unsettling series of cases has come to my attention recently that brings to the forefront this discussion of risks vs. benefits. These cases all involve episodes of apparent significant side effects for some women using long acting contraception (IUDs and Nexplanon implants). The intensity of the problems experienced by these women has not been reported much in the medical literature, but there seems to be an active Internet presence of stories like these.

The first was a very healthy woman in her 40s, no real history of depression, who became totally flattened soon after the placement of an IUD. The connection was not appreciated initially, and she was suicidal, tried meds, and was unable to work for 6 months or more. Finally she came across a website that outlined similar problems caused by IUDs. She had it removed, and her mental and physical health got better soon after. I have since heard two similar stories of younger women with new onset of crippling back pain related to an IUD and Nexplanon. Once removed, they both improved quickly. 

Here is the rub: long-term contraception has been a god-send for women’s health by preventing pregnancies, lowering abortion rates, and diminishing the anxiety from missed periods and forgotten birth control. Now these stories emerge of debilitating problems which may force us to reconsider this approach.

How to move forward?

I’m not sure what the answer is with the IUDs, but the stories are concerning. Keeping informed is somewhat confusing with the Internet, but information is certainly accessible. Be aware that these pharmaceutical tools are extremely powerful, and make your choices carefully.