When the Improbable Becomes Certain

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When the Improbable Becomes Certain

August 12th 2006 -
I recently attended the Annual Scientific Assembly of the Oklahoma Academy of Family Physicians. As in past years, the lectures were highly biased toward the use of prescription drugs in the management of disease processes. In each session the speaker extolled the virtues of the recommended drugs while ignoring or down-playing their potential adverse effects.

Therefore, it is not surprising to me when studies find that physicians dramatically underestimate the number of drug side effects their patients are experiencing. In one study, for example, a group of patients was asked whether they were experiencing any side effects from the medications they were taking. Sixteen percent said yes. When the prescribing physicians were asked how many of those same patients were experiencing drug side effects the estimate was a mere 3 percent. (J Gen Intern Med 2000;15:149-154)

A 2005 study (Acad Emerg Med. 2005 Mar;12(3):197-205) revealed that emergency room physicians frequently overlook the presence of adverse drug effects in patients. In the controlled study, one out of seven severe adverse drug reactions was missed, 10 of 23 moderate drug reactions went unrecognized, and none of the mild side effects that were present were noted.

Since I began actively looking for drug side effects seven years ago I have discovered that almost everyone taking a drug is experiencing an undesirable side effect related to its use. Nearly all adverse drug reactions go unrecognized. Anyone who is taking a prescription or over-the-counter drug should read the drug’s full prescribing information to learn what may happen and what to watch for. It is, at times, a matter of life and death.

Just because an adverse drug reaction is uncommon or rare does not mean that it does not occur. A sad fact about statistics is that when you are the one in ten thousand in whom the reaction occurs, the incidence is your case is 100 percent. Suddenly the improbable becomes certain.

The importance of an individual knowing the risks of taking a drug was driven home to me again this week. A long-time friend, whose mother had died suddenly of a mysterious lung disease, asked me to review her medical records. The cause of the strange malady that caused her death leapt off of the pages. The subtle onset and the dramatic conclusion were straight out of pages of the drug’s prescribing information sheet. She died of methotrexate-induced pneumonitis which, unrecognized, progressed to respiratory failure and death. Sadly, had the adverse drug event been recognized the prospects for her full recovery would have been excellent. No less than six physicians (the prescribing physician, the emergency room physician, and four consultants) had an opportunity to intervene. Not one even raised the possiblility that methotrexate toxicity might be present, let alone be responsible for the lady's condition.

Most pharmacies today enclose drug information sheets when they fill a prescription. If you are prescribed a drug take time to read the accompanying information. Highlight the symptoms to watch out for and report them when they occur. Bring the information sheet with you, as your physician is unlikely to readily acknowledge the possibility that the drug has caused your symptom.

Only the most dangerous or most likely side effects will be listed on the pharmacist’s information sheet, however. If you are taking a drug and things are not going well go a step further. Either go online and type “drug name, prescribing information” into a search engine or go to your local library and read the warnings, precautions, and adverse effects sections of the prescribing information in a book such as The Physician’s Desk Reference (PDR). Your well-being and perhaps your life may depend upon your ability to recognize the drug’s full potential.

Dale H. Peterson, M.D.