Health Sciences Institute e-Alert
May 23, 2002
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Dear Member,
In yesterday's e-Alert, "Like a fish needs a bicycle,"
I told you about a recent article in the Journal of the American
Medical Association that contained this appalling statistic:
as many as 106,000 deaths occur each year in U.S. hospitals
because of adverse reactions to prescription drugs that are
used as directed.
But even more disturbing, and certainly more shocking, is
this statistic from the National Council on Patient Information
and Education: at least 125,000 people each year die from
prescription drugs their doctors never should have given them
- because they had pre-existing conditions that are clearly
contraindicated in the drugs' packaging.
All by itself, that statistic may seem over-the-top. But
just this week, I came across another study that supports
it. It shows that a widely prescribed drug, used to treat
a very common health problem, is often prescribed inappropriately
- and with disastrous results.
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Finding the black box
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As we've told you numerous times, type II diabetes is a common
disease that can lead to other more severe health problems,
including kidney and cardiovascular diseases. The drug most
often prescribed by the mainstream for type II diabetes is
metformin (the brand name is Glucophage). But, this is despite
the fact that it's been associated with a serious condition
(lactic acidosis) that can have fatal side effects for patients
with kidney disease and congestive heart failure (CHF).
In a study reported in the Journal of the American Medical
Association this month, researchers from the University of
North Carolina set out to determine how often metformin is
prescribed to patients with kidney dysfunction and CHF. Using
records obtained from the UNC hospital pharmacy, they identified
all patients with two or more metformin prescriptions within
a nine-month period. The group was then narrowed to patients
who were taking medications for CHF, or whose medical problem
list or clinic notes included a diagnosis of CHF. Patient
records were also used to evaluate measurements of serum creatinine
levels, which reveals kidney dysfunction.
Now, here's where it gets scary...Almost one-quarter of the
patients receiving metformin had CHF, kidney dysfunction,
or both. The UNC researchers concluded that metformin is far
too often improperly prescribed, despite the fact that the
side effects have been well known for years. And, given that
a "black box" warning is prominently displayed on
the package insert, there's no excuse for a doctor to miss
this absolutely essential information.
Clearly, if you're currently taking metformin and you also
suffer from kidney dysfunction or congestive heart failure,
you should run - don't walk! - to your doctor and address
the warnings on your prescription.
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Read all the lines
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The authors of the study note that theirs is not the first
research of this kind, and that several European studies have
shown similar rates of metformin being improperly prescribed.
Obviously this is a widespread problem that is not getting
the attention it requires.
Many people naturally trust their doctors and pharmacists
to prevent these kinds of problems. But this study shows more
than ever that each of us has to be our own watchdog. I've
written before about the flood of post-approval reports that
follow new drugs, and the problems doctors and pharmacists
have keeping up with them. The message here is that each of
us has to rely on our last line of defense: ourselves. The
only way to be absolutely certain that our prescribed drugs
are not going to interfere with other drugs or other health
problems is to read all drug package inserts carefully and
to be diligent about asking questions.
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Cross the t's; dot the i's
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Here at HSI we always strive to give you information that
can help you decide on what sort of therapies are right for
you. In this case - treating type II diabetes with metformin
- we want you to be aware of two important things. One: you
may be risking serious health problems by taking this drug
and you have kidney problems or congestive heart failure;
and two: you can't rely solely on your doctor and pharmacist
to catch dangerous drug interactions and contraindications.
Of course, if you have type II diabetes, you do have other
choices. We've written many times about alternative approaches
to treating it, from diet and lifestyle changes to natural
supplements. You can access these, and all past e-Alerts,
on our
website. Simply type in "type II diabetes" in
the e-Alert search field and you'll find a wealth of information.
In the meantime, we need to keep in mind that doctors are
not infallible. And while it's inexcusable for a doctor to
proscribe a medication that does more harm than good, we have
to recognize that it's a real possibility.
So who should you trust? Trust yourself. Be diligent. Check
warning labels. Ask your doctor and your pharmacist questions.
If you get conflicting answers or answers that sound too easy,
pursue it further. Don't be complacent, and don't take that
drug until you feel satisfied that it's a good fit for your
overall health condition.
To Your Good Health,
Jenny Thompson
Health Sciences Institute
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