Dangerous liaisons

Orientation - from the Health Sciences Institute

Health Sciences Institute e-Alert

May 23, 2002

Dear Reader,

In the 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, www.hsibaltimore.com. 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

Sources:
"Frequency of Inappropriate Metformin Prescriptions"
JAMA, V.287, No. 19, Pg. 2504

* Before making any change or addition to current treatment, please consult your physician. Some protocols may not be appropriate depending on your personal medical history.

Copyright (c)1997-2002 by Institute of Health Sciences, L.L.C.

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By Dr.C.Capozza & www.laleva.cc