In 1960, Nadia Niechoda was 31, pregnant and looking forward to a good life. Then, her doctor in Burnaby, B.C., found she had high blood pressure, and she has spent the past 38 years on prescription medication. In the early 1980s, Niechoda, now 69 and a retired bookkeeper and translator, developed severe gout that disfigured her feet so badly she could barely walk, carpal tunnel syndrome that prevented her from lifting so much as a pot, a painfully sensitive scalp, and a throat so sore the pain would wake her at night. It did not occur to her that the medication may have been the problem until 1993, when she saw a doctor on television warn about adverse drug reactions. Niechoda sought out the doctor, Vancouver clinical pharmacologist Robert Rangno, who promptly switched her medication. Within months, her side-effects faded or disappeared entirely. “That was the
best day of my adult life,” Niechoda says of her first appointment with her new doctor. “If I had not gone to see him, I think I’d be in a wheelchair today.”
Niechoda was lucky.
A disturbing new study by University of Toronto researchers suggests that correctly administered drugs kill an average of 106,000 people a year in the United States. That would make adverse drug reactions, or ADRs, the fourth leading cause of death, trailing only heart disease, cancer and stroke. The controversial report, published in the April 14 issue of the respected Journal of the American Medical Association (JAMA), says about 2.2 million
Americans annually suffer a drug reaction severe enough to require hospitalization, prolong a hospital stay or even cause death or a permanent disability. Dr. Bruce Pomeranz, a professor of physiology and zoology and the report’s principal investigator, says a comparison of U.S. data with that from 22 countries, including Canada, found no sig-
nificant differences. Extrapolating the U.S. figures, Pomeranz estimates about 10,000 Canadians a year are dying from severe drug reactions. “This is a worldwide problem,” he says.
The revelations emerge from an analysis by Pomeranz and medical student Jason Lazarou, the report’s author, of 39 studies conducted in U.S. hospitals since 1966. The researchers calculate there to have been between 76,000 and 137,000 I drug-induced deaths annuald ly. Even at the low end, that J would still make ADRs the £ sixth leading cause of death. I The Toronto researchers * excluded deaths due to pre“ scnption or dosage errors, suicides and drug addictions. About one quarter of the deaths were from allergic reactions. Conceivably, some of those—and many of the others—could have been avoided by a more thorough understanding of the various drugs’ properties. But Pomeranz declines to assign blame. “Drugs have enormous benefits,” he says. “If 100,000 people are killed, maybe 10 million are saved. That’s no reason to stop taking drugs.” Dr.
Tom Perry, a clinical pharmacologist at the Vancouver Hospital and Health Sciences Centre, however, says medical schools spend too little time on drug instruction. “There’s a famous quotation about physicians,” says Perry: “ ‘They poured drugs of which they knew little into patients about whom they knew even less,’ which is amazingly prescient when you think about how hard it is to understand one drug well, let alone dozens or hundreds.”
Medicines may kill over 100,000 each year in North America
Others say the Toronto report represents only the tip of the iceberg, that there are far more adverse drug reactions among patients outside of hospitals than in them, where the studies took place. In Vancouver, Rangno helped create the University of British Columbia’s Therapeutics Initiative, a drug awareness program for doctors. He says doctors get the majority of their information from drug marketers. “And what do they want to do?” Rangno asks. “They want you to use the biggest dose most of the time.”
But any blame directed at the drug companies would be misplaced, says Judy Eróla,
president of the Pharmaceutical Manufacturers Association of Canada. “We are spending a fortune on trying to get patients educated,” she says. When the association commissioned a study of people taking drugs outside hospitals three years ago, it found similar results, “so we’re not surprised,” Eróla says.
Others see it differently. Hank Berkenpas, director of educational services with the Health Action Network Society in Burnaby, B.C., criticized governments and drug manufacturers for trying to curb alternative medicines. “They’re pushing products that haven’t been properly tested,” Berkenpas adds, “yet restricting all of our alternatives.”
An editorial in the same issue of JAMA as the Toronto research cautions that there are inherent weaknesses associated with the kind of study of studies that Pomeranz and Lazarou conducted. Combining results from small studies, which are diverse in character, it warns, “does not necessarily get one closer to the truth.” But, it also acknowledges, “even if the true incidence of ADRs is somewhat lower than reported, it is still high, and much higher than generally recognized.” Niechoda learned the hard way about that risk. “Before, I didn’t question what my doctor was doing,” she says. “But I ask questions now.” An example to live by.
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