Skip to main content

Beware of Unnecessary Medications!

An elderly lady who had tolerated her mild symptoms of abdominal gas for decades, was suddenly metamorphosed to a vegetative state thanks to an unusual side effect of a newly launched drug for gaseousness!. The disturbing video of this lady, with shaking of hands and twitching of face, shown to a gathering of doctors in a meeting in Lucknow recently evoked a uniform surprise “Gosh, I did not know this could also happen!”. Dr Debnandan further shared information gathered from the net that several such instances of an ailment resembling Parkinson ’s disease have been reported with this agent, the disorder becoming permanent in many.
Adverse reactions to medicines do occur in a minority and every doctor faces them from time to time. What constitutes a tragedy is when the reaction is grave or life threatening while the indication for prescribing the medicine was mild.
Take for instance the side-effect of constipation that comes with many draugs such as pain-killers, anti-spasmodics or anti-depressants. It does not pose a danger to life, and if anticipated, can be prevented by co-prescribing a fibre laxative like Isabgol.
Liver damage can however be a fatal complication of some drugs, especially ones used for treating tuberculosis. I recall looking after an eminent scientist who developed jaundice due to anti-tubercular medicines for a mild chest infection. By the time he was brought to us he was deeply jaundiced, developed liver failure, went into liver coma and passed away despite all efforts. Very careful serial monitoring of liver functions is therefore mandated when drugs with potential to harm the liver are prescribed.
Another side-effect we dread is suppression of the bone marrow, a condition in which the white blood cells, platelets and red blood cell counts fall precipitously predisposing the patient to fulminant infections or bleeding. An antibiotic chloromycetin often prescribedfor typhoid fever, used to be the commonest culprit, It occurs nowadays with anti-cancer drugs, but may also occur with certain medications like azathioprine used for treating ulceartive colitis and auto-immune hepatitis.
In this case atleast, help has come from the laboratory. A blood test now helps recognize individuals prone to developing this complication, either based on their genetic make-up (genetic polymorphism in our jargon) or the level of enzymes that inactivate the drug (TPMT enzyme assay). Although somewhat expensive (around Rs 3000/-) getting it done before starting the azathioprine adds a dash of safety and is now internationally recommended.
Unfortunately such tests are very few while the list and inventory of drugs and the catalogue of their serious adverse reactions is sky-rocketing! What means do we then have to make our lives safer?
A useful dictum is to give home remedies a try first and resist the tempation of popping a pill for every minor discomfort. Doctors need to avoid prescribing more drugs than absolutely necessay and remember that old trusted medicines are often safer than the new ones touted as magic cures.
As published in HT City( Hindustan Times) dated 10 June, 2012.

Comments

Popular posts from this blog

Food Fads in Liver Disorders

In an attempt at trying to do well to those they love, spouses and parents often enforce diets on patients of liver diseases that often turn out to be detrimental. The commonest food fad is pale insipid boiled cabbage being doled out to nauseous patients suffering from hepatitis that makes them puke even more.  The liver, in a way, is a buzzing manufacturing unit that requires lots of energy to keep its multiple functions going. And it derives all this from the food we eat. During disease, such as during an attack of jaundice, when many of the liver cells get killed, the liver attemptsdamage control by trying to regenerate quickly. For its cells to multiply however, it requires a generous supply of energy that comes from carbohydrates, and protein, the building block for its cells and tissues. Boiled green vegetables unfortunately have neither of these. Hence the situation often progresses to that of a starved liver unable to recuperate due to cut-off food suppl...

The Doctor’s Dress

The familiar white coat worn by physicians as their distinctive dress for over 100 years, has started generating  murmurs  of controversy. It is not uncommon to find the blood pressure to be higher when measured by a white-coat-wearing-doctor in the hospital or clinic than the readings obtained at home by relatives.  This is due to the anxiety that the white coat and the hospital setting evokes in patients, and has been termed “White Coat Hypertension”. Mature clinicians often routinely subtract a few points from these measurements when entering records in case charts or calculating the dose of anti-hypertensive medications to be prescribed. The white coat scares children too.  Kids often express their dislike for this dress by crying and screaming and by denying access to their bellies or chest for examination by paediatricians in this attire. Many pediatricians across the world have folded up their white coats and taken to informal colourful dressing to...

Uberification of Health Care

The imaginative concept of matching transportation demands of people with cab facilities using a smartphone platform that Uber is credited to having created is now beginning to be applied to health care as well. At the outset, let me share with you what I understand of Uber. It is an on-line transportation company that develops, markets and operates the Uber mobile app, which allows consumers with smartphones to connect with Uber drivers through a software platform for taxi service. Uber itself does not own any assets such as cars, or hire the drivers. Uber was founded by Tavis Kalanick and Garrett Camp as recently as 2009 in San Francisco, but the impact and success of this “start up” has reverberated across the world, being now valued at US $ 62.5 billion. Fresh successful ideas in one domain often tickle the minds of entrepreneurs in other fields. Healthcare experts are now trying to explore if they can bring about a revolution in their sector as well. The proposition se...