DC Medical Malpractice & Patient Safety Blog

The Institute for Safe Medication Practices, a watchdog group, points out that the number of deaths (4,825) and injuries (21,000) from prescription drugs have reached record levels in the first quarter of this year, representing nearly triple the number of deaths in the last quarter.

The blood thinner heparin and the anti-smoking drug varenicline are the most dangerous, according to the statistics.

And where do these statistics come from? That is the worrying part, because they are probably underestimating the reality of the situation:

The data came from voluntary reports of adverse effects to the Food and Drug Administration, which made the data public after stripping information that identified victims. Because the reporting is voluntary, researchers have speculated that fewer than 10% of adverse events actually makes it into the system.

However, the article points out that since the dangers associated with heparin have been recognized, deaths and injuries have gone down. Varenicline is a different story:

Varenicline remains an ongoing problem, however, according to institute officials. Since the drug -- sold in the United States by Pfizer Inc. under the brand name Chantix -- was approved in 2006, it has been linked to 3,325 serious injuries and 112 deaths.

Some reports were linked to people attempting suicide or causing injury to themselves after using the drug, which can evoke serious psychiatric problems. Others were linked to blackouts, seizures or loss of consciousness, perhaps tied to sudden disturbances in heart rhythm...

...One possible explanation for the link might have been the success of the drug and the large number of people using it, the report said. But investigation showed that, during the quarter, varenicline accounted for more reports of serious injury than the top 10 best-selling prescription drugs combined.

Patients who go in for MRIs are often told nothing is wrong, when in fact the scan is of poor quality and so misses the problem, as Gina Kolata's story demonstrates.

Doctors all agree that it is a good idea to get MRIs and other scans done at centers accredited by the American College of Radiology. But, they caution, there is a wide range of quality among those centers. Quality depends on the quality of the imaging coils put around the body part being scanned, the skill of the technicians and the expertise of the doctor reading the image:

At Massachusetts General Hospital, for example, Dr. Gazelle said, “musculoskeletal M.R.I.’s are read by someone who does musculoskeletal imaging every day” — and not “by someone who reads chest M.R.I.’s one day and musculoskeletal M.R.I.’s the next.”

Dr. Forman says it pays to check the credentials of a center’s radiologists.

“If you say, ‘Who will be reading my scan?’ and they say, ‘One of our radiologists,’ you don’t go to a place like that,” he said. (I checked the Web site of the first center I went to. The radiologist who read my scan was a generalist with no special training.)

It also pays to ask the radiology center whether it has the latest generation of scanners. The stronger the magnet in the MRI machine (the "M" in MRI stands for Magnetic), the higher quality the image it produces.

Misreadings of MRI scans can cause tragic, preventable injuries to patients, as our firm's experience has shown.

The other piece of advice we can extract from the article is not to place absolute faith in a first-time scan that turns out negative. If the scan is negative and you feel that something is still wrong--like there is still severe pain--it is worthwhile to get a second opinion.

The Advisory Committee on Immunization Practices, a panel that advises the federal government, is recommending that adult smokers under 65 should get a pneumococcal vaccine that was previously only recommended for anyone 65 or older. Federal officials usually take the advice of this panel, according to the article, and this is the first time an influential body of scientists has recommended a vaccine specifically for smokers. From the article:

Studies have shown that smokers are about four times more likely than nonsmokers to suffer pneumococcal disease. Also, the more cigarettes someone smokes each day, the higher the odds they'll develop the illnesses.

Why smokers are more susceptible is not known for sure, but some scientists believe it has to do with smoking-caused damage that allows the bacteria to more easily attach to the lungs and windpipe, said Dr. Pekka Nuorti, a medical epidemiologist with the Centers for Disease Control and Prevention.

However, some scientists doubt the usefulness of this vaccine for smokers under age 40.

The vaccine protects against a variety of pneumococcal bacteria that can cause pneumonia and other serious lung infections.

An online service called inSPOT allows patients who test positive for STDs to use a website to notify sexual partners, anonymously if they so choose, of the possibility that the partners were infected. A report done by the San Francisco Department of Public Health finds that since 2004, 30,000 people have used the service to send 50,000 notifications of all sorts of diseases contracted through sexual activity.

This project has enormous potential health benefits because embarrassment and a desire to remain anonymous are factors that can prevent people from notifying past sexual partners of their risk of contracting the disease. Of course, as Dr. Richard Rothenberg of Georgia State University notes in the article, it is difficult to track the effects of the project because of confidentiality issues. Nevertheless, the project is valuable:

However, it may be difficult, if not impossible, to study the impact on health because the service is confidential, Rothenberg said. "I think we, and the authors, must be content with the idea that this appears to be an acceptable method to fulfill the moral imperative of notification, and it has a chance to be a better approach than what we currently do," he said.

Tara Parker-Pope at the NY Times Well Blog has an article about how patients can cope with the vast flood of information (and misinformation) that is now available to them through the Internet.

Nowadays, people can look up their symptoms, self-diagnose certain conditions, find studies about the efficacy of various treatments, and find out what the medical community's consensus opinion is on a wide range of issues--all things that they once relied on doctors for.

Dr. Marisa Weiss, a breast oncologist quoted in the article, points out that doing independent research before a doctor's appointment has become mandatory because doctors have less and less time for patients. So it's in the patients' best interests to come in some idea of what's going on, so they can communicate what they've learned to their doctors and the appointment will proceed with more efficiency.

However, coping with so much information can be a puzzling experience. The article lists several helpful suggestions, such as considering what mental impact doing the research will have on you, exploring non-Internet sources, using your research as a supplement to your doctor rather than as a complete replacement, and other such useful tips. The whole thing is worth a read.

We have all looked at the newspaper and noted with interest that some new drug cures 75% of the people who take it.

Some of us may have even based our medical decisions around information acquired in this way, maybe by going to the doctor and asking for that particular drug.

Unfortunately, the study that said the drug was very effective might have been funded by the same people who made the drug--and the article might not have told you that.

From the article:

The mainstream media often fail to report when drug company funding is used for studies of medications, a new review found.

What's more, there's a tendency among both medical and mainstream reporters to use brand names, rather than generic names, when referring to specific medications.

And both of these factors work to skew public and medical opinion toward commercial interests, according to the review, published in the Oct. 1 issue of the Journal of the American Medical Association.

This, despite newspaper editors' assertions to the contrary, the study authors found.

The lead author of the study, Dr. Michael Hochman, argues that everyone should try to refer to drugs by their generic names rather than by their brand names--in order to separate specific drug companies from the discussion of what drug is best for a patient.

Everyone who gets information about drugs from the media should keep this in mind as we read.

It's also a good idea to follow the seven-year rule -- do not take a drug within its first seven years on the market. That is because the injuries and dangers from the drug often don't become well known until it's been on the market for some time. See Public Citizen's Health Research Group web site for a good discussion of practical advice for patients in reducing their risks of harm from drugs.

Dr. Pauline Chen has an article about doctors, empathy and time crunches.

She notes that many doctors would like to express empathy to patients when delivering terrible news, but due to the load of cases they are dealing with, are afraid of spending too much time comforting one patient when there are others that need attending to.

She argues that expressing empathy takes less time than one might anticipate, especially if you use the right strategies: for instance, she recommends expressing empathy throughout a consultation instead of waiting until the very end, as some doctors tend to do.

The whole column is interesting and worth a read.