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DEATH BY PRESCRIPTIONTHE SHOCKING TRUTH BEHIND AN OVERMEDICATED NATION
By Ray D. Strand Donna K. Wallace
THOMAS NELSON PUBLISHERSCopyright © 2007 Ray D. Strand, M.D. with Donna K. Wallace
All right reserved.
Chapter OneDeath by Prescription
With a shiver Cynthia put on the little gown that gaped open down the back. Not too anxious to climb up on the paper-lined exam table, she opted instead to perch on the edge of a short stool while she waited for her doctor to come in. It wasn't cold in the little room, but the patient wrapped her arms tightly around her middle. Over the years Cynthia had become accustomed to her annual gynecological checkup and pap smear, but it would be a stretch to say one ever became comfortable with them.
She had learned years ago that the best way to pass the time in these little rooms was to close her eyes, breathe deeply, and recall her many blessings one by one. She had so much for which to be thankful. At age forty-eight, Cynthia was truly living the life for which most women yearn.
Deep breath in, slow exhale out. Deep breath in ... scenes of motherhood, a lovely home, dear friends, and a partnership shared with her husband in real estate and development flipped through her mind like pages in a family photo album. Some of her favorite blessings were the kids, of course. "Lord, thank You!" she whispered.
The youngest of their three children had just gone away to college, and now she and Phil were looking forward to a new chapter with more freedom-one filled with travel and adventure. Raising three teenagers had given her a few strands of gray hair, but Cynthia remained in excellent health as a result of eating right and staying fit.
Over the last six months, Cynthia had started having night sweats and hot flashes, so she wanted to discuss menopause with her doctor during this visit. She would explain to him that her periods had been getting farther apart and that she had actually missed one entirely a couple of months ago.
After listening carefully and doing a thorough exam, the doctor confirmed that Cynthia was indeed entering menopause and strongly encouraged her to start hormonal replacement with estrogen and progestin. With confidence he explained the tremendous benefits of taking hormone replacement therapy (HRT), with the assurance that estrogen would improve all of her menopausal symptoms. He also claimed that HRT would decrease Cynthia's risk of developing osteoporosis, Alzheimer's dementia, heart attack, and stroke. HRT could even improve her sex life.
Of course, Cynthia was in favor of actively defending her body against such diseases, but she'd always believed that being a good steward of her health was sufficient. Noticeably hesitant, Cynthia questioned the doctor about possible risks of taking hormone replacement therapy. She was not excited about taking any type of medication-especially for the rest of her life.
The soft-spoken physician leaned forward and insisted that every woman needed hormonal replacement and that it was essential for her to take it over the long term. Glancing over Cynthia's chart, the doctor said that HRT could increase her risk of developing breast cancer. But the medical literature had some conflicting reports as to whether or not this was true, and he felt the findings were inconclusive.
With a tone that brought the discussion to a close, the doctor said, "The benefits of taking hormonal replacement far outweigh any risks you may encounter. In the hundreds of patients I've treated, never once have I seen any complications related to HRT."
Cynthia was obviously intimidated, and in the end she consented to accept his recommendations. After all, she was paying for professional advice and wanted to do everything possible to protect her health. Faithfully she began taking her estrogen and progestin each day. She was relieved when her hot flashes and night sweats began to diminish and finally disappeared completely. Soon she also added some calcium and vitamin D supplements to her daily regimen and continued her workout program. Months passed, and she was feeling great.
* * *
Cynthia woke up to sunshine and birds singing. The thermometer read 72 degrees, and she had spring-cleaning in mind. For starters, she would open the doors and windows for some fresh air, then she'd do some thorough scrubbing and cut a bouquet of tulips and daffodils for the foyer.
Suddenly Cynthia felt an unusual, crushing heaviness in her chest. She became short of breath and began sweating profusely. The chest discomfort first spread to her left shoulder and then down her left arm. Phil was not home, so she half-crawled, half-dragged herself over to the phone and dialed 911. Cynthia was beginning to lose consciousness and couldn't form any words. Within seconds, she crumpled to the floor.
With the phone line still connected, the 911 operator was able to trace the call and alert the paramedics. Within fifteen minutes they arrived and found Cynthia lying on the floor. The paramedics started cardiopulmonary resuscitation and rapidly transported her to the nearby hospital emergency room.
The ER physician and entire emergency room staff set to work immediately in a frantic attempt to save Cynthia's life. The reception staff located Phil and informed him about what was happening. Dropping everything, he raced to the emergency room. But when he arrived he was not allowed to go back to the room where his wife lay, still totally unresponsive. Straining, he could see at least a half-dozen people working to resuscitate his wife. He recognized his friend Paul, a local cardiologist, who had been making his morning rounds and had responded to the "code blue" announced over the hospital's intercom system. Phil was gripped in shock and disbelief.
Another twenty-five minutes of gut-wrenching waiting passed after a nurse had ushered Phil to a private family waiting room close to the ER. Just when he thought he could not wait a minute longer, he looked up, and there stood his friend Paul. By the drawn look on Paul's face, Phil knew the report was not good.
Paul spoke with a quiver in his voice, "Phil, Cynthia is dead-we tried everything to save her, but we just could not get a response."
Phil sat in total disbelief. He tried to make sense of the words he'd just heard, but he could see only his wife's face that he'd kissed before leaving for work just two hours before. She had been vibrant and full of energy.
"Phil, she suffered a heart attack and went into cardiac arrest-her heart just stopped. We tried everything to get it beating again, but nothing helped."
The Rest of the Story
Weeks passed after the tragic morning that forever changed Phil and his family's life. Cynthia was gone, and the loss filled every waking moment of their lives. They had consented to an autopsy and learned that indeed, she had died of an acute coronary thrombosis-a heart attack. The news was baffling, because Cynthia didn't have any risk factors for heart disease. In fact, she was physically active, watched her diet closely, and even had normal cholesterol levels. There was not even a recorded history of heart disease in her family. Phil finally decided to go to lunch with his cardiologist friend Paul to get some answers.
His friend wasn't very talkative at lunch, but after some casual, courteous remarks, Phil asked the cardiologist for his opinion. "Why? Why did Cynthia suffer a heart attack?"
After a long pause, Paul carefully informed Phil that he believed Cynthia's heart attack was most likely due to the hormone replacement therapy that she had started several months earlier. Paul went on to say, "Estrogen is known to cause an increased risk of developing blood clots and subsequent embolism to the legs, lungs, or brain." Recent clinical studies had actually shown an increased risk for heart attacks and strokes in women on hormonal replacement, especially during the first year, he added.
Phil was confused. "I distinctly remember Cynthia saying that one of the reasons the gynecologist put her on the hormones in the first place was to decrease the risk of heart attack and stroke!"
The cardiologist shook his head as he responded, "This is what we have thought for years. But in the past year or so studies have revealed this increased risk of heart attacks is probably greater than any of us could have before imagined or anticipated." He concluded, "I am truly sorry."
More questions bombarded Phil's mind. This is a risk of estrogen that has been known for the past year or so ... known for the past year? By whom? The maker of the drug? The doctor who prescribed it? The pharmacist who filled the prescription? Why were he and Cynthia the last to know? If recent clinical studies had shown an increased risk for heart attacks and strokes in women on hormonal replacement, what was it doing in Cynthia's medicine cabinet? And why had the gynecologist actually told Cynthia that one of the reasons he wanted her to take it was to decrease her risk of heart attack and stroke?
Injuries and deaths like Cynthia's are not simply statistics. Each one marks a family that suffers a tremendous and unexpected loss. If only Phil and Cynthia had realized the potential danger of hormonal replacement therapy. After all, menopause is not a disease; it is simply a stage of life. Phil now realizes that this adverse drug reaction does not occur often; however, he also knows that when it happens to you, percentages don't really mean much. As far as he is concerned, this adverse drug reaction may as well happen 100 percent of the time.
A Report That Rocked the Medical Profession
You may be tempted to think that Cynthia's story is rare happenstance, and the chance of you or someone you love having a similar experience is almost nonexistent. Even as a physician I would have agreed with you until 1998, when I encountered a shocking article in the prestigious Journal of the American Medical Association (JAMA). The article was titled "Incidence of Adverse Drug Reactions in Hospitalized Patients."
There the authors reviewed thirty-nine studies detailing adverse drug reactions documented in U.S. hospitals over the past thirty years. They determined, even by very conservative analysis, that in 1994 more than 2.2 million people required hospitalization because of serious reactions to medications. Even more troubling was the fact that more than 106,000 of these patients actually died because of adverse drug reactions-reactions to properly prescribed and administered medications. The authors of the JAMA article concluded that these totals have not changed significantly over the past thirty years.
This report exploded like a bomb in the medical profession. We had no idea the number of patients affected by adverse drug reactions was so high. Physicians were so filled with disbelief that many of them questioned the integrity of the report and its data. The authors, however-all doctors themselves-had gone to great lengths to make sure their conclusions about adverse drug reactions were credible. Their data stood the test. Because they had excluded all questionable cases, their estimated numbers were low, not high.
Why are these numbers so shocking? Other than the personal heartache connected with the death of each of these people, is this really a big deal? It is a big deal. Let me put the numbers into context: the number-one killer in the United States is heart disease-around 743,000 deaths each year. The number-two killer is cancer, which accounts for 529,000 deaths. Number three is strokes, which total about 150,000 deaths annually. Guess what the number-four killer is? Is it automobile accidents or AIDS? No, each of them claim only 41,000 lives every year. America's number-four killer is adverse drug reactions to properly prescribed medication, with more than 100,000 estimated deaths per year. And if you add the 80,000 deaths caused by improperly prescribed or administered medication, adverse drug events become the number-three leading cause of death in this country. In comparison, 56,000 people were killed during the ten years of the Vietnam War and just under 3,000 people were killed on September 11,2001,by terrorist attacks. Now you can understand why the JAMA article caused such a tide of unbelief!
Doctors and patients alike see drugs as a huge contributor to health. We wonder, then, how can it be that this favored tool in medicine is actually a significant foe for thousands of innocent patients? To say the least, this is a terribly disconcerting finding, because we doctors love our drugs. I'll explain why.
The Making of a Doctor
The anticipation I felt as I entered my first year of medical school in 1967 was overwhelming. I was one of the few students who had been accepted into medical school following my junior year of college. I had worked hard, and now it was all paying off. This was the beginning of my dream; becoming a medical doctor would give me the lifelong opportunity to truly help people. Any challenges to come would be well worth the effort.
My second year of medical school was especially memorable because I was finally able to take classes that I felt would really prepare me to be a doctor. After taking rudimentary courses of biochemistry and physiology my first year, now I would study pathology and pharmacology. Physicians being disease-oriented and pharmaceutically trained, I remember my excitement as I learned about all the different medications. Doctors need to know a lot about drugs-namely, how the body absorbs and excretes them. With great enthusiasm I learned when and how I should use each drug. Of course, we eager medical students had to learn the specific side effects and dangers of each as well.
Drugs are synthetic, which means they are not natural to the body. Every drug inevitably affects a natural enzyme system within the body to accomplish a therapeutic result. Most of the time the body completes this process successfully-no big deal. Problems with drugs arise, however, because each drug also affects other enzyme systems in ways that may be harmful. The inherent problem with medications is that no one can know all the possible problems drugs may cause.
In my medical training I concluded that the harmful side effects of drugs were rare, and usually mild, occurrences. One bit of advice did stick in the forefront of my mind, though. My professor of pharmacology emphasized over and over, in regard to prescribing medication, "First, do no harm!" What he meant was, "Always consider whether the potential risk of a drug outweighs any potential benefit for the patient."
I am certain every medical student receives a similar warning. But like most doctors, I was so intent on helping patients and using medication to accomplish that goal, I didn't think too much about the potential danger of drugs. When patients came to me with their complaints, I would think primarily of the possible diseases they might have contracted. I rarely, if ever, considered the possibility of a drug reaction causing their problems. On occasion, especially in cases of patients on antibiotics, I would encounter an allergic reaction to a medication. Yet these instances were typically not serious.
Several years into my medical practice, however, one patient's case changed forever the way I thought about prescription drugs. This man, a prominent businessman in my community, had high blood pressure. To treat his hypertension I prescribed medication from an exceptional class of new drugs called angiotensin converting enzyme inhibitors-now called ACE inhibitors.
Sometime later he came to see me because of a dry, hacking cough that had persisted for several weeks. At times the man coughed so hard it literally took his breath away. These coughing spasms were so brutal and painful that he had to leave the room and bring the coughing under control in private. I examined him and ordered a chest x-ray. To my surprise, the x-ray was normal, and he didn't have any evidence of pneumonia or any other lung problem.
Stumped by his symptoms, I referred the man to a pulmonary specialist who did a complete battery of tests but could not determine a diagnosis either. Three other lung specialists in the same clinic then saw this patient and were not able to conclude what was wrong. We tried various antibiotics and asthma medications. Nothing helped.
After he had suffered six months of almost continual coughing, I referred him to the pulmonary department at the University of Minnesota. Again he went through another round of extensive tests. Still no definitive diagnosis explained the coughing.
When I saw my patient in my office a few months later, he was beyond miserable. He could hardly speak a sentence before breaking into harsh, persistent hacking. He had decided to retire and move south for the winter, hoping to find relief.
Excerpted from DEATH BY PRESCRIPTION by Ray D. Strand Donna K. Wallace Copyright © 2007 by Ray D. Strand, M.D. with Donna K. Wallace. Excerpted by permission.
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