Harmful Drugs Are Reported As Business News — Not Health Or Medical

I was a staff psychiatrist at the Las Vegas VA, when the endocrinologist who was assigned from that august institution to take care of me told me that Meridia for weight loss would be a good idea.

Surprisingly, the first thing that came up on my search today was something from the Forbes magazine health editor. Duh, this is a business story.

When I declined Meridia, because of what he thought were “only a few”
reports of sudden death, I was packing on the weight steadily– due exclusively because of his treatment for me — which included taking a lot of insulin which obviously I did not need.  After all, I had a bit much blood sugar and he never noticed it was chasing my triglycerides, and/or never saw this, although it had been starting even then to become evident to me.

This was the man who was touted as “the best doctor in town” in his specialty.

(Okay, I have more history and data than he did, but still …)

Of course, I declined the drug — thereby probably saving my life (or at least adding many, many years to it).  I should have beat him up, I suppose. I did fire him.  I also left Las Vegas. I am no good at remembering dates, it is probably somewhere on my CV when I left Las Vegas, but this was around 10 years ago.

The circumstances of my departure were far more felicitous than the movie “Leaving Las Vegas” where Nicholas Cage committed suicide by drinking himself to death. Even more felicitous than Elizabeth Shue, far more believable in that movie as a prostitute than as a giggly, cuddly nuclear physicist in a lame movie remake of the classic TV show “The Saint.”

I had a crush on Roger Moore and never missed an episode of The Saint when I was young.

Maybe you like the consumer justice page better.  Yep, they gave me Avandia exactly once before I pulled myself off it — with the help of a doctor who second guessed the doctor who gave it to me.

Is the FDA changing?  That is hard for me to believe, since they have no real legal “teeth.”  Drugs do kill people sometimes.  Is it safe to use a drug that only kills people once in a while?  How big a risk of death is acceptable for a prescription drug?

For myself, I will accept no risk.  I want to believe that human life — and mine and my husband’s and the lives of people whom I love, and lives over which I have some control — are worth more than the prices of drugs.

When I am consulting in a poor community, the clinics will always give
people who have no insurance the cheapest drugs (not the most effective and sometimes not even ones made for their particular illness).  Also, patients who are paying out of pocket (not getting free treatment from the government) routinely ask for cheaper drugs. I rattle off the risks of these drugs, which generally includes death (for some reason, they always list that one last on the package insert — probably hoping nobody reads down the list that far).

This week alone, I have seen someone using carbamazepine (Tegretol)
for mood control.  I told them it could wipe out their bone marrow, causing aplastic anemia — not enough blood cells to protect your body from attacks by bacterial or viral illness.  I would order blood tests to check, using my “drunk with power” mode to get the county to pay for them, but she could die.

Yes, die dead as a doornail — the worst and most irreversible of all side effects.  Yes her.  Yes, this sweet young girl with the beautiful makeup and lots of boyfriends and a street-based lifestyle that put her at risk for every communicable disease I could think of.

She acted at first like she didn’t hear.  I made her at least act like she heard and sign an informed consent for drug treatment.  I was not revered, nor respected, nor even treated decently for telling her the truth.  I told her I had to, that was my role and that was the law and I took this seriously.

She asked me the question I least like hearing.  “Why didn’t the other doctors tell me?” She had chosen the cheapest drug, and I will never know if other doctors really omitted telling her this, although all doctors need to see too many patients too quickly, so they probably didn’t.  I know she was not told in a way she could hear.

As always, I said, “I have no idea why other doctors do or do not do things.”

She was not happy.  There must have been some psychic pain, as she was holding back tears.

“Look, I gotta look myself in the mirror every day, so I gotta tell you the truth,” I said. Ideas such as conscience and ethics seemed meaningless to this 20 year old.  I told her there were other drugs, that did not have that side effect, but that probably cost a little more. She did not want to change.

Back to Meridia.  European Union called for recall in January. Reported at a website called “about lawsuits.”

FDA has been studying this since August.

I have been through pages and pages of references and there are business and drug alert references to the concern and potential recall of this drug.  I have failed to find anything in the literature about how many people had to stroke out and die before this recall was even considered.  I suspect such data is kept secret, for it must surely exist.

There are some lessons here.

As a watchdog, the FDA has been asleep for a long time, on this and I suspect on other such issues.  I hope they really are changing; we will see.

As a watchdog, I am pretty good. I am ahead of the curve.

The value of human life is everywhere diminished. People — given their choice of drugs — often choose cheap and dangerous ones over safe and expensive ones.  In many cases the insurance companies make this kind of choices.  Or doctors might be restricted prescribing only certain drugs if employed by a mill like Kaiser Permanente, and they become numbed to the dangers of the drugs they prescribe as a survival mechanism.

I tell patients every day of my working life. “This stuff is going into your mouth. Check out the advantages and risks.  They don’t even give me time to tell you about all of them. Pump your pharmacist for information, read their printouts, go to the library, anything.  Make sure you are satisfied.  I am trying really hard to  make the best decision I can for you, but the bottom line is it goes in your mouth, so check it out and ask questions.”

There are still a few people left, more relatives than patients who say “You are the doctor — fix him/her dammit” and I review informed consent for medication, and tell them I cannot do that.  The patient’s own decisions, except for the rare times they are conserved so their decision have been deferred to another, are what should and does drive treatment.

I have a similar speech to conservators.

Back to why the endocrinology specialist suggested Meridia for me — a bad move even then — and not other things.

1. He was a tall skinny guy.  Medicine is not a perfect science and prescriptions are more subjective than we want to believe.  I remember when I was in residency, writing a paper (not published, to my knowledge, but delivered at a University meeting), along with one of my professors, that showed that doctors only diagnosed alcoholism when the patient drank more than the doctor.  I suspect the same goes for obesity.  If he had reviewed the danger of the drug and the danger of my overweight in any kind of objective way, I suppose it was obvious even then that the drug was much more dangerous.
2. He was not of my ethnicity.  My hypertriglyceridemia in a hereditary context may simply not have been known to him because it may have not occurred in his lineage.
3. He seemed to prefer prescription drugs over other methods of
treating problems.  He claimed he had read about fish oil lowering
triglycerides, but recommended only prescription drugs for any of my
lipid problems.
4. He was stuck in the mainstream.  I was already starting to distrust same.

Lots of people are out there telling you to let them think for you.

Not me; I am telling you to think for yourself.

The only alternative I can think of right now is, like Cartman sometimes says in South Park,  “Accept my authority.”