When Good Drugs Go Bad

My primary care physician likes to promote relatively new medications and has been known, at least with me, to either not know of or intentionally mislead about serious side effects of particular medications. When he prescribed Tramadol (Ultram) for me he assured me that it was non-habit forming and that there were no serious side effects. He failed to mention that:

"Commonly reported side effects include nausea, constipation, dizziness, headache, drowsiness, and vomiting. Less commonly reported side effects include itching, sweating, dry mouth, diarrhea, rash, visual disturbances, and vertigo. Some patients who received tramadol have reported seizures.Abrupt withdrawal of tramadol may result in anxiety, sweating, insomnia, rigors, pain, nausea, diarrhea, tremors, and hallucinations." [Emphasis mine. Source]

As a matter of fact, because of I'm so leery of taking medications with which I'm unfamiliar, I asked him about possible adverse side effects. He assured me that Tramadol (Ultram) is no worse that prescription strength acetaminophen or ibuprofen. At that time I trusted his judgement. Later at a checkup I told his NP that I sometimes took two pills at a time because they did little to alleviate my pain. She told me it was fine as long as I didn't go over 500 mgs a day. She then consulted with the same doctor that prescribed the medication, and returned to tell me I was taking too much, that it wasn't good for me and I should take the Vicodin primarily for pain. She told me that I could take the Tramadol to boost the Vicodin "occasionally". I was again reassured that the Tramadol was basically safe and not to worry about anything. I already knew about the withdrawl symptoms, now I worried about other things. It's better for me to take a controlled narcotic than this? Bye, bye Tramadol.

Doctors Sometimes Get "kickbacks"

I've known this for a long time. Doctors benefit from prescribing certain medications to their patients. The pharmaceutical reps come in and bring fancy lunches, take doctors to dinner, give expensive "gifts" and in return the doctor prescribes whatever meds the rep is hawking. A lot of times the doctors don't read all of the literature before they start prescribing the medications so they're not aware of all the dangers. They trust the reps to give them the real low-down on the medications. The reps are told to boost sales and make the meds seem like heaven in a bottle. The rep gets a sale, the doctor gets a "prize" and the patient gets... Well, sometimes the patient gets dead.

I have been an unfortunate victim to over-zealous medicine prescribers. When I first started feeling the fatigue that I suffer now I told the NP who worked in my OB/Gyn office. I trusted her implicitly. I really thought she knew her stuff. I took the pills as she prescribed. Within a week I was a zombie with crazy, manic thoughts, I couldn't follow conversations and I clenched my jaw so hard that I broke two molars. When I went off that medication, which I did without consulting my NP, I suffered sever SSRIDS (SSRI Discontinuation Syndrome).

To this day I believe that Lexapro (codename: The Devil's Pill) is the cause of my cognitive impairment.

Giving Up on Your Doctor

When I mentioned this to other doctors I received the ye ol' skeptical stink-eye. The second doctor I saw for my present condition actually tried to convince me to try it again. Because of my experience with Paxil, there was no way I was going to try SSRIs (Selective Serotonin Reuptake Inhibitors). She continued to try to push them on me. At one point, she even tried to give me samples of Nexxium (for acid reflux) to help my pain. HUH? She was so fired.

When I found my for-now present doctor, I told him these stories at his interview. I told him that I have to be careful because my body doesn't do well with drugs. This is before I found out that he is, as my mother-in-law says, a "pill pusher". He is at times even more aggressive than my previous doctor. He wanted me to try Cymbalta. I asked was it an SSRI. He said it was a different kind of SSRI. I refused. He nodded, told me he had something that might help and brought me back a "goody" bag. Inside were samples of Cymbalta (and the prescription for Tramadol). Because he is, to me and probably hundreds of other people, an authority figure and supposedly pretty smart, I thought maybe he was right just this once. I put the pills in my cabinet. I didn't take one for probably 3 weeks. Finally, I couldn't take it anymore and took a couple. For 2 days I was fine. On the third I got lost in a song in my head. The first sure sign of bad things. I stopped taking them and didn't go back to my doctor for 3 months.

It wasn't until the last time I was there that I decided that he was lost in his own little world of making the moolah at whatever cost. When his office didn't have information on Fibromyalgia I had to give up. That's when I found my rheumatologist, who listened to me and gave me a drug that has been on the market for a long time and has proven results. I don't particularly like the drug, but my doctor explained the good and bad risks and didn't insist I try it for a prescribed amount of time. That was nice.

Kickbacks Cost You

Merck has just settled a lawsuit with regards to its "blockbuster" pain-killer, Vioxx. It was touted as the thing in pain medications. My mother-in-law was on it for a while and was angry when Merck took it off the market. Millions of people had been given this drug and subsequently suffered strokes, heart attacks, and some died. It was proven that Vioxx caused a greated incidence of these things in people taking them (as opposed to research participants who had taken a placebo). The drug was on the market for 5 years before the FDA decided to do something about it. By then those that marketed it and prescribed it had done a lot of damage.

Merck was the maker and marketer of this particular drug. They sent their reps out to doctor's offices around the world trying to get Vioxx out there. The reps needed to make money and sold their products the best they could. The doctors who bought into the drug's benefits and ultimately prescribed the drug often were either under-informed or paid well for the prescriptions. They were over-zealous at times and would prescribe this drug for issues for which Vioxx wasn't intended (as is often the case now with anti-depressants). They then failed to fully inform their trusting patients of the dangers of Vioxx, probably because they really didn't have that information to pass along. Some doctors even expect the patients to do the research on their medications, as opposed as doing as much research as possible on behalf of the patients to whom they're prescribing these drugs.

That overzealousness has cost Merck $4.85 billion. What are they doing to prevent these kinds of things from happening more?

"The company said last month it had added $70 million to its reserves for defending lawsuits. As of Sept. 30, Merck had reserved a total of $1.92 billion for legal expenses and spent a total of $1.2 billion."

Not rethinking their marketing strategies as you'd think they'd do. They've increased their legal defense fund.

Don't Trust the New Stuff

This kind of thing is happening more and more. As I write this there is a commercial from a law office asking for anyone who has taken Ortho Evra to call them. The Birth Control Patch releases 60% more estrogen than birth control pills and so the risks of blod clots and strokes are substantially increased. If you look on the website it says:

"In general, increased estrogen exposure may increase the risk of side effects. The risk of venous thromboembolic disease (blood clots in the legs and/or the lungs) may be increased with ORTHO EVRA compared with that of a birth control pill containing norgestimate and 35 mcg of estrogen. One study found a doubling of this risk and another study found no increased risk".[Source]

Not until the FDA demanded they do so did the makers of Ortho Evra make these dangers clear. According to a lawsuit filed recently, the subsidiary of Johnson&Johnson, Ortho-McNeil, who make Ortho Evra went so far as to hide these dangers from the FDA for a substantial amount of time.

"Even that label change failed to address the health risks associated with the patch, according to the lawsuit: the risk of blood clots. The reason why, according to the lawsuit, is that the companies waited several months before presenting the risks to the FDA."[Source]

Other drugs which have been taken off the market recently include Rezulin-2000 (Diabetes), Serzone- 2004 (Depression), Bextra- 2005 (non-steroidal anti-inflammatory), Permax-2007
(Parkinson's Disease), and Zelnorm- 2007 (IBS with constipation). They've all had dangerous and life-threatening side effects happen to too many people. And when doctors don't pay attention to the literature more people become victims. Doctors are the last line of defense for patients and when they don't know enough about a drug they're risking their patients' lives.

There are many more alternatives that a doctor may not offer as treatment simply because they are trying so hard to push the new stuff. Does your doctor have a tendency to urge you to try new or relatively new medications? If so, then it's in your best interests to get the name of the drug from your doctor and do your own research. Though you can find many more listed side effects than what your doctor has probably told you, you shouldn't look only on the drug's website. Often times you'll see the positive in larger type than the bad. Instead look past page one of the search to find stories from people who have taken and suffered because of following their doctors' advice. Then consider alternatives to you medication.

If after you've done this you believe your doctor was actually right, go ahead and take that prescription down to the drugstore. If you feel like that medicine is just too risky, insist that your doctor look for alternative treatments. Don't be afraid to tell your doctor "No". Ultimately, you're the boss. If it comes right down to it, fire your doctor and find another one. If your doctor refuses to take your fears seriously then he's probably concerned more for his pocketbook than your health.