Tag Archives: Reuters

Costs of dealing with drug side effects

Don’t blame patients

Various pills

Various pills (Photo credit: Wikipedia)

 

All too often today, you go to the doctor for a medical problem.

  • A rushed appointment leaves you frustrated.
  • You haven’t been able to voice half of your problems
  • But, like a child, you leave clutching a prescription for pills that are supposed to make you better
  • But somehow you are not sure.

No wonder so many patients don’t bother to take the prescription to the chemist.  Or even worse, collect the prescription but then never bother to take the expensive drugs.   In their mind they know that pills are not the solution to their medical problem, but aren’t able to take this further because doctors are using pills as a way of keeping us quiet.

So often handing out a prescription, and then ‘they’ won’t ask time-consuming questions,  seems to be today’s answer to a whole range of medical problems.  With appointments getting shorter and shorter, patients are already seeing the end result of the Health and Social Care Bill, with cuts everywhere including time spent with patients.  Solution seems to be prescribe more pills so we walk around in a zombie state, not alive enough to ask too many questions.

Or what is worse, when you do take the pills you are suddenly faced with horrendous side effects of whatever drug you have been prescribed.  Now you find you are regarded with suspicion – doctors don’t like patients who produce unfavourable reactions to drugs, because they have no idea how to deal with these.
LaLa’s Health Bill shows he has no idea how to run a health service, and doesn’t seem to realise that his Bill’s requirements to save money means that doctors will turn to prescribing pills, as the time-saving option, rather than taking time to talk through what is the cause of a patient’s problems.
It’s the same across the Atlantic
Latest information issued by Reuters Health in the States should worry LaLa.  He probably has no idea of the consequences of farming out treatment to a hodge podge of providers, but one thing that should have occured to him is that these medics, not knowing their patients, are more than likely to prescribe a drug as a solution.   And that is going to cost more money.
Painful rashes, nausea, vomitting  and other drug-related side effects of newer drugs will jack up treatment costs.
Skin rashes are another consequence, and Reuters says “the average cost of treating each cancer patient who came into a dermatology clinic with skin, hair and nail complaints was almost $2,000.  That included expenses related to doctors’ appointments, dermatology medications and lab tests”.
What happens here

As a patient who uses private treatment when I can afford it, but has to make do with NHS for most care, appointments take two different courses:

Dr. NHS  hardly looks up from their computer screen to ask what’s wrong.  I tell by talking to their bent head.   Am asked one or two basic questions.  Then doctor returns thankfully to their screen and says “take these pills three times a day”.  End of ten minute consultation.
Dr. Private  asks  what they can help with, and listens carefully.  Then asks a range of questions to my face, carefully watching whilst I answer, and prompting responses to which they ask more questions.  Then they suggest possible solutions, which may very well cover life-style changes:  cut down on certain foods;  take more exercise;  have I tried xxxxxxxx?  There is a discussion about consequences of different solutions, until after 20 – 30 minutes I go away with a plan of action – and very seldom any more pills to take.
Ellie-next-door went to see her Dr. NHS.   He said she had a temperature, and was about to prescribe   anti-biotics for her.  “Hold hard” said Ellie.  “Surely I read that these are losing their effectiveness because we are taking too many?  Wouldn’t it be better if I just went home to bed until my temperature goes down?”   Ellie did just that – result is her doctor isn’t speaking to her, but within three days she was up and running;  no temperature and NO horrid side effects from anti-biotics.
After starting on a new drug, my blood pressure reading went through the roof. My Dr. NHS put me on Amlodipine.  BP went down – thankfully – and I was just told to continue taking drug.  Instead, I have stopped taking the pills;  my BP is slightly above what it should be, but instead of talking about alternatives such as exercise, food etc. which is bringing the figure down, my doctor is cross because I am doing what I can to reduce BP by sensible means on my own.
Dr. Max Pemberton called us a ‘nation of pill poppers’ in the Daily Telegraph.  Then told a chilling story of his first ward round as a junior doctor.
“At nearly every patient’s bed, the Consultant took out his pen and…..  crossed off the medication they had been taking prior to admission.  I stood there and thought he must be mad………  But I came to realise that many of the tablets we dish out cause as many problems as they solve”.
Pemberton also mentioned an old lady whose life had changed (for the worse) after she went to her doctor to say she had trouble sleeping.  Side effects of the drug she was prescribed had eventually led her to have a serious fall, and she ended up in hospital.  This reminded me of Mother, who had had exactly the same problem, but when I suggested to the doctor that the sleeping pills were making her unsteady, causing three major falls, and should be withdrawn – he said this was taking away her rights as a patient.  Us kids changed her Temazepam to a similar-looking vitamin tablet – and no more falls.
The solution the Consultant gave to Pemberton’s old lady was a classic – and so sensible.  “If you can’t sleep at night, listen to the World Service.  It’s a lot safer”.

Drugs cause a vicious cycle – so if you are worried take your tablets off to your nearest Pharmacist.  Ask them what are consequences of taking each one,  and which ones you might do without.

No-one should become addicted or used to these drugs – keep them for when we really need them.

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Good News for Breast Cancer survivors

pink ribbon

Image via Wikipedia

Latest Research shows older women diagnosed with early-stage breast cancer can expect to live just as long

as their peers who have never had breast cancer – says a new study.

According to the story posted by Reuters news agency, by “consulting a register of cancer diagnoses in Medicare patients, the authors, led by Dr. Mara Schonberg of the Beth Israel Deaconess Medical Center in Brookline, Massachusetts, were able to identify almost 65,000 older women who were diagnosed with breast cancer of any stage between 1992 and 2003.

For comparison, they collected information for a group of about 170,000 women of similar age, also on Medicare, who were not diagnosed with breast cancer”.

Research involved tracking women in both groups through 2006 (close to 8 years of follow-up on average), to determine how many of them died, and from what cause.

Good News

Women diagnosed with ductal carcinoma in situ (DCIS) – the earliest stage of breast cancer – and stage I cancer were just as likely to survive through the end of the study period, as women who were never diagnosed with cancer.

Apparently, if you were under 80 and diagnosed with DCIS, you were actually slightly more likely to survive for at least 5 years than women who were not diagnosed with breast cancer. Researchers believe that could be because of the “healthy user effect;” women who are diagnosed with breast cancer are more likely to have been screened for cancer than women who aren’t diagnosed, and may also be more health-conscious in other ways.

The findings, the authors say, suggest that doctors should be talking with older women about the risks and benefits of being screened for breast cancer. Screening might pick up an early stage cancer that is advancing – in which case treatment could prevent the cancer from becoming worse.

In some cases, however, screening might pick up cancers that would not end up cutting a woman’s life short, especially if she was at risk of dying from another condition, such as heart disease. In that sense, a woman is at risk of being treated with invasive procedures unnecessarily since they would not extend her expected lifespan.

“I suspect that a lot of these cancers are cancers that never would have affected someone’s life expectancy” had they not been caught, Schonberg told Reuters Health. However, she said, it’s very hard to know which cancers are going to progress and which are not likely to cause a woman’s death.

“This is the fundamental problem in screening for cancer in general,” Elkin added. She said that each woman’s decision about whether or not to get screened should depend on how much she would benefit from doctors catching an early-stage cancer. Every older woman “should not just get a mammogram routinely, but have a discussion with her doctor,” she said.

The main message is that “screening can be effective even in older women,” Elkin said. “What’s important is not necessarily a woman’s age but her general health and her life expectancy … and that’s true for any age.”

SOURCE: http://bit.ly/eKY591 Journal of Clinical Oncology, online March 14, 2011.
Copyright © 2011, Reuters

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Sometimes, we DO know best when it comes to our health

Capsules
Image by Auntie P via Flickr

Side effects of cancer drugs

often surface years after

drug approval

.

Have you had a medical problem, which you think might have been caused by one of the drugs you are prescribed – but doctors pooh – poohed any suggestion these might be the cause?

Recently Reuters Health reported  on a story released by Canadian researchers, saying that  “serious and sometimes life-threatening side effects often go unreported until years after cancer drugs have been approved”.  Reuters Health compiles serious analysises of medical research and treatment emanating from major studies.

For many patients, drugs are life-extending.  We wouldn’t have improved survival statistics if it wasn’t for these products.  However, a growing minority are experiencing side effects caused by these drugs – some of which are very nasty.

Sounds familiar?

When asked if they have experienced problems, for many cancer patients the answer will be a resounding yes.  Often   they have tried to get their medical team to listen if  they report  problems, but find it impossible to get them to even check if symptoms might – just might – be caused by a drug they were or are on.

If you have experienced problems, researchers from the University of Toronto have discovered, “within four years of approval, five of the 12 drugs they looked at had earned a “black box warning” from the U.S. Food and Drug Administration, which approves new medications”.

The research was led by Prof. Ian F. Tannock, who says  “it’s a warning to be very careful.,”  Tannock is an oncologist at the University of Toronto, and said “patients need to be informed that with a new agent there may be added risks.”

Tannock’s team examined so-called targeted therapies, a budding class of cancer drugs that work by interfering with specific molecules involved in tumor growth. Therefore it was expected that the medicines would be safer than traditional chemotherapy.

However, results questioned this assumption.  When questioned by Reuters Health, Dr. Thomas J. George commented, “it’s concerning to say the least. When we as oncologists prescribe new therapies we have to be on the constant lookout for side effects and outcomes that aren’t necessarily what the trials would have predicted,” added George, of the University of Florida.   (George was not involved in the study).

The new findings come in the wake of research showing that most trials of experimental cancer drugs report increases in at least one severe or life-threatening side effect.

So what about your experiences?

You might have had nasty problems, and wondered if these were caused by the drugs you were put on.  But when you ask your oncologist, they tell you, “I have never seen/heard of this before”.

But they need to be more vigilant, and keep up with what the researchers come up with.

After all, who would have connected carpal tunnel syndrome with a commonly-prescribed aromatase inhibitor?  Or heart problems, skin lesions, blindness, etc?  All symptoms that have recently been acknowledged as possibly been caused by drugs patients were taking.

Some of these horrid conditions may have had nothing to do with the drugs they were taking, but the medical profession needs to undertake more research and LISTEN to patients, before they dismiss their fears.  Most patients won’t challenge a doctor, but sadly they often need to do so.

Why does this happen?

According to the Reuters report, one reason why this can happen is that trials, which form the basis for FDA drug approval, might be too small for rare side effects to surface, or they include only highly select patients.

To help yourself, you can now point to this research, and other studies, and demand more investigation.

What happens in UK

In Britain, cancer survivors have long suspected that drugs they are on might cause problems, but with the limited average of ten minutes allocated for an NHS visit to an oncologist in Clinic, many don’t have time to discuss what might be causing these.  The solution is often the easy option of  “come off the drugs”.

This is not fair on the patient, who wants the reassurance that the drugs might help them to live longer.  But may well be a contributory factor to why, in Britain, our survival rates lag behind those of most European countries.  From personal experience, when I had nasty side effects, and had been told to “come off the drugs”, I didn’t.  Instead I went off to hospitals in France and Germany, where the side effects I experienced were well documented, and immediately the doctors to whom I spoke suggested clinically trialled solutions – which worked.

But this took time :  the doctors had to listen to me, examine me, take samples, swabs,  go through my medical notes, ask questions, etc.  in order to come up with a solution which worked.  This type of treatment is something that the NHS has less and less time to offer to patients.

Or the drug companies tell the patient to “fill in the Yellow Card”.  These are a fairly long form that the patient fills in, listing symptoms.  Patients will often have to phone round to get facts confirmed.  Once filled in, they are sent off – and that’s the last the patient hears.  When I phoned to ask what had happened to ‘my Yellow Card, I was told “because of Data Protection Act   we can’t tell you – even though you filled in the card.  So I gave up.

Solution would be to be more helpful to patients, and take a pro-active stance in investigating – but drug companies hide behind convenient rules and regulations, which mean that patients have the frustration of trying to find information, but coming up against brick walls. Then they are told to go back to their doctor – the very person who has originally dismissed their concerns and told them “I have never seen this before”, or similar statements.

Or else the solution means going to a major cancer centre in Europe get solutions.  But who can afford this every time?

Why does this happen?

Tannock says the problem is that very few doctors actually look at the labels. Instead, they stick with the published studies that led to the drug’s approval and first label.

Focusing only on drugs with updated labels, Tannock’s team found that half of the 76 serious side effects described in them hadn’t been on the initial label. Of potentially fatal side effects — such as blood clots, strokes and lung problems — that number was 58 percent.

“Many of the reports that led to the warnings did not come from published studies,” added Tannock, whose findings appear in the Journal of Clinical Oncology.

So if you have unexplained side effect:

Print out report link.reuters.com/byd27m

1.  Take this to your Oncologist and/or CNS

2.  And don’t take no for an answer.

Background on Prof. Ian F. Tannock

Currently working for Ontario Cancer Institure, gained his PhD at Inst. Cancer Research UK in London etc.

If you Google him you come up with a lot of very interesting info, particularly his statement, “I have a long-standing interest in improving methods for undertaking clinical trials, and especially in use of endpoints such as quality-of-life that reflect patient benefit directly. We have applied these endpoints in clinical trials for patients with prostate and breast cancer, and are interested in the mechanisms by which chemotherapy may cause fatigue and cognitive dysfunction.

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