Friday, March 6, 2009

FDA, Warnings, Medication, Side Effects

I learned something new today which has gotten me to thinking about an old problem - that of medication risks and side effects.

I learned that many of the medication patches (transdermal delivery systems) that are now used commonly can cause skin burns if one is wearing them during an MRI scan. There are now 60 different medication patches that are used for a variety of conditions from nicotine cessation, to hormonal replacement to pain control and many others. Apparently about 1/4 of these patches contain traces of aluminum or other metals in their backing which can overheat and cause burns in the MRI scanner. I did not know this. The FDA is considering placing a warning label on every patch so patients will know to remove them during the scan.

This got me to thinking about FDA warnings and medication side effects in general and how it is becoming increasingly more difficult for doctors and patients to weigh the risks of taking a medication or undergoing a treatment.There are so many more medications now than in the past that it is hard for anyone person to keep up to date. In addition to side effects and risks there are many drug-drug interactions which can be harmful. On top of this there is now direct to consumer advertising from the pharmaceutical companies urging patients to discuss certain medications with their doctor to see if they are right for them. When I look at The Physician's Desk Reference (PDR) which is the detailed prescribing information on all medications it sometimes appears that any medication can cause any side effect! How to tell the the most common and potentially the most dangerous is not easy for us as patients. For example what does a person make of advertisements for antidepressants that tell of possible increase in suicidal risk or asthma medications which can cause respiratory problems and death. What about arthritis medication that says it can cause serious life threatening infections?

Medication data bases are the best way to screen for drug-drug interactions but are not helpful in making decisions about whether or not to take the medication in the first place. These decisions are based upon the relative risks vs the potential benefits in any one individual. What we all need to remember is that no medication is safe. There is no treatment without risk. I believe that the only good way to handle these dilemmas is a good doctor-patient relationship in which there is full freedom and opportunity to discuss these issues. We as physicians must take the time needed to have these kind of talks.

Thought for the day

"O love, you ever burn and are never extinguished".

St Augustine

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