The Good News About "The Bad News" on Rx

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Two stories appeared in the news recently that tried create alarm about modern therapeutic methods -- but had the opposite effect on me, and should on you too.

The first news item was taken from the July 1st issue of Cancer Research, in which researchers from the University of Vermont Medical School reported that forty-five children whose chemotherapy allowed them to survive Acute Lymphoblastic Leukemia (ALL) had a high number of DNA mutations -- approximately 200-fold in excess of the number expected in the normal population. One of the researchers said, "The therapies used to assist these children to overcome ALL have the potential to cause genetic damage to many different cell populations in their rapidly growing bodies."


When I went to medical school (class of '72, if you must know), ALL (along with most of the other leukemias) had a survival rate of under 10% -- well under it. These were not "potential" dead children, but really dead; survival was almost miraculous back then. In the ensuing three-plus decades, newer chemotherapies and the application of radiation therapy to "hidden" areas (where leukemic cells are not susceptible to routine chemo) have led to amazing increased cure rates. Over 80% survival is now the rule.

So the headline about the "bad" news of genetic mutations in survivors of ALL should be seen for what it is: a possible problem down the road, but one much preferred by these kids and their parents to the near-inexorable fate of patients in the recent past. The difference is made possible by innovations and research in new drug modalities.

A second dire warning was published in the recent British Medical Journal "theme" issue devoted to -- get this -- "the harm caused by medicine." The article, by scientists at the University of Liverpool, warns that more than 10,000 patients may be dying every year (in the UK) as a result of commonly prescribed drugs.

May be.

No one denies that many patients are injured, and sometimes even killed, by untoward reactions to prescription medicines. Some are harmed by preventable errors by doctors, nurses, or pharmacists; others' injuries are entirely unpredictable, termed idiosyncratic, such as by an allergy that was never experienced before. Most "iatrogenic" harm -- that caused by therapy -- is not readily avoidable, due to unpredictable reactions or to systemic shortcomings. These all need to be addressed and, to the degree possible, prevented.

The drugs incriminated in the causation of the most harm include aspirin, anti-arthitis drugs, the blood-thinner warfarin, and diuretics -- "water pills" used to reduce blood pressure and swelling.

The study authors are paraphrased saying "drugs have benefits, as well as causing harm." Really? Is that how best to summarize the net effects of today's pharmacopeia? How about the millions of lived saved and improved? (See "Chemoprevention of Coronary Heart Disease" -- even statin drugs occasionally have side effects, a small price to pay to prevent heart attack. See "Chemoprevention of Breast Cancer" -- I'd bet women whose lives have been saved from breast cancer would be in favor of pills to prevent future cases of this disease, despite some possibly serious side effects.)

Nowhere in the news story, which appeared in the British newsmagazine The Independent, does it note that aspirin is commonly used to prevent heart attacks, the #1 killer of both Brits and Yanks. Nowhere do we learn that diuretics are not only the cheapest but also a quite effective means of preventing high-blood-pressure induced strokes, heart attacks, and kidney failure. Warfarin is indeed a powerful drug associated with bleeding and needs to be closely monitored but is useful to prevent lethal blood clots. Arthritis therapy may not be lifesaving, as the other drugs mentioned are, but easing the pain of arthritis is certainly worth some small risk. No medication is entirely safe, and before prescribing any therapy, the risk-benefit equation must be considered. Giving warfarin or an anti-arthritis drug to a patient with a history of bleeding ulcer is generally unwise, for one example.

Rather than feebly pointing out that "drugs have benefits, as well as causing harm," shouldn't we described the life-saving and life-enhancing effects that modern pharmaceuticals have had, while still calling for ever-improving safeguards against preventable errors in prescribing and dispensing? This glass, as the survivors in the ALL story remind us, should be viewed as well over half full.

Gilbert Ross, M.D., is executive and medical director of the American Council on Science and Health.