Adverse Reactions : doctors

Let us prognose

Bryan Hubbard — Fri, 02 Nov 2007 11:50:00 GMT

It's been said that medicine is the new religion. Drugs and surgery have replaced God in our drive for certainty and control in a world that appears random. For his part, the doctor often dons a white coat as a player in the brave new priesthood, while dispensing prescription sheets to the laity, or patient.

As a priest-like figure, the doctor has enormous power. I'm sure there is a placebo effect even in prescription drugs, especially if the patient is convinced they will work.

But perhaps his greatest power is the prognosis, his considered view of the patient's chances of survival and recovery. The prognosis is so influential in the outcome that it becomes self-fulfilling, especially for the patient who is open to suggestion.

I have direct experience of the prognosis. My own mother was given three months to live after she had hidden her breast cancer from everyone for several years. We didn't tell mum what the doctor had said, but instead took charge of her therapy ourselves. She made a full recovery within a year, and went on to live for quite a few years afterwards.

I'm reminded of the power of the prognosis, and how uncannily inaccurate it is, by a report in today's British Medical Journal. A study found that doctors at 92 intensive care units consistently got their prognosis wrong, even though they were so sure of its accuracy that they saw little point in treating the patients they had already consigned to the mortuary.

More than 60 per cent of patients were alive 180 days after treatment, when doctors had said less than half would survive that long. Even the patients who were at death's door survived far longer than the doctors predicted. Doctors reckoned just 10 per cent would survive the next 180 days, but 40 per cent did so.

Perhaps they survived so long because they were too ill to hear the prognosis.

How doctors choose the 'right' drug for you

Bryan Hubbard — Fri, 18 May 2007 12:00:00 GMT

It would be nice to think that he balances and deliberates before making his choice - but there are more dubious pressures at play. All has been revealed by a drug company salesman who has just retired, and perhaps has a pang of conscience. He writes:...(read more)

It gets nasty for Nice

Bryan Hubbard — Fri, 17 Nov 2006 14:50:00 GMT

For such a haven of faceless bureaucrats, NICE has suddenly become the hate figure of the UK. NICE - or the National Institute for Health and Clinical Excellence - is the gatekeeper of the National Health Service, and it is the ultimate arbiter of the drugs that are prescribed by doctors.

Sometimes drugs are turned down on grounds of cost, sometimes because they just don't work. For the drug company, a rejection is nothing less than a commercial disaster, especially if the drug concerned is a pioneering one that would have cost at least £150m to get approved.

The patient, too, may see the drug as the great hope. It happened with the *** cancer drug Herceptin, and it's happening again with the Alzheimer's drug Aricept. If the drug is the 'answer', then NICE's rejection is nothing less than a callous disregard of human life.

Alzheimer's sufferers and their carers are planning a major protest against NICE's decision with nationwide marches and demonstrations. The same thing happened with Herceptin, and the government finally wilted to public demand.

In the case of Aricept, the protestors are being joined by the manufacturer, Pfizer, which is calling for a judicial review of NICE's rejection. If it goes ahead, it will be the first time that NICE has been challenged in court, and itvmay well not be the last.

But how does the patient know that the drug is the solution to his or her ills? In the case of Aricept, there are a few anecdotal reports that the drug has helped, but a major review that was published in 2004 concluded that it wasn't providing any benefits, even to the early-stage patient.

A similar story can be told about Herceptin. Many of the protests were encouraged by the drug manufacturer which eventually got its way.

Will the same happen with Aricept? You betcha it will.

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