Side effects

Margaret McCartney

I am the first to accept that modern medicine is not always good: lots of it is still unproven, or weakly proven, and in general use: and it has taken a very long time for doctors to realise that good intentions are not enough.

One has to have evidence of benefit and knowledge of harms: and to inform the patient of these and the uncertainties connected with treatment.

But – this only applies, it seems, if you are a regulated doctor. If you are dealing in unproven medicine, and your intentions are good, then it doesn’t really seem to matter whether your treatments work, or even if they give you cancer or renal failure.

This report on the judgement from the UK Old Bailey on a practitioner of Chinese medicine – Chinese herbal pills destroyed UK woman’s health – quotes the judge as saying “Although the MHRA did their best to try and make sure everybody knew about the dangers and about the regulations, it is not a foolproof system and I am certainly not blaming you for the fact you didn’t know about these regulations”.

This seems really rather a mystery of logic to me. If I set up a shop selling erratically behaving electrical goods which had a habit of giving the odd fatal electric shock, would I not be in some way responsible for my actions?

Margaret McCartney

Sibutramine, the weight-loss drug otherwise known as Reductil, has had its licence suspended after a European-level review concluded that it raised the risk of non-fatal heart attacks. The good news for those taking it is that it wasn’t a terribly effective medication in the first place. Despite our massive efforts to find one, a pharmacological solution to obesity remains stubbornly out of reach.

The drug still prescribed for weight loss, orlistat, can also be bought over the counter at a different dosage, as Alli. Both orlistat and Reductil reduce weight; the problem is what happens afterwards. Orlistat cuts an average of 3kg compared to control groups. However, it also has unpleasant gastric side effects – a common reason why patients stop taking it.

Continue reading “The bigger picture”

Margaret McCartney

Following the Christmas day bomb attempt on a US aircraft, the British and American governments have vowed to tighten airport security, including plans for CT body scanners. This has raised concerns – not least that the images generated by the scanner would infringe on personal privacy. The more pressing issue for me is radiation exposure. How big a dose will these scanners deliver, and can we be reassured that they are not going to do us harm? Attitudes towards radiation have changed over the years. While nowadays doctors are told to justify every single exposure, this has not always been the case. In the US, in the 1920s, children’s shoe shops often used x-ray machines to assess whether shoes and feet were a good match. (The trend reached the UK later.)

There were no warnings about overuse or risks to pregnant women, and it wasn’t until 1949 that a paper appeared in the New England Journal of Medicine questioning the practice. In 1956 a paper appeared in the British Medical Journal investigating the radiation dose from machines made in the UK. Attention was also drawn to case reports of children with abnormalities of the leg, thought to be due to radiation. The authors didn’t propose a ban, but they did suggest regulation.

Continue reading “Long-haul radiation”

Margaret McCartney

It used to be seen as embarrassing, extravagant, foolish. But improving your looks under the surgeon’s knife has now passed the stage of social unorthodoxy to become something acceptable, appealing – even fun. Just think of the rise of Botox parties, where a nurse wielding the syringe will come to you (and the host gets a discount).

In Los Angeles, studies of women found that more than two-thirds of respondents were interested in having cosmetic surgery. In the UK, a study of female university students showed that low body mass index, lack of body appreciation and media influence were predictors of a desire for cosmetic surgery. Indeed, one US study links watching TV makeover shows with a more favourable attitude towards cosmetic surgery, as well as an increased pressure to try it. This does not necessarily prove cause and effect, but it does raise the question of how people acquire enthusiasm for these procedures.

The remainder of this article can be read here. Please post comments below.

Margaret McCartney

In September this year, a young woman fell ill and died, hours after she was injected with Cervarix, the vaccine intended to prevent cervical cancer.

Several media reports questioned the safety of the vaccine and called for the schools vaccination programme to be scrapped. The batch of vaccine was quarantined until investigations could be completed, but after a postmortem concluded that the schoolgirl had died of a previously unknown tumour, the vaccination programme continued.

I am no great fan of Cervarix, but not for safety reasons. Rather, I am not convinced that doubts about its performance have been adequately addressed by research. The management of this unexpected fatality, however, was faultless. The possible link to the vaccine was instantly spotted and properly reacted to. Deaths in young schoolgirls are uncommon, so the potential danger was easier to identify, and in this case it was relatively easy to rule out.

The remainder of this article can be read here. Please post comments below.

Margaret McCartney

Thank goodness for the small but awfully potent Drugs and Therapeutics Bulletin (DTB). On its front page this month, it notes that new warnings about side effects of statins have still to be included in the patient information leaflets about them. These side effects include sexual dysfunction, memory loss and depression.

In February 2008, they say, the Medicines and Healthcare products Regulatory Agency  (MHRA) decided, following a review of clinical trials, reports of adverse drug reactions, and publications, they were to update the leaflet ” to reflect a number of different side effects as class effects of all statins”.

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Margaret McCartney is a Glasgow-based GP and FT Weekend columnist. She started writing for the Life and Arts section in 2005 and moved to the magazine in 2008. She also has her own blog: www.margaretmccartney.com/blog

Clive Cookson has been a science journalist for the whole of his working life. He joined the FT in 1987. Clive, the FT's science editor, picks out the research that everyone should know about. He also discusses key policy issues, from R&D funding to science education.

Andrew Jack is pharmaceuticals correspondent, covering the industry and public health issues. He has been a journalist with the FT for 19 years, based in London, Paris and Moscow

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