Sometimes I feel embarrassed when I get the big pharma-bible out to check the list of side effects of a particular medication. But what else can you do, if a patient arrives puffing and panting and the specialists already reassured him, that there is nothing wrong with him? Well, three different pills of his assortment can cause breathlessness and the challenge is to find an alternative.
Sometimes I cringe, when people ask me about side effects: did you know that around 50 different adverse reactions are listed for the innocent Paracetamol and at least three of them can be deadly (that excludes the overdose)? Unfortunately, most of the thousands of medicines have a larger register of possible adverse reactions. American studies suggested in the past that up to a quarter of hospital admissions are related to side effects of drugs and one study showed that during a physicians’ strike the mortality rate actually fell.
At least that reassures me that there are a lot (all) of us out there unable to memorize a list of the size of the telephone book for a city like Birmingham or so.
In 2009 only 1729 adverse drug reactions were reported to the center of pharmacovigilance in Andalucía and that by only 533 health professionals, although the reporting system is very easy (if you know where to look for it). 912 suspected adverse reactions were classified as severe and the majority of notifications came from hospitals.
A patient can only report suspected side effects to a health professional who interprets his symptoms and if he suspects a significant adverse event all too often he does not use the alert system, because professional training increasingly neglected the most important principle in medicine: do not harm. Nowadays it is all about following protocols and fulfilling targets.
The current reporting practice for adverse events, before and after the introduction of a drug, is entirely based on the doctor’s interpretation of the patient’s symptoms. There is lots of evidence that shows that the severity of symptoms is being systematically downgraded, and that health professionals fail to interpret the cause of the symptoms as side effects. Other trials however confirm that patient self-reporting of suspected side effects would result in earlier and more frequent reporting with a higher evaluation of the symptoms. This way the higher suicide rate of adolescents starting to take modern antidepressants may have been detected earlier, although this example also shows that the pharmaceutical companies tried to hide this fact, even after it became apparent.
Objections to adopt a patient-centred approach to the monitoring of safety of medicines always focused on bureaucratic constraints, feasibility, administrative concerns and costs. But with advancing technology this has rapidly become an excuse, rather than a valid concern. Particularly, by recognizing side effects earlier, one would save money and if the American studies are correct, tons of it.
Thus, I am waiting for the day where patients rate their medicines on the Internet just like their doctors, without the interference of health professionals and the pharmaceutical industry.