An unfortunate fact of life is that “medical misadventures” can and do occur. Participants in the healing arts, physicians, nurses, and pharmaceutical producers are generally kind-hearted people who sincerely want to help the patients they serve. The goal is to ease the pain and suffering that people have from any variety of illnesses and injuries.
Sometimes fate uses these good intentioned people as unwitting pawns to spread calamity and destruction. A medication, given to treat a particular condition or mitigate a troublesome symptom, can sometimes cause a problem much worse than the infirmity being treated.
Throughout time there have been some medicines that have produced catastrophic results. Some of the worst debacles in medical history are discussed here.
This is probably the grand master of all the medical blunders. During the 1950’s, this sedative medication was also used to treat the severe nausea that can be associated with morning sickness during pregnancy. Children born to mothers taking this medication were prone to have severe deformities and nervous system problems. This happened sometimes even if the mother had only taken one dose of the drug. These children often had very short limbs that were said to resemble flippers.
The March of Dimes estimates that 10,000 babies were born with the limb deformities between 1956 and 1962. It took a long time to recognize that thalidomide was the culprit in maiming so many children.
2. DES (diethylstilbestrol)
This synthetic estrogen hormone was on the market from the 1940’s through the 1990’s. It was used to treat cancers of the prostate and breast for years. It was also used to prevent some problems during pregnancy such as miscarriage. During that time period, thousands of pregnant women took DES for that purpose. More effective drugs have been developed for the cancer treatment, and DES was ultimately shown not to help prevent the problems with pregnancy. Women who took the medication are themselves at slightly higher risk of getting and dying from breast cancer.
Once again, the real disaster was dealt to the children of those women. In particular, their daughters have much higher incidence, forty times greater than unexposed women, of certain vaginal and cervical cancers. Even sons of those women have more reproductive tract problems. DES is still the only medication that has been firmly established to be a transplacental carcinogen; that is, it has been shown to cause cancer to a fetus exposed by maternal ingestion.
As with thalidomide, DES was widely used during a time when surveillance for drug side effect problems was not nearly as stringent as it is currently. It is unlikely that direct injury problems will be missed for such a long period today.
However, the next few examples will show that even in this more modern era problems do still exist.
3. Fenfluramine and Phentermine (fen-phen)
Obesity is widely recognized as being an epidemic in our society today. The problem is getting worse all the time. In 2008, more than 1.4 billion adults were overweight and more than half a billion were obese. At least 2.8 million people each year die as a result of being overweight or obese. The prevalence of obesity has nearly doubled between 1980 and 2008. No wonder the healthcare community wants to do everything it can to combat this problem.
By now, everyone knows the cornerstone recommendations are for a sensible diet, high in fruits and vegetables, cutting down on fatty and sugary foods and regular exercise. Clearly, this message is not enough, and alternative treatments have been explored.
The idea of appetite suppressing drugs has been around for a long time. A combination of the two drugs fenfluramine and phetermine was use widely for this purpose particularly in the 1990’s. Several million americans were likely exposed to these medications. In 1997, people who administered heart echo tests in Fargo, North Dakota and Rochester, Minnesota started making a correlation between heart valve problems and use of the medications.
Ultimately, one component of the drug combination, the fenfluaramine, was taken off the market. Fen and other drugs like it have been found to change chemicals in the body that somehow lead to degeneration of tissues in heart valves. Hundreds of patients who had taken these medications developed valvular heart disease that can lead to heart failure. Several of the patients required heart surgery.
The healthcare community has still not found any pill that is great for treating obesity.
4. Steroid Injection – Recent Contamination Incident
A person should not be misled here. Steroid shots in joints and in the epidural space (the area just outside the spinal cord and spinal nerves) have been used successfully to treat many patients with painful conditions such as arthritis and disk herniations in the back for many years. However, beginning in July 2012 and peaking in early October 2012, a number of patients started showing up with unusual infections after they had these procedures.
Approximately 14,000 people in 23 states were exposed to one particular type of steroid, methylprednisolone acetate, from one compounding center in Framingham, Massachusetts. This medication was contaminated with fungus. These patients were getting fungal infections related to their treatment with this particular lot of medication. So far, 720 infections including abscesses and meningitis, which is an infection of the covering over the spinal cord, have been reported.
50 people have died.
Of course, that medication has been recalled. The problem was with that one batch from that one facility. Because that type of infection can take a long time to develop, medical providers are still being urged to watch closely patients who may have been exposed.
Medical providers probably have no bigger love-hate relationship with a group of medications than they do with narcotics. Pain relief is an admirable goal. A person is hurting. A medication might help. What is the problem?
- First, narcotics are not always as effective at relieving pain as hoped. Some types of pain predictably do not respond to narcotics at all.
- Second, they can cause impairment that might cause to safety issues with things like driving and child care.
- Third, patients who use them, even for legitimate reasons can develop dependence on the drug and even outright addiction.
- Fourth, an overdose of these kinds of medications can occur accidentally. The result can be respiratory failure and even death.
- Finally, the biggest problem is abuse.
These drugs are often used for illicit purposes, and the scope of the abuse problem is enormous. Nearly half of the 1.2 million emergency department visits in 2009 for the non-medical use of pharmaceuticals was related to this class of medications. Some people go to great lengths to get these drugs. They will steal them from family members. They will present to medical facilities with fictitious or exaggerated pain problems. They will rob pharmacies. The behaviors of that ever growing segment of our society negatively impacts healthcare for everyone. They take up valuable time from healthcare providers. They cause endless frustration for everyone around them, healthcare personnel in particular.
Groups including The American Society of Addiction Medicine (link), Physicians for Responsible Opioid Prescribing (link), Public Citizen’s Health Research Group (homepage), and the Drug Enforcement Administration are pushing for stricter prescribing regulations and at least one state has moved in that direction. A collaborative effort from many groups in healthcare, law enforcement, and government is needed to combat this ever increasing social cancer.
For now, this is something that individual medical practitioners and patients have to wrestle-achieving pain relief without contributing to this ongoing medical misadventure.
Naturally a person might worry that he and his own physician could end up dealing with the terrible result of a bad medication. Some simple measures might help protect you and yours. Ask your doctor about expected side effects of new medications. Call your doctor if something does not seem right after starting a medication or having a procedure. Pay attention to the news. If you hear a report about a medication or procedure that might pertain to you, call your doctor’s office to see if you have any real concern. Have one doctor to manage ongoing pain management issues. Keep medications, especially for pain relief, in a safe, locked location.
Try to keep things in perspective. The awareness and scrutiny for adverse drug problems is much better today than it was in the past. While these examples are absolutely tragic, they are still just a very small percentage compared to the vast number of successful treatment encounters that take place every day.