Phil Brewer thought he knew exactly what to do when the ambulance crew wheeled a well-dressed man in his late sixties into the emergency department. What he didn’t know: He was about to be involved in a series of events that would kill his patient. Brewer, then an assistant professor of emergency medicine at Yale School of Medicine, had been alerted by the crew that the man, Sanders Tenant (a pseudonym), had suddenly begun to talk gibberish while dining out with his family. Then his right arm and leg had gone weak.
Brewer suspected an acute stroke, but first he had to rule out conditions that can masquerade as a stroke, such as low blood sugar, a seizure, a brain tumor, and migraine headache. He had only minutes to make the correct diagnosis. Then the gathering medical team would decide whether to use a new stroke treatment that had recently been approved, a clot-buster known as tPA. Brewer called in a neurologist and the stroke team. After a CAT scan of the patient’s brain showed no sign of bleeding (something that would prevent the use of a clot-buster), the decision was made: Yes, use tPA. Despite following each step of the established protocol for this new treatment, Brewer experienced the unthinkable—his patient’s death. Tenant suffered a massive brain hemorrhage and died, not from his stroke but from effects of tPA, the drug that was meant to save him.
When we go to the doctor, we assume that the drugs he or she prescribes have been carefully tested to make sure they are both safe and effective. Most times they are. Yet sometimes the drugs cause more problems than they solve. Adverse drug reactions kill tens of thousands of people annually; one widely cited study published in the Journal of the American Medical Association (JAMA) in 1998 puts the number at more than 100,000. Recently a series of drug recalls have pulled back the curtain to show how the media, the public, and some doctors can misinterpret medical studies or take them out of context in ways that make medical treatments look safer and more effective than they actually are.
To a greater degree than ever before, powerful forces in the marketplace are impacting the quality, use, and safety of prescription medications. Drug manufacturers are spending more to promote their products while being subjected to tighter regulation and greater pressure for financial returns. The media are talking up each new “miracle cure” in headlines and television segments. Doctors have to navigate a tangle of administrative and medical concerns, one physician noting that “if you have a patient in your office, you can’t say, ‘Oh, I’m going to look at the drug company’s online database about Zyprexa.’ Most doctors don’t even know the databases exist. But even if they did, the next thing you know, three or four hours have gone by and you’ve missed all the patients waiting to see you.” Insurance companies and even the stock market play a role too. And consumers, increasingly subject to pharmaceutical advertising, are routinely urged to demand the best and the newest for their health. All together, this is a perfect storm for prescription drug problems.
