In September 2016, U.S. News and World Report dropped a prescription-drug bombshell on unsuspecting consumers.
Quoting professor Donald Light of the Rowan University School of Osteopathic Medicine in Stratford, N.J., the magazine says, “By far the greatest number of prescription drug-related hospitalizations and deaths occur from drugs that are prescribed properly by physicians and taken as directed” by patients.
Light, who also writes for Harvard University’s Edmond J. Safra Center for Ethics, continues, “About 2,460 people per week are estimated to die from drugs that were properly prescribed.”
Dr. Alan Rosenbaum, a cardiologist at the Indian River Medical Center’s Welsh Heart Center, is every bit as concerned as Light. Maybe more so.
“I think it’s a very important topic,” says the thoughtful Rosenbaum. “It’s unique. I think it’s something that doctors don’t really think about that much and we should. It’s very important. That is a shocking number.”
Harvard Medical School is as shocked as Rosenbaum and points to the temptation of some physicians to prescribe the newest available drugs in lieu of ones that have been proven over multiple years to be safe when prescribed and taken as directed.
“Very few people,” says the Massachusetts medical school, “know that new prescription drugs have a one in five chance of causing serious reactions [even] after they have been approved” by the FDA.
This is not a “new” problem. As far back as 1998, the Washington Post reported that “one in 15 hospital patients in the United States can expect to suffer from a serious reaction to a prescription medication.” Even if that prescription is taken exactly as directed.
As a cardiologist, Rosenbaum is especially sensitive to this problem.
After all, many of his patients have just undergone successful life-saving heart procedures. Putting those post-op patients on drugs whose potential side-effects or interactions with other medications are not fully known is something Rosenbaum weighs very, very heavily before putting his pen to a prescription pad.
“Well, first of all,” explains Rosenbaum, “with any medication, there is a learning curve. So, you have to – as a physician – learn about the medication and then use it sparingly at first until you get comfortable with it. Then you can use it more comfortably as you get more experience with it.”
Just fully learning about all those medications is a tall order in and of itself.
There are, quite literally, tens of thousands of prescription drugs currently on the market and more are coming on constantly – a near-record number of drugs gained FDA approval in 2016.
The learning curve for all these medications may be sharpest in cardiology. There are so many causes of heart disease, so many different procedures and so many drugs available, that cardiologists like Rosenbaum must, in fact, remain full-time students long after getting their degrees.
Rosenbaum’s encyclopedic knowledge of the different medications available for different cardiac conditions is both massive and reassuring, but he’s definitely not above turning to technology for a little assistance.
“We use E-clinical Works,” says Rosenbaum, which is a computer algorithm that can automatically alert him to potentially harmful drug interactions as well as the risk for medications that might “build up” within the body. The program also alerts when multiple drugs might bind with the same receptor cells within the liver, cancelling out their effectiveness.
All of that, however, is not to say Rosenbaum will automatically “just say no” to all new cardio drugs.
“There’s a brand-new medication now called Entresto,” says Rosenbaum, “which is huge. It’s going to help us with our heart-failure patients tremendously. And there is excellent data supporting it.”
Indeed, according to Rosenbaum, “There’s so much supportive data for Entresto that all cardiologists are using it. Or they should be.”
Still, this particular cardiologist is also well aware of the circumstances that can lead to serious prescription drug problems.
For example, Rosenbaum cites what’s known as “a hospital formulary.”
In a nutshell, that means that given the sheer volume of drugs on the market, hospitals can’t carry every medication or brand name.
“So when patients come in,” explains Rosenbaum, “let’s say they take Crestor as home. A hospital, for whatever reason, may not carry Crestor, so they will substitute Lipitor or a generic Lipitor, which is atorvastatin.
“The patient will come home with ‘atorvastatin’ written on their discharge papers with a prescription. But they also have Crestor sitting at home. I’ve had patients taking [both] atorvastatin and Crestor when they come to me for their post-op visit.”
That’s double-dosing and it can be extremely dangerous.
Similarly, says Rosenbaum, “I’ve had patients who are prescribed furosemide in the hospital, but they’re on Lasix at home. Of course, that’s the same medication. Lasix is the brand name of furosemide.
“There’s another issue that worsens that whole problem,” Rosenbaum continues, “and that is automatic [prescription] renewal from a pharmacy. It’s a big problem because those medications just keep coming,” and if not closely monitored the result can be fatal.
The best safeguard for every patient is to ask questions. Don’t worry about “bothering” your doctor with those questions. Take notes if you need them to jog your memory. Prescription drugs can improve, enhance and prolong your life.
But they can also kill you.
Dr. Alan Rosenbaum is with the Indian River Medical Center’s Welsh Heart Center. His office is in the new Health and Wellness building at 3450 11th Court, Suite 102. The phone number is 772-778-8687.
