Friday, October 06, 2006

Those evil pharmaceutical companies

Here's the thing about side effects: they aren't side effects. A drug that is meant to treat an illness is a pretty barbaric entity. It isn't quite on the level of blood-letting and enemas, but on the molecular level drugs are bulky and inexact. Drugs are chemicals, they are small, and as specific as the brilliant chemists might make them, there are many parts of the body that will see that chemical and at least think about dancing with it. There is no magic bullet - our bodies are too beautifully coordinated and integrated for such specificity to be possible.

Once the drug enters the body, a lot of things can happen: the stomach can cause changes to the drug due to the high pH; the intestine can alter the drug during absorption, or it can avoid absorbing the drug altogether; as soon as the drug hits the bloodstream it goes straight to the liver where it will almost certainly be modified. Once in the bloodstream, that drug goes everywhere. Want to treat a headache? That pain reliever is going to hit every major organ and tissue before reaching the brain. One of my favorite examples of a "side effect" is the anal leakage of Olestra. Anal leakage is not a side effect - it is a direct result of too much fat in the large intestine. You put fat in your mouth, your body is supposed to break it down, shuffle it around, and then get rid of what it can't store or burn. Trying to put it in your mouth and then trick the system and bypass the absorption step - it just doesn't work.

Likewise the issue of COX inhibitors and the ongoing lawsuits against Merck and Pfizer (oh, what, you haven't heard that people are suing Pfizer? Of course not because that would require education and back-tracking by the media. Pfizer makes two Cox-2 inhibitors and didn't withdraw theirs when Merck did, even though the presumed mechanism of heart damage by Merck's drug is the exact same as Pfizer's.). People were prescribed Vioxx because the other similar pain relievers caused stomach bleeding. COX-2 receptors are everywhere and inhibition of them always had potential to cause other issues. But every drug is like that, and the role of the scientist/pharmacokineticist is to watch how these drugs interact with animals and then draw a line regarding whether the "side" effects of the drug (more appropriately called "off-target" effects) outweigh the usefulness of the "desired" effects.

Just as in life, there are consequences for every choice. Want to live with less pain? What are you willing to compromise for that goal?

(this rant can be attributed to the doctor who wrote on one message board about Vioxx "I will never ever prescribe a Merck product if there is an alternative!" Give me a break. Go read a medical journal.)


At 8:04 PM, October 11, 2006, Blogger Sa said...

Well said. It scares me to think that as a doctor, most of my patients will be looking to me to provide that magic bullet. Something has to change.
Maybe we can start a movement
Or at least a club
A hey lets think about medicine and our bodies more realistically club.


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