‘Hurry’ is the most dangerous word in medical care
“No man who is in a hurry is quite civilized.”—Will Durant
The world is in a hurry. Patients are in a hurry to get better; and so is the doctor who wants quick results. Neither has the patience which is essential for recovery from illness. Most patients think that there is a pill for every ill and demand immediate interventions. We have plenty of doctors who oblige them happily and load them with drugs. My newly acquired specialty is to ‘de-drug’ them, similar to de-addiction! Big Pharma, with their eyes on profit, use all methods to make doctors prescribe their wares immediately on release.
One wise man, Sir William Osler, had warned us that “the most important obligation of every doctor is to dissuade patients from taking drugs!” Of course, today’s super-specialists will say that Sir Osler did not know as many facts as they know today and did not have access to as many powerful drugs as we have today. In my opinion, the best doctor is one who knows when not to give drugs. On their part, drug companies are in a tearing hurry to pour new drug molecules into the market. That process has become easier in the United States these days as the Food and Drug Administration (FDA) has become an extended arm of pharmaceutical companies. Almost 80% of FDA’s budget is now coming from the pharma lobby as government funds have dried up. Drugs come to the market faster with less than transparent testing processes.
Companies do not seem to have learnt their lessons from certain drugs like Viox; they seem to be in a hurry to shove drugs down the patients’ throats. Paxil, an anti-depressant, is another drug in question. Although their original study data did show enough evidence that these molecules abet suicidal tendencies in all—more so in adolescents—the company got the drug into the market, keeping the regulator in the dark. Now that the cat is out of the bag, it has had to pay a small percentage of its huge profits from that drug as a fine. In all these games, the poor patient is the one who pays for our sins, with his life!
I am absolutely comfortable prescribing just about two drugs armamentarium—digoxin, which has been with us for well over 300 years, and sorbide nitrate, which has been with us for 350 years, both having come from homeopathy. Despite their long life, we still do not know the ideal dose of digoxin and the correct indication. The Drug Information Group (DIG), a research body, comes out with contrasting reports even today. Some colleagues boldly prescribe such drugs, most of them just months old in the market. I strongly feel that drug companies should not be in a great hurry to push their molecules. Large independent studies must doubly reassure us that the drug is safe after longer prospective studies of its toxicity.
When a new drug is in the market, doctors have an added responsibility of diligently looking for side-effects. That is the real test of the drug toxicity when millions of people get exposed to the drug. Milrinone was another example of our hurry to set the drug on the go. The drug did not have any human study before being introduced. Later research showed that it killed lots of patients with heart failure, the very diseases the drug was supposed to cure! I can go on and on; suffice it to say that, when it comes to drugs and surgical quick-fixes, it is better to take time before acting. ‘Hurry’ is the most dangerous word in medical care and that is why someone is called a patient when s/he gets ill. The patient should be patient.
(Professor Dr BM Hegde, a Padma Bhushan awardee in 2010, is an MD, PhD, FRCP (London, Edinburgh, Glasgow & Dublin), FACC and FAMS.)