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Six Commonly Missed Diagnoses +1: Rx Drug Side Effects

Posted 01/25/2012

I’d planned a series of six commonly missed diagnoses, but today I have one more, a life-threatening addition you’ll want to add to your mental list. If you’ve been following this series you know we’ve covered low levels of vitamin B-12 and vitamin D, subtly underactive thyroid, gluten sensitivity, intestinal parasites, and candida (yeast) overgrowth.

These all share several characteristics: symptoms are generally mild (but persistent and annoying), people who have these conditions are tired of hearing “all your tests are normal,” and most doctors either don’t test for them or, worse yet, don’t believe they exist. In other words, to diagnose any of the six requires you to be a feisty, proactive patient. On the plus side, the six are generally not immediately dangerous to health. Do they chip away at the quality of your life? Yes. Will any of them appear on your death certificate? No.

Today’s missed diagnosis—the side effects of correctly taken prescription drugs–can in fact kill you. An article in the Journal of the American Medical Association (JAMA) estimated that somewhere between 75,000 and 125,000 people succumb annually to this condition, making prescription drug use the fifth leading cause of death in the US.

Still, odds are you won’t die from taking prescription drugs, but chances are high you’ll suffer needlessly from unexplained symptoms caused by them.

Held tight in the grip of drugs
We’re a culture that has grown to depend almost exclusively on prescription drugs to treat virtually every malady we experience, from thinning hair and toenail fungus to strengthening our exhausted hearts and cheering us up. The pharmaceutical industry is so vast it controls huge segments of international politics and quite literally owns a chunk of Congress.

Every year I receive a heavy cardboard box containing my free copy of the Physician’s Desk Reference (PDR). It’s thousands of pages long and printed in a small font, double column, on tissue-thin paper. If you’ve ever opened a prescription drug, you’ve unfolded that seemingly endless accordion of paper, glanced at it, and tossed it aside. The PDR is simply the bound version of each drug’s package insert listing the reported side effects from the drug. In other words, the very hefty PDR is one vast compendium of side effects. Yum!

Now let’s talk about a prescription drug–it doesn’t make any difference which one. This applies to all of them. Whatever drug you’re taking, if you take enough of it at one time (an overdose) it will kill you. Unlike a food, like pigging out on a bag of Oreos, if you pig out on any prescription drug, you’ll die. Therefore, it’s reasonable to say that all prescription drugs are poisons. But what the pharmaceutical industry does is dilute that poison to a small enough amount that one of its effects accomplishes something useful–ease a headache, lower blood pressure, calm us down, grow our hair. But remember, you’re still taking a poison that can (and probably does) have many other effects in your body. These are the side effects.

Luckily for the pharmaceutical industry, most people don’t notice the side effects of the drugs they’re taking. Others find side effects intolerable, mutter “I can’t take this crap,” and toss the drug, occasionally letting their doctor know of their decision. Usually this is met with derision (“You really shouldn’t play doctor!”). That or your physician might give you a second prescription to reduce the side effects of the first.

Subtle side effects missed by patient and doctor
What becomes an extraordinarily common missed diagnosis is this: the subtle side effects of prescription drugs that neither the prescribing doctor nor the patient herself can link to the medication. Yet when you look through the PDR, or actually read the unreadable package insert, virtually every physical and emotional sensation could conceivably be a side effect. Many are so obscure, so off-the-wall, that they’d never be considered drug-related.

Do your heels hurt? Might be your antibiotic. Suddenly betting your life savings at the racetrack? Could be your new medication for restless legs syndrome. (Both are actual side-effect possibilities.) For any drug prescribed, doctors really only attempt to memorize the top five or six commonly reported side effects. But the FDA requires that all side effects be reported for every drug on the market and this list—called “post-marketing side effects”–can grow into the hundreds.

Don’t get me started on what happens when patients take more than one drug. We simply have no real idea what occurs when two, three, or more poisons are combined in the human body. Click here and be astonished by how many prescription drugs the average person in your state was taking in 2010. The national average is 12…as in 12 drugs per person annually. What?

You can easily see why doctors write prescriptions and keep fingers crossed, hoping you won’t end up like the poor guy in David Kronenberg’s “Scanners.”

Tricks of the trade: do try this at home
When a patient arrives with an inexplicable new symptom (anything, really—fatigue, headaches, depression, a rash), doctors should always explore in depth when the symptom began. The very next question should be (but often isn’t) “During the month or two before the symptom, had you started any new prescription drug? Anything at all?”

If the answer is yes then the odds are good your “mysterious symptom,” the “missed diagnosis,” is a side effect from the new drug.

Sometimes I’ll hear from the patient, “You know, I thought it could be the drug but my doctor reassured me she’d never heard of that being a side effect.” Remember, if your doc’s brain remembers fewer than ten side effects per drug and there are hundreds more, this reassurance is singularly unhelpful.

And this is why Al Gore invented the internet.

Try this yourself. It’s what I do when you’re sitting across from me relating your symptoms. Let’s say you’re one of the 10% of Americans taking antidepressants and while your mood is better, you’re an artist and convinced your creativity is on the decline. I go to Google and type “antidepressant effects on creativity” and discover that  some people whose depression is helped by the drugs become more creative, while others report creative numbness. These are self-reported side effects not even on the package insert and not reported to the FDA. But enough people are mentioning them that they should be on the FDA list.

When I Google for information on side effects, the source might be a reference to the PDR, but it also might be an article in a foreign medical journal or, as in the case above, an exchange on a message board for patients themselves. I find message boards incredibly useful. These are real people taking the medication in question, asking the very sane question “Could my symptom be due to my drug?” or sending an to alert everyone, “The symptom is not your imagination. It’s happening to me.”

The best advice? Always ask yourself whether you need that drug in the first place.

Be well,
David Edelberg, MD 

Leave a Comment

  1. aisha lamb sobh says:

    And then there is the actual research results that many health professionals either do not read (not in their specialty) or do not connect to a drug they have prescribed. Does the patient have red hair? This might explain why some pain meds have little effect on them (instead of accusing them of making it up). Problem? This does not have to lierally mean red hair. Many people have a ‘reddish’ tint whether their hair is blonde or dark, or used to when they were younger. Many people also color their hair. We now know the actual genotype that causes both (the red hair/opiates not working)-but I have never heard of a dr. who has asked a patient about their hair before prescribing pain medication.

  2. Dr E says:

    Hi Aisha
    You bring up a very interesting point that I did not address in this article, namely how our individual genetics affects the way we respond to drugs. At this point, I think the verdict is still out on the redhead-susceptibility issue. The first article below is from the New York Times reports redheads have a higher pain tolerance. The second, from a redhead’s own blog uncovers some research that showed redheads had a lower pain tolerance and needed higher doses of pain meds (or higher doses of anesthetic) to suppress pain.
    The whole point however is that if you consider the possibilities between all our genetic variabilities and all the drugs out there, especially when used in combinations, the number of potential interactions gets too high for the human brain to get a handle on. So we just close our eyes, put the pil in our mouth, and hope for the best in this best of all possible worlds.

  3. Judy Kayser says:

    Dr. E. Great advice. This is good to do before surgery too. I did this to see what people, who actually had a surgical procedure that I was soon to have, had to say about recovery etc. I was pretty astonished to read some side affects of the surgery that were never mentioned by the surgeon, nor any of the medical sites explaining the procedure. While the surgery was necessary, I appreciated the info. beforehand. While it’s very important to have a good surgeon, only people who actually have endured it can tell you the real deal. Wouldn’t it be great that if, by law, before a doc performs a surgery he has to go through it himself? Just kidding.

  4. Annie says:

    So what do you do about meds that you need, such as for blood pressure?

  5. Dear Dr. E: Recently I was hospitalized for atrial fibrillation; coud not have the debrillator “shock” treatment due to a tiny skin flap on my aerotic vavle. Now on six prescriptiions (incuding 2 I had been taking –lisinopril and Vesicare). How do I find out possible interactions? Gratefully, Jean

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