I'm still ungritting my teeth and untensing my body (is that a word?) after last week's Food and Drug Administration hearings about risks that might or might not be posed by the diabetes drug Avandia. If you skipped over the news coverage because diabetes isn't an issue for you or your family, the point I want to make today is that whether it's Avandia for diabetes or some other drug taken for some other chronic condition, the bottom line is that there's no bottom line.
Every drug has risks. But assigning odds to risks, attaching hard numbers that tell a given patient whether or not to worry about the prospect of taking a medication forever, is a statistical battle rarely won. The risks may be subtle, mostly affect certain patients, or surface only above a particular dose or after X years. "Talk to your doctor" is the standard wisdom when a medication suddenly becomes suspect. But the talk session well may be as frustrating for a physician who has to say, "We just don't have all the answers yet," as it is for a patient who has to hear it.
And that includes me. I take the highest approved dose of a powerful statin medication because of a history of heart difficulties. Our current issue has a column by Bernadine Healy, a cardiologist and my esteemed colleague, that dissected a just-published analysis of statins suggesting that the cholesterol-lowering drugs may cause cancer. If true, why didn't we know? Why wasn't I told? We didn't know, and I wasn't told, because it can take 10 or 20 years or longer for such a problem to appear. Hmm. I've been taking a statin of one kind or another for 24 years. Should I be concerned? I choose not to be; it isn't at all clear that there's a cause-effect relationship, and even though I write about medicine, I'm a guy, and therefore good at denial. Just don't use me as an example.
Yes, talk to the doctor. It is a good idea. You may be monitored more closely in the future, which makes sense. But don't expect her to tell you what to do. She may be as confused as you are.
U.S. News's Avery Comarow has been editor of the America's Best Hospitals annual rankings since they first appeared in 1990. His reporting on clinical medicine, from the latest cholesterol guidelines to robotic surgery, has been driven by the question: What does this mean to patients? And that is the perspective he brings to his observations and commentaries on the increasing number of programs by hospitals and other healthcare providers to improve care and patient safety.
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