By Jennifer Paterson
More Canadians are taking prescription medicine than ever before. Many busy people believe in the don't-think-twice, pop-it-in-your-mouth, "magic bullet" cure for all illness and disease. Total drug expenditures per Canadian were tallied at $681 in 2004 — up almost 8 per cent from 2003, according to a report by the Canadian Institute for Health Information.
Teenagers take birth control pills. Children rely on Ritalin. Troubled adults are prescribed anti-depressants. Canadians are popping pills like never before. Are we aware of the benefits and risks of the drugs we are ingesting in such record quantities? Should we listen to what our body is telling us instead of expecting a quick fix in the form of a pill?
Recent studies by the Ottawa Health Research Institute (OHRI) show that Canadians may not be aware of what their daily medication is doing to their health long term, reinforcing the need to educate them about the pills they take.
Due to growing numbers of women giving birth in their later years and the subsequent rise in fertility treatments, there has recently been an explosion in twin, triplet and quadruplet pregnancies. While studies have been conducted to determine the impact of these fertility treatments on babies, mothers were until now largely ignored.
Dr. Mark Walker, an associate scientist at OHRI, was struck by the lack of such vital information, and set out to find the data on his own. His report determined that multi-fetal pregnancies increase the risk of adverse outcomes for mothers: heart attacks are almost four times more common, while heart failure is almost 13 times more common and venous thrombolysis (a blood clot disorder) is 21/2 times more common.
Conclusively, Dr. Walker found that multiple gestation pregnancies are associated with an increased risk of morbidity for the mother. It is clear that mothers need to be better informed to cope with the increased risk associated with multiple gestation pregnancies.
Paradoxically, anti-depressants actually increase the risk of suicide for some patients. A study conducted by Dr. Dean Fergusson of OHRI calls for closer monitoring of individuals who take these widely prescribed drugs. Dr. Fergusson found that the overall rate of suicide attempts was 18.2 per 1,000 patients treated in clinical trials. This is a significant increase (more than twofold) in the rate of suicide attempts for patients receiving Selective Serotonin Re-uptake Inhibitors (SSRIs), compared with placebo or therapeutic interventions. Although the risk appears minimal, it bears watching, because of the pervasive use of SSRIs in Canada.
Dr. Paul Herbert, who was involved in the analysis and interpretation of information on the study, believes it is important for patients to be made aware of the short-term benefits and risks associated with taking SSRIs. Unfortunately, not all doctors are equipped for the process. The study highlights a known risk and all patients must be made aware of it, Dr. Herbert says: "It is the most comprehensive evolution of published literature on the subject, and it highlights the deficiencies of current literature." Ultimately, patients using SSRIs require more thorough monitoring when the treatment is started. In some cases, talk therapy is more effective for some mental disorders than anti-depressant medication, yet the patient generally chooses the pill because it’s perceived as a quick and easy cure.
Another OHRI study examines the importance of building knowledge about the drugs we use. In the past, it was difficult to rate the efficiency of drugs used to combat muscular dystrophy. Little was known about how these glucocorticoid treatments worked against the incurable condition. Recent studies solved the mystery, providing insight into the treatment, making it possible to treat the condition, much like Type 1 Diabetes. This case demonstrates how effective a medication can become as information accumulates.
Until quite recently, doctors did not understand why glucocorticoid drugs worked when used to treat inflammations in children suffering from muscular dystrophy. The doctors simply noted the results. "You can take a drug that's effective and not understand its mechanisms, but still have a positive outcome at the end of the day," observes Dr. Lynn Megeney, a senior scientist at OHRI.
Dr. Megeney and his colleague Dr. Bernard Jasmin discovered that glucocorticoid treatment alleviates symptoms of muscular dystrophy by countering the devastating effects of a specific biochemical pathway in muscle fibres. For those who suffer from muscular dystrophy, the treatment translates into improved mobility and longer lifespan. This study is opening the door to a series of promising possibilities. For instance, it is now possible to improve the drug by targeting those aspects that make it work. "There's always a rush to get a drug to the marketplace to treat a patient population:' Dr. Megeney explains. "However, certain circumstances can be avoided if we understand the full effect of the drugs."
This study highlights the importance of knowing as much as we can about how a drug works. With more research, Dr. Megeney hopes that the drug can give children suffering from muscular dystrophy a hope at a normal lifespan.
A recent CBC News investigation showed that more Canadian seniors are being prescribed potentially dangerous benzodiazepines for anxiety and sleeping problems, despite the fact they face special risks. Brand-name benzodiazepines include Ativan, Xanax, Halcion and Valium. Long-term use of these central nervous system depressants can lead to physical dependence and addiction. In high doses, these stimulants also lead to paranoia, dangerously high body temperatures, and irregular heartbeat.
Benzodiazepines are not recommended for long-term regular use, yet tranquillizers and sleeping pills are among the most frequently prescribed medications in Canada, particularly in long-term care centres for the elderly. After Dr. Jim Wright of the B.C. Therapeutics Initiative led a provincial study on benzodiazepine use, he concluded that doctors are missing the danger signals. "They don't appreciate that psychological dependence is the biggest risk when you start taking these drugs," said Wright. "Once that psychological dependence occurs, patients continue to ask for drugs and feel they need them."
Dr. Owen Hughes, a family physician from Ottawa, sees a transition between treating known diseases and treating patients' symptoms, such as stress and insomnia. "Patients want to cure their problems by taking something rather than changing their lifestyle:' he says. "I'm not a big pill-pusher, so they don't get much sympathy from me."
While menopause was once considered a disease, it is now recognized as a range of symptoms in a rite of passage that more than half the population must experience. Built up by the pharmaceutical company as a treatable disease, there are now countless pills to seemingly cure menopause. "Patients expect an easy cure, but doctors are not in that business:' Dr. Hughes opines.
Well over one million Canadians are taking anti-depressants. One in four women and one in five men are receiving at least one prescription of benzodiazepine per year. Yet despite the SSRIs' link to suicide attempts and the dangerous side-effects that have been tied to benzodiazepines, we should not discount the very important benefits of using these medications. Learning more about the benefits and risks of drug therapy is always advisable. We should be better informed about all the pills we ingest (including over-the-counter pain relief medication) bearing in mind that a quick fix is not necessarily the right approach.
