I often state the statistics that the most common cause of death and disability in the world is cardiovascular disease. It keeps me in a job. The second most common cause of death and disability and, closing in fast, is cancer.
Disturbingly, the third, most common cause of death and disability is Western healthcare. The most expensive health care system in the world, the United States of America, rates number 45 in terms of longevity. Clearly, over investigation, unnecessary medical procedures and the excessive use of pharmaceutical drugs contribute significantly to this statistic.
Although there have been enormous strides in medical investigations and therapies over the past few decades, significant complications of medical procedures and side effects from pharmaceuticals are unfortunately rather commonplace. It could be easily argued that, if the person was left alone, their underlying condition could either cause them significant issues or even bring on an early death. But there are increasing concerns, both within and outside of the practice of medicine, that we should look carefully at the medications we prescribe and the medical procedures we perform on many patients.
Two recent studies have clearly shown the concern over commonly prescribed medications. The first from the University of South Australia published in the journal Australian Prescriber looked at just under 8,900 veterans with hip fractures and compared them to 35,310 people without this condition. The average age in the study was 88 and 63 per cent were female. The study showed that those patients who were chronically taking antidepressants, opioid painkillers, anticonvulsants and the common anxiety relieving pills the benzodiazepines such as Valium, had a significant increase risk for hip fractures. One or a combination of any of these medications may lead to an alteration in the level of consciousness, dizziness, blurred vision and unsteadiness. All these factors can then contribute to a fall leading to a traumatic hip fracture.
Is estimated that if an older person is on one of these medications, he or she has double the risk for hip fracture but, for example, if you combined antidepressants with anti-anxiety treatments, the risk is five times.
It is estimated that in Australia alone there are 28,000 with hip fractures per year in people over the age of 50. Of these people, 5 per cent die during the hospital stay and 10 per cent are admitted to aged care. Clearly, the best treatment of hip fracture is prevention and most doctors and patients need to examine carefully the medications they are prescribing and swallowing to determine whether they are vitally necessary.
The second equally disturbing study was published recently in the British Medical Journal by researchers at the Washington University School of medicine in St Louis. This study examined the use of the commonly prescribed heartburn drugs known as PPIs, such as Nexium, Pariet and Somac, to name a few. They examined the data from 2002 to 2004 from 157, 625 people prescribed PPIs and 56,842 people prescribed the gentler H2 blockers. These patients were mainly male, caucasian and over the age of 65 followed for 10 years. The study showed that there were 45 excess deaths 1,000 people prescribed PPIs compare to H2 blockers and in particular deaths related to cardiovascular disease, stomach cancer and chronic kidney disease.
The risk of death increased with the duration of treatment, even at low doses. The suggestion from the study was that taking PPIs for months and especially years is not safe and, in fact, should not exceed 14 days.
It is important to realise, however, that heartburn and other forms of peptic ulcer disease can be disabling in many people and the PPIs are wonder drugs for the relief of symptoms. Over the past decade there have been a number of studies linking chronic PPI therapy to not only cardiovascular death but also heart attack and actual fibrillation. One study suggested a 40 per cent increase risk for dementia especially with Nexium. There is also a link with osteoporosis and as mentioned gastric cancer and chronic kidney disease.
Strong medicine has strong effects, no doubt, but clearly may also have significantly strong benefits. Anyone reading this article who has been prescribed any of these therapies on a chronic basis should not stop treatment without discussing the pros and cons with your doctor.
The first line of the Hippocratic oath is “first do no harm”. For something written 2,500 thousand years ago, it still is highly relevant for today’s practice of medicine.
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