One of the fundamental problems with drug-driven medicine is that the most drugs don’t actually cure anything. What they do is suppress symptoms or spur biological processes that give a sense of relief to the person taking them. In this way, they’re used to “manage” chronic illnesses. They’re taken for long periods of time – sometimes for life.
This creates another problem, since drugs are mainly tested only over the short-term. We don’t know their long-term effects until problems begin to emerge in the people taking them – for instance, the heart problems caused by COX-2 inhibitors and elevated suicide risk caused by SSRIs.
In this respect, drug-driven medicine is a big, ongoing experiment in which human patients are the unwitting subjects.
Happily, though, more doctors are calling for at least a re-evaluation and scaling back of how drug therapy is commonly used – the subject of a recent LA Times article on how bisphosphonates are used. Bisphosphonates are drugs like Fosamax and Boniva, used for treating osteoporosis, as well as osteopenia or “pre-osteoporosis,” or, more accurately, “the state of being an older human who might get osteoporosis.” (We all lose bone density as we age. It seems weird and wrong to consider it any kind of medical condition – unless you view life itself as a medical condition.)
In the last few years, evidence has emerged that long-term use of osteoporosis drugs — particularly the oldest class of drugs, the bisphosphonates — may do more harm than good. Some doctors are starting to tell at least some of their patients to stop taking the drugs for a time — in other words, to take a “drug holiday.”
That strategy is a tough sell for consumers who have been bombarded with osteoporosis medication advertisements for years.
When osteoporosis drugs first came out, “people thought, this is a recurring disease, like high blood pressure. So why wouldn’t you treat it for the rest of their lives?” said Dr. Richard Eastell, an expert in bone metabolism at the University of Sheffield in Britain who spoke about the issue last month at the annual meeting of the American Society for Bone and Mineral Research. “But there are now some anxieties with long-term use.”
Several factors are merging to usher in a new era of caution surrounding the medications. One is the simple acknowledgment that some people are approaching 10 to 15 years of continuous use.
“Worldwide, it’s a commonly discussed question as to how long you should go on with these treatments,” Eastell said. “Beyond 10 years, we have no knowledge of how these treatments work.”
Although conventional physicians by and large still hold to the faith that there’s an important role for these and other drugs, we think a move toward greater caution is a good and important step toward a more conscious and conscientious practice of medicine.
Image by anolobb via Flickr