Imagine: you bought a wonderful medicine – and on TV was advertised, and friends praised, – they opened the box, opened the liner, and there in the side effects section – diarrhea, and aching joints, and dizziness. How to be? Accept, in spite of everything, or search for something else? Or maybe even give up all sorts of pills? Professor Sergey Martsevich, Head of the Department of Preventive Pharmacology of the Institute of Preventive Medicine of the Ministry of Public Health of the Russian Federation, will help in understanding these issues.
Imagine: you bought a wonderful medicine – and on TV was advertised, and friends praised, – they opened the box, opened the liner, and there in the side effects section – diarrhea, and aching joints, and dizziness. How to be? Accept, in spite of everything, or search for something else? Or maybe even give up all sorts of pills? Prof. Sergey MARTSEVICH, Head of the Department of Preventive Pharmacology of the Institute of Preventive Medicine of the Ministry of Health of the Russian Federation, will help to clarify these issues.
– Sergey Yuryevich, your department, among other issues, is studying the undesirable effects of drugs. Where is the boundary between side effects and contraindications?
– You correctly raised the question: 90% of our people do not see any significant differences between these phenomena. But in fact, everything is quite simple: contraindications are those conditions in which a specific medicine cannot be prescribed due to the fact that it can adversely affect or worsen the course of another disease that a patient has. The general rule is: you can not treat one at the expense of the other – this is with regard to contraindications. And side effects can occur during treatment and are an undesirable effect that interferes with a person. In the overwhelming majority of cases, it is incomparable with the benefits that the medicine brings. For example, well-known nitroglycerin is contraindicated in people with low blood pressure. The rest – please. In this case, the side effect of nitroglycerin is that immediately after taking the head will hurt. Of course, any pain is unpleasant, but in this case, it passes quickly and does not bear any health hazard consequences.
Side effect likelihood
– In the abstract indicate and contraindications, and side effects. The first is clear: the doctor will not prescribe a medicine that will damage the patient’s health. And how to treat the list of side effects, which in terms of volume often exceeds the list of positive properties?
– Side effects are given for information so that the patient, taking the medicine, can better orient himself in his well-being. Just do not think that all that is listed in this list will be fulfilled. When the drug passes clinical trials, experts are obliged to record every adverse event, even if it manifested itself in one person out of one hundred thousand. That is, in fact, the probability of some of the declared states is very small.
– The number one hundred thousand is not too high?
– When testing new products, such an extensive audience is, of course, not involved. But there are other drugs that are prescribed to millions, for example aspirin. And here it all depends on whether clinical data are constantly monitored. If controlled, the list of side effects is constantly updated. The wider and longer the drug is used in time, the better the range of its side effects is known.
– Do Russian doctors take part in this monitoring?
– The Ministry of Health issued a decree on the need to register side effects, and it seems that samples of documents were sent to health facilities, but they have not yet reached the doctors.
"Old" – does not mean "bad"
– Old medicines are good that their undesirable properties are comprehensively studied. How in this regard to treat new?
– Of course, supernovae are not always free from side effects, and it is clear that information can only be fully accumulated after a certain experience. But do not think that a new medicine is a cat in a bag. Laboratories are creating new-generation drugs, given the shortcomings of the previous one. In order to maximally protect themselves from the side effects, they try to follow the path of creating mono-drugs, that is, those that are intended for the treatment of a strictly defined disease. For the sake of fairness, it must be said that breakthroughs are actually measured by very small quantities and, in general, we are not getting a fundamentally new drug – no matter what they say about it.
Old medicines are always cheaper than new ones, and besides, we know not only their advantages, but also disadvantages. Yes, a new medicine is advertised, prospectuses claim that no side effects have been found, but over time in most cases it turns out that a new medicine takes up a very modest place in its class. For a long time, diuretics and beta-blockers were used to treat hypertension. Then they were replaced by calcium antagonists and ACE inhibitors (angiotensin-converting enzyme). Recently conducted several studies: some patients were treated "old" drugs, other – "new". Result: no difference in treatment, both groups are quite comparable in effectiveness. There are, of course, some nuances, but they do not affect the general direction.
To be treated in Russian
– Is it always possible to believe in the healing properties listed in the abstract?
– Abstract – not advertising, as many people think. The insert provides the necessary detailed information on the pharmacological effects, contraindications, side effects and dosage. The fact that the drug perfectly helps to cope with any disease, it is forbidden to write, all positive ratings are considered advertising.
For our man, this situation is not entirely correct. The doctor prescribes a good, proven medicine, the person reads the abstract and does not see there confirmation of excellent healing properties. Makes a conclusion: "There is no benefit from it, and there are no side effects above the roof. Why did he appoint him, one wonders? I will not accept".
– And how does not our man reason?
– In the West, there is another algorithm. The doctor tells in detail about the need for the selected medication, including mentions the most frequent side effects. If a patient believes in a doctor, he also believes in medicine.
We have such communication between the doctor and the patient is not accepted. One day an Austrian came to see me. I prescribed a medicine for him, and at the same time, he thoroughly and thoroughly asked me about all his positive and negative properties, and only then left. Frankly, I thought that the patient doubted my qualifications and most likely would not go to the pharmacy. A few months later he called me to thank for a good drug that helped him a lot.
What is more harmful?
– Take the usual situation: a person drinks medicine, and this is accompanied by all imaginable side effects. What to do?
– You don’t have to tolerate, immediately consult a doctor, he will prescribe another drug – the benefit is almost always the choice.
When you start taking medicine, you need to be more attentive to your well-being. Very often, a person does not want to understand and accepts for side effects something different, stronger, but not related to side effects. The consequence of such an attitude: the patient begins to think that the medicine is harmful and it is better to surrender to the power of the disease than to associate with additional ailments.
– Any medicine has side effects. We put the strongest effects on one side of the scale, on the other – a disease without drugs. What will drag?
– It often happens that the patient takes a drug for years, and then throws: tortured nausea, drowsiness, and so on. Then time passes, and the medicine has to return: drowsiness, it turns out, is better tolerated than, say, interruptions in the work of the heart.
A disease in itself is many times more dangerous than a side effect. And the effect on the degree of harmfulness is negligible compared to nicotine, food preservatives and polluted air.
– It happens that a side effect is so strong that it covers the main action?
– It happens, but rarely. And it is very rare for firms, fearing for their honor, to withdraw such preparations from the market.
Sometimes they try to turn an undesirable phenomenon into a positive one. Previously, there was the drug minoxidil (chemical name) – a powerful vasodilator substance, which was used to treat hypertension. With his admission, his patients began to grow hair. Then tried to use it for the treatment of baldness. Unfortunately, nothing happened, the hair did not grow where it was needed.
By the way, some first-generation antidepressants were discovered in a roundabout way, through side effects. They invented a drug for the treatment of tuberculosis, they began to try, and it was found that the medicine had little effect on the condition of the lungs, but at the same time the mood of the patients improved markedly. There are quite a few such cases when a medicine moves from one class to another. In particular, using the drug doxazosin for the treatment of hypertension, doctors noticed that it is effective for the treatment of prostate adenoma. As a result, the emphasis shifted: as a drug to reduce the pressure, doxazosin is rarely used, and urologists praise.
And all would be nothing, but there is one detail: our doctors are highly specialized. Many urologists (unknowingly) do not think to ask the patient: how did the pressure behave? This is not an idle question, doxazosin can greatly reduce pressure, in practice its various side effects are known, up to and including fainting.
– It turns out that the patient’s health is in the hands of the patient himself.
– Not always, but often. Remember: when you come to the dentist, are you asked about anything before anesthesia?
– Is there any allergy to procaine?
– Novocain – a drug of complex action. In addition to an allergic reaction, it can very sharply reduce the pressure. In the old days, doctors "Ambulance" used this medicine to treat attacks of hypertension.
Another example. Adrenaline is added to lidocaine, which is more commonly used in modern dentistry. With a noble purpose – to narrow the vessels around the tooth and reduce bleeding. But if the patient turns out to be hypertensive, with coronary heart disease or after a heart attack, the introduction of adrenaline can instantly provoke a hypertensive crisis. For comparison: in the West, a dentist will definitely ask if a person suffers from heart disease. In some of them, a prophylactic course of antibiotics is prescribed a few days before the tooth is removed. Otherwise, the infection can get on one of the heart valves and cause septic endocarditis. That is, from an infectious disease get a heart. True, the percentage of such complications is small, statistics say that about 5%. The organism can give the same reaction to some gynecological procedures, a modified heart valve is very susceptible to any bacteria.
– As a cardiologist, you protect the interests of the cardiovascular system. But is there no medicine in cardiology that has side effects on other body systems?
– For example, a group of beta blockers. It is beautiful from the point of view of cardiology: it lowers blood pressure and keeps angina under control, but at the same time these drugs increase the tone of the bronchi. The smoker may worsen bronchitis, and sometimes develop an asthmatic attack.