Orientation - from the Health Sciences Institute 


Health Sciences Institute e-Alert

May 23, 2002


Dear Reader,

In the e-Alert, "Like a fish needs a bicycle," I told
you about a recent article in the Journal of the American
Medical Association that contained this appalling statistic: as
many as 106,000 deaths occur each year in U.S. hospitals because
of adverse reactions to prescription drugs that are used as

But even more disturbing, and certainly more shocking, is this
statistic from the National Council on Patient Information and
Education: at least 125,000 people each year die from
prescription drugs their doctors never should have given them -
because they had pre-existing conditions that are clearly
contraindicated in the drugs' packaging.

All by itself, that statistic may seem over-the-top. But just
this week, I came across another study that supports it. It
shows that a widely prescribed drug, used to treat a very common
health problem, is often prescribed inappropriately - and with
disastrous results.

Finding the black box

As we've told you numerous times, type II diabetes is a common
disease that can lead to other more severe health problems,
including kidney and cardiovascular diseases. The drug most
often prescribed by the mainstream for type II diabetes is
metformin (the brand name is Glucophage). But, this is despite
the fact that it's been associated with a serious condition
(lactic acidosis) that can have fatal side effects for patients
with kidney disease and congestive heart failure (CHF).

In a study reported in the Journal of the American Medical
Association this month, researchers from the University of North
Carolina set out to determine how often metformin is prescribed
to patients with kidney dysfunction and CHF. Using records
obtained from the UNC hospital pharmacy, they identified all
patients with two or more metformin prescriptions within a
nine-month period. The group was then narrowed to patients who
were taking medications for CHF, or whose medical problem list
or clinic notes included a diagnosis of CHF. Patient records
were also used to evaluate measurements of serum creatinine
levels, which reveals kidney dysfunction.

Now, here's where it gets scary...Almost one-quarter of the
patients receiving metformin had CHF, kidney dysfunction, or
both. The UNC researchers concluded that metformin is far too
often improperly prescribed, despite the fact that the side
effects have been well known for years. And, given that a "black
box" warning is prominently displayed on the package insert,
there's no excuse for a doctor to miss this absolutely essential

Clearly, if you're currently taking metformin and you also
suffer from kidney dysfunction or congestive heart failure, you
should run - don't walk! - to your doctor and address the
warnings on your prescription.

Read all the lines

The authors of the study note that theirs is not the first
research of this kind, and that several European studies have
shown similar rates of metformin being improperly prescribed.
Obviously this is a widespread problem that is not getting the
attention it requires.

Many people naturally trust their doctors and pharmacists to
prevent these kinds of problems. But this study shows more than
ever that each of us has to be our own watchdog. I've written
before about the flood of post-approval reports that follow new
drugs, and the problems doctors and pharmacists have keeping up
with them. The message here is that each of us has to rely on
our last line of defense: ourselves. The only way to be
absolutely certain that our prescribed drugs are not going to
interfere with other drugs or other health problems is to read
all drug package inserts carefully and to be diligent about
asking questions.
Cross the t's; dot the i's

Here at HSI we always strive to give you information that can
help you decide on what sort of therapies are right for you. In
this case - treating type II diabetes with metformin - we want
you to be aware of two important things. One: you may be risking
serious health problems by taking this drug and you have kidney
problems or congestive heart failure; and two: you can't rely
solely on your doctor and pharmacist to catch dangerous drug
interactions and contraindications.

Of course, if you have type II diabetes, you do have other
choices. We've written many times about alternative approaches
to treating it, from diet and lifestyle changes to natural
supplements. You can access these, and all past e-Alerts, on our
website, www.hsibaltimore.com. Simply type in "type II diabetes"
in the e-Alert search field and you'll find a wealth of

In the meantime, we need to keep in mind that doctors are not
infallible. And while it's inexcusable for a doctor to proscribe
a medication that does more harm than good, we have to recognize
that it's a real possibility.

So who should you trust? Trust yourself. Be diligent. Check
warning labels. Ask your doctor and your pharmacist questions.
If you get conflicting answers or answers that sound too easy,
pursue it further. Don't be complacent, and don't take that drug
until you feel satisfied that it's a good fit for your overall
health condition.

To Your Good Health,

Jenny Thompson
Health Sciences Institute

"Frequency of Inappropriate Metformin Prescriptions"
JAMA, V.287, No. 19, Pg. 2504

* Before making any change or addition to current treatment,
please consult your physician. Some protocols may not be
appropriate depending on your personal medical history.

Copyright (c)1997-2002 by Institute of Health Sciences, L.L.C.