We must always worry about both errors of comission and errors of omission. The NY Times today reports on an interesting article in today’s NEJM – Study: Heart Drug Use Resulted in Deaths
This is an old story which I covered in a talk last year – Update 2003 – Congestive Heart Failure
This is the problem:
Quoting from the NY Times
The researchers say their findings illustrate what can happen when doctors apply drug-study results to their own patients. They suggest that some of the patients probably shouldn’t have been given the heart failure drug and that doctors weren’t checking for dangerous potassium buildup.
“I have no doubt that in the right patients and with careful monitoring that this is still a good drug combination,” said Dr. David N. Juurlink, one of the Canadian researchers. “It’s just when we prescribe it more widely and maybe we don’t monitor patients quite as closely as we should, then that’s where we get into trouble.”
This unfortunate study raises a cautionary note. Everything that we do in medicine has risks and benefits. We have the challenge of balancing those risks and benefits.
It is likely that the complications of spironalactone occurred because physicians were trying to practice excellent up to date medicine. Unfortunately, they knew just enough to get patients in trouble. I encourage interested readers to review slides 47-49 from my 2003 talk.
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3 Responses to Unintended consequences
The Proximal Tubule
August 5th, 2004 at 4:08 pm
Smothered
My humble impression, after just 4 years in medical school, is that we are so inundated with information that it’s exceedingly difficult to separate the wheat from the chaff. We’ve so heavily subsidized education and research that we get more “educa…
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