Map of life expectancy at birth from Global Education Project.

Wednesday, February 06, 2008

Uninformed Consent

It turns out that Heath Ledger's death is what we in the biz call an iatrogenic event, i.e. "caused by healing." [sic] He had taken a lethal combination of oxycodone, hydrocodone, diazepam, temazepam, alprazolam, and doxylamine. Now, I have no reason to believe his death was not an accident, but if you wanted to kill yourself, that would be a good way to go.

He had prescriptions for two opioids, three benzos -- two of which are marketed as tranquilizers, and one as a sleeping pill, but they're similar -- and an antihistamine that makes you drowsy as what used to be a side effect, but is now the reason it is prescribed. He had apparently complained of difficulty sleeping, but I don't know why he had the scrips for the junk and the tranks. What I do know is that you sure as hell aren't supposed to take them all at the same time, for reasons which should now be obvious.

It is possible to buy most of that shit -- I don't know about the doxylamine -- on certain street corners, but if a doctor gives it to you, there is a doctrine called informed consent, which means that the physician is supposed to tell the patient about the benefits and risks of the drug. There is also a doctrine called, in the technical language of medical ethics, "don't kill your patients," which means you are supposed to know what other prescriptions they have and warn them not to take combinations of drugs that can produce the medical condition known as "you ain't got no red corpuscles, Jack you dead." Apparently Mr. Ledger's doctor or doctors failed to follow these guidelines.

I wish I could say this was outrageous and egregious, but unfortunately it is completely standard medical practice. Studies have shown that when physicians write prescriptions, they do not, in the large majority of cases, warn patients about side effects or drug interactions. There are a couple of reasons for this, of varying degrees of defensibility. It's a huge but unquantified, underrecognized, understudied problem. As a matter of fact doctors often don't even know very much about the side effects or counterindications for the medications they prescribe. They're busy ordering unnecessary CT Scans to avoid highly unlikely malpractice suits, even as they are handing out powerful toxins without telling people about the bad things that can happen if the people go ahead and take them.

Any time you are given a prescription, you need to read the FDA label. Now, don't get all hypochondriacal and start imagining that you're having the horrific side effects listed as occurring rarely. One reason doctors don't like to mention them is because they know that's exactly what you'll do. But do pay attention to the warnings, interactions, and counterindications, and do pay attention to what your body is telling you, without getting too bent out of shape about it. Most common side effects, like an upset tummy or a headache, will go away after a short time. But you need to know what you're getting into.

Can we find ways to get doctors to do a better job of informing their patients, and preventing tragedies like the death of Heath Ledger? I hope so. We're working on it. But meanwhile, caveat emptor.

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