Everyone knows that pharmaceuticals can have side effects.
For example, a sizeable minority of people are allergic to penicillin or to anaesthetics, coming out in a rash or even developing liver damage and other complications if they are wrongly prescribed. Approximately 15% of the population are allergic to one or more common drugs. More worryingly, 0.1% of hospital inpatients actually die as a result of adverse drug reactions. Many of the pills prescribed for the symptoms of mental illness have deeply unpleasant side-effects. And nobody should forget Thalidomide, which caused limb impairments in 10,000 babies worldwide in the late 1950s. It’s been estimated that adverse drug reaction is the fourth commonest cause of ill health in the US.
But there are some silver linings amongst all this gloomy data. The drug Viagra, saviour of middle-aged Lotharios everywhere, was discovered by accident: male patients who were prescribed Pfizer’s new angina drug – then known by the catchy label of UK-92,480 – reported that they were getting unexpected and stimulating side-effects in the trouser department. What their partners felt about their newly horny husbands is not recorded, but Pfizer realised they were onto a good thing, and the little blue pills have been boosting love lives – and profits – ever since.
A study in a medical journal this month highlights another unexpected drug side effect. Patients with Parkinson’s – which affects some 120,000 people in the UK – suffer from a lack of the neurotransmitter dopamine. This causes their characteristic tremors and rigidity. A class of drugs called dopamine agonists compensate for the lack of natural dopamine and reduce early symptoms. However, a team of researchers in Minnesota have now found that these drugs – particularly a type called pramipexole – also turn some patients into compulsive gamblers. In fact, they can become compulsive about lots of habits – not just gambling, but also drinking, eating and sex. All of which goes to make pramipexole sound like the ‘Seven Deadly Sins’ of side effects, and which is no doubt worrying puritanical Christians everywhere.
The big question is: how long will it take before these drugs are available on the black market? After all, every time I open my email inbox, people are trying to sell me human growth hormone, Viagra and numerous other dubious pills, not to mention rather more unsavoury medications such as Rohypnol. The latter, developed to treat insomnia but now notorious as a ‘date rape’ drug, has been implicated in a wave of sexual assaults over recent years.
Closer to home, the sad truth is that most drugs which we take regularly have more mundane side effects. Along with tens of thousands of other folks with osteogenesis imperfecta or osteoporosis, my partner uses alendronate to strengthen her bones. It appears to reduce fractures, but it comes at the cost of causing almost constant wind – fewer fractures, but more burps. And any of us who suffer regular pain know the perils of codeine – less aching, but more constipation. Meanwhile, the people who take cannabis to control their spasms or nausea risk encounter the notorious ‘munchies’ – that sudden craving for toast in the early hours.
Looking to the future, many medical researchers have pinned their hope on pharmacogenetics, which is the theory that understanding the genetic basis of drug action and reaction will lead to a new generation of ‘tailor-made therapies’. Rather than giving out generic treatments, which don’t help everyone and actively harm a minority, doctors will be able to test their patients before prescribing the precise pharmaceutical to help each individual. Well, that’s the concept. Whether the science works – and whether the drugs will be cost-effective – remains to be seen.
This month, the National Institute for Clinical Excellence is going to decide whether four new drugs for the treatment of Alzheimers can be prescribed on the NHS. Rivastigmine, Memantine, Donepezil and Galantamine may sound like characters in a sword-and-sorcery novel, but to people suffering from dementia, they are an effective treatment. But NICE says they aren’t value for money.
With powerful pharmaceuticals, the “can’t live with them, can’t live without them” adage seems particularly relevant. Every beneficial drug seems to come with its own unique – and sometimes comical – set of side effects. And each successful treatment innovation raises new questions about access, equity and rationing. The most disturbing statistic is that 90% of pharmaceutical research is conducted on diseases which affect 10% of the world’s population. This means that treatments for baldness and obesity may be just around the corner, while the global killers – TB, HIV, the Ebola virus – may have to wait a bit longer. The worst side effect of the big Pharma is injustice.
Tom Shakespeare is the Director of Outreach at the Policy, Ethics and Life Sciences Research Institute in Newcastle. His non-fiction books include Genetics Politics: from Eugenics to Genome and The Sexual Politics of Disability.
Everyone knows that pharmaceuticals can have side effects.
For example, a sizeable minority of people are allergic to penicillin or to anaesthetics, coming out in a rash or even developing liver damage and other complications if they are wrongly prescribed. Approximately 15% of the population are allergic to one or more common drugs. More worryingly, 0.1% of hospital inpatients actually die as a result of adverse drug reactions. Many of the pills prescribed for the symptoms of mental illness have deeply unpleasant side-effects. And nobody should forget Thalidomide, which caused limb impairments in 10,000 babies worldwide in the late 1950s. It’s been estimated that adverse drug reaction is the fourth commonest cause of ill health in the US.
But there are some silver linings amongst all this gloomy data. The drug Viagra, saviour of middle-aged Lotharios everywhere, was discovered by accident: male patients who were prescribed Pfizer’s new angina drug – then known by the catchy label of UK-92,480 – reported that they were getting unexpected and stimulating side-effects in the trouser department. What their partners felt about their newly horny husbands is not recorded, but Pfizer realised they were onto a good thing, and the little blue pills have been boosting love lives – and profits – ever since.
A study in a medical journal this month highlights another unexpected drug side effect. Patients with Parkinson’s – which affects some 120,000 people in the UK – suffer from a lack of the neurotransmitter dopamine. This causes their characteristic tremors and rigidity. A class of drugs called dopamine agonists compensate for the lack of natural dopamine and reduce early symptoms. However, a team of researchers in Minnesota have now found that these drugs – particularly a type called pramipexole – also turn some patients into compulsive gamblers. In fact, they can become compulsive about lots of habits – not just gambling, but also drinking, eating and sex. All of which goes to make pramipexole sound like the ‘Seven Deadly Sins’ of side effects, and which is no doubt worrying puritanical Christians everywhere.
The big question is: how long will it take before these drugs are available on the black market? After all, every time I open my email inbox, people are trying to sell me human growth hormone, Viagra and numerous other dubious pills, not to mention rather more unsavoury medications such as Rohypnol. The latter, developed to treat insomnia but now notorious as a ‘date rape’ drug, has been implicated in a wave of sexual assaults over recent years.
Closer to home, the sad truth is that most drugs which we take regularly have more mundane side effects. Along with tens of thousands of other folks with osteogenesis imperfecta or osteoporosis, my partner uses alendronate to strengthen her bones. It appears to reduce fractures, but it comes at the cost of causing almost constant wind – fewer fractures, but more burps. And any of us who suffer regular pain know the perils of codeine – less aching, but more constipation. Meanwhile, the people who take cannabis to control their spasms or nausea risk encounter the notorious ‘munchies’ – that sudden craving for toast in the early hours.
Looking to the future, many medical researchers have pinned their hope on pharmacogenetics, which is the theory that understanding the genetic basis of drug action and reaction will lead to a new generation of ‘tailor-made therapies’. Rather than giving out generic treatments, which don’t help everyone and actively harm a minority, doctors will be able to test their patients before prescribing the precise pharmaceutical to help each individual. Well, that’s the concept. Whether the science works – and whether the drugs will be cost-effective – remains to be seen.
This month, the National Institute for Clinical Excellence is going to decide whether four new drugs for the treatment of Alzheimers can be prescribed on the NHS. Rivastigmine, Memantine, Donepezil and Galantamine may sound like characters in a sword-and-sorcery novel, but to people suffering from dementia, they are an effective treatment. But NICE says they aren’t value for money.
With powerful pharmaceuticals, the “can’t live with them, can’t live without them” adage seems particularly relevant. Every beneficial drug seems to come with its own unique – and sometimes comical – set of side effects. And each successful treatment innovation raises new questions about access, equity and rationing. The most disturbing statistic is that 90% of pharmaceutical research is conducted on diseases which affect 10% of the world’s population. This means that treatments for baldness and obesity may be just around the corner, while the global killers – TB, HIV, the Ebola virus – may have to wait a bit longer. The worst side effect of the big Pharma is injustice.
Tom Shakespeare is the Director of Outreach at the Policy, Ethics and Life Sciences Research Institute in Newcastle. His non-fiction books include Genetics Politics: from Eugenics to Genome and The Sexual Politics of Disability.