MEDICATED MEDICINE - A MODERN HORROR STORY

    The annals of medicine will eventually, almost certainly, record instances where medical treatment went awry, with appropriate caveats admitting to the possibility that profits rather than good medicine were the driving force.
    In the latter half of the twentieth century a rather clever invention was taken into common practice as a method of keeping arteries open that were subject to clogging and closure, causing heart attack. The idea was to create a tubular wire mesh device which in its collapsed form could be emplaced in the blood vessel and then expanded so blood could flow unimpeded through that area. It worked remarkably well. A stent installed in one of my arteries sixteen years ago is still open.
    It happened then, that someone came up with the clever idea that if the wires in the stent were to be coated with a special medicine, then the stents could be relied upon to stay unclogged far into the future. The hitch was that in the first year things were a bit iffy. Unless the patients were treated with a blood thinner, the liklihood of the medicated stents to clog up during the first year was higher than for non-medicated stents. This is quite a bizarre concept: medication to make medication work. A parallel in the real world would be a need for an additive in motor oil to prevent the bearings from seizing. Why would common sense doctors accept that fix, something not too different from a computer software patch, but possibly far more risky?
    Six months ago I had two medicated stents installed following a mild heart attack.
    Coumadin is a reliable blood thinner. Pharmaceutical firms don’t like it because they can’t make a nickel on it. Coumadin is cheap. It is a bit of a nuisance for doctors as the patient has to come in frequently for a short check to be certain that the concentration of coumadin is in a safe and effective zone. Not much money there either. But Plavix, a new drug to save the stents is a wonder drug. It does the job and at the same time makes a pile of money at nine or ten dollars a pill. A prescription might call for two pills a day.
    But it would be too much to expect no other downsides. Plavix has several undesirable side effects. I happen to be the victim of one of the worst of them: may cause sudden numbness down the left side of the body. It doesn’t subside, probably because it is reinforced every day. It is interesting that the warning is accompanied by the advice: See your doctor immediately. As it happens, doctors don’t have a clue and don’t respond, not even to the extent of calling the pharmaceutical company that produces Plavix- Bristol-Meyers.  Not surprisingly, the company did not respond to my inquiry.
    Since Plavix is so profitable, it is not surprising also that other similar medications would soon make an appearance. An alternate to Plavix was suggested to me. The problem was it carried identical warning about the possibility of onset of sudden numbness down on the body’s left side.
    The mischief continues. Not many months ago another blood thinner appeared on the market, purportedly safer than coumadin on the basis that bleeding risks are lower.  It is called Apixaban; its generic name is Equilis. My cardiologist approved a switch to Equilis from Plavix, with the idea that the numbness might be abated. Unfortunately the new medicine carries the same warning about sudden numbness.  After a month there was no relief, and no relief from a $20.00 a day prescription charge. At times it seemed that the numbness was worsened.
    There comes a time when the patient has to take charge. Too often doctors are not using common sense. Too often they won’t lift the phone to talk with another or with a pharmaceuticasl firm. How much pressure they are under to live and let live with the pharmaceutical firms is  subject to conjecture.    
            To sum up: this patient has had it. The next step is hard negotiation to switch medication to coumadin. Failing that, a search for a new cardiologist.