Medicine Reactions a Leading Cause of Death

Star Tribune - Wednesday, April 15, 1998

Health Roundup

Associated Press

Bad reactions to prescription and over-the-counter medicines kill more than 100,000 Americans and seriously injure an additional 2.1 million every year – far more than most people realize, researchers say.

Such reactions, which do not include prescribing errors or drug abuse, rank at least sixth among U.S. causes of death - behind heart disease, cancer, lung disease, strokes and accidents, says a report based on an analysis of existing studies.

"We're not saying, 'Don't take drugs.' They have wonderful benefits," said Dr. Bruce Pomeranz, principal investigator and a neuroscience professor at the University of Toronto.

"But what we're arguing is that there should be increased awareness also of side effects, which until now have not been too well understood."

The harm may range from an allergic reaction to an antibiotic to stomach bleeding from frequent doses of aspirin, Pomeranz said. The study, by Pomeranz and two colleagues at his school, did not explore which medications or illnesses were involved.

The authors analyzed 39 studies of hospital patients from 1966 to 1996. Serious drug reactions affected 6.7 percent of patients overall and fatal drug reactions 0.32 percent, the authors report in today's journal of the American Medical Association.

In the study, serious injury was defined as being hospitalized, having to extend a hospital stay or suffering permanent disability.

The most surprising result was the large number of deaths, the authors said. They found that adverse drug reactions ranked between fourth and sixth among leading causes of death, depending on whether they used their most conservative or a more liberal estimate.

In 1994, between 76,000 and 137,000 U.S. hospital patients died, and the "ballpark estimate" is 106,000, Pomeranz said. The low estimate, 76,000 deaths, would put drug reactions sixth. The "ballpark estimate" would put them fourth, he said.

An additional 1.6 million to 2.6 million patients were seriously injured, with the ballpark estimate 2.1 million, he said.

New doctors: They report mistreatment, sleepiness

They've been dumped on, hit on and even hit. Ninety-three percent of medical residents report they were mistreated at least once during their first year after medical school, according to results of a survey published in today's Journal of the American Medical Association.

Most fledgling doctors also have watched their colleagues mistreat patients or make sleep-impaired decisions, says the survey of 1,277 medical residents nationwide. Nevertheless, residents gave their first year after medical school an average rating of good.

"They weren't ecstatic about it, but they didn't hate it either," said Steven Daugherty, a researcher at Rush Medical College in Chicago who oversaw the 1991 survey.

The survey is among the first to compile residents' grumblings over the multiple-year transition from medical student to doctor that can be a grueling, often sleepless process, Daugherty said.

About half of residents said they felt belittled or humiliated by more senior residents. The mistreatment was often verbal, including public scolding and threats to their reputations or careers. But almost 39 percent also said they'd been slapped, pushed or hit – most often by patients.

Nearly two-thirds of female residents reported sexual harassment and discrimination. Some women, however, say the situation has improved. And then there is the problem of not enough sleep. Of those surveyed, 70 percent reported seeing a colleague working in an impaired condition, most often due to sleep-deprivation.

Survey questions also asked about ethics. About 46 percent of residents said they saw other medical staff members falsify records. That could mean something as simple as adding information to an old case file.

Legal advisers make it clear to students that they must separate and properly date new material, said Dr. Gary Morton, director of education for the a nesthesiology department at the Texas A&M School of Medicine.

Memory: Stress-related hormone can shrink brain

Chronically high levels of a stress-related hormone can shrink a part of the brain and impair memory in older people, a study suggests. The finding might indicate a way to prevent some agerelated memory loss and even Alzheimer's disease, researchers say.

The finding does not necessarily mean that a stressful life will erode memory, experts said.

The idea that high levels of the hormone cortisol can shrink a brain feature called the hippocampus has been suggested before in studies of people with Alzheimer's or Cushing's syndrome, a condition that produces high cortisol levels. The new work indicates it's also true in healthy older people. Prior studies also have concluded that high cortisol levels can hamper memory in healthy people.

Scientists haven't yet found out whether elderly people with chronically high and rising cortisol levels are especially prone to getting Alzheimer's or depression, which also robs older people of memory. But if they are, medications to cut cortisol levels might prevent those illnesses.

The work is reported in the May issue of a new journal called Nature Neuroscience.

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