16 December 2008

Fear and Loathing on the Island of the Terminally Ill

Dana Jennings writes in the New York Times today what it's like to be, as he puts it, "Person, Patient, Statistic." It's a fine meditation on illness and its cures, the problems with the cures, the medical professionals who see patients as (again in Jennings' word) "meat."

It hits home hard for me this week. Over the protests of its manufacturers, the FDA voted recently to take Serevent, a long-acting bronchodilator, off the market, because they say it's masking worsening symptoms and leading to more patient deaths. But they've allowed the drug-makers to keep Advair (which contains Serevent plus an inhaled cortic0steroid) on the market, on the argument that the steroid mitigates the problems with the Serevent.

Advair has been keeping me breathing very effectively for the last year or so. I chase The Offspring, and go out running, without getting exercise-induced asthma, which has plagued me for -- literally -- as long as I can remember, since my early childhood.

Now, though, I get a chill of fear with each morning's dose and each evening's dose.

For my doctor, it's about statistics, and about "patient compliance" -- a problem medical professionals often ascribe to sloth, or to patients' daft inability to follow directions.

For the drug companies, I feel fairly confident in arguing, it's all about the bucks. Big Pharma has a pretty well-documented history of dismissing, down-playing and concealing evidence of serious side-effects of medication. Unless the medication in question has just gone generic, in which case they're happier to have it taken off the market, so they can sell more of something that they can make more money on.

(Case in point: Seldane was killing people back in the 1990s, but the FDA didn't make the manufacturer take it off the market until they had developed Allegra to replace it; Allegra, conveniently enough, became available just as Seldane was getting sold in generic form.)

Yeah, it's important to stay up-beat. And I don't really have time to think about it this week; I'm knee-deep in papers and finals that need grading. But I'll be having a little chat with my doctor when I see him next in a couple of weeks about whether I really should keep taking this medication.