Just a few
hours ago I penned an article called:
Are Using
Drugs the Key for Disease Management and Good Health?
https://scientificlogic.blogspot.com/?zx=7a88886cde19be9e
We also have
another problem using drugs to treat. I need not have the time to continue to
write on another issue. We need to consider the benefit against the risk the
patients may face if a drug is given especially for long term management of a
chronic disease. The benefit-risk ratio in drug therapy is a way to evaluate
the overall value of a medication by comparing its therapeutic benefits to its
potential risks or side effects. It's a crucial concept, especially in the
long-term treatment of chronic diseases where patients may need to take
medication for extended periods. The benefit means the positive effects of the
drug, such as symptom relief, disease management, and improved quality of life,
and the risk is the potential negative effects, including side effects, adverse
reactions, and long-term health concerns.
The
benefit-risk ratio is not always a straightforward calculation but rather a
qualitative assessment where clinicians weigh the pros and cons based on
clinical data and patient-specific factors. The aim is to ensure that the
benefits of the medication outweigh the risks for a particular patient. Let me
give you a few simple examples here:
In the
management of type 2 diabetes), the medication is normally Metformin. The
benefits are it helps lower blood glucose levels, reduces the risk of
diabetes-related complications (e.g., cardiovascular issues), and is generally
well-tolerated. But t risks are gastrointestinal side effects (e.g., nausea,
diarrhoea), rare risk of lactic acidosis. The benefit-risk ratio for most
patients with Type 2 diabetes, the benefits of controlling blood glucose and
reducing long-term complications outweigh the gastrointestinal side effects,
making Metformin a first-line treatment.
Another
example is the management of hypertension. Normally clinicians may use
medication such as Angiotensin-Converting Enzyme (ACE) Inhibitors (e.g.,
Lisinopril). The benefits are that it is effective in lowering blood pressure,
reducing the risk of stroke, heart attack, and kidney damage, and has
additional benefits in patients with heart failure or diabetic nephropathy. But
the risks of common side effects include cough, elevated potassium levels, and
potential for angioedema (swelling). Its benefit-risk ratio is, despite the
risks, the substantial reduction in cardiovascular events and kidney protection
typically make ACE inhibitors a favourable choice for many patients with
chronic hypertension.
Let’s take the
management of chronic obstructive pulmonary disease (COPD) as the third
example. The normal medication used is inhaled corticosteroids (e.g.,
Fluticasone). The benefits are reducing inflammation in the airways, leading to
improved breathing and reduced exacerbations. But the potential risk includes
oral thrush, hoarseness, and, in some cases, a slight increase in the risk of
pneumonia. The benefit of using inhaled corticosteroids for many COPD patients
are improved respiratory function and fewer exacerbations. This outweighs the
risks, especially when using a combination with long-acting beta agonists.
Let’s now take
the fourth example with rheumatoid arthritis. The agents used are
disease-modifying antirheumatic drugs (DMARDs) such as Methotrexate. The
benefits the patient gets is slows disease progression, reduces joint damage,
and improves long-term outcomes. The risk is, potential side effects include
liver toxicity, bone marrow suppression, and gastrointestinal issues. In
terms of benefit-risk ratio, despite the risks, the long-term benefits in
managing disease progression and maintaining joint function typically justify
the use of DMARDs for many patients.
The
benefit-risk ratio helps guide decision-making by emphasizing that while no
medication is free of risks, its therapeutic benefits often outweigh these
risks when managed properly. Individual patient circumstances, including their
specific health conditions, other medications, and overall health status, play
a crucial role in determining the best approach.
However,
despite some of the benefits of using drugs for long-term management of chronic
disease, using them may not offer a long-term solution if both the clinician
and the patient are unable to treat the root causes of disease. In that case we
are just using drugs as an easy and short cut to our health problems. I don’t
subscribe to such an approach in medicine.
For example, I
have come across many patients with chronic diseases telling me their doctors,
some of their doctors I personally know very well, who told them this “as long
as you take my medicine you are alright” To me, such an “advice” by the doctor
whoever they are, gives the patient a false sense of hope for any cure. As long
as the patient needs to take the doctor’s medicine, he or she is NOT alright.
The patient is ONLY alright if he or she need not take any more drug or
medicine prescribed by the doctor. He / she is alright only if he /she needs to
take only food and water to stay healthy, not all those medicines given by the
doctor.
The word
“cure” means you need just one treatment with a medication, and not having to
come back for refill with the same drug, worse still for more of other
medication for emerging linked diseases. Then we are not curing the patient at
all. We are only suppressing and controlling the disease, not offering the
patient a permanent cure once for all with the application of one drug without
needing to come back for follow up.
The crowd we
see in hospitals and clinics are the same patients for follow-up who never got
cured with any drugs, with new cases with the same chronic conditions adding on
to the more and more milling crowd. We are not getting anywhere. We are not
curing them at all. We are just controlling their illnesses with more and more
medication to take home. I don’t think clinicians are taking the correct
pathway if they are unable, or do not know, or not trained, and do not have
that crucial knowledge on how to address the root causes of the patients’
disorders. Then all they know is just prescribe the medicine hoping the disease
will disappear
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