Saturday, February 26, 2011


February 26, 2011, 9:30 a.m.

Putting Side Effects in Context
(bought to you by*)

Have you ever listened carefully to the lists of side effects included in the drug commercials on TV?

The horrible possible consequences from the use of these products seem to go on forever. It makes you wonder why anyone watching the ad would ever follow the suggestion that they ask their doctor if the pharmaceutical is right for them.

Yet the ads must work, or presumably the drug companies wouldn't continue spending billions of dollars showing them to us. See, Julie M. Donohue, Marisa Cevasco, and Meredith B. Rosenthal, "A Decade of Direct-to-Consumer Advertising of Prescription Drugs," New England Journal of Medicine, 2007; 357:673-681, August 16, 2007.

I suspect the reason the ads work is that most of us are sufficiently distracted by the commercials' pretty pictures of happy people that we never really focus on the warnings.

If these side effects weren't so serious their itemization would be hilarious. But they are serious.

So to lighten our load a bit, I'm going to close out this blog entry with one set of warnings that is intended to be hilarious but is actually also quite serious.

But first, give these possible side effects for Pfizer's Chantix a slow and focused read:
CHANTIX is a prescription medicine to help adults 18 and over stop smoking. You may benefit from quit-smoking support programs and/or counseling during your quit attempt. It's possible that you might slip up and smoke while taking CHANTIX. If you do, you can stay on CHANTIX and keep trying to quit.

Important Safety Information

Some people have had changes in behavior, hostility, agitation, depressed mood, suicidal thoughts or actions while using CHANTIX to help them quit smoking. Some people had these symptoms when they began taking CHANTIX, and others developed them after several weeks of treatment or after stopping CHANTIX. If you, your family, or caregiver notice agitation, hostility, depression, or changes in behavior, thinking, or mood that are not typical for you, or you develop suicidal thoughts or actions, anxiety, panic, aggression, anger, mania, abnormal sensations, hallucinations, paranoia, or confusion, stop taking CHANTIX and call your doctor right away. Also tell your doctor about any history of depression or other mental health problems before taking CHANTIX, as these symptoms may worsen while taking CHANTIX.

Do not take CHANTIX if you have had a serious allergic or skin reaction to CHANTIX. Some people can have serious skin reactions while taking CHANTIX, some of which can become life-threatening. These can include rash, swelling, redness, and peeling of the skin. Some people can have allergic reactions to CHANTIX, some of which can be life-threatening and include: swelling of the face, mouth, and throat that can cause trouble breathing. If you have these symptoms or have a rash with peeling skin or blisters in your mouth, stop taking CHANTIX and get medical attention right away.

The most common side effects include nausea (30%), sleep problems, constipation, gas and/or vomiting. If you have side effects that bother you or don't go away, tell your doctor. You may have trouble sleeping, vivid, unusual or strange dreams while taking CHANTIX. Use caution driving or operating machinery until you know how CHANTIX may affect you.

CHANTIX should not be taken with other quit-smoking products. You may need a lower dose of CHANTIX if you have kidney problems or get dialysis.

Before starting CHANTIX, tell your doctor if you are pregnant, plan to become pregnant, or if you take insulin, asthma medicines, or blood thinners. Medicines like these may work differently when you quit smoking.
So now let me make sure I understand. If I buy and use this product in accordance with the manufacturer's and my doctor's directions, I may experience the symptoms of serious mental illness (paranoia or hallucinations), an inclination to commit suicide, outbursts of hostility and anger, panic attacks, and a life-threatening swelling of my throat that prevents breathing. My skin may start peeling off my body, while I'm suffering constipation, vomiting, and an inability to sleep (understandable given those other symptoms), plus a three-in-ten chance of serious nausea. I'm sure I missed some of the warnings, but that at least touches on the highlights, right?

Have you seen Norman Lear's 1971 film, Cold Turkey? Put it on your Netflix' list.

And then tell me, why is it the Chantix symptoms are an improvement over the crankiness that giving up smoking cold turkey seems to produce in some smokers?

(Cold turkey was my father's approach to kicking the habit. He just woke up one morning not wanting another cigarette -- and wasn't even cranky about it as I recall. Unfortunately, it was a decision made too late in what turned out to be a 59-year life. But the lesson was not lost on me. I have never smoked a single cigarette -- although years ago I had occasional, brief encounters with other forms of tobacco use.)

Tobacco contributes to the causes of death for some 400,000 Americans a year. Clearly it contains dangerous drugs. But is it really any more risky than using Chantix? Yes -- given the probable percentages of people using Chantix who suffer from one or more of those side effects -- there's little doubt that the odds of serious, ultimately fatal consequences of using tobacco are greater than the odds of serious consequences from Chantix.

So consider . . . "Tequila."

The fact is, like much humor, many of these enumerated tequila side effects hit very close to the truth. Over consumption of alcohol, what is sometimes called binge drinking (especially by teenagers and college students), is no more a laughing matter than the consequences of tobacco use.

With proper care -- diet, exercise, stress reduction, weight control -- our bodies can serve us well for many years. Avoiding things that impede normal functioning, such as tobacco and excessive alcohol (as well as highly advertised, often unnecessary, high-cost designer pharmaceuticals with serious side effects) can provide a big assist. If a little humor can help us see that, it can be a positive public health contribution.

[Notes: (1) Thanks to Sherman Johnson for bringing the tequila "commercial" to my attention. (2) Unfortunately (as he agrees), the video includes one use of an insensitive and politically incorrect reference to those persons professionals currently describe as people with "intellectual and developmental disabilities." See discussion in "Mental Retardation,"]

* Why do I put this blog ID at the top of the entry, when you know full well what blog you're reading? Because there are a number of Internet sites that, for whatever reason, simply take the blog entries of others and reproduce them as their own without crediting the source. I don't mind the flattering attention, but would appreciate acknowledgment as the source -- even if I have to embed it myself.
-- Nicholas Johnson
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1 comment:

sajohnson said...

Just to clarify, I in no way condone or approve of the insensitive and politically incorrect reference in the video to those persons professionals currently describe as people with "intellectual and developmental disabilities."