Personal View: When ignorance is not bliss
Authors: Wendy Jones
Journal: BMJ (2003)

My naive journey into the world of prescription drugs and their side effects began one chilly October morning 14 years ago, hand in hand with my life changing, soul crushing companion—psoriatic arthritis. I awoke suddenly to find that, out of the blue, my right knee had swollen to the size of a tennis ball. That's strange, I thought to myself; I don't recall having had any bumps or injuries there.

After two weeks, the painful swelling was still causing difficulty in walking, and I went to see my general practitioner. I was referred to an orthopaedic consultant, but it was a nine month wait before I saw him. In his opinion, I had torn a cartilage. However, after another year of tests—during which time another three joints were affected—I was diagnosed as having psoriatic arthropathy.

The first course of treatment was cortisone injections, given on a regular basis, which had little effect. I was never told of any potential side effects, but became concerned when I started to read for myself about the long term problems that might occur with this drug. On each visit to the hospital I was asked, “Would you like another injection today, Mrs Jones?” I decided for myself, that, no thank you, I did not.

Naproxen was the next drug prescribed. This I took for several months. Once again, nobody mentioned that there could be problems. Until suddenly I had a rectal bleed. Then I was told that this drug could cause gastric bleeding. Why had no one mentioned this before? This had certainly shaken my trust that the doctor knows best.


There must be many wasted drugs sitting in cupboards everywhere


Since then, I have been referred to a specialist rheumatology hospital and have been prescribed many nonsteroidal, anti-inflammatory drugs. No one has ever discussed with me the fact that these medicines can have potentially serious side effects. But, as the disease has taken more and more of a hold, I have been willing to try anything to ease its relentless, disabling progression.

Sulfasalazine, leflunomide, rofecoxib, celecoxib, ibuprofen, methotrexate, I have swallowed a whole armamentarium of drugs. The side effects have been quite disabling—nausea, dizziness, weakness, headache, diarrhoea, constipation. I have found possible explanations only upon reading the information leaflet. But it has been a case of “Well, this drug doesn't work, so let's try another one—let's suck it and see.”




Figure 1



Credit: ANN GIORDANO/PHOTONICA




The advent of the internet has brought with it better patient information and a greater degree of choice and control. While I appreciate the enormous time constraints upon doctors' time, it would be reassuring if they explained the more common side effects of presciption drugs and it would certainly be better than having patients starting medication, feeling ill, and discontinuing the treatment as a result.

When ill effects occur, the patient reaches for the information leaflet and can be scared, sometimes unnecessarily, into discontinuing treatment. Cardiac arrest, liver failure, blood disorders, stomach ulcers, lung disease—all are guaranteed to frighten the life out of the unsuspecting patient.

As a fairly well informed, non-medical person, and as a result of my own experiences, I now ensure that I gather as much information as possible about any drugs that I am about to take. But not everyone has access to the internet or knows how to get information from the British National Formulary. So a few minutes of explanation when doctors write a prescription would be beneficial to both patients and the NHS. After all, there must be many wasted drugs sitting in cupboards everywhere, as people have stopped taking them because of unexplained side effects.