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| Trial and error |
3-May-2006 |
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The risks of some medical treatments may
outweigh any benefits.
By
Dr Andrew Gunn
THE experimental antibody drug TGN1412 won’t be available over the counter any time soon. It seems safety testing on animals was misleading. In a recent UK drug trial six men almost died from multi-organ failure.
I’ve been a drug trial guinea pig. My hazy memories of med school include several lucrative days, in part spent in pubs, with a crepe-covered cannula in my forearm for self-injection of hep saline. I’ve also been a drug trial medico and find the concept of killing research participants a tad disturbing.
“First, do no harm” is a favourite dictum of docs. It is usually attributed to Galen or Hippocrates but may have first appeared in an obscure 1860 book. However, Hippocrates did write that, regarding diseases (and probably drug trials), a physician should “make a habit of two things — to help, or at least to do no harm”.
Unfortunately, never doing harm requires luck. “Do more good than harm” or “do more good than if you weren’t involved”would be more achievable goals. We all occasionally harm our patients —competency means not repeating mistakes; incompetency means not recognising them.
Some of the harm we cause — such as an avoidable side effect of medication — is obvious through the retrospectoscope. Other harm is less immediately apparent; for instance, problems associated with screening investigations such as PSAs or total body scans revealing incidentalomas.
I’ve successfully discouraged the occasional risk-averse cancerophobe from a needless CXR with the easy-to-remember statistic that a CXR holds about a one in a million chance of causing cancer.
Despite the potential for investigations to cause harm, the medicolegal environment encourages them. Over-investigation is more likely to be viewed by the courts as prudent than perilous. Our treatment of minor Pap smear abnormalities is still affected by a gynaecologist’s insistence in court that, regardless of probability, cancer must be excluded.
A recent study in the Lancet suggested cervical trauma from cone biopsies and large loop excisions of the transformation zone almost doubled the risk of future adverse pregnancy outcomes such as premature rupture of membranes, preterm delivery and low birthweight infants.1
So we’re damned if we do and damned if we don’t. All of which is kinda scary when, first, we want to do no harm.
Dr Gunn is a GP in Brisbane.
This is an edited version of an article that
first appeared in
GPlink
, the newsletter of
GPpartners (formerly the Brisbane North
Division of General Practice).
Reference: 1. Kyrgiou M, et al. Lancet 2006; 367:489-98.
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