Feds: Doctors Must Check Warnings. Several recent high-profile instances in which the FDA has pulled drugs off the market because of serious, even lethal complications point to declining standards of practice in modern medicine. Although critics contend that medications are rushed to market before adequately tested, this is not the problem in my opinion. Certain drugs are “fast-tracked”, but the usual criticism is that it takes too long for significant new therapeutic breakthrough drugs to wend their way through the approval process; new drugs are introduced with considerably more alacrity in Europe, for example.

The more crucial factor appears to be that doctors don’t heed the warnings about interactions and adverse reactions on the drugs they prescribe. Many MDs report they don’t have the time to read “pages and pages of fine print” on a new drug and wouldn’t remember what they read anyway. Worse yet, the source of prescribing information on many a new medication is the pharmaceutical company representative or “detail man”, whose job is really glossing over concerning details to get the product prescribed. Many — indeed, most — drugs we prescribe have adverse effects, and even dangerous drugs can be prescribed safely in the hands of a scrupulous practitioner. Increased regulation is only a very imperfect substitute, but will be increasingly necessary if the slide in practice standards continues. (“The beatings will continue until morale improves”??) Even though there has been an explosion in the numbers of drugs in the pharmacopoeia, the ready availability of information processing capabilities on the doctor’s desktop (or pocket) means there’s little excuse for prescribing with inadequate data.

While in no sense of the term is it the consumer’s responsibility to avoid falling victim to unsafe prescribing practices, there are things you can do in the caveat emptor spirit. The take-home message is that you should require your doctors to inform you to your satisfaction about the reasoning behind their choices of medications, explaining fully the risks and benefits, with particular attention to interactions with any other medications you might be taking. The burden of proof for the doctor choosing a new(!) improved(!) medication instead of a more established drug ought to be higher, to prevent you from being the victim of a pharmaceutical company hyping the latest thing. (Always ask your doctor how long s/he has been prescribing a given drug when it is offered to you; and how long it has been on the market.) Wonder about your doctor’s prescribing practices if s/he is constantly prescribing the newly-introduced medications and offers you only vague explanations of the advantages and the risks. If your doctor appears irked by your inquiries, it’s probably time to find a new doctor. And find a doctor who still reads. Even as a busy, overworked MD, I wouldn’t have it any other way…

Here is a list of the eleven drugs recalled from the market, either by FDA regulation or voluntarily by their manufacturers, since 1997.