Friday, January 27, 2006

Killers in your Supermarket

Dr Dork is perturbed.

It used to be that the only medications available from a supermarket were paracetamol and milder aperients.

Paracetamol is relatively benign. It really only has the one single danger, of overwhelming hepatic metabolism in overdose. That is enough of a danger in itself.

Impulsive and perhaps non-serious attempts at suicide by overdose by those ignorant of the genuine risk can lead to dramatic liver failure unless promptly treated.

I have seen one case of a young girl who took a mere 16 tablets. A normal supermarket packet contains at least 20. Her liver started to fail. She did not want to die. It was never her genuine intent. Thankfully she presented early enough that she made a full recovery with treatment. Without treament she would have been dead within days.

But NSAIDs (non-steroidal anti-inflammatories) such as nurofen, brufen and the like are a more insidious problem. Now I begin to see more and more advertising of traditional NSAIDS, particularly ibuprofen. Marketed direct to the public.

Firstly, there is the risk of gastrointestinal bleeding. Although the work of Profs Marshall and Warren - itself a fascinating tale for another day - shows that H. Pylori is often the cause, NSAIDS and aspirin are probably the commonest precipitant.
These were taken off the OTC (over the counter) market many years ago in Australia (Oz), and there was a resultant fall in kidney failure due to analgesic nephropathy. Which is a fancy name for kidney damage from painkillers. Which had been rising significantly prior to this intervention.

Why on earth were NSAIDS put back on the OTC market ? They are now again being aggressively marketed.

How many ruptured ulcers and ruined kidneys before this decision is again reversed?

We all make mistakes. Stupidity is repeating them. Especially when people will die as a result.

Even docs, in prescribing software applications, are vulnerable. And we're supposed to be able to see through this crap. What of the general public ?

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