by Don Storch
Right or wrong, the consumer media, not primary care physicians, are becoming the American public's chief source of medical information. With so many prescription drugs being approved for over-the-counter sale, we tend to bypass the doctor and head right for the pharmacy shelf. And, the medications we select there are often the ones we have read or heard about in news stories and advertisements.
This increasing reliance on the media for medical information places new burdens on the health reporter. It is no longer enough to simply report on discoveries, events, or studies describing adverse reactions; it is now necessary to place new information in the context of the product category. If people are going to base medication selections on what they read and hear, without consulting a physician, it is important that they receive enough information to allow them to make educated decisions. If for example, a new OTC antacid hits the market, people need to know how it compares with the other antacids already available. How do the side effects profiles differ? What drug interactions can be expected relative to those of other products in the same category?
As a consultant for McNeil Consumer Products Company, I have observed firsthand what can happen when reports on drug-related issues are incomplete. Acetaminophen, the active ingredient in Tylenol¨, recently received significant media attention following a report of acetaminophen-related liver problems in people who abuse alcohol. However, in covering this subject, many reporters failed to mention just how rare these occurrences are--so rare, that over the course of 30 years of acetaminophen use by hundreds of millions of people, there have been approximately 200 reports in the medical literature describing acetaminophen-related problems in people who use alcohol. This was information that would have given consumers some important perspective on the issue. Similarly, the fact that these patient reports most often involved abusive use of alcohol and acetaminophen overdose was another piece of the consumer story that was not always mentioned, but definitely needed to be told.
Adding to the problem, reports frequently did not describe the side effects of other pain relievers, such as aspirin, naproxen sodium, and ibuprofen--known collectively as non-steroidal anti-inflammatory drugs (NSAIDs). These are the only OTC products people could turn to if they were to quit using acetaminophen. And yet, media reports did not always include critical information on the risk of gastrointestinal ulceration and bleeding associated with NSAID use, nor did they mention how complications from prescription and non-prescription use of NSAIDs (even at recommended doses) result in about 200,000 cases of gastrointestinal hemorrhage and at least 10,000 deaths in the U.S. each year.1 Similarly, little attention was paid to the fact that the risk of gastrointestinal bleeding in NSAID users increases substantially in the setting of alcohol abuse.2,3
Such omissions in reporting set the stage for uninformed switches in OTC medications--switches that can get some people into serious trouble. While there are many consumers who can change from one OTC product to another without problems, there are others who need to be extremely careful about which medications they use.
We are entering a new era in medical reporting in which what is left unsaid often can be more dangerous to the reader than what is said. Too often, the news story is the reader's first and only source of medical information. And, right or wrong, fair or unfair, this trend is shifting a tremendous responsibility to the shoulders of today's medical reporter.
1. Food and Drug Administration: HHS News. DHHS Publication No. P88-40. Rockville, MD. U.S. Department of Health and Human Services, Dec. 27. 1988.
2. Benson, GD: Perspective on mild analgesic use in the alcoholic, in Aronson MD (ed): Alcoholism: Recognition of the Disease and Considerations for Patient Care. Springfield, New Jersey, Scientific Therapeutics, Inc. 1993, pp.32-39.
3. Lanza F, Puera, D: "GI Bleeding Report." Presented at the 60th Annual Scientific Meeting of the American College of Gastroenterology, New York, New York, October 13-15, 1995.