When a doctor prescribes a medicine there is an implicit promise that it will relieve symptoms or cure us when we are ill. The Hippocratic Oath that most physicians take upon graduation is widely understood to prohibit doctors from doing harm. Patients should not have to deal with a drug boomerang, a situation in which the medicine causes causes more harm than good!
What Is A Drug Boomerang?
Boomerang: n.
1. (Australian) a curved piece of wood; when properly thrown will return to thrower.
2. A miscalculation that recoils on its maker.
This definition from Webster’s Online Dictionary describes the unintended consequences of certain medications.
When doctors prescribe a drug to solve a problem, they don’t expect it to make things worse. But sometimes prescriptions lead to a drug boomerang.
Why The Hippocratic Oath Matters!
The precise phrase, “first, do no harm,” is not technically part of the oath. Hippocrates wrote it in a different work titled “Of the Epidemics.” In the actual oath, doctors promise to “do no harm or injustice” to their patients.
Of course, all medications have the potential to cause side effects in some patients. All you have to do is watch a direct to consumer (DTC) drug commercial on television to appreciate that. Health care providers are supposed to balance benefits against risks for every medicine they prescribe.
Most patients understand this. They don’t expect, however, that a medication will cause the very problem it’s being prescribed to treat. That, dear reader, is a drug boomerang!
Was Hormone Replacement Therapy a Drug Boomerang?
During the 1980s and 1990s women were told that they needed to take hormone replacement therapy (HRT) to build strong bones, diminish wrinkling and reduce their risks of having a heart attack or other cardiovascular complication. I recall a conference in which a woman asked the speakers about HRT and breast cancer. She was dismissed on the grounds that the great benefits of estrogen and progestin for preventing heart attacks far outweighed a small increase in cancer.
Then women who had been told they needed hormone replacement therapy after menopause to protect their hearts learned that HRT could increase their chance of a heart attack. This was the conclusion of not one but two clinical trials, the Heart and Estrogen/Progestin Replacement Study and the Women’s Health Initiative (Hypertension, Oct. 11, 2004).
You can read more about the HRT drug boomerang at this link.
The UDGP Drug Boomerang:
Drugs for type 2 diabetes are intended to control blood sugar. But the reason for that is to reduce the risk of developing cardiovascular complications such as heart attacks, strokes and premature death. Heart disease is the reason people with diabetes often die younger.
In 1970, scientists reported the results of a clinical trial that alarmed endocrinologists. In the University Group Diabetes Program (UGDP), a drug widely prescribed to control blood sugar was compared to placebo. The trial lasted for several years and enrolled more than 800 people. To their shock, the investigators found that people taking tolbutamide (Orinase) were twice as likely to develop heart trouble as those on placebo.
The CAST Drug Boomerang:
A decade later, researchers decided to test drugs being prescribed for serious heart rhythm problems. These can be frightening and dangerous. The medications flecainide (Tambocor) and encainide (Enkaid) were compared to placebo in the Cardiac Arrhythmia Suppression Trial (CAST).
Nearly 1500 volunteers participated in the trial. After ten months, 89 people had died. These were disproportionately patients taking the active medications, who died from heart rhythm problems and other cardiac causes. As a result, the investigators stopped the study (New England Journal of Medicine, March 21, 1991).
Antidepressants That Increase the Risk for Suicide:
If you look at the black box warning for antidepressants such as sertraline (Zoloft) you will read something alarming:
“Antidepressants increased the risk of suicidal thoughts and behavior in pediatric and young adult patients in short-term studies. Closely monitor all antidepressant-treated patients for clinical worsening, and for emergence of suicidal thoughts and behaviors.”
If that isn’t a drug boomerang message we don’t know what is. Most people assume that antidepressants reduce the likelihood of suicidal thoughts. You will be surprised to discover that the research does not support that assumption. Here is a link that will blow your mind.
Are New Alzheimer Meds A Drug Boomerang?
Perhaps you have heard about the new “breakthroughs” against Alzheimer’s disease (AD), aducanumab and lecanemab. These drugs are very effective at ridding the brain of beta-amyloid, which was thought to be the underlying cause of AD. But do these drugs restore memory and improve the lives of people with dementia? You can read our recent analysis of these medications at this link.
The media has made a big deal about these new AD drugs. What you have not read much about is a possible side effect: brain atrophy. Brain shrinkage is not good for people who are at risk for dementia.
NSAIDs and Cartilage:
The latest example of an unexpected outcome was recently presented at the Radiological Society of North America. Researchers recruited 277 patients taking NSAIDs such as ibuprofen or naproxen for their knee osteoarthritis. They compared these subjects to 793 individuals not taking these anti-inflammatory drugs.
All the volunteers had MRI scans at the outset and again after four years. At the end of the study, those taking the nonsteroidal anti-inflammatory drugs had more inflammation and less cartilage in their knees than the people in the control group.
Final Words on the Drug Boomerang Effect:
Drug boomerang complications leave patients and doctors as puzzled as the FDA. It is shocking that it often takes decades for scientists to discover when medications may be causing more harm than good. Drug companies and doctors should try harder to follow the Hippocratic oath to “do no harm or injustice.”
What do you think? Please share your thoughts in the comment section below.
