*Ex. Hon. Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof.
of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.**NKP Salve
We doctors presume that if any new molecule
of a drug used in day to day practice arrives in the market, we should start
using it. In fact, the medical representatives see to it that the family physicians
start using the new molecule and forget about the old one. This is true of most
of the drugs - e.g. those being used in hypertension, diabetes, NSAID group
of drugs, drugs used by psychiatrist and those used to control hyperacidity
or migraine, etc.
Usually, I am the last practitioner to start prescribing any new drug unless,
it has a tremendous advantage over the previous generation drug.
But unfortunately, recently I was the victim when on one occasion I did not
follow this dictum. Since I have been taking regular statins (I have a stent
put in my heart 5 years back), I have been changing to new statins with the
conviction that each new one will have better benefits. Thus I switched over
from Simvastatin, to Atorvastatin, to Provastatin and few months back to Cerivastatin.
But in Aug 2001, when my secretary telephoned the chemist to send Cerivastatin,
she was told that this drug has been banned because it caused nearly 60 deaths
due to Rhabdomyositis!! Thus, I went back to old statin.
The point I want to make is that I get weekly issues of British Medical Journal,
Lancet and New England Journal of Medicine for the last 35 years by air mail.
How is it that this calamity did not appear in the literature? How will people
like me, who do not surf or browse over the internet, come to know that this
new drug is dangerous!!
It is quite possible that I could have died if I had continued to take this
drug. Till the end of November, I did not see any article in the Standard or
International Medical Journals mentioning these tragic deaths which are not
less important than the deaths caused by the terrorists.
I have come to the conclusion that I should continue my life time practice of
prescribing the old molecule of a drug and wait as long as possible before starting
the new molecule.
We should not forget that some time back a new molecule which was introduced
for treating Hypertension (on which the pharmaceutical company had spent millions
of pounds) was suddenly withdrawn from the market after a couple of deaths took