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Practically every week brings another warning from the Food and Drug Administration or the Centers for Disease Control and Prevention about the possibility of developing a side effect of a medication or treatment.
Some of these warnings result in reactions by patients that surprise me. For example, there was a concern raised about acetaminophen (Tylenol) toxicity because of some patients overusing pain medicines like Vicodin. This caused some people to stop taking Tylenol that had been safely controlling their pain for years. Other people became unreasonably suspicious of all pain medicines.
During the past week, the FDA informed us that they would be requiring stronger warnings regarding the risk for cancer associated with tumor necrosis factor (TNF) blockers. The warnings will highlight the increased risk for cancer in children and adolescents who take TNF blockers for the treatment of juvenile rheumatoid arthritis, Crohn’s disease, and other inflammatory diseases.
On average, an increased risk for cancer was reported after 30 months of treatment with TNF blockers. Lymphoma was the most common cancer type, accounting for about half of all cancers. The FDA is requiring warning about reported cases of leukemia in adults, adolescents, and children, as well as additional information on cancer in children and adolescents.
Psoriasis is also associated with the use of TNF blockers. The revised medication guide given to patients will include all of this new safety information.
The TNF blockers include infliximab (), etanercept (), adalimumab (), certolizumab pegol (), and golimumab (). Therefore, everyone who has taken or might take one of these drugs needs to discuss the risks with their doctor.
Some of the confusion that develops in the sort of discussion I just recommended is the difference between the benefit you might get by treating a disease or disorder that already exists compared to risk of developing a bad side effect from the treatment.
On one side, you are already sure you have the problem. Hopefully, the desired effect of the treatment will be obvious (for example, pain relief) or can be measured (for example, blood pressure). If you do not get the effect you desire, the treatment can be changed.
On the other hand, you do not already have the side effect. In fact, if the percentage of risk is less than 100 percent, you may never develop any problems from the treatment. The problem is that if you do develop the side effect, it will not matter how many other people did not. For you, the side effect incidence is 100 percent or zero, all or nothing.
Therefore, when considering any treatment, you need to look at how much the existing problem bothers you. How much good effect can you expect to get from the treatment? If the worst side effect possible occurred to you, do you think you could accept that fate? How much are you willing to risk for the good effect?
We make these sorts of decisions every day without much consideration when we decide to do even simple things like crossing a street. Do we want to be on the other side bad enough to gamble that we will not be hit by a cement truck and squashed like a bug?
Since the odds seem to be low of that cement truck coming along, most of us will cross without much thought. The rarity of a tragic event allows us to get where we want to go even though we know that vehicles strike people every day (though seldom are they cement trucks).
The point of all of this is that even though there is a small risk of a serious and possibly life-changing complication, some risk is unavoidable if you are going to feel better and get where you want to go.
I believe we should always hope for the best and prepare for the worst. If the worst occurs, deal with it then.
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