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Comment by refurb | Hacker News Reader

As someone who works in the industry, this shouldn't be much of a surprise. Most drugs have a very low incidence of serious side effects. Even over the counter products do. The reason they are approved is that they are so rare.

A great example of a serious side effect is Toxic epidermal necrolysis (TEN) and Stevens–Johnson syndrome (SJS). There are many everyday drugs (ibuprofen, antibiotics, etc) that can cause this rare disorder. Your skin basically sloughs off and you end in a burn ward. Super rare, but they happen.

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Last month, my doctor gave me a shot of toradol (for reasons I don't want to go into). The allergic reaction I got from that shot had me terrified I was experiencing the early symptoms of TEN at first.

I had hives all over my body, plus muscle pains all over my arms and legs (at its worst, I could barely hold a razor and needed a cane in order to shuffle around). You know what comes up when you search for bumps all over your body combined with pain? Yeah, TEN.

Fortunately it was just allergy-induced hives and myalgia, and I understand that the pain I went through functioned like an acute case of rheumatoid arthritis, but that was still nasty. I ended up in the emergency room twice. The first course of steroids they prescribed me wasn't long enough or strong enough: the hives never fully went away, and the myalgia came back as soon as I finished the prednisone. So I had to go back, and then they gave me a shot of decadron and put me on a two-week course of prednisone.

Yeah, that wasn't pleasant. At all. The side effects I suffered from the prednisone were awful and insidious, but at least it killed the allergic reaction.

Oh, and during that time, a friend of mine died, and her death was all over the local news because of how mysterious it was (they still haven't solved it or even released a coroner's report yet). April 2017 was terrible all around.

How much where you on? I have had to take pred (40mg /d) and did not have any major side effects apart from one incidence of mood swings went from stressed to giggling inside of 10 min (I told my boss I think I had better go home and have a lie down).

It did ramp up my appetite "mmm doughnuts" and my aggression a bit.

I do know there are some funkier side effects but I did not get those

Let me guess, you are a MLB pitcher? Toradol was famously used to help pitchers deal with arm pain before starts, starters put a lot of stress on their pitching arms. It helped them get loose to pitch, until people noticed a pattern of severe injuries from pitchers being able to pitch through pain.

My Doc wanted to shoot it into me for a bad back (muscle spasms). I passed.

Not to mention there's a risk-benefit thing going on. Serious side-effects are something to really care about for a drug that treats allergies. But if it's meant to treat terminal cancer, then you're more likely to let the potential of adverse side-effects slide.

Another example is Brigatinib (AP26113) which I'm familiar with. It's only approved recently because ~1% patients may get a severe side effect. But desperate patients who heard the news and cannot get it have managed to make their own based on the formula and the powder they made has saved hundreds of people's lives with metastatic lung cancer in the past a few years.

Stevens–Johnson syndrome seems to occur as a response to several different drugs, but apparently only to people with a specific HLA genotype. Part of the solution here is that currently we only approve a drug if it is safe for nearly 100% of the population, even if it is useful for far fewer (see statins) and the path forward needs to give more consideration of the differences in people, and having suitable genotyping a prerequisite for some medications.

Agreed on the general principle, but note that the incidence of SJS varies by drug. For example, lamotrigine causes SJS in 10-30% of people taking it, depending on how fast the dosage is increased.

There they don't address it by trying to predict who will show SJS symptoms and who won't; they just put people in it slowly (which reduces incidence) and take people off the drug (or hold at a given dose until the body accepts the drug) if they show symptoms.

But rare is relative to usage, yes. It's also a function of the side effects. I mean, if 1M ppl use X and 1% get a rash, that's not the same as .5% of 10M having some sort of major organ reaction.

That said, America loves drugs. Patients expect them. Doctors prescribe them. Big Pharma counts the money. Everyone is happy.

And that's why only Doctors can hand out prescriptions and they are trained to evaluate the risk for you. So this system should actually work fine.

Of course, I've noted that pharmacists often have a better idea about interactions than doctors do; i've been stopped taking medications concurrently because I find dangers when picking up my prescription. Perhaps doctors shouldn't have this privilege! I shouldn't have to double check my own doctor.

You mean like opiods? Or nexium? with a 50% addiction rate once proscribed for longer then 2 weeks???

I think u will find that most of the top selling drugs approved by the FDA have a host of side-effects that are VERY common, and then they themselves have a host of other drugs specifically to counter those side-effects.

Essentially the FDA is no different to how russia is run. If u have enough money for the approval process, u have enough money to rig all the trial data in your favour and surpress anything else, including research into competing drugs.

The industry itself is the keeper to all drugs, they decide what the most profit will be made off and then research that, get a patent, then do everything int here power protect that patent including not researching better drugs. Only in the worse cases of drug company fraud will the FDA step in to stop a drug.

</BigPharmaRant>

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