Causing alarm is not good doctoring
‘Is frightening patients now part of a GP’S remit?” a reader inquires, challengingly. She had felt it might be time to give alendronic acid, her bone-strengthening tablets, a rest, having taken them for several years following a scan showing early signs of osteoporosis. But her doctor would have none of it, warning she would end up “crippled in agony”, with fractures of the spine or immobilised by a broken hip “that could kill me”.
Just how likely was this dreaded scenario?
In her case, the merits of this class of drug (known as bisphosphonates) are so minuscule as to be scarcely detectable – reducing the risk of any fracture by 1.8 per cent, and to the hip by just 0.2 per cent. They are slightly more effective in those who have already sustained a fracture and definitely indicated for those on long-term, bone-thinning steroids.
Thus, her doctor’s dire warnings would seem to contradict a fundamental tenet of good doctoring – not to cause unnecessary alarm.
He might also have acknowledged that giving the drug a rest might be positively advantageous in reducing the chances of its paradoxical effect of causing, rather than preventing, fractures. “Three years ago, I slipped at home and ended up with my right femur broken in several places,” writes a previously fit and active 66-year-old woman. “When
I arrived in A&E, the trauma surgeon bent over my stretcher and immediately asked: ‘Are you on alendronic acid?’ When I replied, he said: ‘Oh, another one of these…’.”
She spent five months in hospital recovering from having her femur pinned, and is still on crutches. She had been taking alendronic acid for nine years (also following a bone scan), contrary to the current recommendation that, even for the relatively few for whom it might be of value, it should be discontinued after five years, to avoid precisely this sort of mishap.
A weight off
The woman recently featured in this column with unexplained weight loss – down from a slim nine stone to a near-skeletal seven – has prompted the observation this might be the only sign of an overactive thyroid. “My wife began to look almost anorexic, with no change in her food intake,” writes a gentleman from Cardiff. Her doctor arranged for tests of her thyroid function (astutely, as she had none of the other characteristic symptoms) that confirmed markedly elevated levels of the hormone.
For those whose thyroid tests are normal, another reader suggests a daily regime – commended by her Harley Street specialist – of two Mars bars a day and a pint of Guinness.
A purple patch?
Finally, further to the merits of nicotine patches in improving the mobility of those with Parkinson’s, retired neurologist Dr Lee Illis notes this “interesting phenomenon” was first reported more than 50 years ago. However, its effect is not as widely appreciated as it should be, because of the reluctance of medical journals to publish any studies indicating the possible benefits of smoking.
Nicotine patches have also been shown as strikingly effective in alleviating the abdominal pain and diarrhoea of the inflammatory bowel disorder ulcerative colitis. This was first described a mere 25 years ago, resulting, for a substantial proportion, in a complete remission of the illness.
A third possible use for nicotine patches is as relief from the earliest symptoms of dementia, as nicotine is a cognitive enhancer, boosting neurotransmitter levels in the brain. The evidence here is more equivocal as, although they may indeed boost attention and memory span, they do not apparently convey any overall clinical benefits. They might, however, be worth a trial in case they make a difference – either on their own, or together with the widely prescribed (if also, regrettably, not very effective) dementia drugs donepezil or memantine.
Her doctor warned she would end up ‘crippled in agony’ with fractures of the spine, immobilised