March 10, 2007 - Drugs that Heal, Drugs that Harm

Back on April 10, 2006, when I was in the midst of my chemotherapy treatments, I attended a workshop at the local hospital on managing cancer fatigue. It turned out the event was sponsored by the manufacturers of Procrit, a drug that helps boost red-blood-cell counts. I walked away with all kinds of swag with the Procrit name emblazoned across it, then wrote about the experience in this blog (photo above is from April, 2006).

Today, a New York Times article informs me that the FDA has raised questions about the safety of both Procrit and its chief competitors, Aranesp and Epogen. Evidently, there’s new evidence linking these drugs to heart problems and premature death.

It’s not that the FDA is completely banning these medications, which have undeniable benefits in helping chemo recipients keep their blood counts up and avoid transfusions. The government regulators are just encouraging doctors to be much more cautious in prescribing them, avoiding them whenever there’s an alternative.

This story highlights the paradoxical nature of many cancer medications, including many of the chemotherapy drugs themselves. They cause immense difficulties for patients. Some of them are even possible carcinogens. Yet, using a complex, lesser-of-two-evils calculation, doctors have no choice but to prescribe them, anyway. It’s a roll of the dice, but a calculated one.

This makes me think of a scene from one of the Star Trek movies. A team of starship Enterprise crew members, including the inimitable Dr. McCoy, have traveled back through time and landed on Earth in the 20th century. Walking down a hospital corridor, Dr. McCoy passes a patient on a gurney who’s writhing in pain from an inflamed appendix. The good doctor reaches into his bag of tricks and gives the patient a pill. In no time at all – to the utter amazement of his 20th-century doctors, who haven’t seen McCoy slip the guy the drug imported from the future – the patient leaps up from his gurney, completely cured, without surgery. Dr. McCoy goes quietly on his way, muttering something about the appallingly primitive nature of 20th-century medicine.

Last spring, I was fully prepared to receive Procrit or Aranesp. Dr. Lerner had mentioned these drugs to me as possible treatments, should the chemotherapy depress my blood-cell counts. Fortunately, I got through all six chemo treatments without having that kind of difficulty. If I hadn’t, though – and if I’d received Procrit or Aranesp – I expect I’d be reading this article today with a great deal more anxiety.

These drugs have been around for fewer than 20 years. Medical science is still working the kinks out of them – as is true of so many cancer treatments. It makes me wonder what unforeseen, long-term side-effects may emerge, down the line, from the treatments I have actually received.

Even more, what will the Dr. McCoys of the twenty-second or twenty-third century think of treating cancer patients with chemotherapy, radiation or even surgery? Will they look on these treatment strategies in the same way today’s doctors look on bloodletting? Will there even be such a thing as cancer, in that enlightened era?

We’re creatures of our time and place, no doubt about it. We cancer patients gratefully accept the treatments and medications we do receive – but, we also watch our backs, because who knows when an article like this one will come out, calling into question yesterday’s conventional medical wisdom?