Side Effects

If you read my blog then you know about ototoxicity. If not, then catch up here. Ototoxicity is toxic damage to the ear, and is a common side effect of many medications, including Tylenol. It is an issue that deserves more attention. I was listening to the Freakonomics’ podcast, and their newest episode is an examination on medical trials and why they aren’t always reliable. I thought y’all might be interested in this because it sheds a little light on whats wrong with the way we research drugs here in the US and, by extention, why ototoxic side effects are not of greater concern.

The podcast is fascinating and illuminating. You can listen to it here or you can use your favorite podcast app. Look up Freakonomics and look for the episode Bad Medicine, Pt. 2. In it Stephen Dubner goes over a lot of points, but the biggest one to my ear is that drug researchers spend a lot of time selecting which subjects will participate in the study. Only the healthiest subjects get to participate because, in part, researchers think it makes for the cleanest data set. For example, cancer drugs are tested on only the patients with good health other than the cancer. Another example is depressed people who drink alcohol are excluded from trials on antidepressants. Obviously, this skews the results of the study, and doesn’t ever see how the drug interacts in the real world with real people. The side effects from real world use aren’t ever seen in the lab, and thus never get reported.

If a study does show significant side effects, a drug company can simply decide not to release the results. To repeat, drug companies – who have billions of dollars riding on the sales of their drugs, can simply decide to not release the results of a study. For any reason. It is totally up to them to release a study to the public that shows their drug has too many side effects, or it isn’t more effective that existing treatments. For side effects that do get reported, drug makers somehow fail to report many of those.

In the real world, patients don’t report side effects to their doctors. When patients do report side effects, research shows that many to most doctors dismiss reports of side effects from their patients. The upshot of all of this is that 90-99% of all real world side effects don’t get formally reported. With ototoxic effects, the effect is so slow and subtle that most people don’t notice it occurring. If they do notice it, they probably don’t suspect it to be a side effect of the drugs they’re taking, but instead attribute it all to noise or age.

Obviously, medicine does a heck of a lot of good. I don’t mean to dismiss drugs or medicine and I certainly don’t suggest that you stop following your doctors advice. Far from it. I only mean to make the case that ototoxicity is a real thing, even if it is not well known or well studied. Most of the studies simply wouldn’t catch it, and your doctor may not be aware of it.