MEDICAL DESTRUCTION IN THE WAKE OF SARS--Drug cripples SARS survivors

[Guest guest]

JON RAPPOPORT www.nomorefakenews.com

********MEDICAL DESTRUCTION IN THE WAKE OF SARSJANUARY 11, 2004. Special offer: volunteer to be diagnosed with a brand new disease caused by a virus that was just isolated for the first time; receive medical treatment; and then ROLL THE DICE. And oh yes, this “new disease” is actually very old, and if they ever did isolate a virus, it shows no evidence of causing anything. But the drugs they use to treat you are very real, you can be sure of that. Ha ha. It’s actually one big joke. The laugh, however, is on you. The disease is SARS. The treatment is steroids, called corticosteroids. Also, a drug called Ribavirin. Those crazy folk in China actually decided to do follow-ups on patients diagnosed with SARS last year, to see what happened to them. Big mistake. In the medical world it’s much better to forget that phase and just move on to something else.

Here are a few quotes from a Wall St. Journal story that explain what happened when that follow-up was done. ["Drug Cripples SARS Survivors," by Matt Pottinger] “In China, a debilitating and often irreversible bone disease called avascular necrosis has struck many of the people who were treated for severe acute respiratory syndrome. And the primary cause is one of the main SARS treatments: the corticosteroids that flowed from IV drips into the veins of thousands of patients to prevent them from suffocating because of inflamed lungs.” [Note: many, many of these patients were in no such danger of suffocating; they simply had a case of the flu or a cold.] “In Beijing, where the problem appears by far the worst in the world, orthopedic surgeons estimate that a third of the city's 2,500 former SARS patients are in the grips of avascular necrosis (also referred to as osteonecrosis). Symptoms typically begin with stiffness or pain in the hip, knee, ankle or shoulder

joints and often culminate in the crumbling of those bones, requiring bone grafts or joint replacements. Even in milder cases, people can end up with arthritis bad enough to bring athletic endeavors like running to a lifelong halt.” “In Beijing, a picture is emerging of a medical system that turned to corticosteroids with zeal bordering on recklessness, according to interviews with intensive-care clinicians, orthopedic surgeons and patients. Hard questions also are being raised in Hong Kong, where the bone disease has appeared in 14 percent of more than 850 former SARS patients who have been screened with magnetic resonance imaging.” [Note: it’s very hard to tell the level of “ corticosteroid zeal” outside China, because, as I say, follow-ups have not been done.] “In Toronto, Singapore, Taipei, Taiwan, and Hanoi, North Vietnam, health authorities say they are unaware of SARS-related cases of the bone disease, although they haven't done follow-up studies on patients,

as Chinese cities are now doing -- a strategy that can catch early signs of a disease that sometimes takes a year or two before causing symptoms.” [Note: early signs of a disease actually means signs of bone destruction from the drug treatment. It’s not a disease, any more than pouring gasoline on your arm and lighting it is a disease.] “Most doctors say they plan to use steroids if SARS returns, although many of the same doctors admit they are uncertain that the drugs really help, or what the optimal dosage should be if they do.” [Note: very, very reassuring.] “Clinicians in Beijing say a course of the steroid methylprednisolone routinely lasted more than a month -- twice as long as what doctors said they typically used in Vietnam, Taiwan and Canada. Whereas physicians in Hanoi and Taipei say they gave steroids only to the most serious cases and rarely exceeded cumulative doses of 2,000 milligrams of methylprednisolone, some Beijing hospitals gave the drugs to all

SARS patients. Cumulative doses were routinely twice as high and in some cases five times as high. While doctors in Toronto often used cumulative dosages of 3,000-4,000 milligrams -- comparable to what some Beijing doctors prescribed -- they limited the courses to just nine days.” [Note: of course the effects of nine days of steroids in Canada are unknown, because no one is doing patient follow-up.] “Faith in unproven SARS drugs extended beyond steroids. In a study published in October in the medical journal Clinical Infectious Diseases, doctors in Toronto concluded that the widely prescribed antiviral drug ribavirin hurt SARS patients in Canada more than it helped. Ribavirin's toxicity caused doctors to perform blood transfusions on one-third of the Canadian patients who received the drug. Some doctors hypothesize that ribavirin may even magnify the effect of corticosteroids in causing avascular necrosis, because ribavirin destroys red blood cells that carry oxygen to

bones.” End of article excerpts. Ribavirin destroys red blood cells? Causes very dangerous anemias? Yes. But they use it anyway. ONE-THIRD OF THE CANADIAN PATIENTS TREATED WITH RIBAVIRIN HAD TO HAVE BLOOD TRANSFUSIONS TO REPLACE DESTROYED RED BLOOD CELLS. “Uh, Mr. Jones? That cough you have, and the fatigue? It’s really SARS. We have a very special drug for that. It’s like applying an atomic bomb to deal with a truant schoolboy.” Perhaps some of my friends in Canada will see this as an opportunity to revive that class-action law suit that ended up dead in the water last year. It’ll have a somewhat different slant, but it’ll wake some people up. JON RAPPOPORT www.nomorefakenews.com

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http://www.ajc.com/news/content/news/0104/02sars.html

Drug cripples SARS survivors

By MATT POTTINGER Wall Street Journal

 

 

 

 

 

 

BEIJING -- The Zhangs spent last spring side by side in hospital beds, hooked up to intravenous drips, fighting to overcome SARS. On the afternoon the young couple were discharged after more than a month of treatment for the deadly pneumonia, they celebrated their survival with a seafood lunch.

"Our health had never felt so precious," recalled Zhang Xuewei, a 31-year-old nurse. "After what we'd been through, nothing seemed scary."

Yet both soon complained of dull pain that radiated from their heels when they walked. For her, the pain gradually spread to her hips and knees. For her husband, 25-year-old Zhang Fan, the ache that developed in his hips became so bad he had to avoid staircases.

Today, she is in a wheelchair. "Our bones are dying," she said.

In China, a debilitating and often irreversible bone disease called avascular necrosis has struck many of the people who were treated for severe acute respiratory syndrome. And the primary cause is one of the main SARS treatments: the corticosteroids that flowed from IV drips into the veins of thousands of patients to prevent them from suffocating because of inflamed lungs.

In Beijing, where the problem appears by far the worst in the world, orthopedic surgeons estimate that a third of the city's 2,500 former SARS patients are in the grips of avascular necrosis (also referred to as osteonecrosis). Symptoms typically begin with stiffness or pain in the hip, knee, ankle or shoulder joints and often culminate in the crumbling of those bones, requiring bone grafts or joint replacements. Even in milder cases, people can end up with arthritis bad enough to bring athletic endeavors like running to a lifelong halt.

That steroids can lead to avascular necrosis has long been known. Doctors take that risk because steroids also can be a highly effective treatment. Many doctors who treated SARS are convinced the drugs saved lives. Steroids were administered -- in many cases in heavy doses -- in every major city where the respiratory disease struck.

But when it came to deciding which SARS patients should receive the drugs, what the dosage would be, and -- perhaps most important -- how long the treatment should last, practices in one city differed radically from the next. In Beijing, a picture is emerging of a medical system that turned to corticosteroids with zeal bordering on recklessness, according to interviews with intensive-care clinicians, orthopedic surgeons and patients. Hard questions also are being raised in Hong Kong, where the bone disease has appeared in 14 percent of more than 850 former SARS patients who have been screened with magnetic resonance imaging.

In the neighboring Chinese province of Guangdong, where the SARS outbreak began, only a few cases of avascular necrosis have surfaced. In Toronto, Singapore, Taipei, Taiwan, and Hanoi, North Vietnam, health authorities say they are unaware of SARS-related cases of the bone disease, although they haven't done follow-up studies on patients, as Chinese cities are now doing -- a strategy that can catch early signs of a disease that sometimes takes a year or two before causing symptoms.

The way doctors used steroids to treat SARS highlights another set of troubling lessons from that outbreak. In the heat of trying to rescue patients from a deadly new disease, doctors sometimes fixate on drugs despite insufficient data. In contrast to the global collaborative effort that hunted down the virus that causes SARS, the sharing of information about treatments for the virus was weak. Many SARS doctors say they were unaware of how steroids were used or how many patients contracted avascular necrosis in cities outside their own. Randomized trials, which would have determined the efficacy of steroids by giving placebos to some patients, couldn't be conducted because of logistical and ethical concerns.

Most doctors say they plan to use steroids if SARS returns, although many of the same doctors admit they are uncertain that the drugs really help, or what the optimal dosage should be if they do.

A researcher in Taiwan this month was infected with SARS at a military laboratory, becoming the world's first confirmed case since August. He is recovering and apparently didn't spread the disease.

Cases clustered

As the full extent of avascular necrosis cases becomes clearer over time, the prevalence in China will almost certainly dwarf the rates in other countries. In Beijing and Hong Kong, people already are suffering the crippling effects of the disease, whereas patients outside of China haven't complained of symptoms, according to health officials and doctors in each country with significant SARS outbreaks.

Clinicians in Beijing say a course of the steroid methylprednisolone routinely lasted more than a month -- twice as long as what doctors said they typically used in Vietnam, Taiwan and Canada. Whereas physicians in Hanoi and Taipei say they gave steroids only to the most serious cases and rarely exceeded cumulative doses of 2,000 milligrams of methylprednisolone, some Beijing hospitals gave the drugs to all SARS patients. Cumulative doses were routinely twice as high and in some cases five times as high. While doctors in Toronto often used cumulative dosages of 3,000-4,000 milligrams -- comparable to what some Beijing doctors prescribed -- they limited the courses to just nine days.

The absence of avascular necrosis cases in Canada underscores the critical role that treatment duration appears to play in causing the bone disease. In Singapore, government officials and physicians declined to provide details about the treatment of SARS patients.

Faith in unproven SARS drugs extended beyond steroids. In a study published in October in the medical journal Clinical Infectious Diseases, doctors in Toronto concluded that the widely prescribed antiviral drug ribavirin hurt SARS patients in Canada more than it helped. Ribavirin's toxicity caused doctors to perform blood transfusions on one-third of the Canadian patients who received the drug. Some doctors hypothesize that ribavirin may even magnify the effect of corticosteroids in causing avascular necrosis, because ribavirin destroys red blood cells that carry oxygen to bones.

The Zhangs didn't know the treatment for SARS would prove harmful itself. At no point during their illnesses did either experience serious trouble breathing or need a ventilator. Nonetheless, each was started on intravenous injections of methylprednisolone the day after being admitted to China-Japan Friendship Hospital, they said.

Side effects alarming

With the high number of SARS patients at the hospital, and the head of the intensive care unit and other health care workers sick as well, doctors and nurses from other departments were called to the front lines, including some with little experience treating respiratory illnesses, they said. The Zhangs said an ophthalmologist was among the doctors who looked after them.

In total, Zhang Xuewei received more than 2,000 milligrams of steroids and her husband, Zhang Fan, received about 3,500 milligrams -- dosages that were low for Beijing. But the treatment dragged on for weeks: Zhang Xuewei took steroids for 42 days straight, her husband for 31 days.

During the treatment, Zhang Fan said his limbs swelled so much he could barely stand up at his bedside. He and his wife said their pulses raced at more than 120 beats a minute while they lay still, a side effect also attributed to steroids.

"I was adamant that they reduce the dosage," he said. Doctors replied that they couldn't change the dosages without permission of the respiratory department head. The Zhangs could hear another SARS patient in their ward, the head of intensive care, ordering a reduction in his steroid doses. "You're ruining my body," the man pleaded, according to Zhang Fan.

The man received much higher dosages than Zhang Fan and now has avascular necrosis, too. "He's never left the hospital," Zhang Fan said.

The chief of the hospital's respiratory department, Lin Jiangtao, declined to discuss the Zhangs' cases and said other doctors were responsible for treating the intensive care physician, who couldn't be reached for comment.

Of the hospital's nine health care workers who came down with SARS, five have avascular necrosis. "I believe the steroids may have helped," Zhang Xuewei said. "It's just that it was too much for too long."

She and her husband are living at the hospital again, sharing a room with a single hospital bed. Wearing flannel pajamas, she sits on the sofa they use as a second bed. She is able to walk, but uses a wheelchair to avoid putting weight on her hips, joints and knees.

The Zhangs said they aren't angry at their doctors.

"We don't blame anyone," she said. "We want the Beijing government or the central government to actively face up to avascular necrosis."

 

 

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