DRUG REACTIONS KILL OVER 100,000 A YEAR IN U.S., REPORT SAYS

About 2 million suffer injuries from prescription medications

CHICAGO (AP) - Bad reactions to prescription and over-the-counter medicines
kill more than 100,000 Americans and seriously injure an additional 2.1
million every year - far more than most people realize, researchers say.

Such reactions, which do not include prescribing errors or drug abuse, rank
at least sixth among U.S. causes of death - behind heart disease, cancer,
lung disease, strokes and accidents, says a report based on an analysis of
existing studies.

"We're not saying, 'Don't take drugs.' They have wonderful benefits," said
Dr. Bruce H. Pomeranz, principal investigator and a neuroscience professor
at the University of Toronto.

"But what we're arguing is that there should be increased awareness also of
side effects, which until now have not been too well understood."

The harm may range from an allergic reaction to an antibiotic to stomach
bleeding from frequent doses of aspirin, Dr. Pomeranz said. The study, by
Dr. Pomeranz and two colleagues at his school, Jason Lazarou and Paul N.
Corey, did not explore which medications or illnesses were involved.

The authors analyzed 39 studies of hospital patients from 1966 to 1996.
Serious drug reactions affected 6.7 percent of patients overall and fatal
drug reactions 0.32 percent, the authors reported in Wednesday's Journal of
the American Medical Association.

In the study, serious injury was defined as being hospitalized, having to
extend a hospital stay or suffering permanent disability.

The most surprising result was the large number of deaths, the authors
said. They found adverse drug reactions ranked between fourth and sixth
among leading causes of death, depending on whether they used their most
conservative or a more liberal estimate.

In 1994, between 76,000 and 137,000 U.S. hospital patients died, and the
"ballpark estimate" is 106,000, Dr. Pomeranz said. The low estimate, 76,000
deaths, would put drug reactions sixth. The ballpark estimate would put
them fourth, he said.

An additional 1.6 million to 2.6 million patients were seriously injured,
with the ballpark estimate 2.1 million, he said.

More than two-thirds of the cases involved reactions outside hospitals
rather than in hospitals, the authors reported.

Experts commended the study but disagreed whether the estimates are on target.

Dr. David W. Bates of Partners Healthcare Systems and Brigham and Women's
Hospital in Boston said the estimates may be high. One reason, he said, is
that they may overrepresent large medical centers, which treat sicker than
average patients, who are more prone to reactions.

"Nonetheless, these data are important, and even if the true incidence of
adverse drug reactions is somewhat lower than that reported . . . it is
still high, and much higher than generally recognized," he added in an
editorial accompanying the study.

Dr. Sidney M. Wolfe, director of the consumer advocacy Public Citizen
Health Research Group, said he believes the numbers are on target.

"I've read most of these studies, and they represent large hospitals, small
hospitals . . . a heterogeneous sample of the kinds of hospitals in this
country, and include a whole range," Dr. Wolfe said by telephone Tuesday
from Washington.

Many serious injuries and deaths are preventable, he added. Many drugs have
safer available alternatives, and harmful interactions between drugs - such
as those being prescribed by two different doctors - can be more carefully
avoided, he said.

In addition, doctors need to increase drug dosages slowly for many older
patients, who lack the drug tolerance of younger adults because their
kidneys and livers have declined, Dr. Wolfe said.

Finally, hospitals should find better ways to track and head off problems,
the way a model computerized system does at LDS Hospital in Salt Lake City.

That hospital reported last year that it discovered 50 percent of its
adverse reactions were potentially preventable, including 42 percent that
happened because patients were given too much medicine for their weight and
kidney function.

The hospital now automatically calculates patients' kidney function daily.
It has reduced adverse antibiotic reactions 75 percent and suggested that
other facilities could easily do the same.

Dr. Wolfe said it is "inexcusable, given how inexpensive computers are,"
that other hospitals haven't copied the system.