“Common diabetes drug may cause bladder cancer.” Isn’t that statement scary? Doesn’t it make you think twice about whether or not you should take Actos – the drug in question – or, for that matter, any diabetes drug? Don’t you wonder why we doctors aren’t doing more to make drugs safe?
Actos has been used by more than 2 million people since it came out. Why did it take this long to link it to cancer? Who’s minding the store? Where is the Food and Drug Administration? Where are consumer groups?
I can just hear the medical malpractice lawyers licking their chops (side note: Some of my best friends are lawyers and I like all of them).
So let’s look at the data. The study showed that if you took Actos, you had an 83 percent increased risk of developing bladder cancer. Sounds bad, doesn’t it?
But hold on, let’s do the math: Because the risk of bladder cancer is small to begin with, this turns out to be 88 extra cases of bladder cancer for every 100,000 people who took Actos for one year. That is an increased risk – and don’t get me wrong, no one wants cancer ever – but the risk is small.
The next step in deciding whether to take Actos is to ask, “What’s the benefit?” In medicine, every time we give you a pill, we have to think of the benefit-to-risk ratio.
Let’s try this exercise with two common drugs: aspirin and Tylenol (acetaminophen).
Aspirin is a wonder drug. We gave it to kids until we found out, about the time Jimmy Carter was president, that some children were dying of a rare disease, Reye’s syndrome, associated with aspirin use. We stopped using aspirin for children approximately 100 years after it started being manufactured.
Adults used to take massive amounts for arthritis until we found out, about the time Gerald Ford was president, that people would get bleeding ulcers if they took too much aspirin. We stopped prescribing large doses of aspirin then, but we still give it to prevent heart attacks because the benefit of preventing a heart attack is greater than the risk of a bleeding ulcer. Fair enough.
Tylenol was considered pristine. Advertised as safe for kids and, because it’s easy on the stomach with no bleeding, also safe for adults. Then about 15 years ago, 50 years after Tylenol was first marketed, we found out that in large amounts it can cause liver failure. I knew one guy, 35 at the time, who was an alcoholic and took Tylenol every morning for his hangover. He died of liver failure – not from the alcohol, but from the Tylenol.
Tylenol is still the safest pain reliever we have but, like aspirin, it has a black mark. It has a good benefit-to-risk ratio, as long as you don’t take too much.
The point here is that every drug has effects – the good effects, which are the reason you take it, and the side effects, the dark side.
Now back to Actos. It lowers blood sugar, so it’s good for diabetes, but it slightly increases the risk for bladder cancer. And that’s in addition to other possible side effects of taking it, including weight gain and heart-failure risk.
My spin: I can’t make this call for you. Actos is still on the market and used by many. You and your doctor should make the call. And that means setting up an appointment for a robust discussion. Like so many things in life, it isn’t black or white.
Dr. Zorba Paster is a family physician, professor, author and broadcast journalist. He hosts a radio call-in program at 3 p.m. Saturdays on WNED.