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When the Right Dosage Is the Best Medicine

March 14, 2004

I agree wholeheartedly with many of Jay Cohen's conclusions about the need for pharmaceutical companies to lower drug doses ("The OD MD," by Fred Dickey, Feb. 15). However, some of the blame also falls on our society's desire for instantaneous results. As an emergency physician, I rarely find a patient who is willing to take the time to titrate a drug to achieve the best result at the lowest dose. I cannot count the number of patients I see who have side effects from antibiotics that they never should have taken.

Why are they on these drugs? Because after they developed a viral syndrome, they demanded antibiotics from their personal physician--they "had no time to be sick." You can imagine their displeasure when the side effects are substantially worse and longer lasting than the original illness would have been.

John J. Plosay III

Associate Director for Emergency Services

Santa Monica-UCLA Medical Center

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Dickey's article was great. I have never understood why adult doses are the same for everyone. Over-the-counter medications for children always include a weight chart. Why not have one for adults? I adjust the medication doses for my daughter, who is very slim, because she has never fit into an age-weight category. As for myself, I take Allegra and Celebrex. I ask my doctor for the lower dose, and I take it according to my body's needs.

People need to educate themselves more about medicine. There is so much information now, and they should never rely blindly on their doctors. I applaud this article, and hope it will wake some people up.

Karen Hall

Woodland Hills

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Robert Ehrlich, former vice president of consumer marketing for Parke-Davis, the company that developed Lipitor, says, ". . . a multiplicity of choices would be confusing for patients and too time-consuming for doctors." On the other hand, Cohen says, "Vets or farmers will tell you that they adjust doses for the size of animals, so why don't we do it for people?" Cohen is right. Why would having adult dosages detailed by age and weight be confusing? It seems like an easy solution.

Gail Benun

Los Angeles

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The fact that people get sick from drugs is not debatable, but to blame the drug companies is to look in the wrong direction. If one were to point a finger, and I do not, one would have to point to the Food and Drug Administration because it, and not the drug companies, approves the doses that go on the market.

Why does the FDA approve a particular drug at a particular dose? Because a company has submitted a voluminous set of data using doses they chose, and the FDA has found an acceptable balance between benefits and toxicities. If a drug for a non-life-threatening disorder, such as an antihistamine or anti-inflammatory drug, shows a high percentage of side effects, it will not be approved by the FDA. As for drugs used to treat life-threatening diseases, such as cancer or heart attacks, higher risks are accepted because the benefits are so much more profound.

From this perspective, it is obvious that rather than promote high doses, drug companies look for the dose at which side effects appear minimal with respect to the intended benefits. Their first goal is to get new drugs on the market. Why would they do anything that would jeopardize their chances by using a dose that is higher than necessary?

People such as Jay Cohen, who bash drugs for their dangers, fail to acknowledge that no drug is safe for 100% of the population, 100% of the time. Side effects will always appear from drug treatments, and the necessary dose to effectively treat a meaningful percentage of people will always make some of the population sick.

Fred Abramson

Professor of Pharmacology, Emeritus

George Washington University

School of Medicine

La Quinta

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