Coleman’s First Law of Medicine

Dr Vernon Coleman MB ChB DSc FRSA

Forty per cent of patients suffer noticeable, sometimes lethal, side effects when they take a prescribed drug. The problem about side effects is rarely discussed but you can judge how big a problem it is by the fact that when there are six patients in hospital beds one of them will be there because he or she has been made ill by doctors. Sadly, medicine is now one of the top three killers – alongside circulatory problems such as heart disease strokes and cancer.

Here’s a true story about drug side effects.

It involves a reader of mine.

My reader (an elderly man) went to his local surgery complaining of breathlessness.

A nurse gave him a spirometer to blow into. (A spirometer is a simple instrument which measures lung function). My reader huffed and puffed but could not do much with it. So on the basis of this single test the nurse diagnosed a wonderful new disease called Chronic Obstructive Pulmonary Disease (COPD). (Making this diagnosis was a pretty stupid (not to say dangerous) thing to do. If my reader had put his hands around the nurse’s throat she would have not been able to blow into the tube either. But it wouldn’t prove she had COPD.)

‘You have a chronic cough and bring up sputum every day, don’t you?’ she said.

‘No,’ he replied.

‘Oh well, never mind,’ she replied. ‘I’ll put you down as suffering from chronic obstructive pulmonary disease anyway.’

My reader had no other signs or symptoms of COPD. His medical history did not suggest that he was a likely candidate. But satisfied with her diagnosis the nurse then exercised her newly acquired right to prescribe and prescribed a steroid spray. Steroids are, of course, enormously powerful and equally dangerous. They should only be prescribed when absolutely essential.

Since my reader didn’t have COPD the steroid spray didn’t work. So the nurse gave him a spray containing both a steroid and another chemical. Since the diagnosis was wrong this did not work either.

My reader then went back to the nurse (maybe doctors are too busy attending meetings to see patients these days) and told her that the medicine she’d prescribed wasn’t working. Believing in her diagnosis he trustingly asked if he could double it. The nurse, seemingly as ignorant as my reader, duly doubled the dose.

When my reader developed atrial fibrillation (a known side effect of the deadly mixture he had been given) the doctor found a gap between all his meetings and prescribed digoxin to control the fibrillation. (It did not occur to the doctor to stop the drug causing the fibrillation; possibly because he didn’t know that the drug could cause fibrillation.)

Unfortunately, the digoxin slowed my reader’s heartbeat so much that he started getting chest pains. So the doctor, probably fearing that the digoxin might slow the circulation, create a blood clot and cause a heart attack, started my reader on warfarin to stop his blood clotting.

My reader’s breathing problem was still no better so he then had an X-ray which showed that a fall he’d had some weeks earlier had resulted in several crushed ribs. The radiologist also noticed that my reader had tuberculosis scars on his lungs.

My reader, however, was now taking steroids, digoxin and warfarin (three of the most potent goodies in the drugs business) and was considerably worse than he had been when he’d first visited the nurse.

Naturally, the doctors involved refused to accept that the drug he’d been given could have caused the atrial fibrillation. They claimed that the fact that the fibrillation had started so soon after the drug had been prescribed was just a coincidence.

In truth no one could say for certain whether or not the drug had caused the heart problem but since the drug company had admitted that their product could cause problems of this type it seemed to me that to dismiss the possibility of the link was something an ostrich might have done.

It was rather akin to arguing that if a man who was hit on the head with a hammer subsequently developed a headache there was no connection between the two, or that if a man got a broken arm after falling down stairs the break was merely a coincidence. Or that if someone sat in the sunshine for four hours and then developed sunburn there was no reason to suspect that the two were linked. You get the idea.

Doctors who have prescribed drugs which have caused serious side effects rarely admit that there could be a link between a drug they have prescribed and a worsening of the patient’s condition.

Doctors prefer almost any solution other than the awful one that a patient has been made ill by a side effect, because that means it was their fault (with all the legal and moral overtones that such an admission would carry).

Coleman’s first law of medicine (there are twelve of them altogether) is that if you are receiving treatment for an existing disease and you develop new symptoms then, until proved otherwise, you should assume that the new symptoms are caused by the treatment you are receiving.

Copyright Vernon Coleman June 2020

This article is taken from Coleman’s Laws by Vernon Coleman, which is published as an eBook and a paperback and which is available on Amazon.