Conundrum

"Conundrum (noun): Anything that arouses curiosity or perplexes."  The study and care of the human body in health and disease is difficult enough, but throw in ethics, the law, morals, capitalism, human empathy and suffering...sometimes presents the practicing clinician with conundrums. We just want to make it better. It's not that easy.

Recently a study indicated that a commonly used medication may be killing patients. This medication is not illegal. It is approved by the FDA, studied, marketed by the drug companies..."sold" to clinicians to use for good reasons on patients with the right disease. Clinicians have trusted that the medication is working without doing harm.

The study has indicated that drugs for lung disease may increase risk of strokes, heart attacks and death. This drug is widely (mucho sales) used as first line (the first thing to use) in chronic pulmonary lung disease (aka COPD), which it the 3rd or 4th leading cause of death in the U.S. And the most common cause of the disease is smoking. The drugs are inhaled anticholinergic.

   The authors have pointed out that "a larger clinical trial is needed to validate the findings" though. Of course, "pharmaceutical industry spokespeople issued a statement strongly disagreeing with the conclusions of the study."  Shocking eh?

Consider being a clinician. Your patient is a 70 y/o former smoker (40 years, 2 packs a day) with COPD whom you have had on inhaled anticholinerics. He quit smoking since he's been your patient (with your help) and he's breathing better. His quality of life has improved. And then...he has a stroke. Conundrum.

We respond appropriately with the best information we have at any moment in time. We "do no harm" to best extent possible. We use approved drugs and techniques in approved ways. We don't wake up in the morning thinking we are going to hurt people, but wonder each day if we have. Is it any wonder why people don't choose this profession, and maybe more a wonder, why some do.