In Praise of Rat Poison

In the past few years the drug companies have discovered new ways of preventing your blood from clotting.

Relax. That’s something you might really want. In my case I need a “blood thinner” (as they are called) to curb my blood’s overenthusiastic zeal to clot for no particular reason, due to a genetic disorder called “Leiden something-or-other factor”. Seventeen years ago I had a DVT (Deep Venous Thrombosis) followed by a second PE (Pulmonary Embolism) — a clot that breaks loose and gets caught in the peerless filter of one’s lung; unfortunately, whatever part of said lung is downstream of the plug dies. Unpleasantly. My first PE was misdiagnosed as “pleurisy”, but once you have experienced one, there’s no mistaking it. Trust me, you don’t want to, unless you find unprotected swordfighting a bracing pastime.

So, for the past 17 years I’ve been taking a daily dose of Coumadin, a cheap drug based on Warfarin, a.k.a. rat poison. Seriously, it’s cheap because untold tons of the stuff are churned out every year to feed to unwanted rats and mice (and, if you’re careless, other small animals). They die of dehydration and uncontrolled bleeding, if you really want to know. So there’s considerable motivation to monitor how well the Coumadin is working. The only way to do this that I know of (you med-tech jocks out there, see if you can’t make a phone app to do this non-invasively!) is to stick a needle in a vein and take a blood sample to send to the lab to check your INR (International Normalized Ratio — informative, eh?) or PT (Prothrombin Time). In Europe, it is more common to use a finger-prick and measure your INR on the spot from a glass capillary full of the red stuff. Basically, the higher your INR, the longer it takes for your blood to clot — the more “thinned” it is. For me, the best INR is between 2 and 3. The point is, you want to know that it’s working (no more PEs) and also that it’s not working too well (remember the rats). When your INR is too high, you can cut back your daily dose a little; if too low, take a little more. It works.

Enough about me. Back to the Pharmas. They discovered that whereas Warfarin works by preventing the liver from processing vitamin K to make “biologically active forms of the calcium-dependent clotting factors II, VII, IX and X, as well as the regulatory factors protein C, protein S, and protein Z” [I’m copying from the Wikipedia article; I don’t know what they’re talking about either], the way the new alternatives “work in your body is different from the way warfarin works. They affect a different part of the clotting process. This difference often makes these newer drugs convenient to use.” [Now I’m copying from a Healthline article that was the most informative source I could Google easily.] That article lists 7 examples, and how they are administered, but offers no technical details on which parts of the clotting process they affect, or how.

Well, fine, I guess; who wants to know all those technical details (other than me, of course). One can see why Healthline might balk at telling the whole long technical story to impatient readers. But wait…

They (and all the other analogous sites I’ve visited, and all the ads we are now seeing on TV) go on to list Advantages and Disadvantages (over Warfarin), and there is a glaring omission in every case — while “You need fewer tests during treatment” is always listed under Advantages, there is never any mention under Disadvantages of the following rather significant fact, which I believe applies to all these new drugs (though it’s not easy to find out for sure):

There IS NO reliable clinical test to see how well it’s working.

(Well, strictly speaking, there is: wait to see if you have a PE — if you do, it’s not working; and/or cut yourself to see if you ever stop bleeding — if not, it’s working too well.)

This is probably quite convenient for your GP, whose responsibility ends with the prescription. It saves your health care provider about $17/month (the typical cost of INR tests) and it rather dramatically obscures the cause of death in those (doubtless rare) cases where the stuff works too well or not well enough. There aren’t even alternative dose recommendations; one size fits all!

Most of all, of course, it suits the Pharmas, since these drugs are quite expensive — especially compared with good ol’ rat poison. Finally they are able to make a decent [obscene] profit off us Leiden-factor folks! This cost will usually be split between your health care provider and you personally.

Oh yes, there is one other Disadvantage: with (I understand) 1 or 2 exceptions, there is no way to “turn off” the new drugs if it becomes painfully obvious that they are working too well. (This would presumably be signaled by uncontrolled bleeding from various orifices. Hi, Mr. Rat!)

So… nothing new here, really, just Pharmas doing their thing. Except somehow they have managed to enlist government agencies and GPs in their campaign to convince us that

Ignorance is the best strategy!

That is certainly a revolutionary new concept in medicine. Expect to see more of it in the future.

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