Bitter pills - The Australian May 17, 2008

Suspecting the drugs she was taking were the cause, Kohout resolved to get off them and discovered two things she had not anticipated. One was that she couldn’t function without them. The second was that her doctors refused to help her. 


 Scaling down is a tortuously slow process, made more difficult by the fact that her psychiatrist earlier this year abandoned her, insisting she needed to spend the rest of her life medicated. 

“He told me that if I tried to stop, he couldn’t continue to be my doctor,” she recalls. “His last words to me were: ‘In my opinion, you’re on a path to self-destruction.’” 


Katrina Stott, a nurse whose job it is to review the medications taken by these patients, says 60 per cent of patients aged over 70 arrive at the hospital because of a drug issue. “If you look at these patients, quite often they will take one tablet for a medical condition and another tablet to counteract the first tablet’s side-effects,” says Stott. 


At Fairfield Hospital, Stott once encountered an 82-year-old woman who took 34 medications daily and another 15 over-the-counter drugs as needed. “She came in with nausea and vomiting,” recalls the nurse. “She wasn’t eating, which is hardly surprising.” The blood-thinning drug Warfarin, Stott notes, has prolonged the lives of thousands of old people, but it’s also a rat poison that reacts so unpredictably with common drugs and foods that bruising and even haemorrhaging can result. 

Dr Jay Ramanathan, a GP who works with Stott, says simply: “It’s a perverse thought, but at times you wonder how people survive despite their treatment.” 


The severe side-effects and withdrawal symptoms associated with long-term benzodiazepine use are chronicled in standard medical texts, on websites and in books such as Benzo Junkie, by Australian writer Beatrice Faust. Antidepressants at high doses, meanwhile, can cause a serotonin imbalance, which triggers fever, agitation and muscle rigidity. Kohout does not recall ever being told about these issues by the psychiatrist, and her husband was shocked to find out about them when he came across the benzo.org.uk website in early 2006. 

“We saw so many doctors who knew amazingly little about these substances,” says Johnson. “And these are people who prescribe them, for God’s sake. She’d been assured by the psychiatrist it was safe for her to take these drugs in the way he’d prescribed, and she was meticulous about following his advice.” 

Recovering in hospital, Kohout for the first time received encouragement when a nurse and a consultant psychiatrist quietly advised her to continue reducing her drug load, albeit more slowly. But the hospital psychiatrist could not take her on as a private patient and Kohout found herself in a medical twilight zone: she needed a doctor to continue prescribing the drugs, but her GP refused to manage her withdrawal and referred her to a new psychiatrist, who refused to countenance the idea of her stopping the drugs. 

“He argued with me all the way. He kept saying it was unknown for someone who has been on these kinds of drugs for as long as I had to come off them. He said I had a chemical imbalance in the brain and he went through the whole story I’d heard a thousand times before about how it was evident from my family history that it was genetic.” Having already consulted at least a dozen doctors of one kind or another, Kohout felt her only option was to endure the psychiatrist’s criticisms and continue withdrawing with the help of a naturopath and whatever advice she could glean from the internet. 

Over the course of 2007 her white blood cell count dropped and she developed kidney stones, dehydration and gastric ulcers; she suffered constant abdominal upsets and required surgery to remove a lesion on her cornea – a listed side-effect of fluoxetine. In January her psychiatrist told Kohout he no longer wanted her as a patient because without drugs she was headed for “self-destruction”. By then, however, she was already beginning to regain a measure of her old clarity and strength. After consulting Reconnexion, a self-help group specialising in benzodiazepine dependence, she was referred to a GP, Dr John Walters, who agreed to help with her withdrawal. 
Asked if the drugs she was prescribed might have had a toxic effect, Dr Walters replies: “They would probably be toxic to anyone. If someone gave you one daily dose of what Jana was on – even now, but certainly at the peak of her drug-taking – you would probably be laid out for a few days.” 
“There is something terribly wrong with the culture of doctors and our medical services,” he says. “Jana has found relief with naturopathy and Chinese medicine, where the practitioner is prepared to spend time talking to the person and genuinely trying to find relief for them. It took her nearly nine years to find a GP willing to do this. She’s stronger now than she was six months ago; she looks better and she’s herself again. Whereas for years she was just going backwards. This illness has been a terrible test of her – and it was all because she was such a good patient.”

Staff writer Richard Guilliatt’s previous story was “Why kids hate Australian history” (February 23-24).
http://www.theaustralian.com.au/news/features/bitter-pills/story-e6frg8h6-1111116357589

deaths after surgery account for up to one in five people who die in hospital each year

http://www.smh.com.au/national/health/shame-private-hospitals-over-deaths-say-surgeons-20120728-232vq.html