A MORNING NEWS program recently reported that a young woman, 18 years old I believe, who had died from a blood clot to her lungs while on the birth-control patch.
News of an otherwise healthy 18-year-old dying is very sad. But as a physician, in addition to sadness, my thoughts went something like, "Oh no, there are millions of women on the patch, and this is going to scare them to death."
The report went on to say that the AP had done a study and found that the rate of blood clots, medically referred to as deep vein thrombosis or DVTs, was higher among patch users than birth-control pill users.
Now, I was just waking up and my brain was still a little fuzzy, but, even in that state, something seemed wrong with that statement.
"Did they just say the AP?"
Fortunately, the next person on the screen was Dr. Tim Johnson, medical editor for ABC News, who disputed that the percentage of DVT cases for patch users is higher than for pill users. Johnson went on to make another important point--that the risks of pregnancy far outweigh the risks of any form of contraception.
I was happy that they brought Johnson on to clear up the confusion, but I was left thinking that it must be a slow news day.
We've known for ages that hormonal contraceptives increase the DVT risk. This is nothing new. The death of an otherwise healthy young woman because of a contraceptive is undeniabl tragic. But is it national news? Is it justified to scare the millions of women on the patch because of one death?
I haven't encountered a drug yet without potential side effects. And how do we know that any given drug has a particular side effect? Because someone, somewhere, experienced the side effect while on the drug. More correctly, multiple someones experienced the side effect.
The possibility of side effects, even deadly ones, is not just theoretical. They had to have happened to someone in order to become known side effects.
A large part of what we doctors do is weigh risks. So far we haven't figured out a risk-free way to manipulate the chemistry of the body or to perform surgery. So what we do is weigh the risks of treatment against the risks of no treatment.
In the case of hormonal birth control, the risks of no treatment are unwanted pregnancy and the myriad associated physical, social and psychological risks to mother and baby. Hormonal contraception decreases the risk of ovarian and endometrial cancer, pelvic inflammatory disease, and heavy and painful menstrual bleeding.
Unfortunately, in addition to these benefits, there's an increased risk of blood clots that can lead to heart attack and stroke.
So how do we deal with these risks? One way is through history. If a woman has had a blood clot, stroke or certain other medical conditions that put them at higher risk--or has a close family member who has had a blood clot--we don't put them on the contraceptive pill, patch or ring. If they smoke and are over 35 years of age, another form of contraceptive is recommended. Sometimes lab work to uncover hereditary clotting abnormalities is indicated.
Despite all of these measures there will be tragedies. Today we live in a society with increasingly less tolerance of risk. Fortunately, in large part because of scientific advances, the world is much less risky than it was 100 or even 25 years ago. But risks still exist, and I see no signs of that changing.
What is truly dangerous is that we become so risk-averse that we fail to see the positives. We fail to remember that millions of women are at lower risk for unwanted pregnancy or ovarian cancer because we can't see past the potential risk of blood clots--a risk that is very small in appropriately selected patients. The result is that millions of people who could benefit from a treatment are denied it because there is a chance, no matter how minuscule, of a negative outcome. This would truly be a tragedy of national proportion.
DR. ARLENE LEWIS welcomes reader comments and questions. She can be reached by writing to her at Free Lance-Star, 616 Amelia St., Fredericksburg, Va., 22401 or by e-mail at newsroom@freelancestar.com.