Where to get the lowdown on drug side effects


In the wake of the Vioxx fiasco, is there anyplace a consumer can get reliable information, especially on adverse side effects, about drugs already on the market?

Dr. Jerry Avorn, author of Powerful Medicines and chief of the division of pharmacoepidemiology at Brigham and Women's Hospital in Boston, put it bluntly: "It's hard for a consumer to find a ready source of vetted information."

Imagine, for instance, that you want information on Ambien (zolpidem), the popular sleeping pill. You'd probably start with the Food and Drug Administration Web site (www.fda.gov), but it's tough to find the nuggets you want without drowning in everything from correspondence between the FDA and the drug manufacturer to reports containing highly detailed biochemistry that only a neuroscientist could love.

Besides, it's not just the Web site that's problematic. In early November, the FDA asked the Institute of Medicine, an arm of the National Academy of Sciences, to figure out what is wrong with its entire system of post-marketing surveillance, which is supposed to track problems with drugs after marketing.

Last month, the editors of the Journal of the American Medical Association called for a new, independent drug safety board to oversee post-marketing surveillance for drugs and devices. The editors said it was "unreasonable" to expect the same agency that approves drugs and devices to seek evidence "to prove itself wrong."

More useful is www.PDR Health.com, which provides consumer-friendly information based on the PDR, or Physicians' Desk Reference, the doctors' bible of drug information from FDA-approved drug labels. The PDR itself, a monster book with thousands of pages in teeny type, is available online, but only for health professionals.

Another user-friendly site is www.safemedication.com, provided by the American Society of Health-System Pharmacists.

You can also run an Internet search using a drug name, but the information you get is not vetted by any medical authority, which means company propaganda and consumer complaints are mixed in together.

Even better sites should be available soon. In December, Consumer Reports will launch a free new Web site (www.crbestbuydrugs.org) that will allow consumers to check on drugs by category, such as medications to control cholesterol.

This program, said Gail Shearer, the project manager and director of health policy analysis, will start with three drug categories and expand to as many as 20. It will provide information on effectiveness, as well as costs.

If I lie down during the day, I sleep for two hours. Can a person learn to take shorter naps?

You could certainly take shorter naps by setting an alarm clock. But the fact that you spontaneously sleep so long during the day could be a sign that you're not getting enough sleep at night or, possibly, of a sleep disorder that may need medical attention.

A short (20-minute) nap early in the afternoon can be restorative, sleep experts say, because it fits with a natural dip in the circadian cycle, when most of us get a little sleepy anyway.

But sleeping longer than that or later in the day can cause problems if you tend to have insomnia at night, said Dr. John Winkelman, medical director of the sleep health center at Brigham and Women's Hospital.

In general, if you get sufficient sleep at night -- at least seven hours -- you shouldn't feel sleepy the next day.

Still, many people, from Winston Churchill to Ronald Reagan, have sworn by regular, short naps, according to the National Sleep Foundation in Washington. A foundation poll taken in 2000 showed that one-third of respondents said they would nap at work if it were allowed. An earlier poll showed that 38 percent of adults nap at least once during the workweek, usually for an hour.

But sleeping that long may make you feel worse, said Dr. David Neubauer, associate director of the Johns Hopkins Sleep Disorders Center. After a longer nap, it can take several hours to feel fully alert.

Sleeping a lot during the day can also be a sign of a medical disorder, including sleep apnea, in which you wake up over and over struggling for breath, without knowing it. If you fall asleep uncontrollably during the day, you might have a rare but complex neurological disorder called narcolepsy, which also needs treatment.

Do you have a medical question? You can submit questions via e-mail to foreman@baltsun. com.

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