The BMJ Today: The perils of not keeping your mouth shut

tiago_villanueva A few weeks ago, I had to take parenteral antibiotics for a condition that was not improving with oral antibiotics. Moreover, in my native Portugal it is still common, for example, to prescribe parenteral penicillin for bacterial tonsillitis since for some reason oral penicillin is not available there.

The normal functioning of the upper digestive tract is essential to carry out fundamental tasks to our survival, such as eating or taking medication when required, but this function can also backfire on us.

In the most recent Endgames picture quiz, Max Osborne and colleagues describe the case of a 52 year old man who came to the emergency department complaining of dysphagia and pain in the middle of his throat a few hours after eating a generous steak. The patient was eventually diagnosed with a soft food bolus in the proximal oesophagus, which causes substantial discomfort in patients, who may even be unable to swallow their own saliva.

Benzodiazepines are drugs that are often prescribed, in theory, for the short term management of anxiety or insomnia. But like any GP will know all too well, it is often very difficult to avoid their long term use in elderly patients. A team of researchers from Canada and France has just published a case-control study in The BMJ, looking at the relation between the risk of Alzheimer’s disease and exposure to benzodiazepines, started at least five years before, in people older than 66 years and living in the community in the province of Quebec, Canada. They found that the risk of Alzheimer’s disease was increased by 43-51% in those who had used benzodiazepines in the past, with the risk increasing with the density of exposure and when long acting formulations were used. In a linked editorial, Kristina Yaffe and colleagues call for the development of a global surveillance system for adverse cognitive effects of drug treatments used by older adults with multiple chronic conditions.

In contrast, there are circumstances where keeping one’s mouth shut may not be the best idea. I have to agree with The BMJ‘s patient partnership editor, Tessa Richards, when she argues in an Observations piece that “doctors will inevitably be placed in situations where they don’t necessarily know best.” She adds that patients now routinely “crowdsource” answers to their health problems in online communities and other settings, and that in turn is leading to tremendous change in the patient-doctor dynamics, whereby doctors are becoming guides rather than “Gods” in patient care. She describes how she was able to help a patient she was close to achieve remission from rheumatoid arthritis even though biological therapy had initially been denied in the local hospital. After she found out that prescribing rates of biologicals varied considerably between hospitals, she was able to help this patient secure treatment at a different hospital.

We shouldn’t be afraid to speak up if we have strong arguments to question the proposed medical care to our own health problems, but we should always be very careful with what we put in our mouth, be it food or medication, as things can often go very wrong.

Tiago Villanueva is assistant editor, The BMJ.

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