Primum non nocere; first, do no harm.
As I mentioned last time, I have a dog who has cancer and we are dealing with that as best we can, part of which is giving him a chemotherapy drug. He’s 14 years old and we decided we would not do any invasive procedures at all (ie, surgery) and if he doesn’t tolerate the chemo well we will discontinue it, but this week I had an experience that was harrowing because of its implications, both for our pets and for us as humans who must visit doctors.
This is Karloff:
Karloff had visited the oncologist our vet recommended, and she prescribed a drug called Palladia for his cancer. This drug is so toxic they tell you to wear rubber gloves when you give to to the dog and to keep the dog from licking you while he is taking it, so we know it is pretty strong stuff.
We gave Karloff his first prescribed 80mg dose of Palladia Wednesday with dinner. Thursday morning, out of curiosity, I was reading about the drug online and I saw that Pfizer recommends a far lower dosage for a dog Karloff’s size so I called the oncologist to make sure the amount is what Dr. XXXX wants us to give Karloff. Dr. XXXX wasn’t in but Dr. ZZZZ told me it was not correct and I should bring Karloff in right away, which I did. She ran a blood test, which apparently came back okay, and she apologized for the error, which she realized was a very serious one; if I hadn’t caught it, we would have given Karloff 80mg each time instead of the 35mg he is supposed to get. (She said she thought the dosage had been miscalculated as mg/pound instead of mg/kg like it is supposed to be.) She also prescribed an antacid for any stomach issues for the next week, and she tried to contact the manufacturer to see what they had to say about overdosing with this drug, only to be told that they were “all in a meeting”, something which boggles my mind, given the size of Pfizer.
Dr. ZZZZ was great about all of this, and I thanked her for seeing Karloff right away and I told her that I did not blame her for someone else’s error, but I asked her to express my extreme displeasure about this to “whomever was responsible”, and I also asked her if she could see if they could institute some sort of protocol to prevent this from happening again to another client. Karloff seems to be tolerating the 220% overdose of the chemo okay, but many dogs might not have handled it as well, however the really serious issue here is this: what if the client hadn’t decided to read up on the drug and hadn’t checked the vet’s math? How many people do that, anyway? Then the dog would have been getting the overdose for the entire course of chemo – at least until the next visit when the mistake might have been caught, but maybe it wouldn’t, either.
Where this assumes more importance than just somebody on a blog talking about his dog who has cancer is that in humans mistakes like this are one of the leading causes of death in the United States. (Third highest, to be exact.) When I first read this I was astonished and I had a hard time believing it but now that I have had a firsthand experience with it I can see how even the most qualified people can make errors and the implication is disturbing. Take a look at this study to see what I mean. And here is another article on the same topic. There are people who claim this is all fearmongering paranoia but after my own experience this week I can’t take them seriously.
I would encourage anybody who is taking medications to review them and make sure the dosages are correct!
*Iatrogenic death means death caused by the doctor.