June 01, 2008
I promise you that heparin is a perfectly good drug, though if you have been reading the newspapers lately, you wouldn't think so. Several accounts have referred to the drug as “the contaminated blood thinner” which is probably accurate, though it casts a pallor of gloom over what is a life-saving treatment for many.
At the core of the problem is not heparin itself, but the contaminant known as oversulfated chondroiton sulfate (OSCS). Despite a recall by the FDA, contaminated heparin has apparently remained on the shelves and crash carts. The FDA claims that this chemical has been linked to severe allergic reaction and at least 81 deaths in 11 countries since last year.
The idea that it is hard to regulate a product manufactured in a stepwise process in different countries has not been lost among all the finger pointing that has occurred between China and the US recently.
But the real story here is about the verbal thrashing that heparin, a life-saving treatment for blood clots, strokes and heart attacks, has unfairly taken in the news. Yes, 81 deaths is a lot, until you consider the thousands who are saved by heparin treatment every day. I can't prescribe heparin these days without overcoming worry on the part of the patient, and yet, the chances of a problem from the drug remains infinitesimally low compared to the risk of a problem without it.
I am not saying that OSCS is not a problem, or that Baxter International doesn't bear some responsibility for ensuring its safety. But what I am saying is that fear and perception of safety are far greater problems in this situation than the risk of the drug itself. And while you can't catch the positive (or negative) effects of heparin from your neighbor, you can catch the irrational fear.
Marc Siegel, MD, is an internist and associate professor of medicine at New York University and the author of False Alarm: The Truth About the Epidemic of Fear