This complicated story might be considered of historical interest only were it not for the fact that more than forty years after the significant risks of DES were identified, we still have not established an effective early warning system to minimize such untoward events. Dr. Steven Nissan, a prestigious cardiologist at the Cleveland Clinic, recently complained about the inability of the Food and Drug Administration to fullfill its mandate to sound the alarm about drugs with significant adverse reactions. He said "the agency is extraordinarily slow to act on safety issues and has compromised patients." http://newsatjama.jama.com
Most recently the drug pioglitazone, brand named Actos, used in the treatment of diabetes has been associated with an increased risk of bladder cancer. The Food and Drug Administration has advised it should not be used in patients with a history of or active bladder cancer. Furthermore, the advisory includes cautioning patients to report signs or symptoms of bladder cancer including blood in the urine, urinary urgency, pain on urination, back or abdominal pain. All this is based on a 10 year study with an increased risk seen in patients with the longest exposure to the drug. In France, similar findings were reported and sale of the drug was suspended. In Germany, the official response was to advise that the drug be limited to patients currently using it.
There is no medicine that does not have adverse side effects, many are serious and some life threatening. For example, as many as 1 million patients in the United States may be taking two medications each of which taken alone have no effect on blood sugar but taken together can lead to increased blood glucose. This would present a major problem for anyone with diabetes. This finding was uncovered by data mining the FDA's adverse reporting system, AERS http://www.fda.gov/Drugs/InformationOnDrugs/ucm135151.htm
Clearly, patients should explore this resource to learn what is known about their medications and the potential interactions among them.
One widespread factor that may affect the safety of any medication is environmental exposure to chemicals that have the potential for interactions, including increasing or decreasing the potency of a given drug dose or changing the rate at which the drug is metabolized. Bisphenol A - BPA - a compound used to make plastic hard and clear is found in many products from eyeglass frames to plastic bottles and jars and the lining of beverage cans. It has been shown to interfere with the function of the endocrine glands of animals. There are reasonable questions about it's biochemical activity in humans. As of today the answer is we just don't know.
The history of medicine is crowded with flawed notions held long after clear evidence not only questioned their validity but proved they were erroneous. One might think this would have resulted in physicians being less certain about their practices and more humble in the positions they promote with such authority. A reduction in physician hubris could result in patients being less intimidated. Absent that fundamental change in physician behavior, patients must be alert to the risks associated with actions based on conclusions that may have been arrived at as a result of incomplete or inaccurate information; and the failure on the part of physicians to admit what we know, what we're unsure of and what we really don't know.