Dr. Lucien Abenhaim
PHOTO: PIERRE ROUSSEL
"Scientist of the year" studies lifestyle diseases
DANIEL McCABE | The good news, says epidemiology and biostatistics professor Lucien Abenhaim, is that we've never known more about how to treat illnesses and ailments with drugs than we do now.
The bad news, adds Abenhaim, is that we still know very little about the long-term consequences of most of those drugs.
"It's a better world today than it was 20 years ago in many respects," says Abenhaim, "but it's a more uncertain world as well. We've introduced many new elements into our lives and we can't really be certain about what they're doing to us."
Abenhaim was recently selected by Radio-Canada as its "scientist of the year" for 1997. He was featured on the radio program Les Années-lumière as a result and is also profiled in the February issue of Québec-Science.
His research findings about the potentially deadly side effects of a pair of popular appetite suppressants garnered attention from The Wall Street Journal last year and helped get the drugs off the market.
Abenhaim's studies, first released in 1995, indicated that the drugs dexfenfluramine and fenfluramine -- marketed to the public as Redux and Ponderal -- could cause primary pulmonary hypertension, a rare and often fatal disease.
These findings prompted governments in Europe to seriously curtail the use of the drugs and led to warning labels being placed on packages of Redux and Ponderal sold in the U.S. and Canada.
Abenhaim wasn't pleased with the Canadian government's response to his warnings about the drugs. He told The Globe and Mail that he was shocked when the Health Protection Branch of Health Canada approved the use of the drugs even after hearing of his research results. It wasn't until another series of studies from the Mayo Clinic pointed to more health concerns that the drugs were taken off the market.
Abenhaim told The Globe and Mail "serious questions have to be asked" about a drug approval process that gives more weight to drug company lobbyists than independent medical researchers.
His current research projects cover a wide range of topics -- the long-term effects of vaccines, other types of appetite-suppressants and drugs used to treat osteoporosis.
As the director of the Jewish General Hospital's Centre for Clinical Epidemiology and Community Studies, Abenhaim is also involved in work led by other members of his centre that focuses on Alzheimer's disease and pulmonary disease.
"I look at my work as the study of the side effects of living at the end of the century," says Abenhaim. In addition to drug therapies, he has investigated the effects of pollution and diseases such as AIDS and mad cow disease. "All these things are related to the way we live our lives.
"There are 8,000 drugs available on the market right now," says Abenhaim. "They've all been tested -- but they've been tested for short-term use. We don't have any idea about what the long- term effects of most of these drugs will be.
"Randomized trials use a very limited number of patients for a relatively short period of time. A study might involve 2,000 patients -- when you consider all the people who might eventually use a drug, that isn't a very big sample."
In a perfect world, clinical trials would involve 100,000 subjects over a 10-year period, says Abenhaim. "But that would be almost impossible to fund. I can't see giving someone in need of treatment a placebo for 10 years either."
Abenhaim adds that clinical trials are carefully constructed -- researchers want to avoid complicating factors, so they recruit their subjects cautiously. "For a clinical trial, you probably wouldn't use people taking other drugs or pregnant women or the elderly or people with other types of illnesses. But once you actually make that drug available to the public, you're facing a completely different world than the one you constructed in your clinical trials."
Abenhaim doesn't want to panic anybody. "I'm not saying it's 'Apocalypse Now.' I'm not saying that the world is worse than it used to be -- clearly it's not.
"But we have to be aware of the risks involved in how we lead our lives. We have to monitor the use of the drugs we take because sometimes -- such as the case of the appetite suppressants we studied -- you come across an emergency situation."