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Cure as Disease

Irving M. Bush, MD
JAMA. 1973;225(6):630-631. doi:10.1001/jama.1973.03220330042013.
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"The remedy is worse than the disease" is a phrase that has been used for thousands of years.1 Occasionally it has been applied to such conditions as the development of severe recurrent hemorrhage due to radiation cystitis incident to the adequate treatment of pelvic neoplasia. Cyclophosphamide, an effective alkylating agent prescribed extensively in the treatment of lymphoblastic leukemia, lymphomas, certain solid tumors, and multiple myeloma and used as an investigational immunosuppressive agent in the care of patients with organ transplants, severe rheumatoid arthritis, or other disorders in which immune factors may be important can be, at times, another "remedy more grievous than the offense."2 Hemorrhagic cystitis due to cyclophosphamide metabolites excreted in the urine is a well-known complication seen in 13% to 30% of patients treated with this medication. Usually of a limited nature, its incidence can be reduced by increasing the urine volume and avoiding large single


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