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June 24, 2002

>Should You Just Say No to Drugs?
William M. Buchholz, MD

When your doctor suggests taking medicine for a problem, do you think first of the side effects that drug may cause. While that may be a valid concern, the real question is more complex. The next time you consider taking ANY medicine, vitamin or supplement, consider the following questions.

What outcome do you want? What is this medicine supposed to do? Is it intended to treat an ongoing problem or prevent one in the future? If you have pneumonia you want the antibiotic to eliminate the bacteria. If you hurt you want the pain medicine to get rid of the pain.

What about preventing problems? If you have high blood pressure you want to avoid a stroke or kidney failure. If you have high cholesterol, you want to avoid heart attacks.

What about a less specific outcome, like being healthy? Though generally desired, this is harder to define. The other problems can be readily identified. How do you define "healthy?"

How important is this outcome to you? If you have cancer, getting rid of it is literally a life and death situation. If you are having a panic attack, getting rid of the anxiety may be very important and feel like a life or death issue. If you have high blood pressure, however, and there are no symptoms, how important is it to avoid an event in the future? Studies have shown that people tend to weight the chances of current side effects higher than the chances of future good effects. How important is the disease or condition the medicine is supposed to treat?

How likely is this medicine to work? What is the evidence? For prescription medicines there is published research that shows how well they work. For other substances, you may have direct experience that they work; i.e., you don't need a study to know that prunes help you go to the bathroom. What about other things where the research or your personal experience is lacking? Do you rely on the advice of friends who have taken it? Do you believe the advertisements? Do you take it on faith without any evidence?

What are the side effects? In the PDR (Physicians Desk Reference) the side effects of each prescription medicine are listed. They range from very serious problems like kidney or liver failure to less important ones like mild headaches or rashes. To be licensed, the law requires reporting all events that occur in patients while taking that medicine, whether they are believed to be related to the medicine or not. Unlicensed medicines (herbs, supplements, etc.) do not have to report side effects so you may not know about them.

How dangerous are they? Are they permanent or will they go away when the drug wears off? How likely are they? If you have a side effect, How can I know if the symptoms are due to the medicine or the circumstances of taking the medicine? Tamoxifen side effects, placebo good effects. Whose responsibility is it to know the side effects? How can you work with/trust your doctor in taking meds?

What other issues are going on? Do I feel the doctor has really heard me or is he just dismissing me with a prescription? Is there an underlying concern about my condition or its treatment that is unaddressed? Do I feel out of control if I take a medicine instead of doing it myself? Am I generally suspicious of anything "not natural?" Am I blindly accepting of anything "natural?" What is the balance between good and bad effects?

Should you consider vitamins or herbs drugs? Yes, according to Webster's dictionary, if you take them with the intention of curing, treating or preventing a disease. Just because they don't require a prescription or are not regulated by the FDA doesn't mean they aren't drugs. Anything that is strong enough to help can be strong enough to harm. Even pure water, if you drink too much, can cause problems (by diluting the minerals in your blood).

How do you know if the medicine works? If you have a symptom (pain, nausea, rash) and it goes away after taking a drug you probably conclude it worked. If you take a blood pressure or diabetes medicine and your blood pressure or blood sugar gets better, you'll probably conclude the same thing. What if you're trying to prevent a problem that hasn't happened yet? You may have to take something a long time and never know if it worked or the event wouldn't have happened in the first place. How do you know if it's the medicine that is working and not something else? Placebos consistently give a 20 to 40% response rate in most drug studies.

William M. Buchholz, MD
1174 Castro St. Suite 275, Mountain View, CA 94040

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