Side Effects

(1942 words – 10 minute read)

Aside: “Side Effects” is a great movie starring Jude Law and Rooney Mara, directed by Steven Soderberg.

Disclaimer: This is not medical advice. I am not a doctor. This is just my opinion. Discuss all medical concerns with your primary care physician or your prescribing physician.

Doctors are scheduled a limited length of time to see patients so make a list of things to discuss. Deal with each item in turn. Be succinct. However you should feel free to discuss your concerns and get a sympathetic response.

The days of the dictatorial doctor are over – along with house calls and the horse and buggy.

The take-home message of this article is: “take responsibility for your health and well-being”. (Because generally speaking, no one else knows you so well and/or gives a shit.)

This all got started with an article on about a Lancet article saying that half of all medical research is possibly wrong because the testing they do doesn’t add up.

Dr. Richard Horton, the current editor-in-chief of The Lancet says:-

“The case against science is straightforward: much of the scientific literature, perhaps half, may simply be untrue. Afflicted by studies with small sample sizes, tiny effects, invalid exploratory analyses, and flagrant conflicts of interest, together with an obsession for pursuing fashionable trends of dubious importance, science has taken a turn towards darkness.”

It took me a while to get my head around this: Half of all medical research is simply untrue?!?!

Dr. Horton demonstrated it by getting his research “proving” that chocolate  helps with weight loss peer reviewed and published in several prestigious journals. That’s fucked up!

And if half of medical science is bullshit then what about the rest of the stuff that’s peddled to us as “fact”? There goes everything I see or hear called “the news”.

Anyway enough of that. We can each of us follow our own train of thinking on that one.

Let’s stick to how this affects our own relationship to medicine.

First off we should all know what drugs we are taking, what each one is supposed to do, the dosage, side effects and adverse interactions with other medications.

I’ve worked in hospitals and most patients I’ve come across have only the vaguest idea about the drugs they are putting in their bodies.

That’s dangerous.

There are many websites for drugs but is the one I use.

You may also (if you want to test your doctor’s patience and knowledge – and possibly piss him or her off) want to ask your doctor what the NNT (Numbers Needed To Treat) of a drug is.

The NNT is the average number of patients who need to be treated to prevent one additional bad outcome. It basically tells you how effective the drug is and should be weighed against the possible adverse effects of the drug.

For example 98 patients would have to take 10 mg. atorvastatin (Lipitor) for 3.3 years to prevent one single cardiovascular event (heart attack). And that’s a good result.

You may also want to ask him or her what the Therapeutic Index (or Safety Window) is of a drug. A narrow safety window means that the therapeutic dose is close to the toxic dose. Don’t take more than prescribed. Never double up if you miss a dose.

Most (74.3%) of pharmaceutical related overdose deaths are unintentional. Know how dangerous your drugs are.

Asking these questions could seriously annoy your doctor, especially if he/she doesn’t know the answers. But that’s the doctor’s problem – not yours. Your doctor is not someone you should be afraid of. If he or she says “you don’t need to know stuff like that” – change your doctor. If you’re putting it in your body it’s your business.

You may think I’m getting too worked up over this. Damn right I’m getting worked up and I’ll tell you why.

2.2 million adverse side effects, otherwise known as ADR’s (adverse drug reactions) occur annually.

Combined with medical errors the chance of having a serious injury while in a hospital is as high as 36%. This does not take into account unreported events since only 5% to 20% of these events are actually reported.

This information is from “Unlocking the Healing Code” by Dr. Bruce Forciea.

A 1998 New England Journal of Medicine article published a study showing that 25% of patients demonstrated side effects from the greater than 3.34 billion medications prescribed that year.

100,000 people die a year as a result of adverse reactions making them one of the most common causes of death.

Now this does have to be balanced against the lives saved and health restored by modern medicine. What can be achieved today is truly amazing. And, as the boundaries get pushed, more risks are inevitably taken.So it is up to us, the people who take these drugs, to be to be aware of what we are taking and how it is affecting us.

For example NSAIDS (non-steroidal anti-imflammatories) are one of the medications causing the highest number of side effects. They are routinely given post-operatively as an analgesic in the “one-size-fits-all” mode of medicine we are now in. But we are not all the same size.

My experience is that despite clearly telling the surgeon that NSAIDs cause intense stomach pain, the patient (my wife, Amy) was ignored (after all- what do patients know?) and two days of unnecessary post-operative agony followed.

As a result of this experience Amy and I now check every medication every time it is given. It may take the nurse an extra ten minutes to give the drugs. So what?

“Question any chronic prescription: If you have to have it, make sure you are taking the lowest possible dose that does the job” (theMED – minimum effective dose) advises Candace Pert in “Molecules Of Emotion: The Science Behind Mind-Body Medicine

This advice is echoed by Temple Grandin (played by Clare Danes in the movie of that name): “If you start using a medication in a person with autism, you should see an obvious improvement in behavior in a short period of time. If you do not see an obvious improvement, they probably should not be taking the stuff. It is that simple”.

And what goes for autism goes for everything else.

Our differences define us as much as our similarities. About 30% of people can be described as highly sensitive people (HSP). For such people a small dose of a medication might act like a large dose.

0.125 mg of Xanax is a knockout dose for me. 4mg is the maximum recommended daily dose. That’s a 32-fold difference. It would be dangerous for me to take 4mg of Xanax.

Another example, Clopidogrel (Plavix) a commonly prescribed blood thinner (platelet aggregation inhibitor) is available in one dose – 75mg.

So a 300 lb. man gets the same dose as someone half his weight. Makes no sense.

Women have a different hormonal balance than men. That never gets taken into account.

As we get older our bodies change and we become more sensitive to drugs. Few doctors realize this.

That and a thousand other factors make us each who we are; unique and individual with our own response to medications – we’re all wonderfully different.

75mg of Plavix will only be right for some people. For others it will either be too little, and they will not get the necessary benefit, for others it will be too much and they may bleed to death. These are not trivial considerations.

Also know how to take your vitals – blood pressure, pulse, temperature and O2 saturation.

The equipment is inexpensive and easy to use.

I give an exercise class at our Assisted Living facility. We check our pulse. Putting two fingers on the thumb side of the wrist and finding the pulse we can tell if it feels normal or fast even or irregular (arrhythmia). It’s not difficult.

So far we’ve just looked at drugs/medications.

But there is so much more. More than 60% of Americans have used some form of alternative therapy in a 12 month period. (Unlocking the Healing Code ).

“The Patient Will See you Now: how advances in science, medicine and technology will lead to a personalized health care system” by Eric Topol (the title says it all). This book describes how medicine will be in the near future: personalized and with the patient at the center of it all.

In the past the family doctor would pay house calls and check in on you if you were ill in bed. He was there for us with advice and support. I still remember those long gone days. But with medicine becoming more complex the hand-holding has gone and the doctor is staring at the computer for most of the seven minute visit. It’s all about the lab tests.

The doctor used to be the center of the wheel. The authority in the temple of healing we would travel to in deference and fear.

No more. We, each of us are the center of our wheel and circling us are our many healing resources to be accessed, evaluated and coordinated by us.
Doctor, medical specialist, acupuncturist, masseuse, pastor, medicine man or woman, vitamins, herbs, sunshine, fresh air, exercise, meditation, dance, play, love, friends, family, nutrition therapist, counselor, pharmacist, trainer, energy therapy, church, community, pets, garden, vitamins, herbs, supplements, prayer and so on.

Make your own wheel and realize that, though each one of your helpers may know more than you in their speciality, it is you, at the center of the wheel, who puts it all together.

Now this may sound horrendously complicated and it is up to each us to decide how much to give a shit about it.

For example for most of my life I lived it happily with no concern for anything written so far. Never needed to see a doctor. Didn’t see a dentist for 11 years. Just fine and dandy thank you. Lucky me.

Now I practice and teach Tai Chi with Amy and eat reasonably well. I get my annual check-up and lab tests. Age is catching up with me.  I’m going deaf and getting a little creaky. So far so good, but it is inevitable that I will one day have a row of those little plastic pill containers on my bathroom shelf. And I’d better know what’s in them.

I’ve spent many years working in the medical field and I’ve seen so many mistakes being made, not on purpose, but because it’s all so bloody complicated. The advances being made are truly wonderful – for the most part, but it is unbalanced.

My criticism of mainstream medicine is that drugs and surgery are too often seen as the first and last resort, and that the other resources on our healing wheel are disregarded or considered merely palliative.

For example I long sought to have stress management instruction (teaching patients simple exercises to relieve stress) offered to all hospital patients including those seeing their doctor in the clinic. It never happened.

Seeing a doctor can be a stressful event. It’s called “the white coat syndrome“. Your blood pressure goes up, cortisol surges through your body and you may get put on blood pressure medication – unnecessarily.

That is why you need to be able to take your own blood pressure in the comfort of your own home. Take it at different times of day, every day, until you know what it really is and how it naturally fluctuates. Then you will know if you do have high blood pressure or not.

These and other considerations are important to maintain our health and well-being.

Now we have to step in and play our part. Assemble your team. Conduct your orchestra. Be the boss. Be well, be happy.