GETTYSBURG MEDICAL NEWS
THE CLINICAL VIEW
By: Phillip E. Hoffsten, M.D.
11, January 2001

Rules for Avoiding Drug Side Effects.

One of the better lectures I heard in medical school was given by a visiting professor who talked about drug side effects. He made the statement, “The more effective a medication is, the more serious will be the side effects.” Never was that rule more true than it is today as our pharmaceutical industry continues to develop more specific and more effective medications to help with various disease states. The pharmaceutical industry and the Food and Drug Administration work together to protect the public from side effects. In the past five years, there have been more than 40 medications that have been taken off of the market because of side effect problems. It is interesting that some of these drugs removed from the market really have had no demonstrated problems for the public but because of the perception that problems might develop, the drugs were recalled. This very cautious and conservative approach is protecting the public but perhaps denying some individuals the benefits of the medication. I continue to struggle with the wisdom of denying 99 people out of 100 the benefit of a drug because 1 person in 100 had a serious side effect. Over the years, our rules have evolved such that if penicillin were to have been offered to the market today, it would never be allowed for sale because of the side effect profile. With this sobering piece of information, I would offer the following rules to the public to help avoid drug side effect.

Rule #1: Pick one pharmacy to work with in obtaining your medications. So many times, I see patients getting one drug from pharmacy #1, a different one from pharmacy #2, three products from the local nutrition store and then sending to Mexico or Canada to obtain another medication.  None of the various vendors has any concept of what the others are selling the patient.  The likelihood of a drug side effect from interactions  becomes substantial.

Rule # 2.  Pick one central healthcare provider who knows all of the medications that the patient is taking.  The rules above for the pharmacies applies even more potently to your local healthcare provider.  If he does not know that you are getting a drug from Dr. A., a different drug from Dr. B and now you come to a third healthcare provider to get yet another medication, the likelihood of side effects becomes substantial.  As an example, imagine the unique surprise of a lady taking birth control pills who while on vacation obtained an antibiotic from a local physician.  The antibiotic changed the rate at which her birth control pill was eliminated from her body speeding up the process.  The result was she got pregnant because she had to treat an upper respiratory tract infection.  This lady obtained her birth control pills from a gynecologist in another city, obtained her primary healthcare from a family physician in the city she lived in and obtained an antibiotic from a doctor where she was vacationing.  Her intent was innocent and well meaning but she was still pregnant.  The rule is obtain your medications from one healthcare provider or at least keep that healthcare provider informed of all of your medications as the best way to avoid drug side effects.

Rule #3.  Make changes one step at a time.  One of the common problems patients encounter is going to their healthcare provider for an annual checkup.  It is found that their blood pressure is somewhat high, their cholesterol is somewhat high, they are having abdominal discomfort and they are slightly constipated.  The healthcare provider offers a medication for each condition, and the patient walks out of the office with four new medications.  That is a mistake.  When the side effects come, there is no way to know with any certainty which of the four new medications (or more) is causing the side effect.  Trying to sort out this type of problem can be quite time consuming and very frustrating. The blood cholesterol did not become elevated in a week or even in two or three or ten months and neither did the blood pressure go up in that length of time. Get one condition at a time under control. Be loyal to a program. Don’t start multiple medications at one time; especially do not do that to treat chronic conditions.

Rule #4: There is a publication called The Medical Letter which has been published for 30 years. This publication is the healthcare providers answer to Consumer Reports. In an unbiased very conservative and very reliable way, they evaluate medications that are on the market, make price comparisons and review the advisability of the use of various medications. One of the studies presented in this publication reviewed the incidence of side effects versus the number of medications that a person was taking. Note, this included both prescription medications and “alternate medication” products obtained at the nutrition store. They found that anybody taking six or more medications or alternate medications was having some adverse effect from at least one of them. This is not to say that the adverse effect was not tolerable or a fair trade for the benefit that the medication provided. Rather, it was a message to point out that the more medications that a person takes, the more likely they are to have drug interactions and potentially negative side effects.

Rule #5: Beware of the internet. The Medical Letter described above is a very reliable publication with a board of directors that review the published information. These reviewers have no ties to pharmaceutical companies, health maintenance organizations, insurance companies, or the chains of stores that push medication sales. The internet is not reviewed by anybody except the person who puts the message out there. Most likely, their message is designed to sell medications. The claims do not have to be any more reliable than when charlatans were selling snake oil out of the back of a covered wagon. Internet claims of benefits and side effects need to be considered very carefully and checked for reliability.

Rule #6: As a final rule, I invite you to think about the following: How would you feel about trying to repair your car if you were not a mechanic? How would you feel about trying to repair the wiring to your furnace if you were not an electrician? How would you feel about trying to get into your locked car without a car key if you were not a locksmith? How would you feel about trying to deal with legal matters if you were not a lawyer? Then consider why in the world so many people start and stop medications on their own when they are not healthcare providers. The potential for drug interactions, the misinterpretation of symptoms and the misapplication of a medication is too big a problem for an untrained individual to manage effectively. True, some people may stumble by but fully 20% of the healthcare providers’ efforts are directed to undoing the harm individuals have done to themselves through injudicious use of medications. Before starting or stopping medications, consult with your healthcare provider with whom you can communicate and trust to be sure that your medical regimen has the fewest side effects and the appropriate benefits.