There’s An “I” in Risk – Minding Your Medications

Welcome to Pharmageddon –
Proceed At Your Own Risk


I wrote about the dangers of over-medication last year (see “Medication Madness“). That post’s sub-title was “Has Healthcare in America Reached Pharmageddon?”. I recommend you click the link and look that post over along with what follows.

Whether we’re truly experiencing Pharmageddon in America is something for others to debate. Whether it’s reached the point of crisis or not isn’t important if you’re one of those being over-medicated. For you, it’s a 100% certain crisis.

This post is intended to help you discern why you or a loved one may be at risk of over-medication and what factors to consider in correcting the situation, whether it’s one of too many medications or too high dosages of a single medication.

Let’s start with the false premise – accepted by the vast majority of patients – that FDA approval means a drug is safe.

Drug Dangers Take Many Forms

I’ve written elsewhere, along with many others,  about the corrupted clinical trial process that precedes FDA drug approval (see Our Healthcare Sucks).

I’ll let this graph of drug research retractions due to fraud and errors speak for itself and move on to other factors for you to consider.

Most FDA-approved medications are considered safe for most people – on average.

But that’s reassuring only for average people.

The problem is nobody’s average.

We’re each unique in our genetic vulnerabilities/family history, metabolic efficiency, environmental exposures to toxins, current medication regimens, and lifestyle choices.

And a drug’s impact in the human body is more complicated than doctors currently understand. As a Harvard researcher put it:

“Biology is complicated. When you add a drug to a cell, there’s a lot of stuff that’s being changed. Our pure intuition is limited in understanding all those things.”[i]

And the aggressiveness of American doctors in prescribing multiple medication regimens – so-called “polypharmacy” – compounds the risks of these largely uninformed prescribing practices.

Another Harvard researcher notes in the same report on the ineffectiveness of current prescribing practices that…

“Two antibiotics sometimes work less effectively than one of them would work alone, because one drug is suppressing another”.

So What’s a Smart Patient To Do?

It starts with understanding the many levels at which the medications you take can do you – or a loved one – harm.

Let’s briefly review the most important ones.

1. Drug Safety – When drugs are tested and found to be “safe”, what that really means is they’re thought to be safe for most people. No one can rule out possible adverse side effects – or even lasting injury – from any given medication for any individual patient.

This means safety is always a concern for anyone taking medications of any kind, including over-the-counter (OTC) medications not needing a prescription.

Some drugs are known to have adverse effects on liver and/or kidney function and require regular lab test monitoring to assure the medication isn’t adversely affecting the function of these vital organs.

While the frequency of lab testing can generally be reduced when initial tests are returned as normal, there’s an ongoing need for routine monitoring on a reduced schedule that’s often neglected.

In short, much of this routine lab testing is never completed due to its cost – Medicare and private insurers may not pay for repeat lab tests as frequently as needed – and inconvenience for patients. This exposes them to possible unrecognized organ damage.

Even when a drug isn’t harmful in the short term, its long-term effects may be unknown. No one truly knows, for example, whether cholesterol-lowering statin drugs – the best selling drugs on earth – cause disease or injury over the long term. They haven’t been around long enough yet to know with absolute certainty.

For this reason, older and more established medications are generally – not always – safer than recently approved drugs with no long-term track record to measure. This runs counter to our cultural instinct to favor the latest drug “advance”. It’s also counter to the profit mandate of the pharmaceutical companies that produce them to recoup their research investments with aggressive marketing of new drugs to doctors and patients alike.

“Only in America” – and New Zealand – are drug manufacturers allowed to market directly to consumers with TV commercials and other more targeted promotions. If you can’t bring yourself to flip the channel when these commercials are aired, at least pay close attention to their closing warnings about what these wonder drugs can also do to harm you – which may include causing an early death (Have you ever listened to those warnings? Yikes!).

2. Drug Dosing – Even when a drug has demonstrated relative safety in clinical trials, how much is safe depends on your personal profile. Children and older adults should generally be on lower than full adult doses.

There’s a reason that baby aspirin is often recommended for cardiovascular and colon protection rather than adult strength aspirin. It’s less toxic and yields better overall results because its benefits aren’t offset as much by the excess bleeding that adult strength aspirin can cause.

Tablets and Patches of Clonidine, Comprimés et patch transdermique de clonidine (Photo credit: Wikipedia)

The same applies to medications across the board. Higher doses pose greater risk of adverse side effects and injury.

In addition to your age, your body size, family history, metabolism, gender, and general physical condition all factor into what dosage of any medication may prove toxic for your brain and body.

When all these factors aren’t taken into consideration – and they often aren’t – you’re left with what’s an essentially “trial and error” process of medication prescribing.

3. Safe Drug, Toxic Target? – Many chronic diseases are managed by targeting disease biomarkers like cholesterol, blood pressure, blood sugar, inflammation, and other disease indicators influenced by medications prescribed to improve these indicators and reduce disease risk.

But there’s evidence that some of these targets may be overly aggressive, especially for older adults. High cholesterol, for example, is of lesser importance as you age into your senior years and has even proven to be protective in very old adults over the age of 85.

Blood pressure also can be driven too low in older adults and cause falls and injuries that lead to a downward spiral in many patients.

Blood sugar is a marker for diabetes and pre-diabetes and there’s evidence that it, too, can be driven too low.

The ACCORD study discussed in MedSmart Patients stopped its blood sugar trials prematurely when it was discovered that aggressively lowering diabetics’ blood sugar to non-diabetic levels of under 6% (A1c blood sugar level) actually increased cardiovascular events like heart attacks and strokes.

The blood sugar level associated with the best mortality rates was 7.5% – well above the diabetic threshold.

Here’s an example where the treatment target proved to be overly aggressive and was itself a danger to patients.

The point is that it’s obvious there are multiple ways for your medications to harm you rather than help you.

Is the Benefit Worth the Risk?

All these risk variables have to be weighed against the probability of benefit from the medication(s) approved for your condition. Those with early-stage disease symptoms are less likely to actually realize a drug’s purported benefits.

This is calculated for individual drugs using something called the Number-Needed-to-Treat, or NNT (click here to view NNT results for specific medications).

The bottom line is most medications are effective in a minority of patients – generally in the 25-50% range of effectiveness. This means that, on average, most patients won’t realize the benefits attributed to a medication. Yet they’ll be fully exposed to its risks of side effects and injury and, of course, the cost of a multi-year drug regimen.

The overall context, therefore, for deciding whether you should take a medication or not is one of uncertainty and substantial risk of injury. This is hardly consistent with the cavalier manner in which most of us take medications.

Cautious Compliance

None of this, however, is meant as an excuse to not comply with your medication regimen.

What it is instead is a reason to exert extreme caution in analyzing the risk-benefit balance of your medication(s) for your particular conditions – not just your medical condition(s), but your physical condition, age, weight, body composition, gender, and family history, among other factors to consider with your physician.

Once you decide to use a given medication, however, it’s important to stick with it unless it’s causing you side effects that may indicate underlying damage is being caused by the medication.

And if regular lab tests are recommended to monitor the drug’s effects on your liver, kidneys, or other organs, it’s essential to comply with that lab testing regimen as well – precisely because of the risk of damage.

It’s harder to take medications the right way – with careful screening before consenting, careful monitoring of side effects and possible organ or other damage, and use of diet and select herbs and nutritional supplements shown in clinical trials to work synergistically with certain medications. Increased physical activity can also reduce your need for certain medications, including those prescribed for the “big three” of elevated blood pressure, blood sugar and cholesterol.

This comprehensive approach of balancing both medications and lifestyle behaviors may allow your physician to reduce your medication dosages without sacrificing treatment effectiveness.

Yes, it’s harder. But it’s a lot safer than casually popping pills with complete disregard for their potential harm to your body and brain.

  • If you’re worried about Alzheimer’s Disease, for example, you’d be wise to avoid medications that cause cognitive decline and increase your vulnerability to Alzheimer’s (these are called anticholinergic drugs and include many sleeping pills and antidepressants).

  • If you’re worried about your weight, taking insulin or oral anti-diabetes drugs that cause weight gain may not be optimal.

  • Statin drugs may also contribute to weight gain and inhibit your ability to lead an active lifestyle that’s more protective than any drug will ever be.

There are similar tradeoffs with every drug you take. And the more drugs you take, the more difficult it is to realistically evaluate the negative interactions that may occur that further threaten you with bodily harm.

It’s complicated, so don’t take it lightly. Do the homework required to make smarter medication decisions.

After all, it’s your life on the line.

[i] A quest for more effective drugs. The Boston Globe. 10/17/11.

This article is for informational and educational purposes only. It does not constitute medical advice and should not be relied upon as such. Always seek professional medical attention before making any changes to your medication or treatment regimen.

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John Lynch: John Lynch was founder and CEO of Medical Diagnostics, Inc. - twice named to Business Week's "Best Small Companies" in America. He's since founded MedSmart Members to publish consumer health education publications.
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