The Aching Man And The Sweaty Woman

New patient Phil told me he’d been suffering muscle pain every single day for more than eight years. He’d seen neurologists and rheumatologists, had had an MRI of his spine, was told he had spinal stenosis (narrowing), had cortisone shots, and recently had been scheduled for neurosurgery.

Then a friend told him to stop taking his statin drug. When Phil told his doctor what his friend had said, his physician reminded Phil that this friend was no doctor. Nevertheless, Phil told me he screwed up his courage and stopped taking the statin.

Within a week the pain was gone.

A second patient, a woman in her late 60s I’ll call Jen, sought help because she sweated constantly. “Can’t be menopause,” she said. “That was almost 20 years ago. Can menopause come back?” Although I thought not, Jen’s previous doctor apparently  believed otherwise and started her on hormone replacement therapy. The only effect of the hormones was that her blood pressure started rising, which prompted her doctor to increase her blood pressure medicine from a relatively low dose to a higher one.

Jen finally quit taking the hormones on her own. Despite all this, her sweating worsened, seriously interrupting her sleep. She was exhausted and becoming even more worried because a new symptom had developed. Jen found herself easily becoming out of breath even though she was told her heart and lungs were fine.

I reviewed her medical history, literally year by year. It turned out that the sweating had begun a few months after she started the blood pressure medicine. And yes, when her doctor had recently increased the dose, the sweating worsened. My fingers flew across my keyboard. (The internet: source of all knowledge in the universe. I’d sooner give up my stethoscope than my access to the internet when I’m with a patient.) I brought up her medication, clicked to the list of side effects, became an instant expert, and turned the screen for her to see the side effects, listed in order of frequency:

• side effect #1) Fatigue.
• side effect #6) Excessive sweating
• side effect #10) Shortness of breath

I relate these stories because they’re not unusual. A chillingly large number of the patients arriving at WholeHealth Chicago (and most likely every doctor’s office around the country) have one or more major symptoms caused by the side effects of prescription drugs.

Should this surprise us?

A report was released last week from the National Center for Health Statistics (NCHS) that should raise our collective eyebrows. It showed that:

• 10% of Americans in a survey had taken five or more prescription drugs during the previous month.
• Nearly half (47%) had taken at least one prescription drug.
• The report added that these numbers had increased steadily from previous surveys.

Let’s talk about what half of us swallowed last month. What is it we’re actually taking? Virtually all prescription medicines are completely synthetic chemical molecules created in a lab somewhere, one wall of which sports stacks of caged white rats. Not only is this new molecule non-existent in your food chain, it also likely exists nowhere else in the universe. There are perhaps a handful of prescription drugs that do exist in nature, like Premarin, extracted from the dehydrated urine of a pregnant mare.

Here’s how a new drug comes into existence

Some Ph.D. in pharmacology somewhere discovers that her newly synthesized chemical  has the potential to be useful inside the mammalian body. Maybe it lowers cholesterol, maybe it triggers an enviable erection. Whatever. The lab rats are first in line for testing and if none of them die, the researchers move on to some salaried human volunteers. Because the new discovery is a chemical and not, say, an apple, it also has other effects on the rat and the volunteer, some of them less than useful and others truly unpleasant. These are recorded as side effects and you can hear some of them rattled off with the speed of an cattle auctioneer at the end of a drug’s TV commercial. You probably wouldn’t recognize your side effect symptoms anyway. Phil’s muscle pain is called “myalgia,” Jen’s sweating becomes “diaphoresis.”

But if useful wins over less-than-useful side effects–and the side effects don’t kill the rat or sicken the human–our shiny new molecule wins its patent and is pronounced a new prescription drug. With appropriate government approval, followed by an advertising budget larger than the GNP of many small countries, the molecule can now join one of the hundreds of other drugs that half of you washed down your gullets last month.

If developing a new drug seems like a lot of work, just remember that during Lipitor’s patent exclusivity it generated $115 billion (with a “b”) in worldwide revenues for Pfizer. Other Pfizer blockbusters include Viagra, Celebrex, and Lyrica. Serious money here. Lyrica (aka pregabalin), invented by Northwestern University chemistry professor Richard Silverman, became a cash cow for the university, thus far generating $1.36 billion (another “b”) with the meter still running. Unless you’ve got the metabolism of a Sherman tank, Lyrica’s side effects can be pretty awful, but this issue is conveniently ignored by both Pfizer and the folks up in Evanston.

Side effects? Let me tell you about side effects!

The annual Physicians Desk Reference (PDR) is sent to every primary care physician in the country and the latest edition is well over 3,000 pages, printed on tissue-thin paper in blindingly small type. The PDR has an entry for virtually every prescribed drug, and if you read a single entry from start to finish you’d be surprised how little space (a line or two) is devoted to a drug’s benefits and how much (column after column, page after page) to its side effects.

The PDR entry, by the way, is identical to the full medication package insert (not the large-print abbreviated one) that comes with your prescription drug. It’s that folded and refolded crinkly wad which opens like a Torah and is about as comprehensible. The tiny print, graphs, and charts swim before your eyes. You think, “Boy! I sure hope my doctor read all this.” Trust me, she didn’t. She was too busy arguing with your health insurance company to get the $25 she’s owed from your last visit or writing that letter to get you out of jury duty.

Numbers game

If a typical drug has, say, ten major and 20 minor side effects, the odds are pretty good that a single drug will cause you one side effect or another. For those of you taking five or more prescription meds, the odds of escaping completely unscathed are, let’s say, remote. And when it comes to drugs interacting with one another, or affecting your gestating baby or breast milk, doctors are the first to admit they’re flying blind. “Insufficient studies” or “untested” translates to “You’re on your own, babe.”

If at this moment you’re glancing suspiciously at that row of prescription drugs on your kitchen counter, I also hope you’re feeling a tad queasy. Because keep in mind that the vast majority of meds doctors prescribe are prescribed to address the consequences of our unhealthful lifestyles.

Please don’t think me a pharmaceutical Luddite. At WholeHealth Chicago, I and my associates prescribe drugs when they’re needed, period. People in pain really do need analgesics. Whether or not your diabetes, underactive thyroid, or high blood pressure comes from a bad draw of the cards in your gene pool, take your meds. Then ask your doc if there are any changes you can make to cut back on or quit altogether the drugs you’re taking.

Our aim is to avoid prescribing drugs for the preventable stuff. I didn’t tell you that both the man with muscle pain and the sweating woman were each 50+ pounds overweight. Their drug-induced years of suffering could have been avoided altogether with some guidance and healthy lifestyle choices.

And if you’re now reasonably worried about the effects of Big Pharma’s chemical swill as it courses through your bloodstream, take extra good care of yourself.

Be well,
David Edelberg, MD