Readers of these Health Tips know the usual suspects we look for at WholeHealth Chicago: chronic Lyme disease, toxic mold, multiple chemical sensitivities, but to me, as a physician, the most exasperating source of symptoms are those caused by correctly taken drugs, whether over-the-counter or prescribed by another physician. Because when this is the case, I must place the patient in the uncomfortable position of informing his primary doc that the problem is the med she prescribed. You might have discovered, doctors dislike being challenged by their patients. And during the past few years, in a situation I’ve termed “silo medicine,” patients are seeing so many specialists in different silos who don’t share their information that no one person seems to keep track of what’s going down the gullet, what chemical interacts with what.
Is this common? You bet! The side effects of correctly taken prescription drugs–can in fact kill you. An article in the Journal of the American Medical Association (JAMA) estimated that somewhere between 75,000 and 125,000 people succumb annually to this condition, making prescription drug use the fifth leading cause of death in the US.
Although the odds are very much in your favor that you won’t die from taking prescription drugs, chances are high you might suffer needlessly from some unexplained symptoms you told your doctor (and some specialists) about but no one bothered to check your drug list or start shortening it.
I recently saw an elderly woman with chronic sinusitis using a rarely prescribed nasal spray for osteoporosis prevention. Although the package insert warns not to use the med for more than six months, she’d been on it for five years.
A man arrived with widespread “psoriasis” and was about to start one of the immune suppressing biologics like Humira. Doctors seem these days very generous with meds suppressing other people’s immune systems. I reviewed this patient’s very long (and largely unnecessary) medication list and saw he was taking Bactrim, a sulfa antibiotic for bladder infections now rarely used because of allergic reactions. I asked about the Bactrim and the kidney or bladder infection. He didn’t remember the infection but had been renewing the Bactrim “for years.” Commonest manifestation of Bactrim allergy? Yup! Skin rash.
Held tight in the grip of drugs
We’re a culture that has grown to depend almost exclusively on prescription drugs to treat virtually every symptom or malady we experience, from thinning hair and toenail fungus to strengthening our exhausted hearts and cheering us up. We seem so adverse to discomfort that instead of changing our diets to prevent heartburn and lower our cholesterol and prevent heart disease, we willingly take proton pump inhibitors <PPI> (Prilosec, Nexium, etc.) although doing so for four years or more have a 30% higher chance of developing dementia. And since we already know there’s a link between statins and dementia, combining the two must be making things worse. Yet many a patient has heard from their PCP or gastroenterologist: “PPIs? Safe! You can take them forever!”
At one time, every year I, along with every physician in the U.S., would receive a heavy cardboard box containing our free copy of the Physician’s Desk Reference (PDR). It was thousands of pages long and printed in the smallest of fonts, double column, on tissue-thin paper. Now, fortunately, and for the sake of the world tree population, the entirety is downloaded to our phones.
If you’ve ever opened a prescription drug in its original package, you’ve unfolded that seemingly endless accordion of paper, glanced at it, and tossed it aside. The PDR is simply the bound version of every drug’s package insert listing the reported side effects from that drug. In other words, the very hefty PDR is one vast compendium of side effects. Hundreds of thousands of side effects and drug interactions. Yum!
Now let’s talk about a prescription drug–it doesn’t make any difference which one. This applies to all of them. Whatever drug you’re taking, if you take a big handful at one time (an overdose) it could make you quite ill. Unlike a food, like pigging out on a bag of Oreos, if you pig out on any prescription drug, it is possible to die. Therefore, it’s reasonable to say that all prescription drugs are poisons. Are you following this?
But what the pharmaceutical industry does is dilute that poison to a small enough amount that one of its effects accomplishes something useful–ease your headache, lower your blood pressure, calm you down, grow your hair. But remember, you’re still taking a poison that can (and probably does) have many other effects in your body. These are the side effects.
Luckily for the pharmaceutical industry, most people don’t notice the side effects of the drugs they’re taking. Others find side effects intolerable, mutter “I can’t take this crap,” and toss the drug, occasionally letting their doctor know of their decision. Usually this is met with derision (“You really shouldn’t play doctor!”). That or your physician might give you a second prescription to reduce the side effects of the first.
But do keep this in mind: the average patient in the U.S. takes four prescription drugs. Most of these drugs do not “cure” anything at all. Most prescription drugs “treat symptoms” usually brought about by unhealthful lifestyle choices.
Subtle side effects missed by patient and doctor
What becomes an extraordinarily common missed diagnosis is this: the subtle side effects of prescription drugs that neither the prescribing doctor nor the patient herself can link to the medication. Yet when you look through the PDR, or actually read the unreadable package insert, virtually every physical and emotional sensation could conceivably be a side effect. Many are so obscure, so off-the-wall, that they’d never be considered drug-related.
Do your heels hurt? Might be your antibiotic. (Cipro/Levaquin linked to heel inflammation) Suddenly betting your life savings at the racetrack? Could be your new medication for restless legs syndrome. (Requip and Mirapex linked to pathologic gambling, compulsive shopping and hypersexuality). For any drug prescribed, doctors really only attempt to memorize the top five or six commonly reported side effects. But the FDA requires that all side effects be reported for every drug on the market and this list—called “post-marketing side effects”–can grow into the hundreds.
Tricks of the trade: do try this at home
When a patient arrives with an inexplicable new symptom (anything, really—fatigue, headaches, depression, a rash), doctors should always explore in depth when the symptom began. The very next question should be (but often isn’t) “During the month or two before the symptom, had you started any new prescription drug? Anything at all?”
If the answer is yes then the odds are good your “mysterious symptom,” the “missed diagnosis,” is a side effect from the new drug.
Sometimes I’ll hear from the patient, “You know, I thought it could be the drug but my doctor reassured me she’d never heard of that being a side effect.” Remember, if your doc’s brain remembers fewer than ten side effects per drug and there are hundreds more, this reassurance is singularly unhelpful.
So to help us all, Al Gore invented the internet (so he said).
Try this yourself. It’s what I do when you’re sitting across from me relating your symptoms. Let’s say you’re one of the 13.2% of Americans taking antidepressants and while your mood is better, you’re an professional artist and convinced your creativity is on the decline. I go to Google and type “antidepressant effects on creativity” and discover that some people whose depression is helped by the drugs become more creative, while others report creative numbness. These are self-reported side effects not even on the package insert and not reported to the FDA. But enough people are mentioning them that they should be on the FDA list.
When I Google for information on side effects, the source might be a reference to the PDR, but it also might be an article in a foreign medical journal or, as in the case above, an exchange on a message board for patients themselves. I find message boards incredibly useful. These are real people taking the medication in question, asking the very sane question “Could my symptom be due to my drug?” or sending an to alert everyone,
“The symptom is not your imagination. It’s happening to me.”
The best advice? Always ask yourself whether you need that drug in the first place.
David Edelberg, MD