Doctor, Does This Drug Have Any Side Effects?

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cartoon-doctor

Hello again. It’s Dr. Louella, just winding up my weekend here. I’m a bit tired but still very much excited that I got some time to do this post.

You see, yesterday I was musing on a young patient I had seen earlier this week. He had asked me one of the most frequent questions I get from patients.

But let me give you the context of this case first. It was another busy chronic disease clinic. The ‘patient care attendant’ told me about a walk-in patient to be seen who had chest pain.

I asked for his age. He was 22 years old. Cool. I ordered an ECG ( EKG, electrocardiograph; or ‘heart tracing’) and said that I would see him later.

A few patients later they brought a perfect ECG for me in ‘normal sinus rhythm’ with no abnormalities. Good. No serious heart problem. I saw him a few patients after that.

Normal-Master

He was a healthy looking young male. It was easy to make the diagnosis. He told me he had central chest pain. I asked him why (because most of the times patient already know the cause). He confessed to having lifted some heavy boxes of meat the day before.

I did a brief examination of the heart, lungs and chest wall. He had a muscular strain. Case closed.

But not quite. When I attempted to prescribe an analgaesic (pain killer) for him I was confronted with the oh too familiar question…

“Does this drug have any side effects, doc?”

I think this is where public education should step in because I am asked this question repeatedly nowadays. People need to understand these simple concepts so they can make informed choices.

I start by replying, ‘Of course. All tablets have side effects.  If you look in my book right here (the British National Formulary on my desk), each drug has a long list of side effects.

And there is no way for anyone to remember all of them. That’s why I walk with my book. Doctors usually know the most common and/or most serious effects.

BNF 2009

I like to refer to them as potential or possible side effects because it does not mean that you are going to get them.

Research is done so they know how many people suffer with each side effect of a drug and it is usually a very small number, like 5% or 0.5%. If many people are affected they wouldn’t allow the drug to be sold.

Now for the most, you may get one side effect of a drug. Or if you are really ‘bad lucky’ (Trinidadian for ‘unfortunate’) you may get two.

No one can predict whether you will get a side effect. It is only if  you use the drug you will know the effect. If something happens we  will deal with it. But we would not want to lose the benefit of this drug for no reason.’

Now there are some conditions where I can tell patients that using a medication is optional, such as for pain, itch or stomach discomfort but for diseases such as diabetes and hypertension which can ravage their lives, I urge them to take their pills everyday.

Many of our patients have heard from friends and family that these medication damage their kidneys and liver. They often do not take them as a result, or take them intermittently to mitigate these supposed effects.

Liver and kidneys

I stress to them that chronic diseases (especially diabetes and hypertension)  are the ones that have been proven to damage their organs. The pills are given to them to protect them.

Yes, sometimes the pills themselves can damage organs but this is rare compared to diabetes and hypertension which ALWAYS impair kidneys, whether to a minor or great extent.

People get complications and die of chronic diseases all the time. I don’t really hear of people dying from their medication. But I know it probably happens.

Our patients are also exposed to television advertisements where side effects of drugs are rattled off. But without the explanation I gave above we can see this turning people further away from conventional medicine if they believe that all these negative effects would happen to them.

The young man I saw that day accepted my prescription in the end. He understood that the likelihood of him getting a side effect of the drug was slim and we would deal with that if and when it occurs.

I also explained to him that although he was young and fit there was no reason to strain his body beyond its capacity as he had done recently because he would suffer for it. Damaged muscles often take several months to heal.

chest-muscle-strain

Unlike the young man, some patients turn to alternative medicines. They are free to do so but I let them know my position on it.

I let them know that the medicines we use originally came from plants but they have been purified and from them synthetic ones were made.

All our drugs are extensively researched and the effects documented. Yet allopathic medicine is still far from perfect.

Many herbal products are not purified and contain several chemical compounds with varying effects. There is very little in the way of formal study of these chemicals.

Claims are based on anecdotal accounts (of people’s personal experiences) rather than on large controlled studies. Anyone can sell anything and claim anything about them because there is no regulation of these products. But not everything ‘natural’ is safe.

Alternative-Medicine-of-Pros-and-Cons

But the thing is, it’s not that herbal products don’t have side effects. It’s just that the people distributing them don’t know, so everyone pretends like they don’t. And when people experience them, does anyone sue the herbalist? No! But sue your doctor, because he is rich!

Never mind that, if you see Dr. Louella dying, bring me the tablet, bring me the ‘erb, the weed, bring anything!!!

But while I’m living and can make a rationale choice, bring me the evidence to support your medicine!

Dr. Louella saying, do enjoy your day! Laugh! Sing! Dance! … I do!!!

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