Why Doctors May Prescribe You More Side Effects Than Rx.
It's an all-too-common scenario. A patient is put on a drug and proceeds to develop a litany of effects to body and mind. Many patients ride it out, depending on their level of discomfort. Others return to their health care provider only to be told that they have never heard of such effects and that their current maladies are a separate entity, or another manifestation of the primary illness for which they were prescribed the drug. The patient may go away unaided, or may be given a new prescription to treat the new symptoms.
A close friend developed serious anxiety and was put on Paxil. He developed severe burning of the skin, flu-like symptoms, anguish of soul, and for the first time, suicidal depression. Complaints to his doctors were treated as new manifestations of the anxiety disorder, this because, as his doctor said, such side effects weren't caused by Paxil. He suffered greatly, nearly committed suicide, and after 2 months finally developed a tolerance to the medicine and was able to function to a degree. Over the course of years, Paxil "stopped working" and other medicines were tried. A pattern became evident. Whenever my friend started or increased the dosage of an SSRI, he experienced similar effects. He learned a new term: treatment-emergent effects. He was then able to note the correlation between starting a medicine and the emergence of side effects. He searched web sites where people talked about their experiences with SSRIs and found that he was not alone. He was then able to stand up to the doctors who passed off what he was feeling and be more convincing to them that the effects were indeed caused by the medicines.
We often learn in news sources that roughly 100,000 people die each year from the side-effects of medicines, or from drug-drug interactions. That's the extreme end of the unintended consequences of doctors not having a good handle on medicine side effects. How many more people survive, but experience a negative consequence somewhere along the continuum of discomfort to permanent damage? Of course, many side effects are known to the industry and are published in the Physician's Desk Reference. And many people forge ahead with drug treatment, knowing the potential side effects, but are willing to bear them in order to get help for a more severe condition.
Why do there seem to be so many doctors who are oblivious to the side effects of medicines? I don't know the percentage of doctors who fall in to this class, or how many doctors are pretty good at managing side effects, but occasionally get caught off guard. But I know that too many people are dying from them, and my own experience has been negative enough that I say there is a problem. Possible Reasons?
1. Doctors don't spend enough time with a patient. In the few minutes you have with them, they make rapid decisions about your condition, write a quick prescription, and send you out the door so they can move on to the next patient.
2. Doctors aren't familiar with the potential side effects of a particular drug.
3. Doctors aren't familiar enough with their patient's reaction to drugs.
4. The Physician's Desk Reference (PDR) lists drug side effects and interactions. This may be useful to the extent that the doctor refers to it. But not every patient will develop any or every referenced effect. Thus, a doctor, even when referring to the PDR, proceeds with the prescription, backed up by the printout of side effects given to the patient by the pharmacy, and then instructs the patient to contact them if any side effect develops.
5. The PDR may not contain every possible side effect. This is especially true for new drugs. The side effects were determined during drug testing, involving a relatively small group of study participants. Invariably, the longer a drug is on the market, the more side
effects become known. Prozac was originally thought to cause weight loss and energy. Now it is known that many people suffer weight gain, fatigue, and sexual side effects. Vioxx is another recent testament to post-drug-approval side effects becoming manifest. These side effects eventually make their way in to the PDR, but it may take years. Look up side effects for a new drug, and the list will be shorter than the list for an older drug, even in the same class. Unfortunately, the drug-treated public is part of an extended drug study.
6. Doctors often rely on the information given to them by the drug company representatives. You know them. They are the ones who butt in front of you to talk to the doctor after you have been waiting for hours. They usually paint their product in a positive light. Doctors will excitedly begin using the drug based on this information. Then, they'll gather feedback from their patients and draw their own conclusions. Every doctor seems to have their favorite drugs for certain conditions.
7. Patients don't always reveal other prescription drugs, OTC drugs, or herbal concoctions they are taking. Don't remember to? Don't know they're supposed to?
Side effects aren't fun. We would all like to eliminate them. We trust that new medicines will increasingly target certain areas and not be so broad acting in the body. We hope that consumer forces will pressure doctors to spend more time properly diagnosing their patients, noting prior experiences with other drugs, checking drug databases for interactions and educating their patients on what to do in the case of bad reactions. We need improved tools that network doctors, pharmacies, and drug companies so that the latest information is available to the physician, both drug profiles, as well as patient drug history and concurrent medicines. Part of this network needs to be a quick feedback mechanism that reports a patient's experience with a medicine back to the manufacturer, to the FDA, etc so that the latest statistical probabilities of certain reactions can be available to the prescriber.
In the meantime, what can you do to avoid nasty side effects? First of all, take care of yourself so that you don't need drugs: bed at 10, arise at 6, get early morning sunlight into your eyes, eat lots of vegetables and fruits, and other foods in their natural forms (minimizing processing). Eat blueberries and other brightly pigmented fruits and vegetables. Increase omega 3 fats while eliminating damaged fats. Eat balanced meals consisting of quality protein, healthy fats, and slow-burning carbohydrates. And if you are prescribed a medicine, be proactive in your healthcare. Ask the doctor to show you the cautions in the PDR. Get similar information from your pharmacist. Look up the drugs on sites like drugs.com where you can learn more of what to expect. Go to sites like remedyfind.com to see what others have said about the drug. You can even have genetic testing done that profiles your liver's ability to process a drug (genelex.com). Many drug side effects, interactions, and poor drug performance are related to your liver's drug processing pathways. If they process too fast, you won't have enough drug in your body to benefit. If they process too slowly, drug levels can build up dangerously. One drug may speed up or slow down a pathway, effecting other drugs that use the pathway. Listen to your body. Report back to your doctor any worrisome reactions. If they don't respond, go elsewhere. Remember, the doctor works for you. Be proactive. You're in charge of your healthcare.
About the Author
Paul Stout has developed http://drug-pill-med.com as a search engine/web directory to help people locate the best values in medicines, medical information, health resources, and medical supplies.
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