It is commonly believed that drugs have effects and side-effects. The understanding is that the effects are good for you, but that they come with side-effects. Nevertheless, the benefits are regarded as being worth the risks.
Dr Brom examines these statements.
I once had an obese 80-year-old male patient complaining of a cough of about 2 months duration. He had already received two courses of antibiotics plus a bronchodilator, but to no avail. His cough remained persistent and had now become quite mucous-producing. On further enquiry, I discovered that he was also taking a diuretic, a beta blocker and a calcium blocker for his blood pressure. Doctors have become so accustomed to prescribing drugs that they are not always sensitive to what they are prescribing.
How do drugs work?
How do drugs work, and why are they so often effective in treating symptoms? The general category of the drug usually clearly states its action and the indication for its use. However drugs in all categories interfere with some natural biochemical process in the body by blocking or inhibiting. Antihistamines for example, block the production of histamine. Members of the public regard antihistamines as a normal medication to use for a host of allergy symptoms such as blocked or running nose and itchy skin. They are even given to babies and children with sleep problems. What is generally forgotten is that histamine is a naturally occurring chemical within the body with very specific physiological roles. Keep in mind that I am now referring to ‘histamine’ which is produced naturally in the body and not a drug of the class ‘antihistamines’. Histamine has a modulating role in a variety of inflammatory and immune responses. It plays an important role in acute inflammation following tissue injury, promoting dilatation of the blood vessels and leakage of inflammatory fluid containing all the agents required for healing of the injury. Histamine has a powerful effect on smooth and cardiac muscle and on certain cells of the blood vessels and nerve cells. It stimulates gastric acid secretion from the stomach lining and there is evidence that it acts as a neurotransmitter in the brain.
With the above actions in mind one can understand that the drug class ‘antihistamines’ has been developed to stop acid secretion in the stomach, for sedative effects, drying up of mucous, anti-allergic effects, prevention of motion sickness and dizziness, reduction of inflammatory responses, etc. As the physiological effects are better defined it has become possible to develop drugs with more specific actions. Every attempt is made to be more selective in producing these drugs because clearly the more selective the drug the less it would be expected to interfere with too many functions in the body.
All this sounds very good and useful, but some important considerations need to be evaluated. The body is intelligent and histamine is a major chemical with important physiological effects. What happens if acid secretion is blocked, if there is an interference with the inflammatory and allergic responses of the body? Doctors will point out that stomach ulcers disappear, noses dry up and children sleep through the night. All this may be true, but what is also true is that a natural physiological process is stressed and interfered with and this stress produces the side-effects that are the most important reasons why people eventually stop using drugs.
Effects and side-effects
What are side-effects? They are the poisonous effects of drugs, the result of interfering with the natural physiology. What are the effects? They are also the poisonous effects of drugs, the result of interfering with the natural physiology. So is there a difference between the side-effects and the effects? No! Effects and side-effects are really the same. Drugs are relatively simple chemicals that interfere with physiological action, and although doctors often refer to effects and side effects, what they mean to say is that the ‘effect’ is the main reason for giving the drug and the ‘side-effects’ are the baggage that comes with it, but in truth the effect and side-effects are the same. A drug must be given in a dose that interferes with function. Even a ‘small’ dose to alleviate symptoms must be strong enough to block a natural physiological function. Drugs are powerful chemicals and a handful of the drug is enough to kill most individuals.
Prescribing anti-inflammatories for arthritis or other painful conditions may appear to make good sense. After all, the inflammation is painful and uncomfortable. Nevertheless inflammation is the way the body heals injured tissue. In that inflammatory fluid are the very chemicals required for healing. Anti-inflammatories interfere with this process. They do this by interfering with prostaglandin biosynthesis and blocking the action of certain enzymes, inhibiting the migration of white blood cells into the inflammatory site and interfering with other chemical mediators required in the inflammatory response. While acute inflammation is generally regarded as beneficial apart from its pain and discomfort, chronic inflammation may seem to be another story. Chronic inflammation can lead to damage to joints and organs and even serious heart problems. Nevertheless, anti-inflammatories which relieve many of the symptoms of inflammation still do all this by interfering with function, not only in the area required but all over the body.
So, we gain a bit and lose a bit. Risk versus benefit, your doctor may inform you. Just another poison in your body. But taking this drug for months, years and even for the rest of your life seems a little scary to me. Symptomatic medicine means treating symptoms, but it is important to understand the consequences of this approach. Antidepressants, anti-inflammatories, skeletal muscle relaxants, bronchodilators, anti-hypertensives, etc. all exert their action by interfering with function. There is always deep intelligence behind every action and process within the body. Inflammation is a response of the system to stress of some kind. The excessive histamine producing the symptoms of hayfever is an attempt by the body to protect itself. High blood pressure is not an accident of nature but a response to stress of some kind within the system. The body system will always respond to stresses whether they are chemical, emotional, mental or electromagnetic. Interaction between causes and the body’s attempts to respond to these factors creates the symptoms and signs of illness. Any chemical drug can only work by blocking a physiological process in such a way that the symptoms and signs are changed. The consequences of such an action are the side-effect profile of the drug, which will vary in each individual according to the unique nature of that person’s biochemical profile. The common ‘water tablets’ (diuretics) given to people with hypertension or edema or water retention of some kind is really a misnomer. The way these medicines work is to push minerals out the body through the kidneys. The minerals drag water with them. Over time diuretics will cause loss of potassium and magnesium and disturb the delicate balance of minerals in the body.
So is there a place for drugs in this modern age?
Clearly there is, and despite everything I have stated above, right now, we would probably be much poorer without drugs. They have a very clearly defined role to play, but at the same time anyone taking drugs needs to know the risks attached and the other choices potentially available. Natural medicines are not nearly as powerful as drugs. They don’t need to be. Natural medicine is not meant to interfere with the functional integrity of the body. They are not given to treat symptoms. The approach of natural medicine practitioners has been the same since people first started to do something about managing ill health. The question has never been how to treat disease but how to support health. Treating disease and supporting health require different approaches. Natural medicine supports health, and as health improves the health then does the healing. That is the principle. Sometimes this approach is all that is necessary, but drugs may clearly be appropriate to treat symptoms at some time during the course of an illness or if no other approach works.
Integrative Medicine combines both ways of working. Integrative doctors use natural approaches to support health but are also knowledgeable in using drugs if appropriate, and in clearly defined ways. What about the patient mentioned earlier? Cough is such a common side-effect of many antihypertensive drugs that this is often the first place to start looking for the cause. In a New England Journal of Medicine study1 an alarming 1 in 4 patients suffered observable side-effects from the more than 3.34 billion prescription drugs filled in 2002 in the USA. One of the problems is that doctors often cannot differentiate between the disease of the patient and the side-effects of the drugs. Patients often get additional drugs to treat the side-effects of other drugs because doctors think that the symptoms are due to the disease when they are really due to the drugs themselves.
This article has dealt with only a few of the problems with drugs. There are other major concerns such as dependency, increasing use in children as a way of coping rather than offering guidance on better coping mechanisms, the idea that a quick fix is okay and too bad the consequences, the way that doctors hand out prescriptions or give injections without informing patients and giving them choices that include supporting health rather than treating disease, and direct-to-consumer advertising that puts pressure on doctors to prescribe drugs.
While the FDA and other Medicine Control Councils worldwide have an obligation to protect the public, their job is difficult and often hampered by pharmaceutical pressure, patient pressure, doctor bias and especially the fact that as indicated above, all drugs are chemicals that interfere with function and can always cause unpleasant side-effects in some people. How do you regulate a chemical when firstly by its very nature it is meant to block a natural physiological process, secondly the potential effect on the person receiving it is unknown until the person has taken it, and thirdly it may not be possible to differentiate any long-term effects from the natural course of the disease itself. The General Accounting Office (an agency of the
US Government) found that of the 198 drugs approved by the FDA between 1976 and 1985, 51.5% had serious post-approval risks. These risks included heart failure, myocardial infarction, anaphylaxis, respiratory depression, seizures, kidney and liver failure, severe blood disorders, birth defects and foetal toxicity and blindness. I want to emphasise that I am not against drugs. They have a very particular and important role to play. As medicine moves towards a more holistic and integrative process we will begin to see a more appropriate inclusive role of natural medicines, drugs and surgery.
- Gandhi TK, et al. Adverse drug events in ambulatory care. N Engl J Med 2003; 348:1556-1564.
- Lazarou J, et al. Incidence of adverse drug reactions in hospitilized patients. JAMA 1998; 279:1200-
- Forster AJ, et al. The incidence and severity of adverse events affecting patients after discharge from hospital. Ann Int Med 2003; 138:161-167.
- GAO/PEMD 90-15 FDA DRUG Review:Postapproval Risks. 1976-1985 page 3