Chapter 36: Medicines : Boon or Bane?
|Hes the best physician that knows the worthlessness of most medicines.
- Benjamin Franklin
The right drug for the right patient in the right dose by the right route at the right time: this golden rule sums up the ideal prescription. In order to make sure you get the right prescription you need to help your doctor by giving a complete medical history; and informing him of any previous allergic reactions youve suffered to drugs, foods, or dyes and specifying any other drugs you may be taking. If you are a woman, you should inform your doctor in case you are pregnant or breast-feeding an infant. However, before you leave your doctors clinic, prescription in hand, you have still much more to do as a responsible patient.
Make certain that the following questions have been clearly answered before taking any medicines.
Your first step should be to read what your doctor has written ( no matter how illegible the writing may be), and to clearly understand what the hieroglyphics mean! Dont leave with questions unanswered: ask your doctor or chemist for an explanation of any confusing terms on your prescription.
A very useful reference book you should consider purchasing is the Indian Drug Review. This book is easily available at any medical bookshop and is an excellent compilation of details on all the prescription drugs available in India: for instance, their cost; dosage; therapeutic action; drug interactions; and their side-effects. Though this book has been written for doctors, it is easy enough for any layperson to use. Not only will this book help in making you much more knowledge about the medicines you are taking, but it may also help you to save money , as you can select a less expensive brand of medicine, after discussing the matter with your doctor.
Your doctor can also help you save money by prescribing generic drugs. "Generic" means that the drug is not protected by trademark registration; and the generic name of a drug is usually a shortened form of its chemical name, so that any manufacturer can use it when marketing a drug. Usually, a manufacturer uses a trade name (or brand name) as well as a generic name for a drug, and you should be able to identify the generic name and the trade name of every drug you are taking. Generic drugs are generally priced lower than their trademarked equivalents, largely because the former are not as widely advertised as the latter. This means that you may be able to save as much as 40 per cent by purchasing a generic product. However, not every drug is available generically, and not every generic drug is significantly less expensive than its trademarked equivalent. Also, do keep in mind that for certain drugs it is not advisable to shop around for an alternative, because differences can exist between brands of certain drugs. For instance, the tablets or capsules from different manufacturers may not dissolve in the stomach at the same rate or to the same extent, because of variations in the way they are made or because of the fillers (non-active ingredients) that are used. It is, therefore, important to discuss with your doctor or pharmacist the advantages or disadvantages of any particular generic product.
The amount of medicine you buy at a particular time depends on several factors, the most obvious ones being how much money you have, or how much the insurance company will pay for each purchase. Medicines to treat heart disease, high blood pressure, and diabetes may be purchased in bulk because you will need to take such medicines for prolonged periods. The chances are that you will pay less per tablet or capsule by purchasing large quantities of drugs, and save quite a bit of money: do ask the chemist for a bulk discount !
Many family doctors used to (and some still do) dispense medicines which they ( or their compounders) made up themselves ( in fact, this is how the name dispensary was derived !); for example, cough mixtures . However, this practice is fast disappearing, because it is difficult to control the quality of these medicines. The doctors who still do dispense medicines for their patients basically buy them in bulk from the manufacturers and then sell them to their patients. Such a practice may be cheaper and more convenient for you, but often you tend to be unaware of what medicines you are taking, because they are unlabelled ! Consequently, it is safer to buy the required medicines from a chemist. In any case, you must insist on knowing the names of the medicines you are taking !
All medicines should be kept in their original containers. Different medicines should NOT be mixed in one container. This precaution is absolutely necessary in order to prevent confusion about which drug is being taken. Never remove the label from the medicine bottle. You can safely store most prescription drugs at room temperature and out of direct sunlight. Some drugs require storage in the refrigerator, whereas some other medicines should not be refrigerated.
As mentioned earlier, you should be able to understand the details of your doctors prescription. If you cant do so, even after deciphering his hand-writing, the abbreviations listed below can be helpful. Some doctors still use these abbreviations ( a hangover from the old days, when prescriptions were written in Latin, so as to deliberately prevent the patient from understanding what medicines he was being given !)
ad lib Freely, as needed
b.i.d Twice a day
h.s At bedtime
p.r.n As needed
q.4.h Every 4 hours
q.i.d Four times a day
t.i.d Three times a day
While its still as difficult as ever to decipher the doctors handwriting, fortunately many doctors now computer printouts for their prescriptions, to ensure legibility !One should never misuse medicines. While medicines are useful in the treatment of certain illness, the overuse of drugs has taken its toll, not only in the form of unnecessary expenses but also in the form of sickness, and even death, as a result of an adverse reaction to the medicine. Patients still believe that there is a pill for every ill - and this desire for instant relief translates into billions of rupees for millions of pills, potions, ointments and powders. ( The pharmaceutical industry in the second-most profitable in the world - right after illegal drug trafficking !) Most people take one medicine at least weekly, and more than 25% of the worlds population consume drugs on a daily basis. Most patients are not happy unless the doctor prescribes a medicine for them - whether or not they really need it. Often, doctors too will contribute to this "overmedication syndrome", and the huge advertising budgets as well as the largesse of pharmaceutical companies lure them to do so on a regular basis.
You must, however, understand that no drug is without side-effects - after all, anything which has the potential to do good also has the potential to do harm. A therapeutic effect is a desired effect, and a side effect is an undesired effect - but both are simply effects of the same drug on the body, and go hand in hand ! Remember that 80 per cent of all illness are self-limiting and require no treatment . Therefore, think carefully about the costs and risks as well as the benefits before taking any medicine.
You should be especially careful when your doctor prescribes the "latest" and newest drug. For one, such as drug is likely to be much more expensive than its older counterparts. Drug companies nowadays spend large amounts of money in order to induce doctors to prescribe there newest products, because they are much more profitable for them. Also, remember that newer does not always mean better - in fact, new drugs may be more dangerous! since they have not been used for long enough, as a result of which some of their harmful effects may not become apparent until many patients consume them over a long period of time. Older medicines, which have been tried and tested over many years, are a safer bet, because doctors have considerable experience with them, and are aware of their risks and benefits. For example, Duract, a new non-steroidal anti-inflammatory drug (painkiller), was withdrawn from the market just a year after being approved for use in the USA (after having undergone rigorous testing), because it was linked with a dozen cases of liver failure, four of them fatal !
Theres really no such thing as a safe drug, in the sense that the term means a drug completely free from harm or risk to everyone. The best drugs are simply those whose benefits far outweigh their hazards. Aspirin, for example, is an excellent painkiller and has been proven to prevent heart attacks. But it isnt totally benign either, and can sometimes causes serious gastrointestinal bleeding or, in rare cases, leads to Reyes syndrome in children.
Surprisingly, no one knows how many deaths, injuries, and side effects prescription drugs cause each year - there is no agency which monitors these effects! Whos responsible for this modern epidemic of drug - induced disease? The answer is: all of us! Pharmaceutical companies, for a less than rigorous study of their approved drugs, physicians, who incorrectly prescribe drugs, or over prescribe the latest drug; patients who dont follow their directions or dont tell their physicians about the other drugs they are taking; and even government agencies for not monitoring drug safety more carefully. As a patient you can help to protect yourself form a therapeutic misadventure by not opting for a newly approved drug unless there arent any other, well-established alternatives : old is still gold ! Also, if you think a prescription medicine is causing a serious side - effect, inform your physician at the earliest. If the problem is drug related, encourage him to report it to the relevant government agency.
Older people are especially prone to the problem of unnecessary drugging. It is astonishing how often neither the patient nor the family knows vital facts such as the name of the pills, what they are supposed to do, their correct dosage, and what possible side-effects they could produce! Often, once a doctor starts a patient on a medicine, the latter continues taking it, whether or not he needs it any more. And each specialist adds his mite to the drug overload, invariably without having a clue what else the patient is taking . Not uncommonly, it turns out that only one or two of the assortment of drugs are really needed and, once the unnecessary medicines are eliminated, the patient starts feeling much better !
A good doctor is one who knows about all drugs, but who prescribes as few drugs as possible - someone who believes in therapeutic minimalism. In contrast to todays enthusiasm for drugs , it is wiser for you to be a "therapeutic nihilist" as well, in order to let the body heal itself whenever possible.
The following factors should always be borne in mind:
The following checklist can help you to learn more about your medicines :
Medicine _________________________ _____________________
(Brand name) (Generic name)
Dosage ___ mg ___ cc 1X___ 2X___ 3X___ 4X____ Daily
Should the drug be continued or stopped when symptoms are better? __
Should the drug be taken before, with or after meals?
Should I avoid: Alcohol? Yes ___ No ___ .
Should I avoid particular food or other drugs? ______________________
Pertinent diagnosis ________________________________________________
For symptoms only? Yes ___ No ___ Which symptom? ____________
Is drug necessary for cure? Yes ___ No ___
Will the condition resolve without treatment? Yes ___ No __
Is there an over-the-counter alternative? _________________________
Is a generic substitute acceptable? ______________________________
Is there any written information about this drug? __________________
Common side effects What to do if it occurs
Rare side effects What to do if it occurs