What Are Those Prescription Drugs Doing in Your Body, Anyway? – You live in your body – not your doctor, Part III
It was a long and arduous process, but after years of research and millions of dollars, various drug companies have probably managed to offer you remedies for some of your ailments. These remedies came in a little brown bottle full of pills expertly prescribed by your physician. Probably, some pills made you feel better, some made you feel worse and others just plain didn’t work.
They usually come in a small pharmacy bag with all manner of warnings stapled to them. If your prescription came in packaging from the drug maker, it also came with a rice-paper thin, folded up tome of science gibberish. This is alternately called patient information, the package insert or just “the PI.”
You probably routinely throw out this little nugget and just read the dosage stickers and “take with food” icons affixed to the bottle. Go to the trash and get that paper out.
No seriously, now. This PI is a treasure trove of information you never knew you wanted but that you really should have. If it’s covered in coffee grounds already, then go to the drug website and find the “patient information” or the “important safety information tab.”
OK, there are few reasons –most are boring except to nerds like me–but, the most interesting reason is side effects. Side effects may also be referred to as “adverse events.” Lately they’ve been called “untoward events” – which sounds more like you didn’t mind your manners at afternoon tea, than that your drug gave you unremitting diarrhea.
In any case…the side effects are important to know about, so you can recognize if you are experiencing any and can tell your doctor. But the concept of “side effects” is essential to understand because of what it implies.
Side effects tell us about the lack of precision of a medication. Again, I will caveat – I am a medical writer, and not against Western drugs used appropriately. But rather, I want to illustrate our role as patients in the use of these drugs. And one way to illustrate this is to learn about what these things we willingly ingest are, in fact, all about.
A clear cut and common example is morphine. If you have had surgery, you have almost certainly had morphine or some opiate derivative of it (OxyContin, Oxycodone, codeine, dilaudid, etc.).
Opiates dull pain. They act on opioid receptors in your brain and spinal cord to stop your perception of pain. Useful.
The point is:
1.) It will behoove you to know that morphine can do this – because post-op constipation is particularly painful and can be prevented or mitigated if you know it is coming.
2.) The body uses these same receptors for completely different functions – and your bloodstream will carry the drug to most or all of these receptor types. This means the drug may act in many places, not just the one that you (and your doctor) want it to act.
Furthermore, this only addresses the receptors we do know about. We don’t know how every cell works or how every substance that comes in contact with those cells is going to react. Some side effects don’t make sense to what we know yet… as I pointed out in my previous entry, science is still evolving and learning. There are still a lot of unknowns…
Makers of prescription medications go through some serious hoops to 1) identify side effects, and 2) to justify that the curative effect of the drug outweighs the side effects.
It’s high time we as consumers of those drugs go through one or two hoops to learn about what we are ingesting - both for our own safety and for our education. (It’s fun, really, I promise!). It is your body, after all, that you are putting that medication into. Your doctor doesn’t suffer the side effects - you do. So, ask him or her what to expect. Read the materials.
Empowering yourself to understand what the drug may do or shouldn’t do will help put you in charge of your own healing, let you know when you should call your doctor for more help and provide education about the wonderfully fun things we call our bodies.
That said… needing to take as few drugs as possible should be all of our goals and something we all try to work toward. So, please make the lifestyle changes that can make that possible, if that’s applicable to you. But if you do need to take prescription meds – understand as much as you can about them before you ingest them.
“Organic.” When that word first took root in our parlance people used it in business meetings to suggest that their project (or business) would grow unfettered. I don’t know about you, but this usage of “organic” along with other yuppie words (like “facetime”) made my head spin.
But the reason “organic” wheedled its way into our vernacular was not because it implied that a business project would have a higher vitamin content. It just meant it wouldn’t be unduly cultivated by outside forces. The project would just grow, as apparently nature intends business projects to do.
Let me be clear before I continue. I am not recommending organic or non-organic food in this blog. I only aim to illustrate how an article can bias science facts — just by how it was written. I am using the New York Times article as an example. But many similar pieces across publications came out the same day.
1.) Let’s start out of the gate with the opening line: “Does an organic strawberry contain more vitamin C than a conventional one?”
If you were hooked by this, you may have been lured into “accepting the premise.” If you accepted the premise, you may have then thought that organic food should be more nutritious and it should have more vitamins than non-organic food.
It should not.
If you read the Organic Food Production Act (I just did, and it’s actually pretty interesting. OK, it is not even half as interesting as the celebrity photos on HuffPost, but it is worth perusing), you will see that there is no mention of nutrition, nutrients or higher vitamin levels whatsoever.
Read more on Huffington Post
The year before last you couldn’t go more than one winter week without a headline or news anchor telling you that your winter blues may be due to vitamin D deficiency, at which point vitamin manufacturers and sellers everywhere littered your grocery store aisles with vitamin D bottles. We all took loads of vitamin D.
Jump two years forward. A recent study came out suggesting that vitamin D deficiency does not cause depression, but data implies it is the reverse. Depression causes vitamin D deficiency. Right.
There is a link between vitamin D and depression. That seems clear. What that link looks like, though, is still somewhat uncertain. This raises three important issues.
To read the full article please click here to go to the Huffington Post.
Huff Post is picking up my blog – so if you like it, please do say so on their site!
The only thing more impressive than how much we know about biology – both in scale and content – is how much we don’t know. Yet, a pervasive thought exists that might have been borne out of the vaguely all-knowing feeling that Google gives us. The world thinks that science knows how the body works – entirely.
This gives me a chance to use my favorite neuroscience quote; “Our understanding of something as simple and straightforward as, say, looking at a tree, is not even clear,”said Dr. Eric Nestler, chairman of neuroscience at Mount Sinai Medical School.
Looking. At. A Tree.
The next giant medical discovery you read about, please remember that we do not know what it means for you to look outside and comprehend a tree.
Now, I am no naysayer of Western medicine and you’d be hard pressed to find someone with more respect for science. In my research as a medical writer I am constantly amazed by the leaps in modern science and medicine. Heck, I am still in awe of antibiotics; those things are great! (When used appropriately, obviously, as inappropriate usage is surely going to hasten the next plague.)
But this amazement is also held in check by a pretty thorough understanding how much – or how little – we know about medicine, drugs and biology. I have often had to write “the mechanism of action of this drug is unknown.” Even when the topic I was writing about was the mechanism of action.
We have some very good guesses at how some things work. And we solidly know how some other things work. This turns out to be enough to create some extremely effective interventions against many wicked diseases. But there are still several Grand Canyon-sized gaping holes in our knowledge of biology and medicine.
Why is this critical to how we think about healthcare?
Because, as I had written in a previous entry, we have handed over our health to physicians and to medicine in a blind act of trust that they can (and indeed that they should) figure it all out for us.
In doing this, we’ve removed a huge source of data about our own health. Namely – us.
Yes, trust your doctor. (Well, first research this person thoroughly…then do the trusting.) Yes, medical advances are amazing. And YES, we should do everything in our power to ensure that science research is ongoing because eventually – even in uphill battles like HIV vaccines – science can prevail.
BUT… no, we should not treat medicine like it is magical, infallible, or all-knowing. (Really, only Google maps is all-knowing – and seriously, what IS that?!) Science is the best thing going, but is still discovering new & exciting details about you.
It is not science’s fault. A human body is outrageously complex. And there are presently about 7 billion human bodies going on about life on this planet – each one a tiny bit different from the other. Sometimes that difference doesn’t matter much at all, and others it matters a great deal. Think anaphylactic shock from something as innocuous seeming as penicillin, for example. Most of us can take penicillin…but others have a life-threatening allergic reaction to this potentially life-saving antibiotic.
On the whole, we do have a good deal of biology in common with each other – even with many animals. But individual variance among we 7 billion is, well, significant.
This variation may mean a drug doesn’t work for you at all, or is the best thing for you, or causes an allergic reaction. This is part of the reason why it’s so critical to get back in touch with your body. To know your individual variations. Get to a point where you can hear your body talking to you, so that you trust yourself about yourself.
There’s another rather huge payoff, too. Stress reduction. According to stress physiologist Dr Robert Sapolsky, having a sense of control and ability to predict an outcome reduces your stress response. Over the long term, this may reduce your chances of suffering from a stress-related illness.
You get that sense of control over your body by understanding your body. You are a valuable, significant source of data that CONTRIBUTES to medical knowledge – not just someone who is affected BY it.
Do this and you can make your doctor a partner in your healthcare – not your guru. It just may improve your healthcare, and is bound to improve your health.
I don’t know when it happened, exactly. But at some point in the last few decades, we as a nation, collectively turned over our bodies to doctors and said “here, fix this and get back to me when you have it sorted out.”
It makes some sense. We need lawyers for legal things. Accountants for the undecipherable tax code, and so on. We outsource complex things to complexity experts. It’s a useful division of labor.
But outsourcing your health is not as uniformly advantageous. It works well in complex or emergency situations – and is the right thing to do in those cases – but not as well as in the ho-hum of everyday malaise.
And most disease is of the ho-hum variety. It is a slow creep toward a tipping point. Most disease is really quite boring. And that’s a good thing – you never want House to have to fix your health. Most people would have died before the 3rd commercial break.
But this also means that most of disease is in our day-to-day, ho-hum lifestyles. I could quote the statistics – but we’ve all seen them. Preventable heart disease, diabetes, lung cancer, etc. – all the heavy hitters are preventable or least modifiable …if we’d change our habits.
So why aren’t we changing our habits? We seem not to change until we are forced. And even then someone has to enter us into a TV contest and pay us to lose weight.
I am going to tackle this in a few parts. The next issue will be about the limits of science & medicine. But for now, I will focus one on facet of the patient’s role.
A useful analogy is your car. If your engine falls clean out of your car, you’d likely hire an expert to put it back. But surely, you fill your car with the right gas, get the oil changed and keep it running all without your car mechanic’s sign off? Your car has a dashboard full of indicators telling when to do all these things – it’s easy.
Your body has these indicators, too. But we have coated the dashboard in butter-laden Bolognese pasta, tubs of frosting, and fountains of soda pop. We can’t even see the indicator lights anymore – they are covered in nutella.
Even if indulgent desserts are not your vice, how many times this week alone have you “pushed through” to make a deadline…to endure some sort of pain when your body wanted rest…to appear tougher than you are? We let our speedometer read 145 mph and our engines overheat then we wonder why our cars wouldn’t go to sleep when we finally got it home from a 16 hour day?
Whatever we use to cover it up, the fact is that many of us have lost touch with our useful, gently calibrated blinking light dashboards. To compound the issue, biology is actually quite obliging on this point. If you fill your body with sugar every day – your homeostatic balance will reset. This is true of almost every physiological set point. If you are not a sugar eater – and you eat a whole chocolate bar, you are going to feel giddy, jumpy, possibly nauseous. But if you do that every day, your body will adjust. You will not feel giddiness anymore – but the damage to your cells will continue, unbeknownst to you. You have created “tolerance.” Tolerance decreases the sensitivity to the feedback from your body.
If you are suffering from obesity, type II diabetes, stress or any number of diseases that have accumulated slowly – you may not even remember what health feels like. And in that case – it is plenty difficult to be motivated to change. What are you trying to change to? You are used to how you feel, now. You are tolerant of it.
Last week I talked about numbing out. I believe that this is part of the problem here; we are numb to our own bodies. And in the numbness, we don’t get feedback at the right levels anymore, so we turn to doctors and ask them to tell us what the feedback may be. Doctors are here to help you when the problem has outpaced your skills, or has become complex and you need their expert care. They can help put you back on course – but once you are back on course, how you drive is up to you. And it’s worth taking that mantle back.
The good news is this. Just as biology reset your homeostasis in one direction – you can leverage biology to reset your homeostatic balance in the other direction.
The human body is the most precision instrument on our planet. It puts a Formula 1 Ferrari to shame. Use your health care providers like a pit stop crew, but remember you are the driver. You win the trophy at the end of the race, not the crew.
This issue is obviously more complex than I’ve outlined here – and I am happy to talk individually on it and how to reset your homeostasis. But I wanted to scratch the surface of what I think is an enormous problem we face in the West of hoping that there is a pill which will cure everything.