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The 10 Commandments of Medication Usage.

By Chris Rangel MD ⋅ June 13, 2005 ⋅  Email this post ⋅  Print this post ⋅ Post a comment

The 10 Commandments of medication usage

1. Understand that every single medication that you use can and will have side effects. There is no 100% “safe” medication. This may seem self-evident to many but as the case above illustrates, many people are too willing to believe that their particular medication is completely safe.

2. Understand the risk-benefit concept of taking medications. Because there is no 100% safe medication there will always be some amount of risk involved in treatment by medication. When you take a drug you do so because the expected benefit of the drug outweighs the risks and the amount of risk is acceptable to you. The actual amount of benefit and risk involved is usually very difficult and impractical to exactly calculate and is unique for each patient and each drug. However, just simply understanding the concept that there is always risk involved is critical.

3. Educate yourself (or your care provider) on the risks and effects of every medication you take. This is your obligation to yourself. This happens to be your physician’s obligation as well but it does not release you from your obligation to be an educated patient. If you have questions then ask you doctor! If your doctor doesn’t or can’t answer your questions to your satisfaction then get another doctor (if possible) or talk to your pharmacist and be sure to read the information about your medications that comes with your prescriptions.

4. Resist the temptation to self diagnose. I.e. consult with your doctor before you alter your medication dosing or stop your medication. Not all symptoms are side effects of your medication. They may be related to your underlying illness and should be communicated with your doctor. It is your doctor’s job to figure out if your symptoms are medication related or not. It is your job to communicate with your doctor. And never take medication that is NOT yours even if you feel completely certain that you know exactly what ails you and how to treat it. You may be putting your very life in danger just to save yourself a few bucks and the hassle of seeing a doctor first.

5. There is no guarantee that the medication you are taking will be effective in treating your illness! We don’t yet have the technical ability to know exactly what drug at what dose will work in specific patients for specific problems. Almost always it is a matter of trial and error in the case of medications prescribed for acute symptomatic illnesses. The same goes for medications prescribed for often asymptomatic chronic illnesses like hypertension, diabetes, or hypercholesterolemia. These medications taken chronically reduce but do NOT eliminate the risk of subsequent catastrophic illness as a result of these conditions. Just because you take aspirin every day does not mean that you will never ever get another heart attack or stroke.

6. ALL medications should be considered to be experimental. What I mean by this is that medical science is continuously learning new things about the medications that you take. Some of these new things are good like new health benefits and some of them are bad like discovering previously unknown side effects or health risks. There is no way to predict the evolution of this process and often research on FDA approved medications takes years or even decades to complete. Newer medications tend to be safer but we know less about their use than we know about drugs that have been around for many years. Just keep these risks and uncertainties in mind.

7. Beware of specific drug information obtained from “unofficial” sources i.e. anyone other then a doctor or pharmacist who does not act in the best interests of the patient. Many web sites make their money by hyping the bad effects and risks of medications while downplaying the benefits. Often they do this because they are selling some type of “alternative” medication or therapy. Remember, these web sites only have their own interests in mind, not yours. Ironically the reverse goes for ads directly from the drug companies themselves that hype the benefits and downplay (or neglect to mention) the risks. Don’t believe the hype. If you have questions see commandment #3.

8. Over the counter medications can be just as dangerous as prescription medications! OTC drugs can worsen certain conditions or interact with your prescription medications. The same goes for most herbal medications as these are not regulated by the FDA. See commandment #3.

9. Try to use medications only if necessary or as a last resort. This may seem a strange statement coming from a medical doctor but as a society we depend far too much on medications and most physicians are all too willing to accommodate. I.e. not every fever demands an antibiotic, not every pain requires a narcotic, and as I suspect is the case as with the example above not every “depression” requires an antidepressant. It used to be that we prescribed medication only for severe cases of clinical depression (i.e. where the patient is unable to function and/or who is truly suicidal). Now we hand out SSRIs to anyone “having a bad day”. If you don’t absolutely need to take a drug then don’t. Avoid the risks of medication when ever possible.

10. Fight the “pill society mentality” - This is similar to commandment # 9. The future of the pharmaceutical industry is to develop so called “lifestyle drugs” i.e. those drugs like Viagra that promise to improve our lives rather than simply to treat illness. But Viagra does not have the properties of an aphrodisiac and the late weight-loss drug Fen-Phen helped its users lose only a few pounds while causing an increased risk of heart valve damage. We should not expect medications to cure all ills and lead to a risk-free and effort-free state of happiness in some sort of modern realization of Huxley’s brave new utopian nightmare. Sadly, the second the next brave new weight loss pill rolls off the R&D shelves hundreds of thousands will be in line waiting for a chance at risk-free and effort-free life improvement even though such a thing does not exist.