American College of Physicians: Internal Medicine — Doctors for Adults ®

 
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Friday, September 20, 2013

Your medication can kill you

You probably already know that what you do know about your medicine could kill you. You may not know that what you don’t know could do so as well. Hold that somber thought; we’ll get back to it.

You, and I, and everyone else has seen those direct-to-patient drug ads that Big Pharma runs on primetime television. Invariably, they feature a person skipping through butterflies and wildflowers, demonstrating the wonders of better living through pharmacotherapy, as an announcer calmly rattles off the ways the drug can destroy your health: It can make your liver explode, and your eyeballs catch fire, and your kidneys fall out, and so on. But you won’t mind; you are too busy skipping through meadows.

Except, of course, that people do mind! In fact, I can’t understand those ads at all, since the purpose of advertising is to talk people into things, not out of them. Overwhelmingly, my patients who have seen such drug ads are scared to death of those medicines, and very much disinclined to take them. I don’t recall the last time a patient said to me: “I want that medicine I saw on TV that can make my eyeballs catch fire ...” Generally, it’s quite the opposite; if I recommend that medication, they tell me I must be crazy. As advertising goes, this really is odd.

Before getting to my point, I have a few things to point out to forestall a rush to judgment about my motivations.

I don’t like taking medications myself, not even when I need them. Most of my patients seem to feel that way, and I respect it. I am not on Big Pharma’s payroll and have no stake in the use of any drug. What’s more, I have worked for nearly a decade and a half in integrative medicine, in a model of my own devising, side by side with naturopathic colleagues, with a focus on natural treatments whenever possible. Even those looking for nasty things to say about me would really be pushing it to call me a pill pusher. I’m the guy patients come to see when they want alternatives to their prescribed drugs. Seriously.

It is in that context I need to point out that it’s not only what you do know about your medications that can hurt you; it’s what you don’t know. What people tend not to know is the side effects of not taking medication when it’s truly warranted.

I am a 50-year-old guy with five kids and a desk job. I take no medications. My blood pressure is that of a very fit 20-year-old, and my cholesterol is under 150, with HDL higher than LDL. There are more good biometrics where those came from, but that will do. I am not boasting. None of this is evidence that I’m a swell guy, or special in any way. This is all merely the result of practicing what I preach, and using lifestyle as my medicine.

Everyone could do the same with the right skill set, and if more people did, the pharmaceutical business would be a whole lot smaller and less profitable. From my perspective, that’s a consummation devoutly to be wished, and I am doing all I can to help people get there from here. I devote my time and energy to developing lifestyle programs for adults and children alike; to developing training programs in lifestyle medicine for clinicians and patients alike; and to writing books on the topic for both health care professionals, and everyone else. I practice lifestyle medicine, I preach it, and I am passionate about its potential to improve the human condition.

But I am also pragmatic. I look around and see a world awash in chronic disease, stealing life from years and years from life. And while lifestyle is best to prevent all that misery, modern medicines are often best for treating it.

Despite all the valid concerns about environmental contaminants, cancer rates and deaths have declined, not risen, over recent decades, due largely to advances in medical technologies and drugs. Stroke rates and stroke death have declined dramatically, due to advances in risk factor identification, and in particular, better pharmacotherapy for high blood pressure. Heart attack occurrence, and mortality, have declined, due overwhelmingly to advances in both technology, and pharmacology- from clot-dissolving agents, to statins. These are facts of epidemiology, not principles of ideology.

Lifestyle could be our best medicine, and I both plan and pledge to keep doing all I can to help make it so. The very best medicine means less time in clinics, because it reverberates through our culture.

But in the interim, we do have widespread diabetes, and heart disease, and hypertension, and dyslipidemia, and insulin resistance, and cancer, and so on. All too many of us have conditions that warrant treatment, and for which, fortunately, we often do have effective pharmacotherapy.

Here, then, is the point. Big Pharma is obligated to rattle off the side effects of their drugs in those ads; there are no corresponding ads to rattle off the side effects of needed drugs that go untaken.

Yes, side effects of medications can kill. But so can the side effects of declining medications we really need. When prescribed judiciously by clinicians who know what they are doing to patients who know what they are getting, drugs are far more likely to help than harm.

So here’s to needing less medication; we could make that happen. But until we get there from here, I advise an open mind and lack of prejudice. Get good information from sources you trust, and then take the path of most likely benefit, least likely harm, knowing it may or may not involve a stop at the pharmacy.

David L. Katz, MD, FACP, MPH, FACPM, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care. He is a board certified specialist in both Internal Medicine, and Preventive Medicine/Public Health, and Associate Professor (adjunct) in Public Health Practice at the Yale University School of Medicine. He is the Director and founder (1998) of Yale University's Prevention Research Center; Director and founder of the Integrative Medicine Center at Griffin Hospital (2000) in Derby, Conn.; founder and president of the non-profit Turn the Tide Foundation; and formerly the Director of Medical Studies in Public Health at the Yale School of Medicine for eight years. This post originally appeared on his blog at The Huffington Post.

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Blog log

Members of the American College of Physicians contribute posts from their own sites to ACP Internistand ACP Hospitalist. Contributors include:

Albert Fuchs, MD
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000.

And Thus, It Begins
Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich., from which she which chronicles her journey through medical training from day 1 of medical school.

Auscultation
Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.

Zackary Berger
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.

Controversies in Hospital Infection Prevention
Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Iowa City, IA, with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).

db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.

Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.

DrDialogue
Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.

Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.

Everything Health
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.

FutureDocs
Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.

Glass Hospital
John H. Schumann, MD, FACP, provides transparency on the workings of medical practice and the complexities of hospital care, illuminates the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician, and offers behind-the-scenes portraits of hospital sanctums and the people who inhabit them.

Gut Check
Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.

I'm dok
Mike Aref, MD, PhD, FACP, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging.

Informatics Professor
William Hersh, MD, FACP, Professor and Chair, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, posts his thoughts on various topics related to biomedical and health informatics.

David Katz, MD
David L. Katz, MD, MPH, FACP, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care.

Just Oncology
Richard Just, MD, ACP Member, has 36 years in clinical practice of hematology and medical oncology. His blog is a joint publication with Gregg Masters, MPH.

KevinMD
Kevin Pho, MD, ACP Member, offers one of the Web's definitive sites for influential health commentary.

MD Whistleblower
Michael Kirsch, MD, FACP, addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.

Medical Lessons
Elaine Schattner, MD, FACP, shares her ideas on education, ethics in medicine, health care news and culture. Her views on medicine are informed by her past experiences in caring for patients, as a researcher in cancer immunology, and as a patient who's had breast cancer.

Mired in MedEd
Alexander M. Djuricich, MD, FACP, is the Associate Dean for Continuing Medical Education (CME), and a Program Director in Medicine-Pediatrics at the Indiana University School of Medicine in Indianapolis, where he blogs about medical education.

More Musings
Rob Lamberts, MD, ACP Member, a med-peds and general practice internist, returns with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind).

Prescriptions
David M. Sack, MD, FACP, practices general gastroenterology at a small community hospital in Connecticut. His blog is a series of musings on medicine, medical care, the health care system and medical ethics, in no particular order.

Reflections of a Grady Doctor
Kimberly Manning, MD, FACP, reflects on the personal side of being a doctor in a community hospital in Atlanta.

The Blog of Paul Sufka
Paul Sufka, MD, ACP Member, is a board certified rheumatologist in St. Paul, Minn. He was a chief resident in internal medicine with the University of Minnesota and then completed his fellowship training in rheumatology in June 2011 at the University of Minnesota Department of Rheumatology. His interests include the use of technology in medicine.

Technology in (Medical) Education
Neil Mehta, MBBS, MS, FACP, is interested in use of technology in education, social media and networking, practice management and evidence-based medicine tools, personal information and knowledge management.

Peter A. Lipson, MD
Peter A. Lipson, MD, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. The blog, which has been around in various forms since 2007, offers musings on the intersection of science, medicine, and culture.

Why is American Health Care So Expensive?
Janice Boughton, MD, FACP, practiced internal medicine for 20 years before adopting a career in hospital and primary care medicine as a locum tenens physician. She lives in Idaho when not traveling.

World's Best Site
Daniel Ginsberg, MD, FACP, is an internal medicine physician who has avidly applied computers to medicine since 1986, when he first wrote medically oriented computer programs. He is in practice in Tacoma, Washington.

Other blogs of note:

American Journal of Medicine
Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.

Clinical Correlations
A collaborative medical blog started by Neil Shapiro, MD, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.

Interact MD
Michael Benjamin, MD, ACP member, doesn't accept industry money so he can create an independent, clinician-reviewed space on the Internet for physicians to report and comment on the medical news of the day.

PLoS Blog
The Public Library of Science's open access materials include a blog.

White Coat Rants
One of the most popular anonymous blogs written by an emergency room physician.

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