Is It Safe to Take Medicine?

IF YOU looked in the medicine cabinet of a typical affluent home, what would you see? Often it is so stuffed with remedies that there is hardly room for a toothbrush. It seems to be a human weakness to want to take medicine. In fact, the late noted Canadian physician, Sir William Osler, once mused that “the desire to take medicine is perhaps the greatest feature which distinguishes man from animals.”

In the United States, some $10 billion a year is spent for drugs to relieve various ailments. Doctors write some 2.4 billion prescriptions annually for medicines. And the use of prescription drugs is predicted to keep on increasing at the rate of 9.5 percent a year. Why?

One reason is that ever more effective medicines are being developed to combat many diseases. But largely responsible are the advertising efforts of pharmaceutical manufacturers. Annually they spend some $800,000,000 to push their products. Thus there are more than 100,000 medications on the market, according to an estimate of the U.S. Food and Drug Administration. The nonprescription drug most widely used is aspirin, with Americans consuming upward of 15,000 tons of it a year!

But does it make good sense to use medicines so freely? Is there danger involved in their use?

Sobering Considerations

That the lives of many persons with serious infectious diseases have been saved by such modern-day drugs as penicillin is well known. But for some persons these medicines are a two-edged sword, since they may also cause harmful side effects, even death. Medical literature has often acknowledged the dangers involved, sometimes in a very impressive way.

This is done in the Life Science Library book Drugs, coauthored by Walter Modell, professor of pharmacology at the Cornell University Medical College in New York city. No doubt in a desire to emphasize the paradoxical nature of medicines, the first chapter of this volume is entitled “Poisons That Save Lives.” There we read in its early paragraphs:

“All drugs are poisons, and all poisons are drugs. It is no accident that the words ‘poison’ and ‘potion’ come from the same root, or that the Greek word pharmakon, which we find rooted in our own words ‘pharmacy’ and ‘pharmacology,’ originally meant both a healing draught and a deadly one.

“In the broadest sense, a drug—or a poison—is any chemical that can effect an alteration in the function or structure of living tissue. . . . As commonly used, of course, the word ‘drugs’ implies medicinal chemicals—those substances that, in carefully regulated doses, produce desirable changes in the human body, counteracting disease or relieving distress.”

It has often been termed “miraculous” how carefully regulated doses of modern drugs have saved patients. There is little question that there are untold thousands of persons alive today who would otherwise die if denied their so-called “wonder drugs.” Yet Professor Modell put matters in balance, explaining:

“Even the most beneficial drugs notoriously possess adverse effects. Some experts estimate that perhaps one American hospital patient in 20 lands in the hospital as a result of reactions to drugs. The best one can say of any drug is that its beneficial effects outweigh its harmful ones—for most patients, most of the time.”

Do the Benefits Outweigh the Harm?

Doctors, by and large, will probably say that the benefits of medicinal drugs do outweigh their harm. They may point to their own individual medical experience—their own observation—where hundreds have been benefited by drugs and only a few adversely affected. But certain medical authorities are beginning to question such a conclusion.

For example, consider the use of antibiotics. In 1943 the first antibiotic, penicillin G, was marketed in the United States. Since then, antibiotics have become the most commonly prescribed class of drugs, with at least 8,000,000,000 doses being certified for use in 1972 by the Food and Drug Administration! In view of such massive use, some doctors are evidently overprescribing and misprescribing antibiotics. Regarding this, the lead article in The Journal of the American Medical Association (JAMA) of March 4, 1974, entitled “This Is Medical Progress?”, concluded:

“We believe it is appropriate to pose two questions, even though it may be impossible to develop the data sufficient to answer them: (1) Have we reached the point where the enormous use of antibiotics is producing as much harm as good? (2) Are the risks beginning to outweigh the benefits?”

These are considered valid questions by certain medical men who have been alarmed by the increasing evidence of harm being done to many patients by antibiotics.

Illustrating the Need for Caution

Doctors have observed, for example, that the overuse of antibiotics has been a factor in the development of resistant strains of bacteria. According to figures cited in the above-mentioned JAMA article, these bacteria have multiplied to the point where it is possible that they may be causing up to 100,000 deaths a year in American hospitals!

The two doctors who presented this evidence in JAMA singled out chloramphenicol as a particularly dangerous antibiotic that may produce aplastic anemia as a serious side effect. They explained: “The problem of aplastic anemia has been well documented; this fatal reaction occurs about once in approximately 60,000 to 80,000 doses.” With nearly four million patients a year reportedly being given chloramphenicol, it is apparently responsible for scores of deaths annually.

Regarding these deaths, the JAMA article laments: “A large majority of these usually fatal reactions occurred in patients who received chloramphenicol for either trivial infections, undocumented infections, or infections for which a safer and as effective alternate antibiotic could have been selected.”

Surely there is need for caution in the use of such drugs as chloramphenicol. Most physicians are well aware of the dangers of these drugs, reserving them for certain life-threatening conditions. Yet evidently some doctors are either uninformed about the dangers, or they use very poor judgment in prescribing them.

But there is probably a more important reason why chloramphenicol is still used so frequently. The former head of the U.S. Food and Drug Administration claimed that its manufacturers “have successfully promoted Chloromycetin [trade name for chloramphenicol] contrary to the best advice of the medical profession.”

Yet unwarranted claims for drugs are common. Thus one government agency found that, of 16,000 over-the-counter drugs it tested, 60 percent violated the law by claiming more for the preparation than it was able to do. The National Academy of Science reviewed 4,349 prescription and nonprescription drugs that were promoted for the treatment of 1,600 different conditions. It found that, of 1,610 claims made for the products, only 19 percent could be substantiated. Another survey showed that, of 1,859 drugs tested, only 301, or less than 17 percent, were effective for all the conditions for which they were promoted.

It is a big job to try to prevent the marketing of medicines that can harm people more than they help them. Thus about fifteen years ago a so-called “perfect sleeping pill” containing the drug thalidomide was widely used in many lands. However, a pharmacologist in the employ of the United States government held up its approval pending clarification of various suspicions she had regarding it. It was a good thing, since shortly thereafter it was discovered that thousands of babies born to women who had taken thalidomide during pregnancy were horribly deformed.

This further illustrates the need for caution in taking medicines. For even though no bad side effects may be experienced immediately—or even for days or weeks—they can be realized months or even years later. “In medicine today, we are using many stronger drugs and all kinds of esoteric chemicals and machines,” observes Dr. Eugene Saenger, professor of radiology at the University of Cincinnati. His conclusion: “There are certain to be some long-term consequences.”

The fact is, some of these long-term consequences have only lately begun to be experienced.

A Calculated Risk

For example, between 1945 and 1971 the drug called diethylstilbestrol (DES) was commonly prescribed for pregnant women to prevent miscarriages. Although some miscarriages were probably prevented, what have been the delayed results? A high incidence of vaginal cancers in the teen-age daughters of the mothers who took this drug has resulted! Thus, a Los Angeles, California, specialist in gynecologic tumors advises: “Daughters of women who were given DES should be examined regularly from their 13th birthday on.”

Similarly, the London Daily Mail of March 7, 1974, reported: “Sales over the counter of one of the most widely used pain-killers are to be banned following evidence that the drug can cause kidney damage. . . . In Britain it is estimated that up to 500 people have died each year from kidney failure directly attributable to excessive dependence on phenacetin compounds.”

Also, a study of drugs that are commonly taken orally to control diabetes indicates that they may cause 10,000 to 15,000 deaths a year due to heart disease. This study, which was reported in the JAMA of February 10, 1975, indicates that the death rate from heart and related diseases was twice as high among diabetics taking these drugs as it was among diabetics treated either by insulin injection or by diet control.

Does this mean that drugs should be avoided altogether? No. They have relieved the suffering of tens of millions, and have saved perhaps millions of lives. How thankful such persons can be for them! The risk involved in taking them is often warranted. There are, no doubt, many thousands of patients with heart disease who would die within weeks if they failed to take digitalis. In fact, even to alter a carefully regulated dose could be hazardous. Yes, digitalis is a “poison,” but when used wisely and under expert supervision, it has proved to be a real lifesaver.

A diabetic, too, is probably more likely to die from his disease if he does not take medicine than he is to die from the heart disease his medicine allegedly may cause. Similarly, one may accept the “risk” of taking even aspirin in preference to the discomfort and inconvenience of a headache. But the point to remember is that taking medicine is a calculated risk—it is a two-edged sword.

How are you to know, then, whether to take a medicine or not? For this you are largely dependent on the advice of a physician. As a protection to you, powerful drugs can be obtained only on a doctor’s advice and prescription. Since his judgment can affect your health, and perhaps whether you live or die, you will do well to respect his judgment. But, for the same reasons, it is wise to ascertain carefully his qualifications. Is he conscientious as well as knowledgeable? Does he really have your welfare at heart? In certain cases you may want also to consult another physician as to whether the use of a certain drug is warranted.

Patients Often to Blame

The fact is, however, that patients themselves are often to blame for the overuse and misuse of drugs. Many of them feel cheated if the doctor does not prescribe some medicine or give them an injection. Dr. Calvin M. Kunin writes in the JAMA: “Patient pressure is one of the most important factors that leads physicians to overprescribe in office practice. This is by no means subtle and often comes from the most articulate and best educated people including health professionals. Visualize the telephone calls to a busy physician requesting and sometimes even demanding that an antibiotic be prescribed.”

Describing the problems, one surgeon and practitioner wrote: “When a man comes in to see me with a low backache that he acquired while cleaning out his basement, I feel like saying, ‘Look, take your money and run.’” What the person needs is some heat and rest, and perhaps aspirin to kill the pain. But since this advice would displease the man, the doctor gives him what he wants. He makes a “big deal” out of it—the patient pays $10 for an office call, $20 for an X ray, $5 for some medicine and $3 for a diathermy treatment. “The man goes home [satisfied but] thirty-eight dollars poorer and physically no better.”

Need to Exercise Common Sense

The foregoing indicates the need of common sense in the use of all types of medicines. It only makes sense, for example, not to use powerful drugs when weaker ones will serve, for the more powerful the drug, the more likely the danger of side effects. Thus, after making a big ado about “wonder drugs” in the treatment of arthritis, it was found that the old standby, aspirin, much of the time served as well, if not even better, than these “wonder drugs.” So do not be disappointed if your physician advises aspirin instead of some expensive prescription drug, which is potentially more dangerous than aspirin.

Common sense when going to the medicine cabinet would also indicate not resorting to drugs for every little discomfort. A case in point is aspirin. As already indicated, it has its uses. But excessive use can cause a variety of disorders, such as bleeding, especially of the stomach. If there is any bleeding situation, such as menstruation, hemorrhoids, or an ulcer, aspirin may only make it worse. Aspirin especially should be avoided by pregnant women, since it is believed that it may damage the developing fetus.

It is noteworthy that habitual users of over-the-counter drugs for killing pain have been found to be more likely to have anemia, ulcers, high blood pressure, depression or anxiety states. Especially singled out for severe criticism by stomach specialists is Alka-Seltzer. Would it be alright to use it occasionally? Yes. Regularly? No.

And since all drugs have potential side effects, common sense would indicate not using or resorting to medicines if other remedies will serve. An instance where this applies is in constipation. For many, a laxative is an occasional necessary evil. But continual use can be harmful so that one is wise to give thought to practical nonmedical measures—the development of good bowel habits, proper diet and regular exercise. According to one well-known physician, these practical measures will serve for 95 percent of the people troubled with constipation and who therefore can treat it “with a minimum of medicine and a maximum of common sense.”

It is clearly evident, then, that there is a real need to exercise caution and to use common sense when it comes to taking medicines. They can be beneficial, even lifesaving; but remember, too, they can possibly cause harm. The certain, lasting remedy for human ills will be realized only when, in God’s righteous new order, Jesus Christ exercises his power to heal all human infirmities.