Scared to death

Jamaica Gleaner - - OPINION&COMMENTARY - I Garth A. Rat­tray is a med­i­cal doc­tor with a fam­ily prac­tice. Email feed­back to col­umns@glean­erjm.com and garthrat­tray@gmail.com.

THE PHRASE ‘scared to death’ is usu­ally used metaphor­i­cally. On rare oc­ca­sions it is taken lit­er­ally – in in­stances of a se­vere fright pre­cip­i­tat­ing a fa­tal heart at­tack or stroke.

How­ever, there are in­cal­cu­la­ble hun­dreds of thou­sands of pa­tients who are so scared of tak­ing pre­scrip­tion med­i­ca­tions that they ei­ther refuse to take them or take them im­prop­erly and end up with se­ri­ous ill­nesses (kid­ney fail­ure, stroke, heart fail­ure, heart at­tack, aneurysm, pe­riph­eral neu­ropa­thy and/or vas­cu­lar dis­ease, blind­ness) and pre­ma­ture death.

Through­out my 35 years in medicine, I spend a lot of time and ef­fort try­ing to ex­plain the crit­i­cal im­por­tance of tak­ing pre­scribed med­i­ca­tions and their very favourable risk-to-ben­e­fit ra­tio. My fa­ther, of blessed mem­ory, used to quip that odds of one in a mil­lion sound great un­til you are that one. How­ever, in spite of their chem­i­cal ac­tions, the vast ma­jor­ity of drugs are per­fectly safe. You would have to have bad luck to ex­pe­ri­ence a se­ri­ous side ef­fect.

The prin­ci­ple of ‘risk’ is very in­ter­est­ing. For ex­am­ple, I tell pa­tients that the risk of in­jury or death while driv­ing on our roads is con­sid­er­ably greater than be­ing anae­thetised and hav­ing a ma­jor op­er­a­tion. Al­most ev­ery­one frets and gets the jit­ters prior to surgery, yet no one gets ner­vous leav­ing the hospi­tal for home. If you look at it sci­en­tif­i­cally, you will see that ma­jor op­er­a­tions are much safer than our roads.

Pa­tients hear or read how bad the pos­si­ble side ef­fects of pre­scribed med­i­ca­tions can be and some lit­er­ally panic and de­cide to take their chances with the nat­u­ral out­come of their blood pres­sure, di­a­betes or high choles­terol or they try al­ter­na­tive (so-called ‘nat­u­ral’) med­i­ca­tions. This wor­ries me for sev­eral rea­sons. The listed side ef­fects are only pos­si­bil­i­ties and are by no means cer­tain­ties. Even when pa­tients are on polyphar­macy (sev­eral dif­fer­ent med­i­ca­tions), the ac­cu­mu­lated risk from dele­te­ri­ous ef­fects re­mains quite low when com­pared to their ben­e­fits.

The prob­lem is com­pounded by tele­vi­sion (di­rect-to-con­sumer) ads that say what the med­i­ca­tion is good for but then must go on to list a plethora of pos­si­ble side ef­fects, some­times even speak­ing of fa­tal­i­ties. Pa­tients hear one good thing that the med­i­ca­tion can do for them, but then they hear 100 pos­si­ble bad things that it can do to them. In­ter­est­ingly, peo­ple who aban­don man­u­fac­tured med­i­ca­tions and choose ‘nat­u­ral prod­ucts’ in­stead are making fun­da­men­tal er­rors due to mis­con­cep­tions about these al­ter­na­tive drugs.

First of all, ad­ver­tised ‘nat­u­ral prod­ucts’ are not found that way in na­ture. In na­ture, they are not con­cen­trated, pre­served, sat­u­rated with ad­di­tives or pack­aged. Fur­ther­more, na­ture does not spec­ify any dosage in quan­tity or fre­quency of ad­min­is­tra­tion. Of­ten­times, it’s a tri­a­land-er­ror thing.

LEAP OF FAITH

Sec­ond, as far as I am aware, over­the-counter ‘nat­u­ral prod­ucts’ are not se­verely scru­ti­nised, sub­jected to a myr­iad of an­i­mal and hu­man tri­als over many years and reg­u­lated like pre­scrip­tion med­i­ca­tions. There are no dou­ble-blind stud­ies or ad­verse ef­fects reporting plat­forms for them. Tak­ing them rep­re­sents a leap of faith.

Third, just about any­thing might have lim­ited ben­e­fits if the pa­tient be­lieves that it will work. This is called the placebo ef­fect.

Ap­proved pre­scribed med­i­ca­tions must strik­ingly out­per­form the placebo ef­fect in or­der to be deemed ef­fec­tive. A bunch of anec­do­tal tes­ti­mo­ni­als are no match for sci­en­tific ex­per­i­ments span­ning decades.

Fourth, it is very im­por­tant to note that for any med­i­ca­tion/drug to do some­thing for you, it must do some­thing to you. There must be some chem­i­cal changes go­ing on in­side of you for there to be any ef­fect. Ob­vi­ously, there­fore, even if there is some ben­e­fit to be de­rived from a ‘nat­u­ral prod­uct’, it must make changes to your body and some of those changes might come at a price. In other words, if an al­ter­na­tive med­i­cal prod­uct is to work, it must also have pos­si­ble side ef­fects.

Un­rea­son­able fear of the risk of side ef­fects cause pa­tients to take noth­ing, or take sub­op­ti­mal doses or take in­fre­quent doses or turn to un­proven prod­ucts. Whereas pre­scribed med­i­ca­tions might have side ef­fects, the med­i­cal con­di­tions for which they are pre­scribed do have se­ri­ous side ef­fects and lead to pre­ma­ture death with­out proper treat­ment.

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