Skepticism about science and medicine

In search of disinterested science

Posts Tagged ‘over-prescribing of drugs’

Don’t take a pill if you’re not ill

Posted by Henry Bauer on 2013/02/26

And don’t go to the doctor either.

I mean don’t take a prescription drug if you’re not ill. Some vitamins and supplements can be useful, I believe, especially those that occur naturally in the body like ubiquinone (Coenzyme Q10) and for which long experience attests that they do no harm.

By contrast, I’m hard put to think of any prescription drug that doesn’t have the potential to do harm. Long-term intake of any foreign substance is likely to damage the liver, whose job is to process foreigners. Even short-term use of some prescription drugs may cause tangible harm: antibiotics, unquestionably useful when infections cannot be defeated by the immune system alone, kill beneficial bacteria in our gut as well as the harmful bacteria. On two occasions when I took Cipro against prostate infections, within a week I contracted a yeast infection (thrush), in the mouth or on the penis; the beneficial gut bacteria (intestinal microflora) guard especially against fungal infections like thrush. Too many doctors fail to advise patients taking antibiotics to also take probiotic supplements to replace the beneficial microflora killed by the antibiotic.

Science is universal, but medicine is not. For a fascinating account of differences in medical practice among developed countries, read Lynn Payer, Medicine & Culture: Varieties of Treatment in the United States, England, West Germany, and France (Henry Holt, 1988/96). For example: My first wife suffered occasional abdominal pain, and her gynecologist offered her a hysterectomy whenever she felt ready for it. Shortly after that we spent a year in England, and an eminent gynecologist there said they would not dream of doing a hysterectomy with so little indication of its necessity. Again, on a visit to Scotland I thought I had contracted a urinary tract infection. The doctor confirmed it, and said, “These things are usually self-limiting. We don’t like to use antibiotics unless really necessary. If it hasn’t cleared up in a few days, come back and see me”. I didn’t have to go back. Here in the USA, I would have been given an antibiotic immediately, quite likely Cipro.
A London hospital recently did the experiment of drastically reducing its use of antibiotics. Within weeks the rate of super-infections by resistant bacteria had declined by nearly half.

Central to the promiscuous prescribing of pills is the practice of diagnosing by “objective” test instead of felt symptoms. Jeremy Green, MD and medical historian, has described how medical practice has changed from clinical diagnosis based on how a person feels and what a doctor can observe to the use of numbers from impersonal tests — blood pressure, blood sugar, PSA (prostate specific antigen), cholesterol and triglyceride levels, and more (Prescribing by Numbers: Drugs and the Definition of Disease, Johns Hopkins University Press, 2007). As a result, “perfectly healthy-feeling adults will receive a diagnosis for a disorder that they did not know they had. . . . [F]or most people these diagnoses lead directly to the prescription of a drug they will take for an indefinite period, if not for the rest of their lives” (p. vii). In 2003, the average American filled 10 prescriptions; those over 65, an average of 25 prescriptions (p. viii).

There are many reasons why this is an irrational and harmful situation. In the first place, there is no sound evidence connecting those laboratory-test numbers with the diseases with which they are conventionally associated. In the second place, even if there were such conclusive evidence, there is no sound reason for presuming that a population-average number is optimal for every individual, yet current practice is to strive to bring everyone’s numbers to the average or even “better”. Third, any potential benefit ought to be carefully weighed against the known risks of long-term use of any prescription drug, yet this is rarely if ever done in practice.

Here’s something to ponder. If it is universally desirable to bring everyone’s blood pressure, cholesterol, blood sugar, etc., to something like the population average, why do we focus so much on bringing numbers down but not up? “High” blood pressure is routinely treated with drugs, whereas low pressure is regarded as not necessarily unhealthy or to be treated unless there are troublesome actual symptoms; and in that case, the cause of the low pressure is sought (Low blood pressure {Hypotension}; Understanding Low blood pressure — diagnosis and treatment).
Again: if one’s cholesterol level is below average, should we not try to increase it? After all, the body manufactures cholesterol, which is a needed component of cell walls, and deficiency of it might even be a cause of Alzheimer’s disease (Henry Lorin, Alzheimer’s Solved, ISBN 1-4196-1684-6).

The concept of preventive medicine is attractive. However, the knowledge is not at hand to base prevention on laboratory tests; and there are innumerable possible conditions that might be detected if every conceivable test, including imaging and colonoscopy and the like were done routinely. So in practice the only proven preventive medicine is advice that can be given without any tests: exercise reasonably, eat reasonably, don’t put on weight, avoid stress, sleep well . . . .

Anecdotes may not be regarded as scientific evidence, but they do provide information. I never had annual check-ups before moving to the United States, and didn’t start here until I became an administrator and my employer mandated an “annual physical”. I passed in 1981 with flying colors, including EKG and chest X-ray. Two weeks later I fainted in the office, and an angiogram revealed a severely restricted coronary artery. Two successive angioplasties cured that.
In 1991, I passed my annual physical with flying colors, including EKG, X-ray, blood work, etc. A few weeks later I woke up early one morning unable to breathe, and within a week I had had a quintuple coronary by-pass.
My heart problems never showed up in any of the usual ways, including stress tests. I concluded that no amount of annual testing could be relied on to find even serious potential problems, and that the range of available tests is so great that using them routinely makes no sense.

Several medical associations and many specialists have been discounting the value of routine mammograms, PSA tests, colonoscopies and the like; not only because they are not cost-effective, revealing only a tiny number of conditions needing treatment compared to the numbers of tests carried out, but also because any test is liable to produce a certain number of false positives that bring the danger of unnecessary and damaging treatment of people who never needed treatment. In a recent radio interview, medical-science journalist Shannon Brownlee said that she eschews mammograms because she believes the risk of false positive and its consequences to be greater than the risk of detecting a possible tumor only when it becomes physically noticeable.

But this post is specifically about pills.
Current practice is that your doctor will likely prescribe drugs for you to take if your blood pressure is above 140/90 or so, and if your cholesterol level is 200 or even 180 or so, and if your blood sugar is above average; and if you feel sad or “down” too much, or if you feel unpleasantly anxious too often for your liking; and in many other situations as well.

  • The problem is that many of the conditions
    for which pills are prescribed do not need treatment.
  • And that the pills may not even be effective
    against the condition for which they are prescribed.
  • And that the pills may actually do harm.
  • And that the pharmaceutical industry thrives
    because it has succeeded in making pill-taking so routine,
    especially for so-called “chronic” conditions
    that imply life-long intake of drugs.
  • And that those “chronic” conditions
    are often not illnesses at all
    but perfectly natural conditions,
    in particular accompaniments of aging
    (Seeking Immortality? Challenging the drug-based medical paradigm).

Don’t take a pill if you don’t feel ill.
Don’t go to a doctor if you don’t feel ill.

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