Why Say No to Drugs?

Hearing the news about Vioxx causing an estimated 140,000 cases of stroke and heart attack reminded me of a patient I saw in my office not long ago. He was a hard-working fellow who woke up one morning feeling achy and tired. Thinking that he was coming down with a cold, he popped a few Advils and went to work. As the day wore on his condition worsened to the point his wife brought him in to see me by afternoon. When I first laid eyes on him in the waiting room, I knew that something was terribly wrong.

I was taking his blood pressure, when suddenly he had to go to the bathroom. A few moments later there was a loud thud. His wife and I looked at each other and then ran to the bathroom. Pulling open the door we found him laying on his back unconscious and beginning to heave. Being a big fellow, it took both of us to turn him on his side as he began to vomit. The toilet bowl was streaked with crimson red blood and liquid stool. He had passed out from a bleeding stomach ulcer as a result of the Advil that he had taken that morning. Lying on his back unconscious, he was just seconds away from breathing in his own vomit, which alone would have given him a better than a 50% chance of dying from aspiration pneumonia.

Fortunately, he regained consciousness and we got him to the hospital where the bleeding artery in his stomach could be cauterized. But it could have easily gone the other way. He could have been one of the 16,000 people who bleed to death each year from non-steroidal anti-inflammatory drugs (NSAIDs). NSAIDs include everything from aspirin and ibuprofen, which can be purchased over the counter, to drugs like Vioxx, that require a prescription. Curiously, those at greatest risk to developing gastrointestinal bleeding are not the people who get an upset stomach with NSAIDs, but those who don’t have any side-effects at all, until it’s too late.

The next time your friendly physician offers you a free drug sample, there is one study you should be aware of, reported in the Journal of the American Medical Association, April 1998, from the University of Toronto. Based on a meta-analysis of 39 prospective studies on adverse drug reactions (ADRs) from US hospitals, they concluded that in 1994 approximately 2 million hospitalized patients experienced an adverse drug reaction, of which 100,000 were fatal, making ADRs between the fourth to sixth leading cause of death.

It is amazing how easily we shrug off such large numbers, like 16,000 people bleeding to death, or 140,000 unnecessary strokes and heart attacks. Clearly, when all you’re trying to do is ease the pain of a headache, sore back, or stiff joints, death is an unacceptable risk. Can you imagine the media response if say, 5,000 people bled to death undergoing acupuncture each year? Fortunately, in skilled hands, acupuncture is not only extremely safe, it is also quite effective. A recent double-blind study conducted under the auspices of the National Institute of Health at the University of Maryland Medical School found that of 570 patients with knee arthritis 40-45% improved in both pain and function with acupuncture over and above the standard medical treatment they already were receiving.

Certainly there is a place for drugs in medicine, but not nearly as big as the full-page ads would suggest. Drugs are inherently dangerous whether you buy them on the street corner or in the pharmacy. This is because each drug has a number of biological effects. The desired drug effect is called the “indicated effect” and the undesirable actions are called the “side-effects.” However, our individual biochemical make-up is so unique that the same drug may effect each of us very differently, hence the risk of ADRs.

I once addressed about seventy Colorado judges who were attending a yearly continuing education conference to learn about stress reduction. At one point in my presentation I boldly stated, “The war on drugs is not about drugs, it’s about who should be in control of manufacturing and distribution.” As I looked around the audience to gauge their reaction, about half of the judges nodded their heads knowingly. The real war on drugs begins in your medicine cabinet.

I have met a number of people who want to get off pills but find it very difficult to give up their anti-depressants, pain medications, or sleeping pills due to horrendous withdrawal symptoms. In these situations acupuncture and detoxification diets can be very helpful, not only by minimizing the withdrawal effects, but by effectively treating the underlying problem as well.

Unfortunately, as modern medicine becomes more and more like any other big business, caveat emptor (buyer beware) is the ethic of the day. Like the old saying goes, “There’s no such thing as a free lunch,” and certainly there’s no such thing as a free drug sample!