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Reducing the Risk of Adverse Drug Events

Critics of mainstream medicine often point to the dangers of drugs. I previously wrote about “Death by Medicine,” where I explained the fallacy of fixating on harmful effects of drugs without putting them into perspective with all the good drugs do. Yes, patients have died from severe allergic reactions to penicillin, but penicillin has also saved countless lives.

A recent article in The New England Journal of Medicine looks at emergency hospitalizations for adverse drug events in elderly Americans. It confirms that adverse reactions are a serious problem, but some of its findings are surprising.

The elderly are seven times as likely as younger people to have adverse drug events. They are more susceptible because of physiologic changes with aging, frailty, coexisting conditions, and polypharmacy. Forty percent of people over 65 take 5-9 medications, and 18% take 10 or more. Combinations of medications can cause unexpected problems.

Among adults age 65 and older, they estimate nearly 100,000 emergency hospitalizations every year in the U.S. for adverse drug events.  Half of those were in those over age 80. And most of them were entirely preventable. If you tried to guess which drugs were most often to blame, you might guess NSAIDs or psychoactive drugs, but you would be wrong. Drugs previously recognized as “high-risk” in this age group were responsible for only 1.2% of these hospitalizations. Four medications were implicated in 67% of cases:

  • Warfarin 33.3%
  • Insulin 13.9%
  • Oral antiplatelet agents 13.3%
  • Oral hypoglycemic agents 10.7%

Further down the list are opioid analgesics, antibiotics, digoxin, and chemotherapy drugs. Even further down: sedatives, blood pressure meds, and anti-seizure medications. And nearly two thirds of hospitalizations were for unintentional overdoses. They concluded that simply improving management of commonly used antithrombotic and antidiabetic drugs could have a big impact, both in reducing harm and in reducing health care costs.

Warfarin, or Coumadin, is by far the biggest offender. Appropriate dosage varies with the individual and over time; adjusting it requires frequent blood tests to measure the INR (international normalized ratio of prothrombin time compared to a standard). It may be necessary to monitor the INR every day or two at first when readings tend to fluctuate markedly, and when the readings become stable the frequency of testing can drop down to monthly. Bleeding complications are more likely to occur when the INR goes above the target range. One specialist told me he had never seen a complication in a patient on Coumadin whose INR was in the target range.

It is conceivable that the biggest problem drug could entirely drop off the list and 33% of drug-related hospitalizations could be prevented if only doctors managed Coumadin dosing more effectively and if patients complied better with instructions about medication and diet. At my local hospital (Madigan Army Medical Center), all patients on anticoagulation are managed by a Coumadin Clinic run by an experienced clinical pharmacologist using rigorous procedures and guidelines; I don’t have any figures, but I think that approach is much better than having individual doctors manage their own patients.

A pharmacist, Robert Steven Gold, has written a book with specific proposals for reducing medication risks. The title is Are Your Meds Making You Sick? The title led me to expect a typical anti-establishment rant about evil Big Pharma poisons. It is anything but. The format is engaging: it presents a series of mini-mystery case reports and challenges the reader to detect which drug is the culprit.

Gold provides 16 rules for reducing the risk from drugs:

  1. Learn which medications are sending people to emergency rooms
  2. Know your kidney lab values
  3. Know your liver lab values
  4. Be aware that the elderly are different from younger people
  5. Take your meds as your doctor prescribed
  6. Know your lab-test schedule
  7. Know your medication’s monitoring parameters
  8. Don’t hesitate to call your doctor
  9. Be aware of drug interactions
  10. Understand that OTC meds, herbals, and alcohols are drugs too
  11. If your health changes after you add a new drug, think drug-induced disease
  12. Know that most adverse drug reactions are due to dosage issues
  13. Insist on medication reconciliation
  14. Don’t stop taking a medication without talking to your doctor
  15. Remember that elderly individuals should be on lower doses
  16. Ads don’t warn of incidence of adverse events – don’t believe them.

He explains each of these in detail, and refers to them as he goes through each mini-mystery. He adds “above all, record and report,” pointing out that the majority of drug reactions go unreported.

Just one mini-mystery example: a woman experiences weight loss, heartburn, nausea, weakness and dizziness. She is on medicines for high blood pressure and osteoporosis (Fosamax) and takes an over-the-counter non-steroidal anti-inflammatory drug (naproxen) for back pain. Endoscopy finds ulcers in her esophagus and stomach. Yes, we know NSAIDs cause GI bleeding, but in this case naproxen was only an accomplice. The real culprit was Fosamax, and the patient was to blame because she had failed to follow the instructions to take it with plain water and remain upright for 30 minutes after taking it. She had been taking it with orange juice and reclining in a chair for 30 minutes. She had also ignored the package insert for Fosamax that warns against combining it with NSAIDs. She had violated rules 5, 9, 10, and 16.

In 1860, Oliver Wendell Holmes famously said,

I firmly believe that if the whole materia medica could be sunk to the bottom of the sea, it would be all the better for mankind and all the worse for the fishes.

He wouldn’t say that today. We have come a long way since 1860. Modern science has developed effective medications that can save lives, control diseases, and relieve symptoms; but anything that has effects is likely to also have side effects, and these medications can also harm. Drugs can be hazardous to your health. Of course, not taking them can be even more hazardous: insulin reactions occur and can even sometimes kill patients, but if diabetics stopped taking insulin they would be certain to suffer unnecessarily and die prematurely. Both this article and this book are great examples of how science-based medicine is constantly striving to improve itself, in stark contrast to so-called “alternative” medicine: we recognize problems, confront them head-on, and try to reduce risks. Replacing medicine with “alternative” medicine because of drug reactions would be as foolish as replacing cars with walking barefoot because of automobile accidents.

Gold’s book contains essential information that anyone taking medications should know for their own safety, and that doctors should be more aware of. As a doctor, I already had a grasp of the basic principles, but reading this information taught me more about the details. Almost every mini-mystery case in Gold’s book could have been prevented by following his 16 rules. Both health professionals and consumers can do much better than we have been doing.

 

Posted in: Pharmaceuticals

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35 thoughts on “Reducing the Risk of Adverse Drug Events

  1. DugganSC says:

    :) As someone who walks around barefoot, I find that the second metaphor suffers a bit since I think the world would be a lot better off if more people walked around barefoot, at least from time to time. Shoes are wonderful things for fending off specific adverse conditions, have you ever looked at what they’re doing to the shape of our feet? We condemn foot-binding traditions and yet it’s becoming normal for a woman’s foot to have her big toe and little toe out of line with the rest because they’ve been squeezed into ill-fitting shoes.

    Although, honestly, I could see someone taking the metaphor further out. Most people don’t really need shoes for day to day life — they wear them due to social pressure — and similarly, most people don’t need medication in day-to-day life. Automobiles are a bit more necessary, if only because the assumption that everyone drives means cities aren’t built to allow someone to get where they want to without driving. Still, would it be so bad for more people to walk a few blocks down to the store and back rather than firing up the car? Similarly, I think that there are cases of people using medication in instances when addressing the root causes of their illness would work better for them. After all, a pill is easy to prescribe and easy to take. Changing one’s lifestyle is difficult.

    Overall, I do agree with the book’s premise that most drug reactions are due to patients not paying attention to the warnings on their medicines and/or not speaking with their doctors. :) I just couldn’t resist exploring that metaphor.

  2. Steve Packard says:

    I assume that most of these are self-administered. It’s quite easy to make a mistake when it comes to medication. I’ve gotten up, taken a shower, had breakfast and then thought “Wait, did I take my allergy pill when I was brushing my teeth or did I not take it.”

    Not such a big deal with allergy medication. Taking twice as much as you’re supposed to is not likely to be fatal and forgetting to take it is not going to result in anything more than a miserably stuffy nose.

    I can easily see how someone taking something more potent could get into some major trouble, of course.

    Perhaps doctors and pharmacists should make it a point to encourage people to use those daily medication planner things with the individual boxes for each dose? Those would seem to be a lot more mistake proof

  3. Harriet Hall says:

    Those pill boxes with compartments are indeed an excellent aid. Our Coumadin Clinic hands them out to every new patient.

  4. Thanks for the article And book review Harriet Hall. The book sounds very useful.

    One thing I wasn’t clear on, although maybe I just have to read the book.

    What is medication reconciliation?

  5. On the pill boxes…I am forever forgetting whether I’ve taken my medication or not. But, since I have kids around, I don’t like leaving pills in an easy access container. I finally came upon the solution of keeping my day of the week pill container next to my medication (in the original container). Each week, I close all the lids on the weekly container. Each day when I take my medication, I flip open the lid of the appropriate day, that way if I forget if I took my pill, I can look and see whether the lid is open or closed for that day, but the pills are still in a child-proof container.

    Okay, maybe I’m inordinately proud of that idea. :)

  6. Harriet Hall says:

    Definition of medication reconciliation: “A specific, formal process of creating a complete, accurate, and current list of all medications a patient is taking and comparing that list to the patient’s medical record or medication orders – all to make sure the patient is getting correct dosages regardless of where they are within the health-care system.”

  7. Scott says:

    Regarding the Holmes quotation, it occurs to me that the current tools of naturopathy have a great deal in common with the materia medica he was referring to. REAL medicine has moved on, quackery has not.

  8. overshoot says:

    Disclosure: my mother has been on coumadin for almost forty years, and is having increasing trouble with it. But then again, she’d in her mid-80s.

    The challenge for people in her situation is getting her dose monitored as she becomes both more brittle and less mobile. She doesn’t drive any more, although (fortunately) one of my brothers and one of his (driving) sons live nearby. At some point for people in a similar situation, managing coumadin starts to take over their lives and perhaps the lives of their families. For those without family nearby, it’s got to be even worse.

  9. Harriet Hall says:

    @overshoot,
    There are reliable instruments available for INR self-testing at home with blood from a fingerstick, and they are covered by Medicare and private insurance. Getting one might make your mother’s situation far less burdensome as well as safer.

  10. overshoot says:

    Thank you Dr. Hall — she’s in assisted living, so we may be able to get it done very frequently.

    Where do I send the thank-you chipotles?

  11. cloudskimmer says:

    Thank you for the fine article. I faced a similar problem to ‘overshoot’: an elderly mother, unable to drive. After she got out of the hospital, home-care nurses were provided for a time and did the finger-stick to check her INR. It’s still a worry about the balance between excessive bleeding should she have an accidental fall, versus the risk of a blood clot. Sometimes I’m tempted to just take her off blood thinning medication.

    Her cardiologist strongly urged her to change to Pradaxa, something I resisted due to the high expense and the refusal of her insurer to pay for it. Pradaxa doesn’t require monitoring, so I now wonder how we can know if the amount of blood thinning is correct, since there is no way to monitor it using this medication. After multiple appeals, the insurer finally agreed to cover it, so it is somewhat more affordable, but lots more expensive than coumadin. (And did you know that if the Part D Medicare insurer doesn’t cover the drug, your cost doesn’t count towards the out-of-pocket expense counted towards getting out of the no-coverage period?)

    Since you mention coumadin, what is your opinion of Pradaxa? It’s unnerving to take a new medication, since I assume a lot of adverse effects will be found. It also makes me angry every time I see the multi-page ads for the drug in popular magazines, since the high cost of the drug goes to paying for those very-expensive ads. Is the drug really so much better than coumadin, or was the cardiologist just repeating what the drug reps told him?

  12. cloudskimmer says:

    michelleinmichigan: What works well for my mother is a medication sheet, one for each week with columns for each day and the rows for each time medication is taken. She is supposed to write down the time she takes them; that way all she has to do is look to see if she has taken something or not. For her pain meds, I write down the interval she should apply before taking another, such as no more than one pill ever six hours. It isn’t perfect, but it helps. Child-proofing is a difficult problem; it sounds like you have found a great solution.

  13. Harriet Hall says:

    @cloudskimmer,

    “what is your opinion of Pradaxa?”

    I reviewed dabigatran (Pradaxa) when it first came out. See http://www.sciencebasedmedicine.org/index.php/dabigatran-a-promising-alternative-to-warfarin/
    The Wikipedia article has more up-to-date information. http://en.wikipedia.org/wiki/Dabigatran There are pros and cons. Studies have shown it to be more effective and safer than Coumadin, but it has not been approved for all the indications that Coumadin is used for. There are questions about the appropriate dosage, and about whether adverse events may be more common than in the initial studies, and the fact that its effect is not readily reversible if bleeding occurs is a concern. We will know more as we gather more experience with the drug. I don’t think there is any compelling evidence that would require us to choose one over the other simply on the basis of efficacy and safety, so for the time being the choice will depend on clinical judgment, other risk factors, cost, patient preference, convenience, etc.

  14. stanmrak says:

    “Both this article and this book are great examples of how science-based medicine is constantly striving to improve itself, in stark contrast to so-called “alternative” medicine: we recognize problems, confront them head-on, and try to reduce risks. Replacing medicine with “alternative” medicine because of drug reactions would be as foolish as replacing cars with walking barefoot because of automobile accidents.”

    This assertion about science-based vs. alternative medicine has no basis in reality – only in bias and prejudice.

    No responsible authority in the alternative community is suggesting that we REPLACE science-based medicine, only offer people alternatives that, according to the statistics, many of us want, oftentimes because conventional medicine has failed us. We’re supposed to be living in a free country where we can make our own choices.

    As far as the list of 16 guidelines, if people were that dilegent about taking care of themselves, they probably could have avoiding getting sick in the first place, by practicing better nutritional and lifestyle choices. They don’t, because they’re lazy and misinformed. People who resort to drugs to treat their health issues don’t want to be responsible for their health – they want a pill that will take of everything for them. Asking them to monitor 16 different items is beyond them. This will never change.

  15. icewings27 says:

    @stanmrak – So what you are saying is that I have ulcerative colitis because I am lazy and misinformed and I’m not eating and living correctly? And that the pills that I take for it that actually do “take care of everything” and make it so I am not completely incapacitated by this disease are flat-out unnecessary?

    You are free to go to a woo quack if you like. But don’t you dare call me irresponsible and stupid for going to a real doctor, getting a true diagnosis, and taking an effective treatment.

  16. Scott says:

    We’re supposed to be living in a free country where we can make our own choices.

    Including, apparently, the choice to tell outright falsehoods to people without the appropriate background to evaluate them, and then take their money for providing a service which doesn’t do what is claimed. The ONLY thing which saves “CAM” from being exactly a subcategory of “fraud” is that most of the practitioners are honestly mistaken and believe their own lies.

    No “health freedom” argument can justify that.

  17. WilliamLawrenceUtridge says:

    stanmrak, you do realize that your argument is about as meaningful as those who argue we should teach intelligent design and creationism as an “alternative” to evolution, right? You’re on the same playing field as Ken Ham and Kent Hovind. The CAM community also uses very similar tactics – never changing their mind, using politics to bypass scientific research and lying to either themselves or those who are receiving CAM.

    Your comment blaming the ill for being sick is contemptible, ignorant, self-serving and rather disgusting. The human body is imperfect and will always break down. While CAM modalities primarily help people feel better about this break down, science based medicine has the potential to actually improve health. Including indicating which foods and lifestyle habits are healthy, and which are harmful. Not to mention science helps even those with diabetes (of either type) and other chronic illnesses live longer, healthier, less painful lives than their ancestors who had little but CAM-style interventions as “medicine”. Perhaps a small cohort has the genes and luck to live disease- and accident-free until they die peacefully in their sleep at 102 – the rest of us will need medicine. Real medicine, not make believe and wishes.

  18. Harriet Hall says:

    @stanmrak,

    I said “Both this article and this book are great examples of how science-based medicine is constantly striving to improve itself, in stark contrast to so-called “alternative” medicine”

    You said “This assertion about science-based vs. alternative medicine has no basis in reality – only in bias and prejudice.”

    My statement was based on easily observable reality. It is only your own prejudice that makes you imagine bias in my statement. Any MD can readily think of diagnostic tests, treatments, and medical advice that medical science has evaluated, found ineffective, and has stopped using. For instance, we’re not doing annual chest x-rays any more. I have searched diligently for examples of things CAM has found ineffective and stopped using. The only one I could find for chiropractic was the “nerve tracing” technique promoted by DD Palmer’s son BJ. Do you know of any others? I’m not aware of any homeopathic remedy that has been dropped from their materia medica and is no longer being used. Are you? The doctors in this article identified a serious problem and were able to pin down which drugs were most at fault and suggest ways to reduce adverse reactions. Are you aware of any similar examples from CAM?

    “No responsible authority in the alternative community is suggesting that we REPLACE science-based medicine”

    I don’t know what you would call a responsible authority on CAM, and I don’t think anyone wants to replace ALL science-based medicine, certainly not for things like emergency trauma care. But they all want to replace scientific medical thinking and rigorous studies with magical thinking and lesser forms of evidence. And there are many CAM authorities who denigrate various aspects of science-based medicine and actively try to discourage patients from seeing MDs. Just one clearcut example: I found a list of tips for chiropractors on how to destroy parents’ confidence in their child’s pediatrician and get them to seek care only from the chiropractor. And many CAM providers discourage vaccination. Naturopaths, homeopaths, chiropractors and others clearly want to replace MDs and become the primary contact for all medical care.

    And your tactic of blaming the sick for their illness is despicable.

  19. urodovic says:

    New guidelines for the management of Pradaxa have been issued by the FDA. Specifically in patients with low renal function. The lower the renal function the higher the risk of bleeding. Like Dr. Hall mentions in this fine article, this is what science based medicine and evidence based medicine is all about. Pradaxa came out in 2010 and as new evidence comes out on the way to lower the side effects this information is passed out to physicians so that these side effects can be reduced or eliminated altogether. Can we say the same of CAM? I dont think so..

    The Medical letter has the details in its December issue:

    http://secure.medicalletter.org/TML-article-1379b

  20. libby says:

    Rule #17:

    Make it a criminal offence for drug companies to conceal information on the side effects of their products.

    By the way, by presenting deaths from drugs and emergency hospitalizations from drugs separately, and then proceed to list percentages based on this selected, incomplete information, you get a very skewed picture of reality. Surely its the same problem and should be looked at as such.

  21. libby says:

    stanmrak:

    I agree with what you are saying. Conventional medicine generally does not promote a healthy lifestyle but a band-aid to an unhealthy one.

    But more importantly you talk of freedom, meaning here that people should have the opportunity to decide for themselves what health care they prefer. With the power and money of corporations behind them, the attempt to stamp out these freedoms is a very serious politico-social movement.

    1. Harriet Hall says:

      @libby,
      “Conventional medicine generally does not promote a healthy lifestyle but a band-aid to an unhealthy one.”

      Conventional medicine most certainly does promote a healthy lifestyle. It’s true that it concentrates more on treatment than prevention, and conventional medicine is constantly making diligent efforts to become better at prevention. And there’s no evidence that any non-conventional medicine is preferable.

      “the attempt to stamp out these freedoms is a very serious politico-social movement.”

      I haven’t seen any credible evidence of any serious movement to stamp out our freedom or that corporations are supporting such efforts. You were free to try homeopathy. Governments try to protect consumers. We have seat-belt laws, but no one has stamped out your freedom to drive without a seat belt.

  22. libby says:

    HH:

    “Conventional medicine most certainly does promote a healthy lifestyle.”

    In order to believe that statement you would have to believe that pharmaceutical corporations and doctors act independently of each other. According to the AMA, this is not true and in fact there appears a rather inappropriate, unhealthy connection between the two. The Stanford Medical Dept along with a few others are trying to reverse this trend.

    “….there’s no evidence that any non-conventional medicine is preferable.”

    Pay attention to semantics here. “Preferable” as an adjective and “prefer” as a verb carry different meanings. To mix the two is sheer confusion.

    By the way, I don’t agree with seat-belt laws.

  23. weing says:

    “By the way, I don’t agree with seat-belt laws.”
    Hey, you’re free to be stupid.

  24. WilliamLawrenceUtridge says:

    I agree with what you are saying. Conventional medicine generally does not promote a healthy lifestyle but a band-aid to an unhealthy one.

    So, your primary care physician has never recommended you become, or continue to be physically active, maintain a healthy weight, eat fresh fruits and vegetables, reduce stress, keep salt intake to a reasonable level and get vaccinations? You should report them to whatever regulatory agency controls physician practice because they should have their license revoked. My doctor has consistently stated that my diet (7-12 servings of fruits and vegetables per day), exercise (activity 6-7 days of the week), and sleep schedule (7-9 hours per night) are all good, and discouraged me from ever smoking. Doctors can’t make patients exercise, they can only ensure that they inform them they should – but in the meantime, it would be unethical to not offer what treatments they can over the short, or long term, to address immediate concerns. Telling a patient with type II diabetes to get more exercise, eat better and lose weight but not giving insulin to control blood sugar significantly increases their risk of death and is downright irresponsible.

    But more importantly you talk of freedom, meaning here that people should have the opportunity to decide for themselves what health care they prefer. With the power and money of corporations behind them, the attempt to stamp out these freedoms is a very serious politico-social movement.

    As someone with state-funded health care and an insurance plan, part of the concern is over use of scarce funds. I couldn’t care less if you want to pay for magic and wishful thinking out of your pocket, but absolutely do not want my tax dollars and premiums to subsidize your stupidity. And this ignores the fact that people are in essence free to get fleeced and have their money taken by unethical (perhaps well-intentioned) pracitioners who are providing little more than expensive mental-health counseling, when they’re not actively discouraging people with serious illnesses from getting effective treatment. All the “Big Pharma” conspiracy-mongering in the world doesn’t make acupuncture, homeopathy or megavitamin therapy effective, it’s just a convenient way for you to ignore the evidence in favour of a preconcieved opinion.

    By the way, I don’t agree with seat-belt laws.

    Well, that increases the likelihood that this conversation will end abruptly anyway. And is further proof you don’t understand medicine, public health or the purpose of state regulation. Do you drink and drive? Because I’m sure those laws impair your precious freedom too.

  25. DrRobert says:

    I absolutely cannot stand the claim by CAM practitioners that they somehow promote a healthy lifestyle. All they promote is expensive quackery that is potentially harmful. Consider chiropractic: they claim that regular spinal manipulations can “restore body balance” and increase “natural healing energies”, but all they are truly doing is needlessly exposing the patient to dangerous spinal manipulations that can result in paralysis, stroke, or death. How is that promoting a healthy life style? Where is the health involved in some quack sticking needles into patients, causing infection and pneumothorax? And who’s promoting health when they are giving flavored water to people in lieu of legitimate medical care while babies die of eczema? And how is health improved when parents are told by quack-holes that chelation therapy is going to remove all these mythical toxins, meanwhile vast amounts of calcium are chelated and the patient dies of hypocalcemic cardiac arrest? And how natural is it to have a “water birth” and the baby drowns in the tub?

    Even these CAM purveyors of fringe “natural” diets aren’t promoting healthy life styles. One quack CAM diet guru told me that eating a fresh pear is going to kill me because of the sugars in it, but it was totally healthy to eat literally multiple sticks of butter per day, and also told people w/ Raynaud’s that if they just quit eating carbs they’d be fine (ignoring the fact that it could have been a presenting sign of Lupus), and also advised all of her customers to stop taking their doctor-prescribed statins because the FRAMINGHAM study was a complete lie. I spent a weekend at this lady’s house. She was a diet guru on Oprah. She also set up her clients with consultations with an herbalist who claimed to have cured Glioblastoma Multiforme, which is the deadliest form of brain cancer, and without aggressive chemoradiation therapy the chances of living are practically nil. Oh, and she also told her clients that antibiotics are useless and that putting tea tree oil on, or ingesting it, is sufficient for any type of infection. …. Me and this quack did not leave on good terms.

    So no, I do not believe that CAM practitioners “promote a healthy lifestyle.”

  26. Scott says:

    In order to believe that statement you would have to believe that pharmaceutical corporations and doctors act independently of each other.

    Why? The only way that would be the least bit of a problem is if one’s definition of “act independently” is so restrictive that you’re effectively claiming that all MDs have as the sole motivation of all their decisions to maximize pharmaceutical profits. Which is certainly untrue.

    In any case, the fact that MDs routinely give advice on diet, exercise, etc. is conclusive proof that you’re Not Even Wrong.

  27. Calli Arcale says:

    libby:

    Make it a criminal offence for drug companies to conceal information on the side effects of their products.

    That may seem like a good idea (I mean, who doesn’t want them to disclose everything?), but I think it’s a bigger can of worms than you realize. First of all, wouldn’t the regulatory framework be a better avenue than the criminal justice system? For one thing, the burden of proof is different. Regulators only need to see whether the appropriate language is present; a criminal court will need to prove some degree of either malice or negligence, and for that to work, you’re going to have to define things like just how much due diligence is required to know what the side effects are, the duration between finding out about a side effect and changing the labeling, what actually constitutes a side effect (nausea is a reported side effect to practically everything, not because everything causes it but because it’s a really easy “nocebo” effect to trigger), etc. There’s also a very real question of whether or not such a thing could be sustainable. Would it create a chilling effect? And wouldn’t it be a bigger problem for alt med, which presently is generally not obligated to report side effects at all, nor to study or monitor the treatments to determine whether side effects occur?

    By the way, by presenting deaths from drugs and emergency hospitalizations from drugs separately, and then proceed to list percentages based on this selected, incomplete information, you get a very skewed picture of reality. Surely its the same problem and should be looked at as such.

    How so? I think it’s important to stratify the data because although deaths are an important endpoint, so are hospitalizations where the patient survives — and it is likely that different drugs will show up differently in these two categories. It tells you interesting and useful information. I’m not sure what your objection to that is.

    I agree with what you are saying. Conventional medicine generally does not promote a healthy lifestyle but a band-aid to an unhealthy one.

    Now, that is completely untrue. My conventional medical providers, health insurance provider, and the company that operates my provider’s clinic and the hospitals where I’ve sought treatment all make constant efforts to promote a healthy lifestyle, including active efforts directed right at me, personally and individually. Maintain a healthy weight; stay active; if not active, get active; eat a balanced diet; get more fiber; get certain recommended screenings to catch problems before they’re bad; monitor chronic health conditions; etc.

    Do you know what my doctor says is the best thing for my asthma? Exercise. Yep. She’s thrilled, too, that I’m no longer needing the inhaled cortisone since I started a regular exercise program. Wherever possible, lifestyle mods are better than drugs. This is the *consistent* message of every health provider I’ve ever interfaced with. Except maybe optometrists, but they’ve got a fairly narrow focus (no pun intended).

    Alt med, by contrast, in my experience promotes bandaids, and seems to discourage the idea that the body actually has some clue of what it’s doing. They tell you to take all of these supplements, to “cleanse” (imagine my shock to learn that doesn’t just mean bathing), to get your chi adjusted by acupuncture, etc. They want you to take all of these things that they say will restore you to the health our ancestors had. But our ancestors didn’t get acupuncture or take fish oil capsules. Mostly, they just got out more — it’s amazing how much of a difference just moving your body regularly will do. And this is a consistent message of *conventional* medicine.

    Y’know who does the most promotion of lifestyle change for better health around here? Blue Cross/Blue Shield, a major health insurance provider. They’re part of the conventional medical system, absolutely, and they know that this is a great way of reducing health care expenses because it WORKS. And they know it because of SCIENCE. They have this great advertising campaign that’s been going on for several years now promoting a very simple message: get off your butt and get your body moving. It’s probably the single biggest challenge to health care in America today. And it’s *mainstream medicine* that I see attacking it the most directly.

  28. WilliamLawrenceUtridge says:

    Calli Arcale, our ancestors also died earlier from infectious diseases, malnutrition (because they genuinely didn’t know what to eat to cure, say, scurvy), and my personal favourite – spear through the belly. Looking backwards to our ancestors for health advice is just plain stupid.

    Also ironic – criticising mainstream medicine for just offering pills. In addition to being false as multiple commentators have pointed out, it’s not like CAM offers a diversity of solutions. Homeopathy consists of identical pills. Acupuncture’s solution is always “needle”. The solutions of massage, craniosacral therapy, reiki, colon irrigation and megavitamin therapy are mutually contradictory but all converge on the idea of one true cause of disease. Hypocrisy to the nth degree.

  29. WLU- now, now, I’ve met some perfectly reasonable massage therapists (and pt folks who do therapeutic massage) with very realistic views of what they can and can not do. The ones I’ve dealt with would never sell their services as curing the one true cause of disease.

    I can’t disagree with the rest of your list, though.

  30. Scott says:

    Let’s also note that a lot of CAM “treatments” involve popping huge numbers of pills (“supplements”). Like, dozens every day.

    My favorite observation is the differing responses to a vitamin C deficiency:

    Typical SBM recommendation: Eat an orange with breakfast every morning.
    Typical CAM recommendation: Take pills.

    The difference in what the two MEAN by a “vitamin C deficiency” is also interesting, but not nearly so amusing. Let’s see, which of those is more “natural?”

  31. WilliamLawrenceUtridge says:

    MIM – too true, I am chastised. Some massage therapists are nutters, but certainly not all. Thanks for the correction.

  32. lilady says:

    I must say that some comments here are not just misleading…but absolutely false.

    The “blame game” has no place in science-based medicine, but is the rallying cry for alternative/complementary medicine “practitioners” and their gullible credulous audience.

    Medical doctors, not homeopaths or naturopaths, do provide information about healthy lifestyles, that include balanced diets based on research from the American Dietetic Association-not from a self-styled diploma mill graduate “nutritionist”. Recommendations for decreasing salt intake, maintaining a healthy body weight and exercise are always prescribed by medical doctors. There is rarely a need for vitamins, but the physician may prescribe certain vitamins to meet the nutritional needs of specific patients. “Other” preventive medicine are vaccinations for all the recommended childhood vaccines, booster shots, yearly seasonal influenza vaccine and pneumonia vaccine for the elderly.

    No “special diets”, no “supplements” and “no vitamins” will prevent a disease for which there are vaccines. Smallpox eradication teams of real doctors, nurses and other health care professionals did eradicate the scourge of smallpox from the face of the earth. But for political unrest in Africa and the Middle East, polio would have been eradicated as well.

    What does alternative and complementary medicine have to offer a patient who has a viral, bacterial, or zoonotic infection? Indeed, what alternative medicine is prescribed that is as effective an anti-malarial medicine? What alternative treatments have ever cured cancer or trauma injuries?

    The only thing that alternative/complementary medicine has to “offer” are ineffective, costly, sometimes dangerous supplements, nostrums, inane and useless treatments and conspiracy theories about Big Pharma, Big Government…and the undermining of our modern health care system.

    Get real folks, we are in the 21st century and have discarded blood-letting and miasmas.

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