Let’s Talk About Drugs

Maybe the timing is coincidental. Maybe studying pharmacology so much lately is making me more attuned to notice stories and posts regarding drugs and disease. Or maybe there has legitimately been a lot of really terrible Facebook posts, links, and comments lately (at least on my Facebook page). When someone on Facebook posts a story and claims “this is why I will never get my kids vaccinated!” I sometimes die a little inside. I would love to dissect their claim, present some objective evidence, and state my own claim in a reasonable manner, but we all know how that goes. Instead, I have turned to my blog, where I will be presenting some of the more common statements I’ve seen and the reasons why they are ridiculous. We’ll start with….

1. Doctors overprescribe drugs. They need to stop throwing pills at problems. They put my friend on too many drugs and he developed all of these side effects. Etc.

As seen in:

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Yeah…I’m pretty good at MS Paint

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First things first: it is very possible to be taking too many drugs. We had an entire lecture on this last week. It’s fine to be on a handful of drugs, but if you have a patient routinely take 10+ pills per day you are going to run into problems with side effects, compliance, and drug interactions. So why is it that patients accumulate so many medications? Why do doctors consistently prescribe drugs for patient complaints?

Probably because that’s what they are trained to do. And because it works. I am not attending medical school to learn how NOT to prescribe drugs. I’m learning how to harness the incredible therapeutic potential available to me and every modern physician. There are so many drugs that work so well at fixing common problems I would be remiss as a physician if I didn’t prescribe.

Example: If a 48 year old man comes into my practice for a check up, and I notice he has high blood pressure, I have two options. I can tell him he needs to eat healthier, exercise, and drink less alcohol. Over time, this would make him healthier and lower his blood pressure. Of course, very few patients will actually do this. He is most likely to walk back into my clinic a year later and tell me that he was busy at work, tried walking but hurt his foot, and otherwise didn’t get any healthier. And he was exposed to an extra year of uncontrolled high blood pressure, increasing his risk for serious problems later on in life.

I could also give him a prescription for Lisinopril. He could take a pill every morning, his blood pressure will go down, whether or not he improves his lifestyle, and I improved his chances of living a longer, healthier, happier life.

The trap of this example is when a patient comes in with an upset stomach, so I give a script for that. They take it and their stomach is better but they feel dizzy and sick, so I give another script for that. That’s usually when people start experiencing really bad symptoms from taking too many drugs. Do people think that the doctors were intentionally trying to hurt people with these medications? There’s nothing nefarious here. The intention was always to treat.

2. If I vaccinate my kids they will get autism. It’s unnatural. I don’t want to expose them to those terrible things. It’ll do them more harm than good.

As seen in:

This has come up a few times lately, especially after we watched Jenna Mccarthy on the Rockin New Years Eve a few weeks ago. I’d like to start by saying that if you are taking healthcare advice from a Playboy model, please re-evaluate your life and see an actual physician immediately. Vaccinations do not cause autism. I’ve looked at the evidence for it, and its pretty slim. For the rest of this article, however, I’ll assume it could (I’m feeling generous). People who don’t vaccinate their children are susceptible to two fallacies. First, that by avoiding vaccination they are somehow protecting their kids from exposure to the pathogens that cause disease. Second, that vaccination is primarily intended to protect their child specifically.

Ever heard of a kid with polio? Rotavirus? Smallpox? Probably not in recent memory. How about whooping cough? Few Americans (or none, in some of those cases) ever develop these diseases. The reason isn’t that the disease doesn’t exist anymore, but instead that vaccination has prevented the pathogen from causing disease. Viruses and bacteria are everywhere. Always watching. Always waiting. Just kidding, but there are way more of them than us, and our immune system clears them very efficiently ever day. If you don’t vaccinate a child against a disease, that doesn’t guarantee that they will never see that pathogen. It just handicaps their immune system if they should ever come across it.

Second, vaccinations aren’t exclusively intended for your child specifically. The key here is a concept called herd immunity. If you prefer to think of the human race as something different than a herd, call it population immunity. When the herd is vaccinated (say 95%) against a disease, only 5 out of 100 members will be susceptible to developing a disease. Should one of them acquire the disease, their chance of spreading it is low, because only 4 of the remaining 99 members can acquire it. If the herd is unvaccinated against that disease, however, one member acquiring it will cause a rapid spread through the herd. There will be a few members who are naturally resistant (there is always a small percentage of people with natural resistance to some disease), but the rest of the herd will be devastated. Getting your child vaccinated is less about their protection than it is for the rest of your kids class. Some vaccines don’t matter for kids, but for adults. Children don’t develop symptoms when infected with Hep A, but they can spread it to adults, where it causes serious illness.

This is what comes to mind when I think of “herd immunity”

3. I’m so worried that I have the swine/avian/llama flu! Everyone is going to die!

Actually probably so. If there is a total disaster to worry about, it would be a mutated influenza virus. We all remember the H1N1 outbreak a few years ago, and ever more recently new mutations like last years H7N9 virus caused concern. Should a strain of influenza develop easy transmission between humans as well as the ability to easily cause disease or death, it will be scary. Influenza changes and evolves quickly enough already, which is why there is a new flu shot every year. Millions of people died in 1918 during an influenza outbreak, where massive global troop and refugee movements allowed it to ravage the world. Despite the present lack of a world war, we have a constant state of travel and mobility, both internationally and regionally. Scary scary.

4. Have you heard about all of these new resistant bacteria? MRSA, VRE, CRE? It’s going to be the end of medicine!

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Surely you have heard of these new “super bacteria”. Are they scary as well? Yup. Are they the end of modern medicine? Nope. That link above was shared by a friend but written by a lawyer. Antibiotic resistance is certainly a problem, but it’s one that we will solve. I have had antibiotic resistance pounded into my head for the last six weeks. When to use antibiotics, when to hold them, how to identify resistant strains, combination drug therapies, etc etc. I can remember a high school teacher from years ago talking about MRSA, how terrible it was, and how that would be the end of modern medicine. Multiple resistant bacteria have developed since then, nastier than MRSA, even. Why am I not worried as much about CRE? First, because its nosocomial (acquired while in a hospital). These super bugs don’t exist everywhere around the world. They usually only infect people with extended hospital stays and invasive therapies (like catheters). Second, they will be beaten as well. People far smarter than me are always working on drugs to combat these resistant strains that develop. A resistant infection is never a good thing, but in order to find yourself developing one of these you would probably already have had something pretty serious going on.

What do you think? Let me know in the comments below or at sortadrwordpress@gmail.com

Thanks for reading

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