Doctor Tom Ferguson and Pharmacologist Joe Graedon discuss fact about medicine that people should know if they want to manage their own medical care effectively.
In 1976, Tom Ferguson — then a fourth-year medical student at Yale — launched a magazine called Medical Self-Care, which he hoped would serve as "a Whole Earth Catalog of the best medical books, tools, and resources."
Tom spoke of his plans for the publicationand of his conviction that self-care could raise the general level of health in this country and lower our inflated levels of medical spendingin a MOTHER EARTH NEWS interview, and left no doubt that he would work toward making those "dreams"come true. Part I of this interview appears here; for Part II, see Medical Self-Care: Facts About Medicine, Part II.
Well, Tom Ferguson is Doctor Ferguson now, and the medical self-care "movement" — as well as Tom's magazine — has flourished. People are beginning to assume more responsibility for their own well-being and are eager for information that will help them take better care of their bodies.
This month's column is about the role of drugs in self-care, and contains the first part of an interview I had with Joe Graedon. Joe's a pharmacologist and the author of The People's Pharmacy, a book for folks who want the facts about medicine to improve their understanding of prescription and nonprescription drugs. He also serves as a consultant to the Federal Trade Commission, does a bi-weekly radio show for National Public Radio, and is on the staff of Medical Self-Care magazine. What follows is an edited version of our conversation.
FERGUSON: What is the most important fact to know about drugs?
GRAEDON: First and foremost, don't ever focus your treatment efforts exclusively on such substances. If you have an ailment, first try to understand the problem, its causes, and its symptoms. Learn what's going on with your body and how it relates to the rest of your life. Then you can consider ways of treatment . . . with a pharmaceutical product being just one possible way of dealing with the ailment.
FERGUSON: What should you ask your doctor when he or she prescribes a drug?
GRAEDON: Anytime you're considering taking medication, you've got to weigh the potential benefits against the potential drawbacks. So you should learn right off whether the drug you may take is intended to give purely symptomatic relief — which will not lead to a cure — or will actually help your body remedy its underlying ailment.
You should also find out about the medicine's common side effects, serious or not . . . about all possible drug interactions with other substances . . . and about any dangerous reactions the remedy has been known to cause, no matter how infrequently such repercussions may occur. Be sure, as well, that you know what the early warning signs for the serious side effects are.
Don't neglect to learn the name of the drug, either . . . that simple but vital fact is frequently not provided to the consumer. And I'm talking about the generic term . . . not just the brand name. In fact, if you're going to be taking a combination remedy, write down every ingredient in the medicine and — if you can — obtain from your doctor an information sheet about each of them.
Lastly, make certain that you understand precisely how to administer the drug — "before meals" is not a very specific time guide, for instance — and the reasons for the instructions.
FERGUSON: Are there any completely safe drugs?
GRAEDON: No, indeed. There are potential problems with all pharmaceuticals. Often, though, doctors and clients risk being lulled into thinking that particular medications are completely harmless . . . so let your doctor know about any side effects you experience from a drug, no matter how minor the reaction. Otherwise, the physician might not think to warn the next patient to whom he or she gives the medication.
FERGUSON: Why do most people rely so heavily on drugs for treatment?
GRAEDON: I think there are four main reasons for that dependency. One cause is the vast number of advertisements for over-the-counter drugs. Just count the number of medication-oriented ads you see on television in one week! Children are bound to grow up thinking that such potions are the answer to all health problems.
The second cause for our culture's drug reliance is the even more intense advertising efforts drug manufacturers make to promote their products to doctors. Pharmaceutical companies have thousands of employees whose sole job is to go to physicians' offices and "push" their drugs. Not only that, but almost every medical journal contains dozens of very expensive medication commercials. Such a sales blitz can't help having a very big impact on doctors' treatment tendencies.
Thirdly, health workers are educated to believe that "there's a pill for every ill." Prevention and non-drug-oriented treatments are too often either ignored or given only lip service.
And finally, the time pressure involved in clinical visits encourages drug therapy. The average doctor has perhaps 10 or 15 minutes to see each client. That's not enough time to think about prevention . . . or even begin to ask how the current problem might relate to the rest of an ailing person's life. In fact, 15 minutes is barely enough time to take a brief history, check the individual's blood pressure, and then write a prescription.
FERGUSON: A lot of people would feel cheated if they got advice instead of medication.
GRAEDON: Absolutely. Many of the pressures for drug use come from the client. We live in an "instant" society today, and when folks are ill they expect instant relief. Besides that, the doctors who are charging you $50 for a 15-minute visit aren't likely to recommend a nonprescription treatment like aspirin, even if that common medication happens to be the best and safest remedy for the illness . . . people will feel that they could have done that much for themselves.
FERGUSON: How can we break such patterns?
GRAEDON: People have to learn some basic clinical medicine for themselves, health workers need to step out of their authority roles a bit and share their own uncertainties and doubts, and medical education needs to stress non-drug treatment.
Right now, if someone comes into a physician's office with high blood pressure, the doctor's first thought will usually be to prescribe a thiazide diuretic . . . but a more appropriate initial step might be to recommend that the person lose weight, begin exercising, quit smoking, cut down on salt intake, learn new ways of dealing with stress, or apply a useful combination of these self-care approaches.
FERGUSON: What are some good self-health-care tools that are available in drugstores?
GRAEDON: One very good tool is the dipstick packet you can use to test your own urine. It provides a number of easy, inexpensive, and completely safe screening tests for excess sugar, blood, or protein in the urine.
Another new kit allows you to test your own stool specimen for traces of blood. Persons over 40 should take such an examination once a year. All they have to do is touch the fecal sample to a piece of moistened test paper . . . the strip changes color if blood is present.
And I highly recommend blood pressure cuffs for home use. Having your own tester is very helpful if you have high blood pressure and are working at controlling it on a self-help basis. The cuff provides a kind of biofeedback.