Vail Valley Dear Doc: Medicine isn’t black or white
Vail, CO Colorado
VAIL, Colorado “-Hot or cold, fast or slow, strong or weak, up or down, safe or risky. We tend to think in terms of one thing or another, each mutually exclusive. For the most part, that type of thinking works. It certainly makes our lives, and the decisions we make, easier. Medicine however is rarely so “black or white.”
I’ve been thinking about that medicine you want me to go on. At first I wasn’t so sure, but now I think maybe I should take it. Can we talk about it again?
Thanks for your help,
Undecided in Gypsum
Your question is perhaps the most important one every patient should ask before taking any medicine. Sometimes people ask questions about their medications, many times they don’t, but the decision is never simple. Before I go any further I would like to share an analogy.
Imagine for example a typical bright, clear day here in Eagle County. Your neighbors are coming over in two hours for dinner. You have not seen them in some time and you are excited to share pictures of a recent trip. The house is clean, the table set and the steaks ready for the grill. Suddenly you recall that the bottle of wine you thought you had set aside was the same one you opened the week before. With not much more than a passing thought, you decide a trip to the liquor store is in order. Now imagine the same event happening in the midst of a 100-year blizzard in January. Travel advisories have been issued on the TV and radio and two feet of freshly fallen snow blankets your driveway. As you hope your SUV will make it to the store, you see the town plow in a ditch at the end of the road and another accident just beyond that. What do you decide to do?
Every day we make risk/benefit decisions. Most of the time the choice is easy and little do we realize that we have judged the balance between two opposing things. Is that bottle of wine worth the risk of the car accident on the way to the liquor store? On even the best of days we might get in an accident driving to the store. (Not surprisingly, most automobile accidents occur within just a few miles from home)
Taking any medicine involves that same risk benefit decision. Truthfully, no medicine is completely safe, although fully understanding the risks and benefits of medication is a challenge. Most people think of the risks first, so let us start there. The risks of taking a medication are often thought of as side effects or adverse reactions. I believe cost plays a big role in that “risk” side of the equation as well. It is a lot easier to swallow a $5 medication than a $200 one. It is the perceived side effects that are complex to understand. Your doctor can be your best advisor when making your decision. Many side effects are over exaggerated while there are others you may not even be aware of. Some occur only when specific conditions are present or in specific individuals. A mild side effect in one person could be life threatening in another. Some adverse reactions are transient, while others never go away.
It is also important to understand how side effects are listed. When a medicine is first studied, patients are asked to report all symptoms they have while taking the drug. Those are listed as adverse reactions. At the same time, a second group of patients taking a placebo pill are asked to report the symptoms they have. Inevitably, many side effects will occur, not because of the drug (these patients are only taking a placebo) but because people experience symptoms all the time. The true adverse reactions then are the ones that are reported more frequently in the medicine-taking group of patients than the placebo group. Ask you doctor about side effects, read about them carefully and you will be a better decision maker.
The other side of the equation seems simpler to understand, but I believe it is actually more difficult. When you are feeling sick, taking a recommended antibiotic a week before a big vacation is an easy decision. The benefits are significant while the risks are low. On the other hand, taking a blood pressure or cholesterol-lowering medicine may be hard to do. The reason I believe is because the risks seem so large compared to the seemingly small benefits. After all, you are feeling just fine and your blood pressure or cholesterol is only a little bit high. In reality though the “benefit” side of the decision is not how much your numbers might come down but rather what those lower numbers mean with respect to your future risk of heart attack, stroke or one of the many other problems high blood pressure and cholesterol cause.
Understanding those future risks when treating a condition without symptoms is essential to doing what is best for you. Each person, circumstance and condition is unique. Nothing is more important than eating well, getting the right amount of sleep, reducing stress and getting regular exercise. When the risk/benefit decision of taking a medication comes your way, remember that with advice from your doctor and careful thinking about both sides of the equation, it really is not that hard to do.
Happy Saint Patrick’s day! Remember your health is your responsibility. Health is our greatest asset and it doesn’t happen by accident. If something doesn’t seem right, or questions are left unanswered don’t wait, call your doctor.
Dr. Drew Werner is the vice chief of staff at Valley View Hospital in Glenwood Springs and the Eagle County Health Officer. He lives in Eagle with his family. E-mail comments about this column to firstname.lastname@example.org.