[Medicine-for-people] Prescription Medications - When to Use Them;
When to Lose Them
Douwe Rienstra
medical at olympus.net
Thu Sep 6 21:38:30 PDT 2007
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Medicine for People!
September, 2007
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Contents
Prescription Medications - When to Use Them; When to Lose Them
- Prolonged Bronchitis - What To Do About that Hacking Cough
- Antidepressants - Dangerous or Helpful?
- Putting it All Together
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Prescription Medications - When to Use Them; When to Lose Them
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Today we docs have some powerful prescriptions medications in our
arsenal. Antibiotics, first used in the 1940s, saved many lives that
would have been lost to infectious disease. They offered incredible
hope, but almost as soon as they were invented, they began to be
misused. My editor, who came down with mononeucleosis in 1948 at the
age of four, was hospitalized and given penicillin shots every four
hours night and day. The painful injections did nothing for the
virus that caused her mononucleosis, and she recovered despite, not
because of, the treatment. Her doll suffered many a pinprick as she
worked through the trauma. Today, the appeal of a pill that will
just "make you better" - be it an antibiotic or an antidepressant -
is still strong. Sometimes that pill can save a life; sometimes it
doesn't help at all. The challenge for both physician and patient is
knowing when to take the pill, when to try something else, and when
simply to allow the body to heal itself.
=== Prolonged Bronchitis - What To Do About that Hacking Cough ===
= Gimme a Pill! =
You've had a cough for ten days. Nothing you've tried seems to
help. You've promised to go to your nephew's wedding, and you don't
want to show up hacking and looking like a corpse. Your friend had a
similar cough, went to her doctor, and got an antibiotic. Within a
few days, she was better. Your friend tells you to go to your doctor
and get an antibiotic.
There's one trouble with this advice. It's wrong.
In almost every study of antibiotics for acute bronchitis, they've
been shown to be worthless. Researchers at Rush Medical Center in
Chicago gave azithromycin, one of our most potent respiratory
antibiotics, to 112 people with acute bronchitis. At the same time
they gave vitamin C to 108 people similarly afflicted. Seven days
later 89 percent of each group had returned to normal activity. No
difference. Why? Antibiotics kill bacteria, not viruses. Pour down
the hatch all the azithromycin you want; a virus-caused bronchitis
just ignores it and soldiers on. We eventually get well no matter what we do.
= So What Can You Do? =
Does that mean just leave bronchitis alone? Sometimes we can do
better than that. Often people with prolonged bronchitis have
developed an allergic response along with it. The allergy interferes
with clearance of the virus causing the bronchitis; at the same time
the virus keeps the allergic response going. When we find that to be
the case, we can break the cycle with an inhaled bronchodilator to
open up the lungs. The Rush researchers did the same in the study
above, giving an inhaled bronchodilator to everyone in the
study. That may be why, after seven days, they had an almost 90
percent recovery rate.
So, if your cough just won't go away, sure, visit your doctor. But
expect that he or she will consider the whole picture. If doctors
throw an antibiotic at everyone who comes in the door, they are also
throwing away the advantages those antibiotics give us against
bacteria. Bacteria are masterful survivors and they communicate with
their fellows. If one bacterium has had to deal with an antibiotic
and survived, it can pass on, chemically, that resistance to other bacteria.
The discomfort and disability of bronchitis is no joke, and requires
intelligent treatment. There are a number of ways to ease the
discomfort and speed healing. An antibiotic isn't necessarily one of
them. We must take advantage of antibiotics when they can help us,
and accept that there are times when they cannot.
=== Antidepressants - Dangerous or Helpful? ===
Antidepressants are some of the most common medications prescribed by
doctors (http://en.wikipedia.org/wiki/Antidepressant ). They are
also some of the most controversial. As a physician who focuses on
preventive medicine and makes ample use of natural remedies, you
might think I'm opposed to them. I am not.
No antidepressant is a panacea. The cornerstone of mental health
lies within us, not within a tablet. Yet there are times when life
is better with the tablet than without. For example, look at people
who abuse drugs. Many of those folks suffer from clinical
depression, and they treat themselves with methamphetamines rather
than Prozac. Which would you rather see your neighbor taking?
Unfortunately, the media find sizzle in stories of children
supposedly driven to suicide by an antidepressant. Those stories
badly distort the truth. Yes, we have known for two decades now that
when severely depressed patients start on an antidepressant, some of
those folks will commit suicide. We think it is because before
treatment they were so vegetative that they could not muster the
energy to act on their suicidal impulses. As the antidepressant
improves their energy, they may reach a point when improved energy
and suicidal impulses can co-exist and lead to self-destructive
behavior. This is a dangerous moment that is usually soon
passed. For a couple of decades doctors have been taught to
carefully monitor people during this crucial time.
If, alternatively, we avoid the antidepressants, over time we see
more suicide as the depression goes on untreated for years. Starting
the antidepressant can be compared to surgery. When appropriately
used, a short-term period of instability is most often followed by
better health.
When the National Bureau of Economic Research looked at this
question, they concluded that increasing use of anti-depressant
medication has led to decreased suicide rates. You can see their
report at http://www.nber.org/papers/w12906; it is pretty abstruse,
but the graph on page 41 provides a quick summary.
Again, treatment of depression best involves not just medication, but
a skilled human being. And, yes, the warnings about medication side
effects are wise, just as we have warning on chemotherapeutic drugs
for cancer. In my view, blanket avoidance of antidepressant
treatment, without attention to the danger of untreated depression, is foolish.
=== Putting it All Together ===
When you see your health care provider, sure, tell about your friend
who took the antibiotic for bronchitis. Bring up articles you've
read about antidepressants or other medications. Let your doctor
know what you are thinking and feeling about whatever medical problem
you bring. Then expect that this professional will be able to add
something intelligent to the conversation and willing to collaborate
with you. People differ, circumstances differ, and you deserve the
best solution possible for your particular situation.
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=== Recent issues of Medicine for People! ===
[August, 2007 not yet posted on website]
July, 2007 Annual Pharmacy Update, Free Pharmaceuticals, Medicine
Far From Home http://www.rienstraclinic.com/newsletter/2007/2007July.html
June, 2007 The Long and Winding Road
http://www.rienstraclinic.com/newsletter/2007/2007June.html
May, 2007 Depression, Dementia, and Lithium
http://www.rienstraclinic.com/newsletter/2007/2007May.html
April, 2007 Beware the Lowest Bidder - Choosing Supplements for
Health http://www.rienstraclinic.com/newsletter/April2007.html
March, 2007 Brain Health as We Age Part 12 - The Final Chapter
http://www.rienstraclinic.com/newsletter/2007/2007Mar.html
February, 2007 Brain Health as We Age Part 11 - Reason for
Hope: Nutrients to Preserve Memory and Sharp
Thinking http://www.rienstraclinic.com/newsletter/2007/2007Feb.html
Janaury, 2007 Brain Health As We Age Part 10 - The Hippocampus, Seat
of Memory http://rienstraclinic.com/newsletter/2007/2007Jan.html
December, 2006 The Shingles Vaccine: is it Right for You?
http://www.rienstraclinic.com/newsletter/2006/2006Dec.html
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Medicine for People! is written by Douwe Rienstra MD, edited by
Carolyn Latteier, and published at Port Townsend, Washington.
Copyright September, 2007.
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