“I DON’T NEED NO STINKING DRUGS”

Today a patient of mine, a nice, active senior gentleman with a new diagnosis of coronary artery disease, informed me he hadn’t started his statin, an important anti-cholesterol medication. He wanted to try vitamins first. So let’s take another break from the tedium of the health care crisis to discuss another topic near and dear to a doctor’s heart (pun intended)—“noncompliance.” That’s the imperious term we use to describe any reason for not taking what you’re told outside of your hair falling out or your digits falling off. Joking aside, not taking prescribed medications because of memory issues or the notion that diet or “natural remedies” will suffice qualifies as noncompliance. We typically learn of it days, weeks, even months after the fact.

While the Internet can be a wonderful source of medical information, it is not always the patient’s friend. If I had a nickel (okay, a quarter) for every time someone told me he or she didn’t take their medication because they went on line and read about all the side effects, I wouldn’t have to charge at all. Every medication a doctor prescribes has a list of potential side effects, minor and serious, that would daunt even the stoutest of hearts (pun again intended). The fact is, we doctors understand we’re not your parents. We know that when we “order” a drug it’s really a suggestion—unlike a veterinarian we can’t hold you down and open your mouth and make you take it. And you’ve hired us as a consultant, for our expertise, even if you decide not to act on it. We’re paid to consider the risks and benefits and come up with the treatment we think is best. But contrary to some people’s beliefs, we don’t prefer drugs to homeopathic or “natural” remedies because we get kickbacks from the pharmaceutical industry. (I’ve always wondered what “natural” means, since the ingredients in these miracle treatments have usually been processed and concentrated, or the concentrations have been left to chance, or there’s next to no active ingredients at all.) We use prescription drugs because they’ve been rigorously tested and they work. Not always as well as we’d like, but they work, as opposed to “nutraceuticals” that generate their huge profits through the mantras of “natural” and “free of side effects,” with the scantest of scientific evidence behind them, if any at all. Some are downright misleading like the so-called “flush-free niacin” that doesn’t even treat what it purports to.

My patient agreed to take the statin, probably the most important pill in his regimen to combat clogged arteries. I hope he doesn’t get the muscle aches that prevent some of my patients from reaping its benefits. We’ll cross that bridge if we have to. But I still won’t give him “flush-free niacin.”

Let me sum it up the way I do for my patients: It you feel compelled to spend your hard-earned money on the Sunday morning radio special of the week, just give it to me instead. I guarantee at least one of us will feel much better.

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