Ask the Doctors

Dear Doctor: Could you please reassure my wife about "side effects"? She won't take some of her prescribed medicine because the potential side effects include liver damage, blindness, stroke, heart attack and death. I have tried to explain the legalities of these statements, but only to a deaf ear. (Maybe that's a side effect too!)

Dear Reader: Your wife's worry is understandable. Having prescribed medications for years, I've seen my share of side effects. They episodically occur in nearly every medication I've prescribed and, on occasion, can be severe. Clearly many people feel a distrust toward the pharmaceutical industry and its desire for profits, but those same people should acknowledge the science involved in creating medications to temper and eradicate disease. Yes, I still prescribe medications on a daily basis because, in most cases, their benefits outweigh the risks.

What concerns me is the need for multiple medications, especially for preventable conditions. Compounding that concern is the juxtaposition in advertisements -- for medications to treat preventable conditions as well as for sodas, desserts, sugary cereals, alcohol and fast food. It is almost as if one industry feeds on another.

The sheer number of medications that are available -- for nearly every condition -- and the propensity of patients to want them and doctors to prescribe them increase the likelihood that, overall, side effects will occur. You're right that most of those side effects warned about in commercials (of which there are so very many) don't normally occur. And your wife is also right to worry that they could.

Whatever the reason your wife was prescribed medication, help her to focus on the possible consequences of not taking it. If she has Type 2 diabetes and can't control her blood sugar with her diet, then explain the downside of poorly controlled diabetes: an increased risk of kidney disease, nerve dysfunction, coronary artery disease and a whole lot more. If she has uncontrolled high blood pressure, explain that this increases her risk of stroke, heart attacks, kidney failure and dementia. The consequences of not treating pneumonia, urinary tract infections, depression and kidney dysfunction can lead to a worsening of those conditions.

If your wife has a preventable condition and doesn't want to take drugs, she should concentrate on her physical and emotional well-being. For starters, she needs to take a hard look at the food she is eating, staying away from processed foods and those high in sugar, and limiting those with high amounts of saturated fat. Two, she needs to stay, or become, physically active. And three, she needs to stay mentally active. Well-being means an everyday focus on taking care of oneself while living in a society with so many unhealthy choices.

If your wife has a condition that isn't reversible through lifestyle changes, she should understand that medications can help control her symptoms and the progression of disease -- and that the side effects of blindness, stroke, liver damage, heart attack and death are rare with the vast majority of pharmaceuticals.

She should also understand that our country has systems in place to protect patients. Regulatory watchdogs and the practice of evidence-based medicine help reduce the risk of harmful medications being administered to the public. At times, severe adverse events have caused medications to be pulled from the market.

Nothing will eliminate the risk, but perhaps a consideration of all these factors will help put things in perspective for your wife.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

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