Garth Rattray | Scared to death

The phrase 'scared to death' is usually used metaphorically. On rare occasions it is taken literally - in instances of a severe fright precipitating a fatal heart attack or stroke.

However, there are incalculable hundreds of thousands of patients who are so scared of taking prescription medications that they either refuse to take them or take them improperly and end up with serious illnesses (kidney failure, stroke, heart failure, heart attack, aneurysm, peripheral neuropathy and/or vascular disease, blindness) and premature death.

Throughout my 35 years in medicine, I spend a lot of time and effort trying to explain the critical importance of taking prescribed medications and their very favourable risk-to-benefit ratio. My father, of blessed memory, used to quip that odds of one in a million sound great until you are that one. However, in spite of their chemical actions, the vast majority of drugs are perfectly safe. You would have to have bad luck to experience a serious side effect.

The principle of 'risk' is very interesting. For example, I tell patients that the risk of injury or death while driving on our roads is considerably greater than being anaethetised and having a major operation. Almost everyone frets and gets the jitters prior to surgery, yet no one gets nervous leaving the hospital for home. If you look at it scientifically, you will see that major operations are much safer than our roads.

Patients hear or read how bad the possible side effects of prescribed medications can be and some literally panic and decide to take their chances with the natural outcome of their blood pressure, diabetes or high cholesterol or they try alternative (so-called 'natural') medications. This worries me for several reasons. The listed side effects are only possibilities and are by no means certainties. Even when patients are on polypharmacy (several different medications), the accumulated risk from deleterious effects remains quite low when compared to their benefits.

The problem is compounded by television (direct-to-consumer) ads that say what the medication is good for but then must go on to list a plethora of possible side effects, sometimes even speaking of fatalities. Patients hear one good thing that the medication can do for them, but then they hear 100 possible bad things that it can do to them. Interestingly, people who abandon manufactured medications and choose 'natural products' instead are making fundamental errors due to misconceptions about these alternative drugs.

First of all, advertised 'natural products' are not found that way in nature. In nature, they are not concentrated, preserved, saturated with additives or packaged. Furthermore, nature does not specify any dosage in quantity or frequency of administration. Oftentimes, it's a trial-and-error thing.

LEAP OF FAITH

Second, as far as I am aware, over-the-counter 'natural products' are not severely scrutinised, subjected to a myriad of animal and human trials over many years and regulated like prescription medications. There are no double-blind studies or adverse effects reporting platforms for them. Taking them represents a leap of faith.

Third, just about anything might have limited benefits if the patient believes that it will work. This is called the placebo effect.

Approved prescribed medications must strikingly outperform the placebo effect in order to be deemed effective. A bunch of anecdotal testimonials are no match for scientific experiments spanning decades.

Fourth, it is very important to note that for any medication/drug to do something for you, it must do something to you. There must be some chemical changes going on inside of you for there to be any effect. Obviously, therefore, even if there is some benefit to be derived from a 'natural product', it must make changes to your body and some of those changes might come at a price. In other words, if an alternative medical product is to work, it must also have possible side effects.

Unreasonable fear of the risk of side effects cause patients to take nothing, or take suboptimal doses or take infrequent doses or turn to unproven products. Whereas prescribed medications might have side effects, the medical conditions for which they are prescribed do have serious side effects and lead to premature death without proper treatment.

n Garth A. Rattray is a medical doctor with a family practice. Email feedback to columns@gleanerjm.com and garthrattray@gmail.com.