Practicing Medicine Without a License

Last week, a friend of mine who was writing an article about Alli, the over-the-counter version of orlistat (brand name Xenical), asked for my thoughts on the side effects of such drugs. For those of you who are unaware, orlistat blocks absorption of a portion of the fat you eat and can result in, um, overactive “regularity.”


First of all, I don’t know what’s wrong with just eating less fat. I mean, do we have to have a pill for everything?

What I said, however, was that I was less concerned about the immediate side effects of any drug and more about the long-term effects that we won’t know about for a while.

Recently, the diabetes drugs rosiglitazone (Avandia) and pioglitazone (Actos) have been in the news for their association with increased risk of fractures in women. (See blog entries “Diabetes Drug Linked to Fracture Risk” and “Second Diabetes Drunk Linked to Increased Fractures” for more information.) Both drugs were approved by the U.S. Food and Drug Administration (FDA) in 1999, so it’s taken about eight years now to find that out.

Remember the insulin sensitizer troglitazone (brand name Rezulin)? Approved by the FDA in January 1997, it was recalled in March 2000 after being suspected of causing nearly 400 deaths, largely from liver damage. (I’d be willing to bet that many of those deaths could have been prevented had more doctors performed liver function tests like they were supposed to.) There was a little problem with heart failure, too.

The problem is, we don’t know what will happen down the road. But I think that, in some cases, we can protect ourselves from future complications by paying attention to what should be happening today. And that goes for more than just prescription drugs.

Truthfully, sometimes I think I need to go to medical school just so I’ll know if my doctor is doing the right thing.

I wonder how many people taking Rezulin did their research and found out that their doctors were failing to order liver function tests. If so, did they then tell their doctors to order one?

One of my former docs told me that a blood pressure of 130/85 was “OK.” Nope, I told him. I have diabetes. It’s supposed to be lower than that. (He wasn’t happy about that. Tough. It’s my health. In fact, it’s my life. Note the word “former” in referring to that doc.)

I recall a friend of mine wondering if her mother would still be alive if only her doctor had sent her for a colonoscopy. By the time the cancer was discovered, it had spread to her liver. There’s been enough news about the need for colonoscopies after the age of 50 that we should be telling our doctors that we need to be having one if they fail to insist that we have one.

Do I really need that medicine? Avandia and Actos are both insulin sensitizers. So is exercise, and the only way I can think of that exercise would contribute to fractures is if we tripped over a crack in the sidewalk while strolling around the neighborhood. Also, unlike Avandia and Actos, exercise isn’t known to cause weight gain. (Of course, it could be that you’re already running marathons and you still need an extra oomph, so I’m not suggesting you take yourself off a diabetes drug without consulting with your doctor.)

I’m nosy, so I tend to read the product information that comes with all prescription drugs. Ask your pharmacist to give you the inserts for your drugs or go online and look them up. I pay close attention to the side effects and warning sections. If I have any of the symptoms listed, I tell my doctor. That’s another place to find out if my doctor is supposed to be doing something—monitoring my liver, for example—that hasn’t been done.

Another thing I do to keep myself safe is to have all of my prescriptions filled at the same pharmacy. That way, the pharmacist and the store’s computer checks to see if there are any drug interactions. If you’re like me, you take a variety of prescription drugs—for high blood pressure, high cholesterol, depression, and so on. I also check over-the-counter drugs with my pharmacist. He’s been known to say that something I’ve selected would not be a good choice, given the drugs I already take plus the diabetes, asthma, and arthritis.

Whew! Now, where’s that application for medical school?

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  • jim


  • Ephrenia

    My former Dr didn’t think I needed an HbA1c (it had been over a year since my last one) because I told her I was doing allright when she asked. She never looked at my logbook. Then decided I didn’t need to test as often as I was.

    My new Dr told me she’s “tough” on her diabetic patients. I said GREAT. I had been “backsliding”. I NEED someone to hold me accountable, while letting me decide on methods I prefer (like exercise instead of meds) as long as its working.

    And YEP, I do research my meds before taking them. I have neuropathy. I didn’t want to take Lyrica (no long term info) so I keep my BSL in range, exercise and started taking Alpha Lipoic Acid instead. I’ve been able to eliminate the pain without Lyrica. It might not work for everyone, but it has for me.

  • Bernie Spector

    you were lucky to have a phamacist to consult with. Most pharmacy contacts are with a technician who usually is more concern as to my insurance coverage rather than my health. Your best bet was to stay on top of the latest information yourself. The ADA professional site is a great place.

  • chemist

    How long do most people stay on oral meds before having to take insulin?

  • Jan Chait

    Chemist, I’ll bet that if you get a gazillion responses, you’ll get a gazillion different answers. Not only does it vary from person to person, but you may never have to go on insulin. On the other hand, you may want to go on insulin even before you “have” to. The goal of whatever diabetes regimen you’re on is to keep your blood glucose in as normal a range as possible for the most part (“always” ain’t gonna happen!). If your current regimen isn’t helping accomplish that, it’s time to take the next step, whatever that is. You can tell when it’s time by checking your blood glucose on a regular basis — and don’t forget to check two hours after you first begin eating a meal once in a while.
    Type 2 diabetes is progressive and changes in regimen will need to be made. Even people who remain in good control need to make those changes. It’s just the way Type 2 works.

  • Timeless Truth

    Two and half months before I made a routine checke up and my fast blood sugar level became 176. My BP was 160/110. I reduced weight drastically i.e 11 KGs and it is now consistently 120/80. I took BP tablets for 8 days and stopped it by Doc advice. A re-check of FBS the next day, it became 165. I had another one on the 5th day and it became144. The Doc said, “you can control this by diet”. I started taking diabetic diet and it is now consistently below 95. And yet I am disturbed for I am not sure whether or not I am a diabetic. Am I diabetic? If I am a diabetic, how could it go so low within a week time? It had even gone as low as 59 and 60 in two of the tests. It was 95 only once and I had eaten pizza the previous night. Is it a pre-diabetes or a diabetes case? Is it wise to start taking medicine at present? should I consult more than one Docs? I am at a loss. It could be of some interest for you to know my brother died of diabetes melitius at the age THE OTHER POINTS I DIDN’T MENTION ARE:
    1. I wake up almost every night two or three times. Sometimes to pee, but mostly for no reason whatsoever.
    2. I do make RBS test almost every day and the highest is 115.
    3. I used to enjoy a couple of beers every night after dinner. I stopped it for the last two and half months. Can I periodically i.e once in a week take a couple of draft beers?

    1 day ago
    1. I had an FBS test today, February 28, 2008 and the result worried me a lot. It became 135. I talked to the Doc and she said, ” I need to have another FBS test on coming Monday.
    2. I once (only once) smelled a non existing nasty hot plastic type smell.
    3. I am having a mild head pain on different places.
    4. I am having a mild pain on my left side under my breast and on my right side too above my waist.
    I had FBS test today, 29/02/08 and it is 83.
    I AM CONFUSED. I highly value and appreciate your responses for whatever they are.of 34. I am 54 yr old.