Practicing Medicine Without a License

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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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