A drug, broadly speaking, is any substance that, when absorbed into the body of a living organism, alters normal bodily function.
By Morgan Lord
Men's Health on NBC News
With 3,480 pages of fine print, the Physicians' Desk Reference (a.k.a. PDR) is not a quick read. That's because it contains every iota of information on more than 4,000 prescription medications. Heck, the PDR is medication — a humongous sleeping pill.
Doctors count on this compendium to help them make smart prescribing decisions — in other words, to choose drugs that will solve their patients' medical problems without creating new ones. Unfortunately, it seems some doctors rarely pull the PDR off the shelf. Or if they do crack it open, they don't stay versed on emerging research that may suddenly make a once-trusted treatment one to avoid. Worst case: You swallow something that has no business being inside your body.
Of course, plenty of M.D.'s do know which prescription and over-the-counter drugs are duds, dangers, or both. So we asked them, "Which medications would you skip?" Their list is your second opinion. If you're on any of these meds, talk to your doctor. Maybe he or she will finally open that big red book with all the dust on it.
It's asthma medicine ... that could make your asthma deadly. Advair contains the long-acting beta-agonist (LABA) salmeterol. A 2006 analysis of 19 trials, published in the Annals of Internal Medicine, found that regular use of LABAs can increase the severity of an asthma attack. Because salmeterol is more widely prescribed than other LABAs, the danger is greater — the researchers estimate that salmeterol may contribute to as many as 5,000 asthma-related deaths in the United States each year. In 2006, similarly disturbing findings from an earlier salmeterol study prompted the FDA to tag Advair with a "black box" warning — the agency's highest caution level.
Your new strategy: No matter what you may have heard, a LABA, such as the one in Advair, is not the only option, says Philip Rodgers, Pharm.D., a clinical associate professor at the University of North Carolina school of pharmacy. For instance, if you have mild asthma, an inhaled corticosteroid such as Flovent is often all you need. Still wheezing? "Patients can also consider an inhaled corticosteroid paired with a leukotriene modifier," says Dr. Rodgers. This combo won't create dangerous inflammation, and according to a Scottish review, it's as effective as a corticosteroid-and-LABA combo.
Diabetes is destructive enough on its own, but if you try to control it with rosiglitazone — better known by the brand name Avandia — you could be headed for a heart attack. Last September, a Journal of the American Medical Association (JAMA) study found that people who took rosiglitazone for at least a year increased their risk of heart failure or a heart attack by 109 percent and 42 percent, respectively, compared with those who took other oral diabetes medications or a placebo.
The reason? While there have been some reports that Avandia use may cause dangerous fluid retention or raise artery-clogging LDL cholesterol, no one is sure if these are the culprits. That's because the results of similar large studies have been mixed. So the FDA has asked GlaxoSmithKline, the maker of Avandia, to conduct a new long-term study assessing users' heart risks. There's only one problem: The study isn't expected to start until later this year.
Your new strategy: Stick with a proven performer. "I prefer metformin, an older, cheaper, more dependable medication," says Sonal Singh, M.D., the lead author of the JAMA study. "Avandia is now a last resort." Dr. Singh recommends that you talk to your doctor about cholesterol-lowering medicines, such as statins or the B vitamin niacin. Swallowing high doses (1,000 milligrams) of niacin daily may raise your HDL (good) cholesterol by as much as 24 percent, while at the same time lowering your LDL and triglyceride levels.
Once nicknamed "super aspirin," Celebrex is now better known for its side effects than for its pain-relieving prowess. The drug has been linked to increased risks of stomach bleeding, kidney trouble, and liver damage. But according to a 2005 New England Journal of Medicine study, the biggest threat is to your heart: People taking 200 mg of Celebrex twice a day more than doubled their risk of dying of cardiovascular disease. Those on 400 mg twice a day more than tripled their risk, compared with people taking a placebo.
And yet Celebrex, a COX-2 inhibitor, is still available, even though two other drugs of that class, Bextra and Vioxx, were pulled off the market due to a similar risk of heart damage. The caveat to the consumer? In 2004, the FDA advised doctors to consider alternatives to Celebrex.
Your new strategy: What you don't want to do is stop swallowing Celebrex and begin knocking back ibuprofen, because regular use of high doses of nonsteroidal anti-inflammatory drugs (NSAIDs) can lead to gastrointestinal bleeding. A safer swap is acupuncture. A German study found that for people suffering from chronic lower-back pain, twice-weekly acupuncture sessions were twice as effective as conventional treatments with drugs, physical therapy, and exercise. The strategic needling may stimulate central-nervous-system pathways to release the body's own painkillers, including endorphins and enkephalins, says Duke University anesthesiologist Tong-Joo Gan, M.D. You can find a certified acupuncturist in your area at medicalacupuncture.org/findadoc/index.html.
Most bacteria in the lungs and sinuses don't stand a chance against Ketek, but you might not either. This antibiotic, which has traditionally been prescribed for respiratory-tract infections, carries a higher risk of severe liver side effects than similar antibiotics do. "Ketek can cause heart-rhythm problems, can lead to liver disease, and could interact poorly with other medications you may be taking," says Dr. Rodgers. "Unfortunately, it's still available, and although many doctors are aware of the risks, some may still prescribe it without caution." In February 2007, the FDA limited the usage of Ketek to the treatment of pneumonia.
Your new strategy: Can't imagine catching pneumonia? The last time the Centers for Disease Control and Prevention calculated the top 10 killers of men, this deadly lung infection (along with the flu) came in seventh. Avoid backing yourself into a corner where you might need Ketek by always signing up for your annual flu shot — if you have pneumonia, it'll reduce your risk of dying of the infection by 40 percent. And if you still end up staring at a scrip for Ketek, Dr. Rodgers recommends asking to be treated with one of several safer alternatives, such as Augmentin or the antibiotics doxycycline or Zithromax.
Prilosec and Nexium
Heartburn can be uncomfortable, but heart attacks can be fatal, which is why the FDA has investigated a suspected link between cardiac trouble and the acid-reflux remedies Prilosec and Nexium. In December 2007, the agency concluded that there was no "likely" connection. Translation: The scientific jury is still out. In the meantime, there are other reasons to be concerned. Because Prilosec and Nexium are proton-pump inhibitors, they are both incredibly effective at stopping acid production in the stomach — perhaps too effective.
A lack of acid may raise your risk of pneumonia, because the same stuff that makes your chest feel as if it's burning also kills incoming bacteria and viruses. You may also have an elevated risk of bone loss — in the less acidic environment, certain forms of calcium may not be absorbed effectively during digestion. "The risk of a fracture has been estimated to be over 40 percent higher in patients who use these drugs long-term, and the risk clearly increases with duration of therapy," says Dr. Rodgers.
Your new strategy: When you feel the fire, first try to extinguish it with Zantac 150 or Pepcid AC. Both of these OTC products work by blocking histamine from stimulating the stomach cells that produce acid. Just know that neither drug is a long-term fix.
"To really cure the problem, lose weight," says Michael Roizen, M.D., chief wellness officer at the Cleveland Clinic and co-author of "YOU: The Owner's Manual." That's because when you're overweight, excess belly fat puts pressure on and changes the angle of your esophagus, pulling open the valve that's supposed to prevent stomach-acid leaks. This in turn makes it easier for that burning sensation to travel up into your chest.
What possible harm to your peepers could come from these seemingly innocuous eyedrops? "Visine gets the red out, but it does so by shrinking blood vessels, just like Afrin shrinks the vessels in your nose," says Thomas Steinemann, M.D., a spokesman for the American Academy of Ophthalmology. Overuse of the active ingredient tetrahydrozoline can perpetuate the vessel dilating-and-constricting cycle and may cause even more redness.
Your new strategy: If you still want to rely on Visine, at least make sure you don't use too many drops per dose and you don't use the stuff for more than 3 or 4 days. But you'd really be better off figuring out the underlying cause of the redness and treating that instead. If it's dryness, use preservative-free artificial tears, recommends Dr. Steinemann. Visine Pure Tears Portables is a good choice for moisture minus side effects. On the other hand, if your eyes are itchy and red because of allergies, pick up OTC antiallergy drops, such as Zaditor. It contains an antihistamine to interrupt the allergic response but no vasoconstrictor to cause rebound redness.
Forget that this decongestant can be turned into methamphetamine. People with heart disease or hypertension should watch out for any legitimate drug that contains pseudoephedrine. See, pseudoephedrine doesn't just constrict the blood vessels in your nose and sinuses; it can also raise blood pressure and heart rate, setting the stage for vascular catastrophe. Over the years, pseudoephedrine has been linked to heart attacks and strokes. "Pseudoephedrine can also worsen symptoms of benign prostate disease and glaucoma," says Dr. Rodgers.
Your new strategy: Other OTC oral nasal decongestants can contain phenylephrine, which has a safety profile similar to pseudoephedrine's. A 2007 review didn't find enough evidence that phenylephrine was effective. Our advice: Avoid meds altogether and clear your nasal passages with a neti pot, the strangely named system that allows you to flush your sinuses with saline ($15, sinucleanse.com). University of Wisconsin researchers found that people who used a neti pot felt their congestion and head pain improve by as much as 57 percent. Granted, the flushing sensation is odd at first, but give it a chance. Dr. Roizen did: "I do it every day after I brush my teeth," he says.
The above headline comes from the United Kingdom on March 11, 2013 from The Telegraph. The article starts off by quoting Professor Dame Sally Davies, the UK Chief Medical Officer (CMO) who said that the threat posed by antibiotic resistance is a "ticking time-bomb", which should be put on the UK's National Risk Register.
Professor Davies's comments were based on her report published on March 11, 2013 titled, "Annual Report of the Chief Medical Officer". Highlighting the importance Professor Davies gives to this issue, the subtitle of her report reads, "Infections and the rise of antimicrobial resistance."
According to the Telegraph article, "The problem is a “ticking time bomb” and should be put on the National Risk Register — which also includes “catastrophic terrorist attacks” and other civil emergencies, Prof Dame Sally Davies said.
Another article on the same subject in The Guardian on March 17, 2013 points out how serious this issue is by saying, "Antibiotic-resistant bacteria kill far more people each year globally than terrorism." The Guardian further illustrates their point by reporting that the, "World Health Organization estimates that for tuberculosis alone multi-drug resistance accounts for more than 150,000 deaths each year."
A number of the articles addressing this issue point out that the main reason for the rise in antibiotic resistance is the overuse and indiscriminant use of antibiotics. One article notes that in years to come, if this problem is not kept in check, almost half of the people who have surgery, such as hip replacement, will succumb to an infection, and of those about 30% will die from it.
In an April 9, 2013 news article on the UK government website Professor Anthony Kessel, Director of Public Health Strategy at PHE, sums up the issue by saying: "We are very pleased that the CMO is giving the issue of antibiotic resistance her full attention. This is not a clinical issue but one that affects all of us and we must change our attitude towards antibiotics. They certainly have their place for treating bacterial infections but too often are given for viral illnesses which contribute towards the problems we are facing today. This will require more awareness raising and education both for clinicians and the public on how we use the antibiotics that we have."
In a report from the Feb. 21, 2002Â PRNewswire comes a story of a national telephone survey conducted by Media General Research in December 2001, in which it was revealed that consumers rely most on chiropractic as the number one natural, non-drug choice for most pains and injuries. The survey found for example, that 42 percent of consumers have experienced back pain during the past year. The number one natural choice was chiropractic care. The study also found that of those patients who saw a chiropractor, 91 percent rated their care as "very" or "somewhat" effective.
The study also showed that while sixty percent of consumers said they would go to an MD if they experienced an injury causing pain to their back or neck, about 23 percent said they would go to a chiropractor. This number was more than physical therapists at 7 percent, massage therapists at 4 percent, and acupuncturists at only 1 percent.
While it is a common public belief to associate chiropractic with back and neck pain, the survey also showed another area that is becoming more recognized by the general public when it comes to choosing chiropractic care and that area is the care of headaches. Although using drugs is still the most commonly used treatment for those who had experienced headaches in the past year, the second most popular choice of care for headache sufferers was chiropractic care.
The report also noted that in 1998, the Journal of the American Medical Association reported that chiropractic was the most frequently used drug-free treatment. Additionally the report mentioned that Chiropractic has been practiced in the United States for more than 100 years, and more than 3 million people visit one of the 60,000 chiropractors in the country every year.
The Los Angeles Times published a story titled “Legal drugs, deadly outcomes” on Nov. 11, 2012 about deaths from prescription drugs.
When people think of deaths due to drug overdose, probably heroin and cocaine as the cause comes to mind before the prescription drugs in the medicine cabinet. An investigation of coroner’s records by the L.A. Times revealed that prescription drugs prescribed by a few doctors were at the root of many drug overdoses.
The L.A. Times investigation revealed that Van H. Vu,M.D., was the doctor responsible for prescribing drugs that were used in the deaths of six people due to drug overdose in a time period of 18 months. Ten more of Vu’s patients died from overdoses in the next four years.
According to the National Institute on Drug Abuse, 2.7 percent of Americans use psychotherapeutic drugs for non-medical reasons with pain relievers being the number one abused prescription drugs with 5.1 million American using the drugs non-medically.
Twelve thousand people died from prescription drug overdose in 2008, according to the National Institute on Drug Abuse. Cocaine deaths were numbered at 4,000 people, and heroin deaths were numbered at approximately 2,000 people. Both numbers are significantly less than the total of prescription drug overdose deaths.
Prescription drugs are obtained by teenagers helping themselves to drugs prescribed for their parents. The most common of these prescribed drugs are Oxycontin, Vicodin, and Xanax. Teens take the drugs for themselves and they also sell them to students at their schools. Pharmacies are threatened with drug robberies to obtain the prescription drugs.
The L.A. Times investigation revealed that prescription drugs caused or contributed to 1,762 deaths in Los Angeles, Orange, Ventura, and San Diego counties between 2006 and 2011. A small number of doctors were found to be associated with the drug prescriptions. Each of the doctors had prescribed drugs to three or more of the people who died. Vu prescribed the drugs for sixteen of the people who died.
"The data you have is something that's going to shock everybody," said Dr. Jorge F. Carreon, a former member of the Medical Board of California.
Only four of the doctors associated with this investigation have been convicted of drug offenses, and a fifth has been charged with second-degree murder due to the prescription drug overdoses of three patients. All other doctors, including Vu, have not been charged.
According to the L.A. Times article, doctors write around 300 million prescriptions a year for painkillers. This amount could allow every adult in America to be medicated 24 hours a day for a month. Pain relievers cause 3 out of 4 prescription drug overdoses. Additionally, for every death, 32 people go to the emergency room for non-fatal drug overdoses.
Many doctors don’t acknowledge the ease with which patients can become addicted to prescription drugs, or the dangers involved with prescription drug use, according to Dr. Lynn Webster, the president-elect of the American Academy of Pain Medicine. "It leads them down a path that can be very harmful, and that's what physicians have to watch for," said Webster.
A study published in the July / AugustÂ 2004 peer-reviewed scientific journal, "Journal of Manipulative and Physiological Therapeutics", compared the effects of chiropractic adjustments to muscle relaxants in a group of patients with subacute low back pain.
This study defined subacute low back pain as lower back pain (LBP) with a duration of 2 to 12 weeks. The study noted that in the United States the incidence of low back pain is as high as 75% to 85% of the population being affected at some time in their lives. On a yearly basis, the study noted that between 15% to 20% of the adult population can expect to experience LBP in any given year.
In the study, conducted at Life University in Georgia, 192 subjects with LBP from 2 to 6 weeks were separated into three groups. One group received Chiropractic adjustments with placebo medication. The second group received muscle relaxants with sham (fake) adjustments. The third group was a control group and received both placebo medication as well as the sham (fake) adjustments. Care was rendered to the group for a 4 week period with evaluations being done at the 2 week and 4 week marks.
Results were measured in terms of patient reported pain, severity, disability and depression, as well as measured flexibility and the patients self usage of over the counter acetaminophen (Tylenol). The results of this short study showed that for the two primary indicators of pain and severity, the chiropractic group did better than the other two groups.Â No significant differences were seen for disability, depression, flexibility, or acetaminophen usage across groups in a study of this short a period of time. All three groups showed improvement in the areas of depression, disability and drug usage.
The authors of the study did note that a longer study could have yielded more differences in recovery. However, in the area of pain, a primary patient concern in subacute LBP cases, the group that received the chiropractic adjustments faired the best. Their comments were: "Statistically, the chiropractic group responded significantly better than the control group with respect to a decrease in pain scores."
Research published in the January 2005 issue of the scientific periodical the Journal of Manipulative and Physiological Therapeutics, (JMPT) showed that patients with chronic spinal pain syndromes did markedly better than patients who received either medication or acupuncture.
Participants in this study were those who had pain for more than 13 weeks. These participants were divided into three groups who exclusively received one type of care. One group got medication, one group received acupuncture and one group received chiropractic care. The participants were evaluated using standardized questionnaires. These questionnaires were given initially when the participant entered the study, then again 9 weeks after the initiation of care. These results were then compared to repeat questionnaires given to the same patients 12 months later.
Researchers were extremely careful to exclude patients who were receiving multiple forms of care for their problem. Their intent was to have the results only reflect benefits from a single type of care. In this way outside factors could be minimized and the results should be attributed exclusively to the type of care the patient received.
Results showed that 12 months later, only the group that received chiropractic care was still experiencing significant improvement. Researchers noted that all three groups had experienced some short term benefits from their various care. They also noted that the patients who got acupuncture did better than those who were in the group that received medication. However, they noted that the group receiving chiropractic are showed the best results. The authors concluded "Overall, patients who have chronic mechanical spinal pain syndromes and received spinal manipulation gained significant broad-based beneficial short-term and long-term outcomes."