HEALTH TALK: About your drugs

Those of you who watch television or surf the net will be aware that every now and then, a drug is withdrawn from the market for a variety of reasons. This applies to “prescription-only,“ as well as over-the-counter medications. Your doctor ought to know about these, for obvious reasons, but it would not hurt for you to be knowledgeable about these developments as well. Let’s just look at a few things about drugs that you may have always wanted to know about. This is by no means an exhaustive piece; a qualified pharmacist and some of you readers can fill in some blanks, I’m sure.

DRUGS IN THE MARKETPLACE

For a “prescription only” drug to reach your pharmacist’s shelf, it means that usually it has been developed over a period of years by a drug company.  Then it goes through a series of clinical trials, where it is tested in animals and humans to determine among a variety of things, its efficacy and side effects.  By the way, animal rights activists don’t like to know that animals are used in testing and development, but we can’t discuss that here because there are so many issues involved that are outside the scope of an article like this.  Other variables that are addressed include whether they are cancer-causing, whether they are safe to use in pregnancy and breast feeding, what their interactions are with other drugs and how they should be used in persons with liver or kidney disease.  The reason this is important to know is that most drugs are excreted by these two organs; if they are diseased and can’t do their jobs, then the drugs will accumulate and can literally poison you.

EXPENSE AND AVAILABILITY OF DRUGS

A Ferrari automobile is going to be more expensive that say, a Toyota.  Well, a small part of it is the name, but much of it has to do with the quality of the vehicle.  And that depends on the amount of time and resources that are put into it.  Some of it has to do with supply and demand as well.  So it is with drugs. A cancer drug is going to be more expensive than an antibiotic for a lot of these reasons.  Of course, we cannot forget that being the big businesses that they are, some of them with virtual monopolies, an effect on cost will result.

Now, because of the way the health system in the U.S. functions, one will find that many drugs are marketed primarily, or only, there.  Simply, there is more money to be made.  So quite often a drug reaches us after it has been available in the States forever, unless it’s a drug in high demand, like VIAGRA, and for obvious reasons, prices will be very high for some time, but will come down after a while.

One may also find that a drug, which has been available elsewhere in the world such as the Third World, for a long time, is only approved for use in the States many years later.  Metformin, used for diabetes, is a good example.  I think it is because of rigorous standards set by the FDA, but there is also a lot of politics and behind the scenes maneuvering involved.

WHAT IS A PATENT?

If you invent something from which you can make a lot of money, you can forget that idea if other people get their hands on it, start producing it and selling it.  The best thing to do is apply for a patent, a legal instrument that gives you the exclusive right to produce that invention.  Drug companies may do the same, to protect their investments, so to speak.  This patent will usually be valid for a period of time after which other people have the right to get in on the act.  Then the inventor’s holiday is over.

GENERIC DRUGS

For “generic”, we can talk about drug names and we can also bring in some of what we just talked about.  Let’s start with the latter.  Every manufacturer that makes a drug will give it its own name.  But every single drug is assigned a generic name – I’m talking about prescription only drugs here.  Doctors and pharmacists often get into the habit of only using the manufacturer’s brand or trade name, particularly if it’s a drug that has been popular or usually available.  This can be an undesirable practice because not all doctors will be familiar with all brand names; drug companies, which advertise their products, will miss some doctors.  But if I am in the habit of using the generic name of a drug, I can treat someone in Dominica with it, and ask for it in a pharmacy in Timbuktu, and they will know exactly what I’m talking about.

You may buy a Nike pair of shoes or a no name brand, which may actually be just as good or better, but pay ten times more for the Nike.  So it is with drugs.  Generic brands have no fancy trimmings; they are the basic drugs with the active ingredient you want, but which was manufactured by a no-name or even big name company, but which comes much cheaper.  This is not to say that they are not properly screened and tested and all; they just come without all the trimmings.

OVER THE COUNTER VS PRESCRIPTION

Often the ingredients of a drug that make you well can be found in preparations you can buy off the shelf (over the counter), but in lower dosages.  In fact, many useful and popular drugs that were once “prescription only” have had their dosages adjusted and become over the counter.  But there are certain drugs and certain classes of drugs, which are designated “prescription only”, which means they cannot be sold over the counter or dispensed by a pharmacist without a doctor’s prescription.  There are laws which address this in many countries, including the Caribbean, which carry heavy fines and other consequences if not adhered to.  Unfortunately, this is not yet the case in Dominica.  Fortunately, it’s being worked on.

DRUG ALLERGY

Persons can have allergies to certain drugs, just as they can to food or things in the environment.  There is no way a doctor can predict if a person will have an allergy (or side effect) to any drug.  So please do not blame the doctor if you end up having one.  You can blame him or her if you were not asked at the visit, if you have any allergies and are then given a drug you were already allergic to, or one in a class of drugs you were allergic to.  If you are not asked and you know, TELL THE DOCTOR.  This is where you take some responsibility for your health.  I always ask and any affirmative answer is recorded in three (3) places in red ink in your record.  Allergies can be life threatening.

HOW ABOUT THE ELDERLY AND YOUNG ONES?

The dosage of a drug that’s suitable for an average adult will not be appropriate for a child or a centenarian.  This is why the doctor must know you or your child’s date of birth and/or weight.  A child’s organs are not sufficiently developed to deal with regular doses of medication and an elderly person’s may have deteriorated too much; they may not have enough fat or may simply be too delicate.

WHAT ABOUT EXPIRY DATES?

This is an issue about which many people are very passionate but misinformed.  Drugs supplied to doctors or pharmacists will come in packages or cartons, which carry the date of manufacture of the drug and its expiration date.  The expiration date indicates that the manufacturer cannot guarantee the drug’s effectiveness past that date.  It does not mean that it will poison you or kill you or anything of the sort.  It is up to the doctor or pharmacist if he wants to give you something which may not have any impact on your health whatever.  This issue is probably dealt with by other persons, although I do have a lot to say about it.

WHAT ARE MY RESPONSIBILITIES?

You bear as much responsibility for your own health as your health care provider.  As far as medication is concerned, you must tell your doctor what you are allergic to.  If you are already taking drugs, you must tell your doctor about them, in other words, you MUST KNOW YOUR MEDICATION so that you don’t unfairly blame him for adverse interactions.  Even tell him about over the counter (OTC) drugs you’re using.  Be truthful about your alcohol intake.  It does not matter; we are not here to make value judgments, just to treat you as best we can.  If you are of reproductive age, KEEP A RECORD OF YOUR MENSTRUAL PERIODS.  Drugs affect the fetus, especially in its early stages of development; we do not want to give you unsafe drugs or even safe drugs except when necessary, if you are or may be pregnant.  When you are given medication for ten days, do not stop after two days if you feel better.  And don’t sweet-talk your pharmacist friend into bypassing a prescription for prescription only drugs.  In the case of antibiotics, for example, both these practices encourage resistance of organisms to medication.  Even though we can’t see them, they are smart, little critters and they find ways to beat our human minds.

WHAT ABOUT FOLLOWUP?

Unfortunately, many patients think that when the doctor asks to see them again, he is simply after another fee.  For some this may be the case, somewhere else, but really I just want to know how you are, if the medication worked, to evaluate possible reasons it did not and to determine what, if any, further steps need to be taken to make you better.  Some of us look beyond the business aspect of our profession and carry a conviction about the nobility and seriousness of what we do.  A follow-up can cost nothing or it may cost a part or a full visit’s fee depending on whether there are new problems, how much time has to be spent and on a variety of factors.

HOW DO DRUGS WORK ANYWAY?

Drugs work in a variety of ways in your body.  Sometimes we don’t know how they work and sometimes we discover that a drug has an effect quite by accident.  This is a book in itself, but if we bear in mind that the cells in your body have receptors on their surfaces into which drugs fit and thereby influence what happens in the cell, we pretty much have it.  For the treatment of organisms, drugs disrupt areas of its growth and reproduction.  Also when there are imbalances of chemicals in your body, drugs can be tailored to restore these balances.

Here endeth this short lesson, which I’m sure can be continued in some form later.

A PARTING SHOT OR TWO

One parting shot, remember that the pharmacist and the doctor work together.  We know that tradition makes some of you think of the pharmacist first and foremost.  This is fine in many cases, but you both have to recognize when the doctor has to be brought in the picture.  Having said this, I will add that although OTC’s are not as closely regulated as POM’s (prescription only medicines), they are monitored and sometimes recalled as well.  If you follow the news, you would have known this.  Recently, I saw a patient with a cold medicine containing Ether and Chloroform.  Folks, these are anesthetics to put you to sleep, as in for surgery (in the old days).  What business did that medicine have on any shelf?  Don’t talk about those which contain alcohol.  Don’t get me started! I have to go.

See you next week.