{"id":29214,"date":"2011-03-02T10:19:46","date_gmt":"2011-03-02T14:19:46","guid":{"rendered":"http:\/\/dominicanewsonline.com\/dno\/?p=29214"},"modified":"2011-03-02T10:21:59","modified_gmt":"2011-03-02T14:21:59","slug":"health-talk-about-your-drugs","status":"publish","type":"post","link":"https:\/\/dominicanewsonline.com\/news\/homepage\/columns\/health-talk\/health-talk-about-your-drugs\/","title":{"rendered":"HEALTH TALK: About your drugs"},"content":{"rendered":"

\"\"Those of you who watch television or surf the net will be aware that every now and then, a drug is withdrawn from the market for a variety of reasons.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 \u201cprescription-only,\u201c 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\u2019s 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\u2019m sure.<\/p>\n

DRUGS IN THE MARKETPLACE<\/strong><\/p>\n

For a \u201cprescription only\u201d drug to reach your pharmacist\u2019s shelf, it means that usually it has been developed over a period of years by a drug company.\u00a0 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.\u00a0 By the way, animal rights activists don\u2019t like to know that animals are used in testing and development, but we can\u2019t discuss that here because there are so many issues involved that are outside the scope of an article like this.\u00a0 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.\u00a0 The reason this is important to know is that most drugs are excreted by these two organs; if they are diseased and can\u2019t do their jobs, then the drugs will accumulate and can literally poison you.<\/p>\n

EXPENSE AND AVAILABILITY OF DRUGS
\n<\/strong>
\nA Ferrari automobile is going to be more expensive that say, a Toyota.\u00a0 Well, a small part of it is the name, but much of it has to do with the quality of the vehicle.\u00a0 And that depends on the amount of time and resources that are put into it.\u00a0 Some of it has to do with supply and demand as well.\u00a0 So it is with drugs. A cancer drug is going to be more expensive than an antibiotic for a lot of these reasons.\u00a0 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.<\/p>\n

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.\u00a0 Simply, there is more money to be made.\u00a0 So quite often a drug reaches us after it has been available in the States forever, unless it\u2019s 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.<\/p>\n

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.\u00a0 Metformin, used for diabetes, is a good example.\u00a0 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.<\/p>\n

WHAT IS A PATENT?<\/strong><\/p>\n

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.\u00a0 The best thing to do is apply for a patent, a legal instrument that gives you the exclusive right to produce that invention.\u00a0 Drug companies may do the same, to protect their investments, so to speak.\u00a0 This patent will usually be valid for a period of time after which other people have the right to get in on the act.\u00a0 Then the inventor\u2019s holiday is over.<\/p>\n

GENERIC DRUGS<\/strong><\/p>\n

For \u201cgeneric\u201d, we can talk about drug names and we can also bring in some of what we just talked about.\u00a0 Let\u2019s start with the latter.\u00a0 Every manufacturer that makes a drug will give it its own name.\u00a0 But every single drug is assigned a generic name \u2013 I\u2019m talking about prescription only drugs here.\u00a0 Doctors and pharmacists often get into the habit of only using the manufacturer\u2019s brand or trade name, particularly if it\u2019s a drug that has been popular or usually available.\u00a0 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.\u00a0 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\u2019m talking about.<\/p>\n

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.\u00a0 So it is with drugs.\u00a0 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.\u00a0 This is not to say that they are not properly screened and tested and all; they just come without all the trimmings.<\/p>\n

OVER THE COUNTER VS PRESCRIPTION<\/strong><\/p>\n

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.\u00a0 In fact, many useful and popular drugs that were once \u201cprescription only\u201d have had their dosages adjusted and become over the counter.\u00a0 But there are certain drugs and certain classes of drugs, which are designated \u201cprescription only\u201d, which means they cannot be sold over the counter or dispensed by a pharmacist without a doctor\u2019s prescription.\u00a0 There are laws which address this in many countries, including the Caribbean, which carry heavy fines and other consequences if not adhered to.\u00a0 Unfortunately, this is not yet the case in Dominica.\u00a0 Fortunately, it\u2019s being worked on.<\/p>\n

DRUG ALLERGY<\/strong><\/p>\n

Persons can have allergies to certain drugs, just as they can to food or things in the environment.\u00a0 There is no way a doctor can predict if a person will have an allergy (or side effect) to any drug.\u00a0 So please do not blame the doctor if you end up having one.\u00a0 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.\u00a0 If you are not asked and you know, TELL THE DOCTOR.\u00a0 This is where you take some responsibility for your health.\u00a0 I always ask and any affirmative answer is recorded in three (3) places in red ink in your record.\u00a0 Allergies can be life threatening.<\/p>\n

HOW ABOUT THE ELDERLY AND YOUNG ONES?<\/strong><\/p>\n

The dosage of a drug that\u2019s suitable for an average adult will not be appropriate for a child or a centenarian.\u00a0 This is why the doctor must know you or your child\u2019s date of birth and\/or weight.\u00a0 A child\u2019s organs are not sufficiently developed to deal with regular doses of medication and an elderly person\u2019s may have deteriorated too much; they may not have enough fat or may simply be too delicate.<\/p>\n

WHAT ABOUT EXPIRY DATES?<\/strong><\/p>\n

This is an issue about which many people are very passionate but misinformed.\u00a0 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.\u00a0 The expiration date indicates that the manufacturer cannot guarantee the drug\u2019s effectiveness past that date.\u00a0 It does not mean that it will poison you or kill you or anything of the sort.\u00a0 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.\u00a0 This issue is probably dealt with by other persons, although I do have a lot to say about it.
\n
\nWHAT ARE MY RESPONSIBILITIES?<\/strong><\/p>\n

You bear as much responsibility for your own health as your health care provider.\u00a0 As far as medication is concerned, you must tell your doctor what you are allergic to.\u00a0 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\u2019t unfairly blame him for adverse interactions.\u00a0 Even tell him about over the counter (OTC) drugs you\u2019re using.\u00a0 Be truthful about your alcohol intake.\u00a0 It does not matter; we are not here to make value judgments, just to treat you as best we can.\u00a0 If you are of reproductive age, KEEP A RECORD OF YOUR MENSTRUAL PERIODS.\u00a0 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.\u00a0 When you are given medication for ten days, do not stop after two days if you feel better.\u00a0 And don\u2019t sweet-talk your pharmacist friend into bypassing a prescription for prescription only drugs.\u00a0 In the case of antibiotics, for example, both these practices encourage resistance of organisms to medication.\u00a0 Even though we can\u2019t see them, they are smart, little critters and they find ways to beat our human minds.<\/p>\n

WHAT ABOUT FOLLOWUP?<\/strong><\/p>\n

Unfortunately, many patients think that when the doctor asks to see them again, he is simply after another fee.\u00a0 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.\u00a0 Some of us look beyond the business aspect of our profession and carry a conviction about the nobility and seriousness of what we do.\u00a0 A follow-up can cost nothing or it may cost a part or a full visit\u2019s fee depending on whether there are new problems, how much time has to be spent and on a variety of factors.<\/p>\n

HOW DO DRUGS WORK ANYWAY?<\/strong><\/p>\n

Drugs work in a variety of ways in your body.\u00a0 Sometimes we don\u2019t know how they work and sometimes we discover that a drug has an effect quite by accident.\u00a0 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.\u00a0 For the treatment of organisms, drugs disrupt areas of its growth and reproduction.\u00a0 Also when there are imbalances of chemicals in your body, drugs can be tailored to restore these balances.<\/p>\n

Here endeth this short lesson, which I\u2019m sure can be continued in some form later.<\/p>\n

A PARTING SHOT OR TWO<\/strong><\/p>\n

One parting shot, remember that the pharmacist and the doctor work together.\u00a0 We know that tradition makes some of you think of the pharmacist first and foremost.\u00a0 This is fine in many cases, but you both have to recognize when the doctor has to be brought in the picture.\u00a0 Having said this, I will add that although OTC\u2019s are not as closely regulated as POM\u2019s (prescription only medicines), they are monitored and sometimes recalled as well.\u00a0 If you follow the news, you would have known this.\u00a0 Recently, I saw a patient with a cold medicine containing Ether and Chloroform.\u00a0 Folks, these are anesthetics to put you to sleep, as in for surgery (in the old days).\u00a0 What business did that medicine have on any shelf?\u00a0 Don\u2019t talk about those which contain alcohol.\u00a0 Don\u2019t get me started! I have to go.<\/p>\n

See you next week.<\/p>\n","protected":false},"excerpt":{"rendered":"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 \u201cprescription-only,\u201c as well as over-the-counter medications. 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