When my children were young, a their doctor, who was describing side effects turned to me to confirm his statement that all drugs have side effects. I didn’t. Coming from a Chinese Medicine tradition where we individualize herbal formulas and dosages to an individual’s constitution, symptoms and underlying conditions, I see “side effects” as the result of sloppy prescribing and one size fits all dosage.
What is a “side effect”? A side effect is one or more of the effects of a drug that does not have to do with a current (arguably restricted) treatment goal. It is not incidental, it is the property of a drug. Drugs are widely assumed to be designed to target a specific organ or medical issue, but they rarely do. They have effects on multiple organs and interact in complex feedback loops. Side effects are just drug effects interacting with a specific individual.
Suppose two young women come to a medical doctor with the same bacterial respiratory infection. “A” is quite thin, pale, vegan, of southern European ancestry and wears heavy sweaters in moderate weather because she always feels cold. Perhaps she also suffers from Renaud’s with cold hands. “B” is robust, omnivorous, has a reddish complexion, drinks alcohol, is perhaps of Nordic extraction and wears sandals and short sleeves well into winter. The doctor could give them the same antibiotic for the infection and it would probably work in the short term, but the longer term consequences would be different: patient “A” might recover initially, but the treatment would tax her immune system and set off a new round of diseases while “B” might do quite well.
Most antibiotics are energetically cold, which makes sense since feverishness is usually present in acute bacterial illnesses. Cold: like mint, yogurt, cucumbers, beans, winter weather, light clothing, insulin and steroids. Thin people tend to run colder than well-insulated fatter people. The elderly tend to be colder than the young. There are certain epigenetic differences in people who originate from different climates. And while the individual’s presentation is more important than any given factor, the energetics of the drug (hot/cold, dry/damp, anabolic/catabolic and suppressive/expressive) should match the needs of a patient.
In the case above I would probably give patient “A” a formula containing warming antimicrobial herbs like cinnamon, ephedra, and ginger, along with more neutral herbs. I might choose a strategy of supporting her fever to fight off the infection. Patient “B” would get a formula with more cooling herbs like coptis or goldenseal, especially if she doesn’t tend to sweat. If I were a MD, I’d have “A” take her medicine with ginger tea, suggest increasing protein during treatment and follow up with warm miso soup instead of yogurt for the probiotic effect.
Unfortunately it is not easy to find a list of the energetics of western drugs. First look at what the drug is trying to treat: if it reduces fever, it is cold. Anti-inflammatories are often both cold and suppressive and may be damp, leading to increases in body weight. Cortizone creams for skin rashes are suppressive- in Chinese medicine we vent many kinds of rashes to get out toxins through the skin- it may get worse before it gets better but will tend to reduce recurrences. I usually look at the side effects listed in the package insert, mentally filtering out idiosyncratic and allergic reactions. Feverishness, palpitations and rashes commonly indicate heat. Numbness, fatigue and cold hands or feet commonly indicate cold. Weight gain commonly indicates dampness – that kind of drug might be better for a dry thin person than a heavier person with persistent sinus infections.
If you are a doctor, try selecting drugs whose side effect profiles tend to compliment the nature of your patient. If you can’t, suggest some mitigating practices: ginger tea with the meds to warm cold patients, mint tea to cool hot patients, cornsilk tea for damp patients and more fluids and fats for the dry patients. (For the latter I often suggest a swig of Carlson’s lemon flavored cod liver oil to swallow pills.) First look at lifestyle changes though: exercise, sleep, a clean diet and engaging in meaningful activities will improve the physical health of most patients. Next consider diet: avoiding sugar and processed foods makes a huge difference. Most people digest better if they taste something bitter before meals- from radicchio salad or kale to Fernet Branca or black coffee. Minerals especially magnesium and trace minerals declined by a third between the mid 1970s and mid 1990s, due to industrial farming practices, leaving minerals essential for cell transport and enzymatic reactions missing- sea salt, seaweeds, dark greens like kale and bone stews can help. Eliminating dairy, gluten or other potential allergens can make a huge difference in many, but have them write down all their symptoms with a 1-10 rating before and after a 30 day trial since we are programmed to forget subtly changing states of illness.
If you are a patient, do not expect that your doctor understands the energetics of a drug, but do some research on the effects of likely drugs before your appointment. If you are depressed but are prone to weight gain, a walking or running program may be better for you than medication- but you have to do it. And if you think you won’t ask him whether weight gain is a side effect of the class of drugs he is considering.
- As you age or go through lifestyle changes, your reaction to drugs changes. The same prescription that works well for you at 60 may not at 70 or 80. The time it takes to process a drug through your liver and the quantity converted may change. A 100 pound teen who is growing and active may need a higher dose than a full grown 100 lb woman because teens are more yang and process drugs faster.
- Doses are typically based on a 150 lb. adult. If you weigh significantly less or more, verify that the standard dosage has been adjusted before you leave the doctor’s office. If you change weight, your dosage may need to change. I know two tiny women who have had serious reactions to anesthesia which had not been adequately weight adjusted. Although I personally tend to reserve allopathic medicine for life threatening conditions, I have been underdosed at times when I needed it. There are some drugs which are not weight dependent for dosage, so ask.
- If you can try natural remedies, try them first. This may not be appropriate for a fast growing cancer or a very virulent flu in the elderly. A baby with a high fever needs medical care ASAP, but a toddler can usually fight off the fever. We evolved with herbs and our bodies know what to do with them while many pharmaceutical drugs pass into the urine largely unchanged. Physical medicine like acupuncture, massage, hydrotherapy, chiropractic or osteopathic manipulation often works as well as painkillers.
- Where possible try to see the appropriate practitioner. A MD probably doesn’t have much training in nutrition or herbs. A pharmacist studies much more about drug interactions than a typical doctor. A health food store clerk probably is not knowledgeable about supplement interactions, although I do know some well-trained herbalists or nutritionists who run health food stores. An acupuncturist with a degree in Oriental Medicine has studied diagnosis and herbs while an acupuncturist without such a degree may be better for physical complaints and MDs or Chiropractors who needle may have only had a few hundred hours of video training instead of a few thousand of hands on training. Naturopathic training varies widely, from mediocre to excellent. The skill of your practitioner is far more important than the degree. And even if you have skills and a degree, you probably have blind spots about yourself and your family.
- Ask if there are lifestyle changes you can make instead of taking a drug. Very often patients with chronic conditions such as diabetes or heart disease can minimize side effects or avoid drugs altogether by losing weight, exercising more and stopping smoking. But you have to do it.
- Know that almost no drugs are tested for interactions with other drugs. Polypharmacy, using more than one drug at a time, invariably has drug on drug interactions after three simultaneous prescriptions. I saw one man who had been prescribed medication for his cholesterol, depression, and arthritis, and he had excruciating headaches after sex when he took Viagra, dismissed as a”just a side effect”. It took a while to find the information, but all of the medications were circulated through the same branch of the liver’s detoxification system, overloading it when the Viagra made its second pass through the liver.
- Carry a list of all your medications herbs and supplements with dosage, frequency and reason. Ask your doctor to staple a copy into your chart. It won’t prevent your doctor from glossing over drugs that interact-they rarely have the time they would like with patients. But by having the list he has liability if the drugs are incompatible, so he may be more careful. Note that doctors may have legal problems telling you to discontinue another doctor’s prescription, but try to get him to call the doctor if he sees issues.
- Ask to be prescribed drugs that have been on the market for at least seven years. It often takes five to 10 years for serious side effects of a new drug to show up in the general population. Some reactions surface only after the patient has been on the drug for a year or more. Only 1/7 new drugs offer an advantage over older and usually cheaper drugs.
- If you’re taking several drugs, ask your doctor or pharmacist to review them. Ask if there can be interaction problems with your drugs and even vitamins and supplements. If your doctor does this you should expect to pay for additional time beyond your typical 15 minutes- otherwise you may get a cursory glance. Pharmacists usually have better training but they are not the ones prescribing (at least in the US.) Consider visiting a certified consultant pharmacist trained in managing a number of drugs. If you’re in a Medicare Advantage health plan, ask if you qualify for its medications therapy management service.
- If you experience a change that doesn’t feel right, tell your doctor. Ask if the symptom could be a drug side effect. It may be transient but could also be a serious problem. Follow your intuition- if it seems very serious make sure you communicate the urgency to your doctor. I once had a diabetic client who could go no more than an hour without drug induced diarrhea, and while she had mentioned diarrhea to her doctor for two years, she didn’t tell her that the diarrhea meant she couldn’t exercise, go to the beach, shop or engage in other activities. When she did and the dosage was cut, the problem went away.
- Ask why the doctor is prescribing a particular drug. Find out what the risks and benefits are, compared to alternative drugs or herbs or nondrug therapies. For instance Parkinson’s patients may respond well for years to exercise, external brain stimulation or acupuncture, while Parkinson’s drugs may only last a few years and cause serious side effects. But most doctors won’t think about alternatives unless you press them.
- Don’t stop taking a drug without consulting your doctor and pharmacist.This is especially important with psych drugs which can send you into severe mental states. Often your body will stop making hormones, neurotransmitters or other compounds when it gets them pharmaceutically. It needs a transition to start up production again. Suddenly stopping certain drugs can be harmful. Ask if you need to titrate down the dose over time and for how long.
- Use AARP’s Drug Interaction Checker to review your medications online.
- Read Consumers Reports’ Best Buy Drugs for information on effectiveness and safety of drugs according to scientific evidence.
- Locate a certified geriatric pharmacist for help managing medications.