Drug News and Health Blog of Doug Bremner, MD.

May 29, 2008.

A Reader Responds to Scurvey Pirate

Doctor Bremner isn't recommending that you not take any pharmaceuticals, but he is
suggesting you educate yourself on the balance of risks and benefits before taking these drugs.

Why does this make the book so very dangerous? Because it directly threatens the foundation of
American medicine, to wit: that you will follow your doctor's orders unquestioningly, and that
drugs "are good for you, otherwise we wouldn't prescribe them."

Look, pal, we're the experts here, just do what you're told and don't ask questions. Unless you
don't have any medical insurance, in which case we're not wasting any time with you unless
you're bleeding. And if you're bleeding, the end of line is back there, buddy; we get a lot
of gunshot victims here in the emergency room and you can wait a couple hours like everyone else.

Another doctor--a dermatologist--wrote that this book was VERY DANGEROUS on amazon.com's
review/comment page. Here is the review comment from Dr. Aragon (typos left intact):

Do you really think that exercise and diet can cure depression? Yes, I saw the citations
at your website, but there are only a few compared with the millions of studies showing
the high benefits psychotropic medications have (includying several from you, ironically !!!)
Again, if this was the case, pharmaceutical companies would be in bankruptcy as I stated in my first post.

I really think that this is a VERY DANGEROUS book. Did you know that there is a lot of ignorance
regarding diseases and its treatments not only in third world countries but in the USA as well?

If someone for example is taking an SSRI for a mental disorder and reads this book, he/she will
think that diet and exercise will cure him/her, and could get off his/her meidcations without
consulting their physician because this book was supposedly written by an MD, and not by an
anti-pharmaceutical company guy (like most naturopaths are).

You are really jeopardizing a lot of lifes by writing this dangerous book.

You asked me if I meant knowledge is dangerous?

Yeah, knowledge is power, but too much of it can be very dangerous, specially when you talk about
diseases and medications.

And here is Dr. Bremner's response:

You mean knowledge is dangerous? I agree that in some cases not taking a pill can be dangerous,
but in other cases taking a pill can be dangerous. But I disagree with the implication that
people should not know anything about their own prescription medications. If people read this
book and it opens a dialogue with their physicians, so much the better. I guess the bottom line here is that we are going to ignore the fact that people have killed
themselves after taking Accutane because they didn't know it could be a possible side effects,
because their dermatologists didn't warn them or their families about depression as a possible
side effect because they were convinced by the manufacturers arguments that this wasn't a real
side effect or they felt uncomfortable about talking about it or both. Now this issue has been
so publicized it is no longer an issue. But it illustrates the fact that health consumers need to educate themselves.

As for the book being dangerous, you mean we should accept pharma marketing's appraisal of the risk/benefit
ratios of medications at face value? without questioning or reading the literature? If someone
disagrees with how the literature is presented I am happy to discuss it with them, but so far
no one has made a specific critique based on the actual studies.

What really rankles here is the assumption that we regular "little people" can't possibly make
our own assessment if a powerful drug's side effects outweigh its benefits. If we experience
a miraculous lifting of deep depression with some medication, then we can figure out for ourselves
the benefits outweigh the risks.

But if the medication makes us feel worse, then our own experience is telling us to stop taking it,
regardless of the studies or what our doctor is telling us.

For instance: if one acne medication out of several possible treatments has been shown to cause
suicidal depression in teenagers, shouldn't the parents and the teenager be aware of this risk
before deciding to take this drug? Being aware of the potential side effect is hugely important
because then the patient and his/her family can at least monitor their mood and behavior for
signs of depression and/or suicidal thoughts.

This is not dangerous to the patient--it's dangerous to a medical establishment based on "doctor
(and drug company) know best," especially when drug company profits are at stake.

As Doctor Bremner points out in his book, there are thousands of medical journals and no doctor
can keep up on the tens of thousands of research papers being published annually. As a result,
the drug companies (Big Pharma) have tremendous leverage over physicians because they can "package"
the positive research while ignoring any negative research, i.e. omitting it or downplaying it
in their marketing material.

The truth is anyone with a 9th grade education can read a stripped-down drug trial result and
figure out the drug isn't that effective. You don't need a medical degree or a degree in statistics
to figure out that if 5 out of 21 patients showed "statistically relevant results" from a drug and
4 people on the placebo also reported benefits, while 3 people on the drug reported negative side
effects, well, this drug just isn't that great.

As an investor, I have plowed through many such drug trials (Phase 1,2 and 3 trials) and these are
typical results of a small initial trial of a new drug.

Our "cure me now" culture puts tremendous pressure on doctors to prescribe something, anything,
other than a healthy diet, exercise and cognitive therapy. Take the case of insomnia. As Dr. Bremner
reports on his blog, drugs don't work as well as cognitive therapy (basically a structured meditation)
but they do come with major negative side effects.

Cognitive Therapy for Sleep Problems Works Better than Drugs

We're getting pounded with ads for sleep meds like Ambien and Lunesta, but before you
take a drug that will decrease your time to fall asleep by only 10 or 15 minutes, and
that could increase your risk of car accidents or sleep walking, consider an alternative.

The most effective therapy for the treatment of insomnia has been shown in studies
to be cognitive behavioral therapy. It is much better than medication to treat
sleeplessness, and results in a significant improvement in sleep duration and
quality without side effects.

But nobody makes billions of dollars off cognitive therapy, so to heck with that. The relentless marketing of drugs directly to consumers--marketing which was
banned in the U.S., and remains banned in most other countries--brainwashes
a receptive "don't make me do anything difficult or disciplined for my own
health, Doc!" culture into actually demanding drugs which can be dangerous.
Talk about a perfect setup for profits-- until the patent runs out, of course,
in which case you chemically manipulate a natural compound like niacin (a cheap
vitamin) into something slightly different, and market it for hundreds of dollars
a year as a heart medication (true story, look it up).

It's easy to blame physicians for over-prescribing drugs and not informing
patients of potential side effects, just as it's easy to blame profit-driven
pharmaceutical companies for pushing their often-useless/often-dangerous drugs as
"the newest, latest cure for whatever ails you" (or we'll invent a new disease for
you if you think you're healthy). But we as consumers need to take some responsibility, too. Reading this book,
which informs you about the potential side effects of 300 commonly prescribed drugs,
is a good first step to becoming a more informed consumer of drugs. If you don't
want to read it for yourself, read it for the family member who is wolfing down
prescription drugs by the handful and not getting better. Maybe there's a reason
he/she isn't feeling better and perhaps feeling worse. Maybe we should all know
more before we take that pill.