Medicines are not magic bullets that cure all ailments
Popping over-the-counter pills is not what the doctor ordered.
US has a pill-popping population where 55 per cent people regularly take prescription medications and nearly half of all adults take over-the-counter medications. In two decades, the number of prescriptions has outgrown the American population four-fold.
Why do humans indulge in prescription-seeking, drug-taking behaviour? Broadly, drugs are defined as chemicals "that affect the living protoplasm". Why we take them is because they save lives: by curing/suppressing diseases; they also alleviate symptoms and improve our quality of life.
Healthcare systems around the world have ensured that time-constrained physicians see prescription-writing as the most efficient way to end their encounters with patients.
Coupled with clever marketing by pharmaceutical companies and prevalent beliefs, we have come to assume that we need drugs for each and every symptom/discomfort - a mere hint triggers medication-seeking behaviour.
A typical sequence of events is this: we have a symptom, take a medicine, which leads to something adverse, we misconstrue it as a new symptom, acquire more medicine to deal with it, and so on, establishing a vicious spiral, the 'prescribing cascade'. Medicines are not inert. Nor are they magic bullets; they have off-target effects. They are capable of harm. Millions of patients go to hospitals due to drug-induced adverse effects. Our own research shows that nearly 4-5 per cent of emergency visits are drug-related.
Billions of dollars are then spent on treating the adverse effects, many of which are preventable.
Pharmacology is the science that studies drugs. Notwithstanding huge advances in the pharmacological sciences, drugs cannot do everything. If clinical pharmacology is also the science of what drugs cannot do, and why, here is a non-exhaustive tour d'horizon.
Can medicines make us more intelligent and/or improve memory?
Humans can perhaps make machines more intelligent than themselves but medications cannot make us brainier. Memory enhancing chemicals have not shown any convincing, reproducible results.
Can medicines make us work harder?
Definitely. But we know of students, who, under the influence of some drugs, prepared for examinations for 1-2 nights without sleeping, failing to recall what they had read. Athletes often abuse drugs for performance enhancement. These medicines have serious adverse reactions.
Can medicines make us happier and/or stress-free?
Happiness-unhappiness, day-to-day stresses, fears and sorrows are part of usual lives. Medications have no role to play unless they become pathological and interfere with normal functioning.
Can medicines make us more beautiful?
Fairness cosmetics and tanning lotions are intensively marketed but there are no systematic high-quality data to show how well they work.
Can medicines make us exude fragrance?
An interesting product - a perfume candy - claims that it imparts to the user a rose-like fragrance! The "active ingredient" is geraniol, constituent of rose oil. Those who have eaten it are not too impressed though.
Can medicines make us more empathetic?
Many studies have shown that oxytocin, a natural hormone, may increase empathy. This is a complicated subject worthy of a full article.
Can antibiotics cure the common cold?
No. Cold is a viral (not bacterial) illness and antibacterial drugs are often irrationally prescribed. There are medicines for providing symptomatic relief, although personally, they make me feel worse than the cold itself. The use of Tamiflu is quite popular although there have been doubts about its ability to reduce complications.
Can medicines cause fever?
Yes, drug-induced fever is a well-known entity and its treatment is stopping the offending drug, if the physician suspects it.
Can medicines lead to the birth of a male child?
Popular products claiming this are available and commonly used but modern medicine has not claimed it.
Can medicines increase our lifespan?
In a patient with cancer or heart failure, yes. In a normal person, no. Whatever the makers of vitamins, antioxidants, omega-3 fatty acids, probiotics and other health-promoting substances claim. At best they are ineffective, at worst they may cause harm. Do not forget they are a multi-billion-dollar market.
Can medicines kill?
Annually adverse reactions to drugs cause nearly 200,000 deaths in the European Union and about 125,000 deaths in the US.
Medicines are a useful invention but not a panacea, as we may like to believe. They can be dangerous. We should avoid their unnecessary use. If you are on (several) medications, talk to your doctor. Those on medications for chronic illnesses must ask their physicians to review their medications once every 6-12 months. Studies show this leads to 'de-prescribing' - cutting the number of medications in 70 per cent cases. On no account should medicines be stopped without asking the physician.
Remember, our medical college teaching pays much more emphasis on prescription writing - how to start medication - than on how to stop.
Samir Malhotra works at the Post-Graduate Institution of Medical Education and Research, Chandigarh