Protect yourself : Be your own FDA

This is the last of a three-part series on the safety of prescription drugs in America.

At the time of regulatory approval for most drugs, a number of issues remain unknown: the occurrence of rare but serious adverse drug events (side effects), drug interactions, late events during treatment or after discontinuation of treatment, effects in pregnancy, or differential effects on subgroups that may be defined by age, sex, or race.”

– Editorial in the Journal of the American Medical Association, Dec. 1, 2004

The scandal over the pain killer Vioxx has told us the Food and Drug Administration (FDA) is going to protect us from prescription drug side effects as though the FDA is run by Major League Baseball. It has also told us that we as patients must ultimately protect ourselves from the pills we take. Here are some suggestions for how to do that.

. When adding a new medicine to your other pills, make sure your doctor or pharmacist runs your whole list of medications through a computerized drug interaction analysis program.

Doctors who think they are smart enough to know all of these drug interactions off the top of their heads are standing behind the green curtain with the Wizard of Oz;

. Know what medicines you are taking, unless you are Barry Bonds and need plausible deniability. That sounds obvious but many patients don’t know, or don’t remember and don’t keep a list. If you answer the question “”What medicines are you taking?” with “You know, Doc, that little green one,” (or a call to your lawyer), wake up and smell the risk of disaster;

. Don’t seek a pill for every problem. Forty percent of Americans now take a prescription drug, and many could find safer, cheaper answers than pills for their problems in physical therapy, weight loss, biofeedback, exercise, counseling, hard work and more;

. Remember that every medication out there that can kill you, one way or another. The only medication that is absolutely safe is the one you are not taking;

. If you walk out of the doctor’s office with a new medicine and don’t know what side effects to watch for, you need a pill to stop you from acting like a moron. If your doctor forgets to give you the information, ask for it. The doctor-patient team must make sure the patient knows what side effects to watch for, because the patient is the side effect cop on the beat;

. If you have a need to reject authority do it somewhere other than in your medication regimen, and take your medications the way you are supposed to, at the right time of day, with or without food or certain foods, as directed, etc. The failure to take medications appropriately often reduces their effectiveness, causing your doctor to prescribe higher doses with higher side effect risks. Inhalers, for example, if not shaken before use and “puffed” with proper technique, can lose more than two-thirds of their effectiveness. Pharmacists can often help with these issues of appropriate medication use;

. In general and if possible, avoid taking the latest and greatest drug being advertised on TV. The less time a drug has been on the market the less we probably know about its side effects. If you have a choice, let others be the mass market guinea pigs. Ask your doctor about older medications, which have been around a while and whose safety profile are more well known. And if a cute yellow bee that sounds like the actor Antonio Banderas can convince you to try a new allergy drug you should take something to clear your brain of congested thinking, my darling;

. When you see a drug advertised on TV your manure meter should flip into the red zone, not because the information is all poor but because TV advertising is about selling you a drug, not about making you a smarter consumer;

. If you have other health problems (particularly liver or kidney disease), or if you take several other medications, you are at particularly high risk of drug side effects and need to protect yourself from them like a pit bull protects the mailbox. A few weeks after starting new medications, such patients should consider having follow-up appointments to make sure they can continue to use the medication safely;

. Keep a prescription medication notebook. In it list your medications, dosages, important side effects you should be aware of, when you should take your pills, what foods to avoid when you take certain medications (for example, grapefruit juice decreases the effectiveness of several medicines if you take your pills soon after drinking it), what medicines you should avoid taking with the other medicines you are taking, etc. Too many of us know more about our stock portfolios than our pill portfolios;

. Don’t suddenly stop a prescription medication without talking to your doctor, lest a seizure, heart attack, or some other side effect of sudden withdrawal interrupt your new-found pharmaceutical freedom. Many prescription drugs should be tapered off slowly;

. Americans need to approach their medications the way they would approach a busy intersection, an intersection where the FDA crossing guard is a little sleepy and high-powered drugs driven by Madison Avenue marketing are barreling down at us.

We need to have our eyes wide open, be a little paranoid, be scanning for trouble, and remember that a false step could get us pharmaceutically flattened or epitaphed. We are, in the final analysis, responsible for our own prescription drug safety because only we are in harm’s way.

And, oh yeah, don’t take any medicines from a juiced-up guy named Jose Canseco.

Erik Steele, D.O., a physician in Bangor, is chief medical officer of Eastern Maine Healthcare Systems and is on the staff of several hospital emergency rooms in the region.