Courtesy of US News & World Report
Don't just swallow every pill your doctor orders without a second thought. Make an effort to educate yourself. Start by asking these questions.
1. Why am I getting this drug?
Place the emphasis on the "I" when asking this question. Your doctor should consider your personal risk factors when prescribing a drug, not the previous patient he treated who may have been helped enormously by the medicine but also may have been far sicker to begin with. If you're considering a cholesterol-lowering statin, for instance, ask, "Has this drug been shown to prevent real clinical events like heart attacks or strokes in patients my age and gender with a cholesterol profile like mine?" says Jerry Avorn, a professor of medicine at Harvard Medical School and author of "Powerful Medicines: The Benefits, Risks and Costs of Prescription Drugs" (Random House, 2004). Ditto for bone-building drugs, which are being given more and more frequently to those with some bone loss, called osteopenia, but not full-blown osteoporosis. Ask, Avorn says, "Will this drug prevent fractures in those with bone measurements like I have?"
2. What are the risks vs. the benefits?
Your doctor should be able to tick off the side effects of any drug she's prescribing as well as serious adverse events associated with the drug and how commonly those occur, says Lisa Schwartz, an associate professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, N. H. You should also have a clear understanding of the benefits. Even in severe cases of depression, antidepressants significantly help one third of patients who take them, mildly help another third, and don't do much good for an additional third - information that has become known in research studies but isn't featured prominently on manufacturer's Web sites. Schwartz and her colleagues at Dartmouth/VA Outcomes Group would like the U.S. Food and Drug Administration to begin offering consumer-friendly information on the risks and benefits of every drug it approves.
3. Is there an older drug or lifestyle alteration that works just as well?
Every time your doctor accepts a free lunch, a fruit basket, heck, even a ballpoint pen from a drugmaker, you can bet that it's for a drug that's new, expensive, and still on patent (which means there's no cheap generic available). "There's no question that doctors are more likely to prescribe drugs that they're being lobbied on," says Avorn, "new ones being heavily marketed by pharmaceutical firms." The trouble with a new medication? "We might not know its long-term benefits or its track record for risks," explains Schwartz. "It's one thing if there's no other treatment available for your condition, but it's quite another if there are a lot of other treatments that have stood the test of time." If your doctor can't make a strong case for why a new treatment may be better, take the older one, says Schwartz. Ditto for lifestyle changes. For those with mild depression, exercise can work just as well as an antidepressant. Salt-sensitive folks with high blood pressure may be able to reduce hypertension simply by lowering their sodium intake. And many of those with type 2 diabetes can reverse their condition by losing weight, increasing their activity, and cutting back on carbohydrates.
4. Will it interfere with other medications I'm taking?
While one fifth of Americans have taken three or more drugs for chronic conditions in the past year, many of them get their prescriptions from different specialists who are supposed to check for medication interactions but often do not. Pharmacies also alert you to dangerous drug-drug interactions, but this may not happen if you don't get all your medications from the same place. Also, it's important to factor in all those over-the-counter medications you may be on like acid blockers, allergy medications, or pain relievers.
5. Has this drug been shown to prevent real clinical events?
You might think that any drug approved by the FDA would have to meet that criterion. But that's not the case. The diabetes drugs Avandia and Actos, for example, were approved "to help improve blood sugar control in adults with type 2 diabetes." These drugs don't, though, actually prevent heart disease, the leading killer of diabetics. "It's not enough to show that a drug lowers blood sugar; does it, in fact, improve clinical outcomes and not cause harm?" says Steven Nissen, head of cardiovascular medicine at the Cleveland Clinic in Cleveland, Ohio, who published a study two years ago showing that Avandia was associated with an increased risk of heart attacks and deaths from heart disease. Nissen and the other experts who spoke with U.S. News would like to see the FDA approve only drugs that clearly show a benefit to the patient, rather than just improving lab test measurements like cholesterol, blood sugar and bone density scores. Schwartz sums it up this way: "Your doctor should be able to explain why you're taking this drug right now. Will it make you feel better? If not, will it prevent something bad from happening in the future? How big is your chance that you'll actually have that bad outcome if you don't take this drug?"
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