I do not get it. Day in and day out, I ask patients why they take a medicine. Many do not know. “My doctor put me on it,” goes the common response.
Take statin drugs, for example. I often ask a person why they are taking the drug? With rare exception, the person says it is to lower cholesterol.
That’s not the right answer–and herein lies much of the problem with preventative medicine. A statin drug does indeed lower cholesterol but its main purpose is to reduce the risk of heart attack, stroke or death in the future. Cholesterol is just a number. It’s a surrogate that we can measure but it’s surely not the only way statins provide benefit. (There are many drugs that lower cholesterol but do not decrease the risk of heart attacks or death.)
The point here is that almost no patient I have met can quantify the benefit or harm of these common meds. I’ve written before that statin benefit in patients without heart disease is very small and may be countered by its small-but-real adverse effects.
Antibiotics are another example. The human body has an immune system for a reason. We fear infections but we don’t seem to fear antibiotics. Now, most hospitals in the US are struggling with problems related to antibiotic overuse.
A patient gets a seemingly harmless prescription for azithromycin (Z-Pak) for a case of viral bronchitis and weeks later nearly dies of Clostridium Difficile. Did that person know the benefits or harms or alternatives? I doubt it.
You can apply these lessons to almost any therapy used in modern medicine today.
It is in this context that I wrote my latest piece for WebMD. 4 Questions to Ask Your Doctor