Evaluation and Health...

Musing this morning about the process we all go through to help us make "informed" decisions. That process is one of evaluation - of weighing the pro's and the con's. In my professional life as a pharmacist, I am constantly asked to interpret the risk of medication use versus the benefit. All medicines carry the risk of side effects, and most often, people will look up the "laundry list" of adverse events and not know how to interpret them in light of their own personal use. Patient Package Inserts (PPI's) are not written in a way that makes the information useful to most people, including most healthcare professionals.

How does one then evaluate the risk of a given treatment? Not surprisingly, people go to patient chat rooms to get their information. While I'm all for the "e-patient" movement and for people to become more empowered in their approach to their health and to management of their disease(s), the caveat must be re-inforced that "one person's experience is one person's experience"! Each human is an individual with unique genetic predispositions. We are now coming to understand that these genetic predispositions matter in all aspects of health and disease and in medication use. We do not, however, have the ability to predict an individual's response to a given drug, or to the combination of drugs that many are asked to take.

Evaluation of risk, therefore, comes down to personal experience and post-marketing reporting. Most of the time, medications are FDA approved on the experience of a few thousand individuals (some times a few hundred). Statistically speaking, when compared to the 300+ million persons in the U.S., and billions of persons worldwide, the experience of even 10,000 persons is not predictive of how things are going to go with a drug when it is used broadly. Experience over the last 25 years has taught me to be careful when adopting new drugs for this very reason. Side effect profiles often look very different after 100,000 persons have taken it in the non-controlled "real world", than it did in the controlled environment of a research trial.

Advocacy and informed decision making require that we evaluate things differently than we have in the past. Medicines come to market with less and less investigation. More and more "information" is posted on internet sites without adequate explanation. Marketing machines are wound up earlier and earlier, leaking information to people hungry for the next big breakthrough (including the financial markets) and this drives use. Where can the average person turn for information that is useful and meaningful and unbiased? One place is Possibilities Journey, Inc, (www.possjrny.org) and the other is your local pharmacist. Your pharmacist is the best resource to help you evaluate what is happening in your life, to advocate for your health, to help you stay consistent and persistent in your medication use, and to maximize the benefit from the medicine.

So this week, stop by to see your pharmacist - or drop us a note with questions. Understand that your local pharmacist is busy, but if you make an appointment and pay the person for their time, you will get their undivided attention and some useful information. Remember to bring a list of all the drugs you are using (herbals, homeopathy, over-the-counter) as well as prescription. Paying a dollar a minute for face-to-face consultation is a good rule of thumb.

Peace and health,
Dan