In this book, "All Medicines are Poison" Melvin H. Kirschner, MPH, MD, sets out to remove the fog of confusion that clouds the landscape patients are required to navigate in their search for health care today. This book describes the risks and benefits associated with the use of medicines, and explores the validity of other treatment modalities referred to as "Complimentary and Alternative Medicine (CAM). He discusses the numerous failings and backroom dealings in the pharmaceutical and insurance industries, and highlights possible solutions to many of these current concerns.
ALL MEDICINES ARE POISON!
Making Your Way through the Medical MinefieldBy MELVIN H. KIRSCHNERAuthorHouse
Copyright © 2009 Melvin H. Kirschner, MPH, MD.
All right reserved.ISBN: 978-1-4490-1165-9Contents
Be an Informed Health Care Consumer....................................................................11. All Medicines Are Poison............................................................................32. What You Need to Know about the FDA.................................................................93. How Drugs Are Classified............................................................................194. Understanding Off-label Prescribing.................................................................295. The Scientific Method: The Gold Standard of Medicine................................................396. Why You Should Read the Package Insert..............................................................477. How Medicines Work..................................................................................538. Expiration, Interaction, and Duration...............................................................619. Side Effects and Allergic Reactions: It's Sometimes Hard to Tell the Difference.....................7110. Medicines and Treatments Must Be Thoroughly Tested.................................................8311. The Role of Sanitation in Disease Prevention.......................................................8712. What Is Informed Consent?..........................................................................9313. Antibiotics, The Wonder Drugs I Wonder If I Need One?..............................................9914. Do Placebos Have A Place In Medicine?..............................................................10515. Dosage Counts: Start Low and Go Slow...............................................................11116. Immunizations......................................................................................115Ethical Issues in Medicine.............................................................................12117. Advertising: The High Cost of Promotion............................................................12318. Why Prescription Drugs Cost So Much?...............................................................13119. Treatment Options Change Frequently................................................................14120. Doing Nothing......................................................................................14721. Conflicts of Interests: How They Affect Your Health................................................153Alternative Medicine, Not always a Good Alternative....................................................15922. Evidence-Based Medicine and Treatment..............................................................16123. High Test? Irradiated? Use Less?...................................................................16524. Poison, Cut, and Burn..............................................................................16925. Natural and Harmless...............................................................................17326. Ginkgo Biloba and Other Nonprescription Cures......................................................18127. Death by Dietary Supplements.......................................................................19328. Homeopathic, Chiropractic, And Holistic Medicine...................................................20129. A Healthy Dose of Skepticism.......................................................................209Challenges in Today's Health Care System...............................................................21330. Chemicals Essential to Life and Laboratory Tests That Identify Them................................21531. The American Health Care System....................................................................22532. The Medicare Modernization Act.....................................................................23333. "First Do No Harm": The Hippocratic Oath...........................................................239Postscript.............................................................................................247
Chapter One
BE AN INFORMED HEALTH CARE CONSUMER ALL MEDICINES ARE POISON
When I was in the second year of medical school in the 1950s, we were taught about medicines and pharmacology. At the University of Southern California (USC), we were very fortunate to have a pharmacology professor of world stature, Dr. John L. Webb. During our first year, while we were learning our basic medical sciences, he was visiting Maoist Red China, studying traditional Chinese medicines. Able to speak fluent Chinese, he was one of the rare Americans invited to China during the Mao era. We met him for the first time as we assembled for our initial class in pharmacology.
The setting was somewhat strange. At that time, the new medical school campus was just starting construction across the street from Los Angeles County General Hospital. Most of our classes were held in the old chemistry building at the main USC campus, which was across town from the planned new medical school location. The old chemistry building was so overcrowded that the pharmacology class had to be held in the cavernous general assembly auditorium on campus. It was designed to accommodate at least a thousand students.
In those days, our medical school class of fifty-eight was mostly male. There were only three female students. Today, medical school classes at USC are split about fifty-fifty. We were seated in a dimly lit corner of the large auditorium. Professor Webb was on the stage, standing behind a brightly lit lectern. He presented a rather commanding figure as he looked down at us for the first time.
"Ladies and gentlemen," he said, "I am here to teach you how to poison people!"
A brief pause followed while we sat stunned by those words. We were expecting to learn how to cure people, not poison them.
Then he added, "Without killing them, of course."
Thus, the title of this book originates from Dr. Webb's introduction to pharmacology. There followed a discussion of why and how all medicines are poison in some situations. I have never forgotten that lesson in the more than fifty years since I heard that statement. Years of medical practice have validated repeatedly what Dr. Webb taught us about medicines. Throughout that semester, he taught us to appreciate the uses and benefits that medicines have, but also the burdens (adverse reactions) they could cause and their interactions with other substances.
Properly used medicines are of great benefit and save lives, but we must always be aware of the burdens. Furthermore anything we ingest can cause problems. With this benefits-versus-burdens relationship in mind, we make our health decisions. Physicians are expected to educate patients about these matters. In our society, doctors advise, and patients decide.
When I was a child, tincture of iodine came in a unique brown bottle with a skull and crossbones embossed on its side. The skull and crossbones implied danger, poison, and even death. In those days, tincture of iodine was widely used as an antiseptic for cuts and abrasions. It stung when it was applied, but not from the iodine. The sting was from the alcohol it contained. It was painted on cuts and lacerations to keep them from becoming infected. Iodine is still used, but in an aqueous solution that is still an excellent antiseptic....
