DR HOOK- Hocus pocus: Even ‘magic' pills have side effects

Magic tricks drive me nuts. How do they do it? One of my friends used to be a magician, and he won't share any of his magic trick secrets. He taunts me: "No, I won't tell you how they're done. But they're incredibly easy– if not stupid." 

If they're that stupid, why can't I figure them out? Grrrr.

Do patients think there's a magic pill for everything?

With so many pharmaceutical commercials trumpeting how great their pill is despite the 7,000 possible side effects, it seems patients no longer believe in a magic pill. They seem to be more worried about the side effects than the benefits. 

"Hey, doc. I want something to lower my cholesterol, but I don't want to die from muscle breakdown or liver failure. I have too much alcohol and too many hamburgers yet to consume while sitting on the couch all day and night." Burp.

I swear, if I sold cigarettes, bacon cheeseburgers, and pastries in my lobby, I'd make five times as much money as I do taking care of patients. (Does anyone want to become a chef in my office?)

My response to such patients is, "Well, your lack of physical activity and your diet have more side effects than the medicines."

This is when I get an innocent smile, "I know. But there must be some medicine I can take that won't kill me faster than my hardening arteries will."

Stephen Sondheim wrote a song in Company that summarizes what most patients want in a medicine, "Marry me a little/ Love me just enough/ Cry, but not too often/ Play, but not too rough."

Often I have patients come back to see me in a few months, only to learn they didn't start the medicine. "Doc, I read all the side effects and they really scared me," they'll say.

I understand that, but what scares them the most is not any one side effect, but the long list itself. Every medicine has a list of reported side effects– from hangnails to death. Everything has to be reported, even if there's no proof the medicine caused the (side) effect. 

But I wonder why we're living longer. It sure isn't because we're exercising more and eating healthier food. (Though angry, mean people seem to live the longest, and it seems this world is filled with them.)

I don't like patients to be on medicines if it can be helped. As in acting, less is more. But when the body has more– more cholesterol, more sugar, more toxic buildup– then medicine can make a dramatic difference.

Understandably, quality of life is vital, so if the side effects of a medicine are intolerable, then it probably shouldn't be used. But I wonder how many people "imagine" they have side effects. In randomized clinical trials, one group might be given a placebo– a sugar pill that doesn't have any medicine in it. But even in the placebo groups, there are usually a percentage of participants who complain of side effects, like weight gain and dry mouth. Hello! You aren't taking anything to cause that!

So when people are hyper-vigilant about possible side effects, it's possible that a) they're having symptoms from the power of suggestion; b) they were having these symptoms before, but didn't pay attention to them; c) the symptom is a coincidence– sometimes we just happen to have diarrhea or fatigue; or d) There really is a side effect.

Nothing in life is perfect. Everything we do, eat, drink, etc. has consequences. So it really comes down to you and what you think is best. There's no magic pill. Only Magic Johnson.

Dr. Hook cracks a joke or two, but he's a renowned physician with a local practice. Email him with your questions.

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