How safe is that medicine you are taking?

(Image: Dvortygirl, via Wikimedia Commons)

South Africa has the largest and best developed pharmaceutical market in Africa, with drug spending reaching R22.49 billion (US$2.68 billion) in 2009 and expected to grow by at least 9% year-on-year[1]. Against this backdrop of continued, dramatic growth, and persistent warnings from the International Narcotics Control Board (INCB) that prescription drug abuse is also on the rise around the world, the South African Medical Nutritional Institute (MNI) has issued an urgent call to consumers to be much more conscious - and cautious - about the medicines they purchase and use.

"Unfortunately, many of us believe that prescription drugs are safe simply because they have been recommended by a doctor, and that anything non-prescription or 'natural' is likely to be an ineffective, quack remedy," observes Dr Conrad Smith, a GP based in Johannesburg and director of the MNI, "but neither instance is always the case."

Tackling our often blind faith in orthodox medicine first, Smith points out that prescription drugs can be very dangerous. In the United States, for example, prescription drugs kill more people every year than traffic accidents and Adverse Drug Reactions (ADRs) have been the fourth leading cause of death, after heart disease, cancer, and stroke, for many years[2].

Some medicines have adverse effects

Studies have also shown that up to 51% of the drugs approved by the US Food and Drug Administration (FDA) have serious, adverse effects not detected prior to approval[3]. "Consumers need to be aware that many of the drugs that are initially deemed 'safe' are subsequently found to have serious side effects and, equally, that some common prescription drugs with known or possible adverse side effects don't carry the medical warnings they should."

Acknowledging that the 'natural' or non-prescription category of medicines has a poor reputation - and some products deservedly so - Smith believes adopting a blanket opinion that all non-prescription medicines are ineffective is to miss the point that almost all medicines were 'natural' at one stage, since they started out as derivatives of plants, and to potentially deny yourself an effective remedy with little or no side effects. "Various charlatans who've been exposed in the media have given natural medicines a bad name," he concedes, "but as both the WHO[4] and Newsweek have argued, 'about 60-plus percent of all drugs are natural products, modified natural products, or mimics of natural products'[5]."

Don't rule out natural medicines

Smith reiterates that we shouldn't rule out natural or non-prescription medicines because there are many inexpensive, tested and proven remedies available which have been used for centuries with none of the undesirable, adverse side effects that are frequently associated with prescription drugs. "As Michael Behar, a freelance writer based in Boulder, Colorado, has eloquently observed: 'Mother Nature is a pharmacological factory'[6]," he notes, "forever producing awesome remedies and cures."

Nevertheless, labelling a product as 'natural' doesn't automatically mean it is safe and Smith is also wary of this common misperception. "We seem to forget that there are numerous 100% natural substances that are actually highly toxic," he says. "Take for example wild mushrooms: some are safe to eat while others are highly poisonous. What's more, a 'safe' natural substance might become toxic if taken with certain other substances or medications."

The solution, as far as the MNI is concerned, is for consumers to adopt a new mindset and no longer restrict themselves to only orthodox or non-prescription medicines. "It is not about conventional versus non-prescription medicine," says Smith.

"There are many natural medicines that are highly effective and, equally, numerous instances where prescription medicines have had to be removed because they proved ineffective or harmful."

Take charge of your health

"What we are saying is that, to protect their health and wallets, consumers need to adopt a new mindset and be more discerning about the medicines they choose. Patient safety is the number one priority and South Africans need to take charge of their health by becoming informed consumers."

According to Smith, the important first step is to look for evidence-based medicines or remedies that have been developed and refined using responsible pharmaceutical practices. "Put simply, evidence-based means that the medicine has been properly tested and proven to work," he explains. "It doesn't matter whether the medicine is prescribed or not, find out what scientific studies have been done on its safety and effectiveness."

"Lastly, remember that we all respond differently to treatments and that some products may interact adversely with others," says Smith. "So make sure you conduct proper research and discuss your findings with your doctor before you make any decisions regarding the medicines you take."

[1] Business Monitor International - http://www.reportlinker.com/p0174634/South-Africa-Pharmaceuticals-and-Healthcare-Report-Q1.html
[2] Jason, et al. (Lazarou et al), Incidence of Adverse Drug Reactions in Hospitalized Patients, Journal of the American Medical Association (JAMA), Vol. 279. April 15, 1998, pp. 1200-05. Also Bates, David W., Drugs and Adverse Drug Reactions: How Worried Should We Be? JAMA, Vol. 279. April 15, 1998, pp. 1216-17.
[3] US General Accounting Office. FDA Drug Review: Postapproval Risks, 1976-85. Washington, DC: US General Accounting Office; April 26, 1990. GAO/PEMD-90-15.
[4] www.who.int/mediacentre/news/releases/release38/en/
[5] Michael Behar. Could This Kill Cancer? Newsweek. November 29 2010:40-44
[6] Michael Behar. Could This Kill Cancer? Newsweek. November 29 2010:40-44