Self-Care Pillar No 3: Medicines and Supplements
The third pillar of the Caleb 5-Pillar Self-Care Model stresses the appropriate use of Medicines and Supplements. It is almost certain that you will either be using medication (pharmaceuticals) and or dietary supplements (nutraceuticals) or know of someone who is doing so. This is especially true for the so-called chronic lifestyle-related diseases and conditions such as Type 2 diabetes, high blood pressure, heart disease and psychiatric disorders. Pharmaceuticals and nutraceuticals are BIG business with global sales exceeding US$1.5 trillion in 2020.1-2
By definition, people the chronic diseases will probably have more than one chronic condition. For example, people with Type 2 diabetes are far more likely to be overweight or obese and have high blood pressure and even depression. Most people with these conditions will use one or more prescribed medicine in order to keep their conditions under control. Prescription medication utilization data is difficult to come by, certainly not for South Africa or any other African country. But as some 40% of South Africans between the ages of 35 and 44 years have high blood pressure, it’s safe to say that many of these people will take medication.3 Add to this all the medication being prescribed for depression, Type 2 diabetes and to lower cholesterol and it’s easy to conclude that a very large percentage of the adult population are using medicines.
Science is increasingly pointing to inflammation as a major cause of the chronic diseases of lifestyle. This form of inflammation results largely from a metabolic dysfunction known as insulin resistance. Several scientists working in this area of healthcare suggest that it makes good sense to first prevent the condition. But what we find is that most of us rely on medicines, which often only address the symptoms and not the cause of these chronic diseases.
The words ‘primum non nocere’ which is Latin for ‘first do no harm’ is a phrase well known to all healthcare students as it is one of the founding principles of bioethics.4 What this means is that medicines and supplements should always be as safe as is possible, besides being effective. As no medicine is really 100% safe, we need to always ask ourselves the million dollar question before using any medicine or dietary supplement: “Do the evidence-based benefits of using this product far outweigh any risks?” 5 To answer the question we must have a certain level of knowledge: we have to be adequately informed. Ask your doctor and pharmacist and, if unsure, verify their answers by going to reputable online resources. Two that I’m happy to recommend are Drugs.Com 6 and WebMD.7 For vitamins and other supplements the best resource that I’ve come across is the Micronutrient Center at the Linus Pauling Institute at the University of Oregon.8
It is ‘good medicine’ for people to adhere to their prescribed medication therapy and to have this therapy reviewed on a regular and ongoing basis. Many, if not all, medicines cause adverse effects–often called ‘side effects’. These adverse effects can be so severe that people have to discontinue using the medicine in question. If you experience any adverse effects when taking prescribed medication then it is ‘good medicine’ to discuss this with your doctor or pharmacist before simply discontinuing the medication.
Iatrogenesis is a word that many of you may not have come across before. It is the medical term for any disease or injury caused by any medical intervention, and this includes using medication. While you may not have heard the of term before, it is said to be the 5th most common cause of death across the globe.9 You may have heard of the opioid addiction problem that has sadly cost many thousands of lives.10 This form of addiction often starts out as the overuse prescription or over the counter (OTC) pain medication and then progresses to full-blown addiction.
We also know that medicines used to treat anxiety (e.g. Valium) and depression (e.g. Prozac) can be addictive, and may often cause very serious long-term adverse effects.11 We should never assume that someone can indefinitely use any medicine without their prescription being regularly reviewed by a suitably qualified and competent healthcare professional. This goes for OTC’s as well as prescription medicines. Medicines often contain powerful chemicals. Think about this: 10 milligrams of a medicine (Zolpidem) will put a person weighing 70 million milligrams (70kg) to sleep:12 Powerful indeed and so use with caution!
There are several dietary supplements available without prescription that are useful in improving disease risk in lifestyle related diseases.8 The key to choosing supplements is to ensure that the active ingredients have safe and efficacious in well-designed clinical trials.8 A key question is, are the manufacturers’ claims supported by good scientific evidence? Another important consideration relates to the quality of the manufacturer of the supplement. Reputable manufacturers apply stringent quality assurance processes and are often willing to share this information with consumers. Unfortunately, the supplement industry has suffered from the disingenuous statements and harmful practices of unscrupulous ‘snake oil salesmen’.
Remember, whether prescription medication or dietary supplements–‘caveat emptor’–let the buyer beware!
|2. Report. Nutraceuticals: Global Markets to 2023; BCC Research. 2018. https://www.bccresearch.com/market-research/food-and-beverage/nutraceuticals-global-markets.html#:~:text=The%20global%20nutraceutical%20market%20should%20reach%20%24285.0%20billion%20by%202021,%25%2C%20from%202016%20to%202021.|
|3. Population health in South Africa: a view from the salt mines. Hofman KJ, Tollman SM. Lancet. 2013;1:e66-67|
|4. Karaosmanoglu HK. Did the COVID-19 pandemic makes scientists forget ‘Primum Non Nocere’, one of the most important principles of bioethics? https://doi.org/10.23750/abm.v92i2.11624|
|9. Peer RF, Shabir N. Iatrogenesis: A review on nature, extent, and distribution of healthcare hazards. J Family Med Prim Care. 2018 Mar-Apr;7(2):309-314. doi: 10.4103/jfmpc.jfmpc_329_17. PMID: 30090769; PMCID: PMC6060929.|
|11. Gøtzsche PC, Young AH, Crace J. Does long term use of psychiatric drugs cause more harm than good? BMJ. 2015;350:h2435. doi: 10.1136/bmj.h2435. PMID: 25985333; PMCID: PMC4707562.|