You have doubtless heard that we live in a “polarized” world where the middle ground has been lost. Pundits usually apply this concept to politics: Republicans vs. Democrats or liberals vs. conservatives. But this binary view of the world extends much further, including to medicines. Many visitors to this website categorize pharmaceuticals as either good drugs or bad drugs. But medications, like people, are far more complex.
Why There Are No Good or Bad Drugs
Journalists love to sprinkle their stories with “vox populi” or the voice of the people. An otherwise dry news piece is “livened” up by an interview with a bystander or someone who has been harmed in an accident.
Pharmaceutical manufacturers have mastered the art of telling 10-second stories by showing people riding motorcycles, dancing or walking on a beautiful beach. These are often portrayed as individuals with devastating ailments like rheumatoid arthritis, Crohn’s disease or metastatic breast cancer.
As we watch people smiling and having a wonderful time, the announcer dashes through a long list of horrific side effects. We are told that this good drug could also be a bad drug, causing liver problems, blood clots, heart failure or infections that could lead to death.
Drug Commercials Lead to Cognitive Dissonance
Viewers are supposed to hold both messages in their brains simultaneously. The amazing medicine being advertised will get you partying with friends and family, but it could also kill you.
Psychologists call that cognitive dissonance. Most people have a hard time holding two opposing ideas in their heads at the same time.
Doctors, for example, are told to “do no harm!” And yet every drug they prescribe has the potential to cause adverse reactions. It’s much easier to embrace the visual message portrayed on television commercials that medicines are marvelous and will improve lives in many ways.
Examples of Good Drugs That Are Also Bad Drugs:
Visitors to this website often complain about what they perceive as Bad Drugs:
Metformin:
This diabetes medication has roots in the Middle Ages. That’s because healers were using the French lilac (Galega officinalis) to treat symptoms suggestive of diabetes. By the mid-20th century, French researchers were using metformin under the name Glucophage (glucose eater in English) to treat type 2 diabetes. The drug received FDA approval in 1994.
Today, metformin is the most widely prescribed medicine for diabetes. Nearly 20 million people take it daily in the US. There are also hints that metformin might have benefits beyond diabetes–against cancer, aging, polycystic ovary syndrome (PCOS) and even long COVID.
Despite such impressive benefits, metformin also poses serious risks. Readers of this column have shared their experience.
One wrote:
“I had to get off metformin as it caused uncontrollable diarrhea and I was afraid to leave the house.”
Another provided more graphic details:
“The doctor started me on metformin because my HbA1C was 7.0. Within a couple of days, the side effects (gas, abdominal pain, diarrhea) started and kept getting worse. I went off the metformin for about 10 days and felt normal.
“When I started it again, the side effects returned with a vengeance. This time the diarrhea was much, much worse. I waited three weeks and took half a pill on an empty stomach. A few hours later I had lunch, and within 20 or 30 minutes I had abdominal cramps and explosive diarrhea.”
Such side effects can be really disruptive, as one reader notes:
“I was on metformin and developed diarrhea so bad I thought I had colon cancer. A colonoscopy revealed nothing, and life went on with all the problems of chronic diarrhea with many accidents after meals. It wasn’t possible to go out to eat.”
Diarrhea is not the only risk. We heard this from a reader:
“I was prescribed metformin and took it until the persistent diarrhea it caused led to dehydration and damaged my kidneys. I am in Stage Four kidney disease. A few of my friends have died from kidney disease after taking metformin.”
Another reader reported:
“Metformin destroyed my mom’s kidneys and led to her death. It’s a terrible drug!”
This scary story had a better outcome:
“My late wife had taken metformin for several years when her doctor upped her dosage. About three months later she was in the hospital with kidney failure.
“After dialysis her kidneys returned to normal. Her kidney doctor said the cause of her kidney failure was metformin, and she could NEVER take it again.”
A rare but dangerous complication of metformin is lactic acidosis. The drug comes with a black box warning about this potentially life-threatening adverse reaction. You can learn more about symptoms of lactic acidosis as well as the pros and cons of this drug at this link.
Millions of people do well on metformin to control their blood sugar. And there may be other benefits. It is neither a good drug or a bad drug. It’s wise to remember that even beneficial medications can have a darker side.
We believe that there are no good or bad drugs, just patients who are well informed so they can spot problems before they get out of control.
Opioids:
There are few drugs in America that have been as vilified as opioids. There is no doubt that abuse of this class of opium-based drugs has called untold misery.
According to the CDC:
“More than 560,000 people in the United States have died from overdoses involving opioids since the epidemic began.”
Almost everyone would say that opioids are bad drugs.
But there is another perspective that must be considered. Opioids remain our best pain relievers. The ancient Sumerians were using opium from poppy plants as far back as 3,400 BC. We have not improved upon the basic pharmacology in thousands of years. While such drugs kill when abused, they also save the lives of people in severe chronic pain.
Here is the story of a person in pain:
“As a retired RN, I have administered pain medications safely for over 30 years. Now I have Parkinson’s disease, causing horrific muscle spasms. I cannot sit or stand when these attacks occur but must lie down!
“For five years, I have been taking hydromorphone (Dilaudid) as a last resort when all other attempts to ease my pain failed. I never took more than prescribed and I never asked for early refills.
“My doctor encouraged me to take the pain med at first, then last year he began to say I needed to get off the opioid. Apparently, prescribing this drug could get a doctor in trouble.
“What is going on here? I always believed that when I got old and sick, at least I would not have to die in pain.
“I cannot live like this. Because of my incurable brain disease, I spend most of the day in bed. Now I am ready to take my own life.”
Another person suffering chronic severe pain speaks out:
“Oxycodone. It’s not a miracle drug but, for many of us chronic pain sufferers it can provide a few hours of reduced pain in a day filled with it. Plus, in this time of runaway prescription prices, it is relatively inexpensive.
“Yes, I know that the drug can be abused by grinding up the pills, dissolving them, and then injecting with a needle to get high. I also know that that can be a way to overdose and die. Most overdose deaths can be attributed to the shooting-up of street drugs that are laced with who-knows-what. This has often times occurred when an illegal version of the opioid fentanyl (said to be strong enough to knock out an elephant) is in the mix.
“I truly feel sorry for those who resort to such things. But what has any of that to do with the legitimate chronic pain sufferer? Nothing.
“After suffering in silence I am finally speaking out for myself and for the hundreds of thousands of human beings in this country for whom untreated chronic pain is an unrelenting reality.
Jaylene describes the flip side of the war on drugs:
“The war on drugs doesn’t do anything but come between doctors and patients. My doctor says I have legitimate reasons for pain medication and he wishes he could give me what I need. But instead, he is forced to cut patients off their medicines. I’ve gone from 60 pills a month to 50 which means I can no longer can have two a day. When I told my doc how much this affects me, he said he would not cut my prescription any further, but he added, ‘Life is pain and you cannot take a pill every time you feel it!’ He said I just need to learn to deal with it! I couldn’t believe he said this knowing how much legitimately documented pain I’m in.
“The sister of a friend of mine committed suicide four months ago. It was because of a lack of opioids. She could no longer get her meds because of these new rules.”
Are opioids bad drugs for cancer patients?
“I am afraid the new restrictions on opioids may leave some people without good options. I don’t have chronic pain myself, but when my mother was dying of lymphoma back in the 70s, she was getting good relief from opioid pain killers.
“Then her doctors, in all their wisdom, took the drugs away because they thought she might become addicted. Yes, they deprived a terminally ill cancer patient the pain relief she needed because they thought she might become an addict. I remember her screams of pain to this day.
“I still feel so much outrage about this; I wish I could go back in time and sue those doctors. I hope reason will prevail now and people with chronic pain will be able to get the pain relief they need to allow them to function day to day.”
There Are No Good Drugs or Bad Drugs:
We have long maintained that medications are double edged swords. They can save lives, ease suffering and improve the quality of our lives. They can also do horrific damage and cause untold misery.
How can we use these tools safely? For fifty years we have been preaching that information is the key to opening the door to the safe use of medications. It is absolutely essential that patients be well informed about the actual benefits and real risks of any treatment that is recommended. What are the most common complications of drug therapy and what are the most dangerous adverse reactions? Patients should always be told what symptoms to be alert for and what to do if they occur.
You will find a great deal of information about protecting yourself from harm in our book, Top Screwups Doctors Make and How to Avoid them. You will find it in the bookstore at this link.
Share your own experience with good drugs or bad drugs in the comment section below. Were you well informed about both the benefits and the risks of the medicine you were prescribed?
