The Trebach Report "Addicts are the scapegoat of our age."
--Reverend Terence E. Tanner, London, 1979

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  • Welcome Message from Arnold

    Sidney M. Wolfe, M.D., Larry D. Sasich, Pharm.D. M.P.H., Rose-Ellen Hope, R.Ph., and Public Citizen's Health Research Group, Worst Pills, Best Pills. New York: Pocket Books, 1999.To order, click here.

    Once again I here switch out of the sequence of books that educated and motivated me years ago in order to deal with a more recent book, one that I have looked into only slightly. I have seen enough, however, to judge that this is an important book that performs a service in an area seemingly not directly associated with the main focus of my work - dealing with the legal rights and the welfare of addicts. Yet, this book and the problems it covers are a vital part of my interests and those of The Trebach Institute. The book (and a related monthly newsletter) focuses on the use of ordinary medicines in ordinary medical practice and in ordinary life.

    What has this got to do with junkies and their welfare? There are three answers to that question. First, my interests and those of the institute go beyond junkies and drug policy, as those subjects are usually conceived. I am concerned with providing a wide array of useful information that might help many people, whatever their status, deal with the drugs and medicines in their lives. Second, huge numbers of so-called ordinary folks, especially elderly people, are junkies, albeit not street junkies and they do not consider themselves in that despised category of human beings. They take large amounts of prescribed and over-the-counter medications very frequently because their doctors told them to do so. Third, a huge amount of damage is done by medicines prescribed in the best of faith by competent doctors. Most of that damage has nothing directly to do with addiction. Too often, the drugs simply kill the patients the doctors intended to help.

    This huge reference volume (772 8x11 pages) provides a great deal of scientific and practical knowledge about medicines that millions of people take every day. In most cases, one assumes, the drugs did what the doctors hoped and the patients were helped. However, the authors of this book are aware of the downside of this equation and seek to provide an array of expert advice and warnings about the potential dangers of drugs taken alone or in combination with other drugs.

    Unabashedly, these medical experts make clear the very uncomfortable fact that medical experts disagree with one another on the most fundamental facts. I can testify to that uncomfortable situation and extend it to the conflict that exists between experts as to the best manner for physicians to treat addicts of any kind.

    All of this means that every one of us - whether we consider ourselves junkies or simply old folks with high blood pressure - have to learn a great deal about our intake of substances and have to be advocates for our own health and well being. No longer can we simply do what our doctors - or what our fellow junkies -- say. Certainly, we should rely more on doctors than our drug-taking friends, but none of them is infallible.

    This book requires a lot of time to wade through because it is not light reading and was not intended to be. Yet, it is very well written and easy to understand, although it contains a huge amount of information. Here are a few shocking but sensible observations. This one is included in the "seven all-too-often-deadly sins of prescribing.... The 'disease' for which a drug is prescribed is actually an adverse reaction to another drug, masquerading as a disease but unfortunately not recognized by doctor and patient as such."

    This next one comes from Ten Rules for Safer Drug Use. "Assume that any new symptom you develop after starting a new drug might be caused by the drug. If you have a new symptom report it to your doctor."

    You do not have to go through all of it. Look up the drugs or medicines that you take regularly. Then discuss your drug intake with your doctor and with other knowledgeable people, whatever their education or professional qualifications. I have wonderful doctors but I just made an appointment with a local pharmacist with a good reputation for providing quiet consultations on the overall impact of all the medicines a person is taking. Seek out such experts and pay them for their time to reflect with you on your whole array of medicines - even those you take illegally for the hell of it. (There should be professional centers like this staffed with pharmacists, nurses, and lawyers. If someone else does not set them up, I may do so - in this life or the next.)

    I have many reservations about this excellent book. I have not waded through it all and do not intend to. Thus, I cannot say with certainty that there is no misleading information in it. I did not encounter any, but I have spent the better part of three decades debunking accepted medical knowledge. Here we have doctors and pharmaceutical experts doing the same thing to their own colleagues in their own way about drugs I never studied. That is no surprise. As I have indicated, the experts disagree about many aspects of medicine and drugs.

    Accordingly, you, dear reader and patient or even drug abuser, cannot accept this book, or any other book, as positively the last word on these subjects. Read the parts that might apply to you, compare them with other information, and in the end decide what you are going to do with your body and your life.

    Facing that uncomfortable responsibility for yourself is tough enough. It gets worse when you are seeking to care for a loved one who is either an out-of-control addict, a mentally incompetent aged parent, or both. However, you still have the need to spend a good deal of time reading and educating yourself about conflicting scientific evidence, communing with God or whatever spiritual resources that you accept, and then quietly reflecting on the cosmic questions involved here.

    If you are interested in further exploring the wrenching dilemmas that arise in medicine and health care on a wide variety of issues, usually not directly involving matters of addiction but still remarkably instructive, you must read the gripping writing of Dr. Jerome Groopman, the Recanti Professor of Medicine at Harvard University. He has written several stunning articles in The New Yorker magazine about the agonies that face patients, and their doctors, when two competent physicians disagree on the proper treatment for an apparently life-threatening condition. One of those articles appeared on January 24, 2000, at the end of which he observed, "This was medicine, not physics." In the future, he wrote, maybe science will provide more precise guidance, but even then, " �. human biology is too variable to be reduced to mathematical calculation. Intuition would still count, and so would luck."

    (Dr. Groopman has recently published a book about a number of his cases that explored the role of intuition and reflection in medicine. It is Jerome Groopman, Second Opinions: Stories of Intuition and Choice in the Changing World of Medicine. New York: Viking Press, 2000. To order, click here.)

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