Stuff one ought to know (part 1)

I just spent too much time writing (but not finishing) a blog post. Then I got up, did some chores, and re-thought the whole concept of "stuff one ought to know."

It's come to my attention, in a fairly dramatic way, that even if a person is given information about the pros and cons of medication or treatment, they are unable to make an informed decision, because they do not understand the information they are given.

Recently I gave the Zoloft  official FDA-approved prescribing information to someone. I didn't go to medical school, so I can't understand all of the science and language, but I understand it well enough to decode it. When I was young, if you got a prescription for a month's supply of medication, it would still be in the drug company box and bottle, along with this information. I always read the entire thing. At some point, pharmacies started putting medication into their own bottles all the time, and one had to ask for the prescribing information. Pharmacies also started to dispense "consumer information" with all prescriptions. Though nothing on these hand outs is blatantly untrue, it is a careful selection of information about the medication. If one asks for the FDA prescribing insert, most pharmacies will not give it to you. They say things like, "We only get one of these for each drug," or even "we're not allowed to give that to consumers." Both statements are not true. Yes, they are obligated to tell consumers what the possible side effects are, and any other pertinent warnings, but there's so much information left out that's it's simply ridiculous. I've heard both doctors and pharmacists say not just that this is "too difficult" for non-pharmacists to read, but also that it is "too scary for patients."

Pharmacies do only get one insert for each bottle of medication, but that doesn't mean they only have one, nor do they need it. They have the same information on the computer and in the Physician's Desk Reference or the dumbed down PDR for Pharmacists.

What people don't realize is that the consumer information is what the drug companies want consumers to know. What I didn't know until today is that the PDR is a commercial publication. Huh. I've read and known about it for my entire adult life, and I did not know this. Yet more "stuff one ought to know."

I've always encouraged people to read the FDA prescribing inserts, and I do tell people they are hard to understand, but that they should at least try. Recently, I realized just how difficult my well intentioned advice is to follow.

For instance, though I think that everyone knows what an SSRI is, this is not so. They made have heard the acronym, but they don't know what it means. If one looks up Zoloft on the Web, and they go to MedicineNet, for example, they will read a little bit about SSRIs, how they work, and what it is that they do for depression. It is stated, "it is believed that some illnesses such as depression are caused by disturbances in the balance bewteen serotonin and other neurotransmitters. The leading theory is that drugs such as sertraline restore the chemical balance among neurotransmitters in the brain. The FDA approved sertraline in December 1991."


This is a confusing piece of information. The two sentences that precede when the FDA approved Zoloft both state that it is theoretical connection between serotonin, neurotransmitters, and depression, but wording makes it unclear, especially in context. The first sentence begins with "It is believed," and the second with "the leading theory is. . ." The logical assumption that most people would make is that the FDA approves of the theory in addition to the medication. This is not so.

I got a far afield of my original intent, which was simply to start providing simple information. I suppose I wanted to explain myself first.

Now, I forget what particular term I wanted to explain! Ah well.

I suppose the fact that there is no proven link between low serotonin levels and depression is a good enough piece of information that falls under the category "stuff one should know." You can read an accessible article about this here. What's interesting to me is that in spite of the fact that there's much evidence that there's different reasons that anti-depressants (sometimes) work, the "low serotonin" theory is still believed and being pushed on every public health website and consumer educational hand out. Is that because it's easier to understand, and therefore can sell drugs better? I'm not sure.

Perhaps it's because the doctors and the drug companies would prefer that "health care consumers" continue to think of researchers and doctors as smart, infallible people who don't make huge mistakes in judgment. I'll continue to blog about just how that isn't true, and I'll continue to tell you stuff I have felt I ought to know. . .

Maybe stuff one ought to know should merely be "definitions of the day." I assume people know what a neurotransmitter is. I'll give you the Wikipedia entry link, but I started to read it, and realize right away that it's probably indecipherable to most. The first sentence says that neurotransmitters are endogenous chemicals. That the heck is that? Well, one can't click on the words "endogenous chemicals" as a concept; one is directed to the pages for endogeny and chemistry. Most people would give up right there. I'm confused, and I happen to know what an endogenous chemical is, or at least I think I do. It's a chemical naturally produced by the body.

Image note: This cool looking image, is found on WebMD's depression overview slideshow. It says, "Doctors aren't sure what causes depression. . ." Good! Some honesty! ". . .but a prominent theory is altered brain structure and chemical function. Chemicals called neurotransmitters become unbalanced." Along with this image, described as "illustrated here are neurons (nerve cells) in the brain communicating via neurotransmitters," most people would get the impression this is more than a theory, and that this is a photograph. 

One has to learn to read very, very closely. Not even well meaning, well educated physicians read that closely, as much as we would like to believe that they do.