“As to diseases, make a habit of two things: to help or a least to do no harm.” Hippocrates

A good friend and medical colleague gifted me recently with “The Little Book of Doctors’ Rules” by Clifford A. Meador, M.D., emeritus professor of Vanderbilt and Meharry medical schools.

In his book, Meador offers much sage advice about the practice of medicine. His section about “Rules for Medication Use” seemed especially helpful as it puts perspective on the benefits and harms of the use of prescribed drugs.

Many patients who seek my care do so because of a strong desire to avoid prescription drug use and to try more gentle, non-pharmacological methods.

This is often because of bad experiences with medications, perhaps because of genomic variability causing them to have allergies or reactions, perhaps because of concern about the long list of potential side effects, philosophical objections or other personal beliefs.

This is understandable and over the years, these patients have taught me a lot, encouraging me to read and research and practice utilizing the benefits of nutrition, botanicals, supplements, mind-body methods and other non-drug treatments.

I share with you here some of Meador’s “rules” about medication use:

• Stop drug use in treatment whenever possible. If impossible, cease a patient’s use of as many drugs as possible whenever possible.

• Never use a potentially toxic drug when its benefit is minimal to zero.

• Any new abnormality that occurs with the administration of a new drug is due to the drug until proven otherwise.

• There are few clinical trials of patients taking more than four drugs, and very few of patients taking three.

• The likelihood of an adverse drug reaction rises considerably with an increase in the number of drugs administered.

• Enemas, sedatives or the use of multiple drugs can cause nighttime falls.

• There are more people taking thyroid hormones who don’t need it than people taking it who need it.

• Never treat a drug reaction with another drug unless this second drug is a proven antidote to the first.

• There’s no manifestation that cannot be caused by any given medication.

• If you doubt a drug will work, you’re probably right.

• If you add a drug to a patient’s treatment, try to remove one.

• The less often a patient has to take a particular medication, the more likely each dose will be taken properly.

• Use as few drugs in treatment as possible.

To be clear, medications have a vital, important and scientifically based role in medicine. I prescribe them daily and am reminded why when I recently saw a man in a wheelchair with right-sided paralysis. He had a stroke at 48 years old because of untreated hypertension. Ten years later, he still has difficulty speaking, walking and is unable to work. Affordable, accessible medications could’ve changed his life.

On the other hand, medications have their limitations. Lifestyle choices are often more effective in the prevention or management of symptoms and disease than medications. Choose wisely.

Dr. Victor S. Sierpina is the WD and Laura Nell Nicholson Family Professor of Integrative Medicine and Professor of Family Medicine at UTMB.

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