Mohamed H. Dahir (Chairman, Pharmaceutical Association of Somaliland)
Drug safety and effectiveness
The whole question of drug safety is a sticky wicket. How safe is safe? What is a reasonable risk? There is no such thing as a 100 percent harmless drug, but obviously some drugs are safer than others. If your doctor says that a drug he prescribes for you has absolutely no side effects, he is straining credulity. He may choose to ignore some of the uncommon but nevertheless conceivable, adverse reactions in order not to scare you unnecessarily. A given dose of a certain medication may not cause any reaction in one individual, while someone else may experience a very severe response. An adverse drug reaction may be caused by the drug or by the special characteristics of the patient. It is therefore damn difficult to predict with assurance how a person is going to react to a particular drug. As a result of this unpredictability, it becomes your responsibility to watch carefully for any possible side effects, no matter what drug has been administered.
Doctors who feel that they cannot bring themselves to warn their patients of a medication’s potential side effects and dangers are taking an unnecessary risk that could lead to disaster. Of course, just as every medical student tends to "come down" with almost every disease that he studies, so, too, many patients will experience the potential side effects the doctor has cautioned about, even if they are more imaginary than real. Let’s face it. We are all extremely susceptible to suggestion. Nevertheless, if it is possible to prevent one serious reaction for every ten false alarms, it is worth the extra trouble. And remember, you can die from a drug-induced illness. Sine there are too few doctors who take the time to adequately educate their patients about possible dangerous or "unwanted" effects, it falls to the patient to protect himself. Each of us must make a real effort to observe any unusual reactions or different feelings and report them immediately to his doctor.
One of the most important responsibilities of any doctor is to evaluate his patient’s characteristics before prescribing a specific dose of a given medication. People are very flexible and everything from age, sex and weight to personality, genes and type of illness can modify a person’s reaction to a drug. Thin people often need less medication than large. Older people and young children also tend to require a reduced dosage schedule. Babies may not be able to tolerate some drugs at all because their developing systems cannot metabolize or eliminate the foreign chemicals. Alcoholics often need increased doses of certain medications because alcohol stimulates their livers to metabolize drugs extra-fast. Since elderly patients are often more susceptible to normal dose of common tranquilizers like Valium and Librium, these drugs should be prescribed with caution. Women appear to be more sensitive to side effects and drug reactions in general and may require a reduced dose of most drugs. It is the responsibility of your doctor to take all these factors into account when prescribing any medication and adjust the dose accordingly. And his responsibility does not end once you have left his office. He should monitor your response to the drug (or drugs) in order to be certain that you are responding favorably and not experiencing adverse effects.
To be continued next week
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