"But Doctor, won't that cholesterol medication wreck my liver?"

The ever-increasingly empowering of patients has caused this type of question to become a regular occurance.  On occasionI find myself longing for the "good old days" when patients accepted without question what the doctor recommended.  Fighting with media sensationalism and internet mis-information takes a good chunk of my time.  Questions were heightened with the recall of the popular drugs Vioxx and Bextra.  The perception is widespread that prescription medications are dangerous while untested and unregulated "supplements" are accepted as safe.

I put some of the blame for this at the feet of the pharmaceutical industry with their direct to consumer marketing.  In an effort to make their drugs seem desirable, they tried to pitch that these medications came with little risk.  When the medical evidence showed otherwise, consumers lost faith in prescription medications. 

So what is the right way for patients to approach taking medications?  I don't really want those "good old days" to return, because I think it is foolish to take anyone's opinion without question.  I see myself as a resource for my patient, and the main resource they should tap into should be information.  I prescribe most medications with a clear idea of the possible risks of taking them, weighed against the risk of not taking them.  I don't know if they truly think I am not aware that statin drugs can cause liver damage, or if they just aren't thinking, but overall I think the main problem is a confusion of the concepts of "risk" and "danger".

When I walk out of my office tonight, I could get hit on the head by a meteor.  It is entirely possible - there is that risk.  It would be inaccurate to say, however, that it would be dangerous for me to go outside due to meteor showers.  I remember when one of the big Power Ball lotteries was going on, a local TV announcer pointed out that you had a better chance of getting in an accident and dying on the way to buying your ticket, than you did of actually winning.  The same can be said for a lot of the perceived dangers of these medications.  You risk more driving to my office than you do taking some of these medications.

Statin drugs (like Lipitor and Zocor) are classic examples of this confusion.  The average person has a 1 in 3 chance of having a heart attack in their lifetime.  This risk is significantly raised if the person has diabetes, smokes, or has high blood pressure.  The risk of having life-threatening liver problems from a statin is less than 1 in 10,000 (minor increases in liver tests are more common, but go away when the medication is stopped).  To face a 1 in 3 risk out of fear of a 1 in 10,000 risk is like not jumping off of the railroad tracks with a train coming at you for fear that you may fall and hit your head on the ground.  Smokers face a 1 in 2 chance of dying from a cigarette-related disease, yet many smokers are nervous about taking prescription medications.

I believe that the main reason for this caution is the overall distrust we all have as consumers.  We all feel that half of what we here from corporate America is a lie, we just don't know which half.  Unfortunately, most patients don't trust their doctor enough to rely on their expert opinion to shed some light for them.  The best way for me to combat this as a doctor is to build good relationships with my patients so they trust what I say.  Probably the most important thing to do to build that trust is to listen to what they have to say and not just dismiss it.  This does get hard at times, with the deluge of headlines, talk-shows, and websites undermining that trust.  If I can't answer these sources, then my patients will get their information elsewhere.