Worst Pills?

by David Mendosa Patient Advocate

Most Americans take a lot of pills, some prescribed by their doctors and perhaps just as many that we buy over the counter. Those of us with type 2 diabetes probably even take more than most people.

Many pills are wonderful. Some may even be live-saving.

And others can cause big problems. Personally, I have tried five different statin drugs to help control my cholesterol, and every one of them gave me excruciating muscle pains. I also can't take Bactrim, a widely prescribed antibacterial combination drug. When I broke out in a rash all over my body, my doctor said, "Sorry that I poisoned you."

Every drug has a therapeutic dose and a toxic dose. For some people, like my experience with the statins and Bactrim, the two doses are the same. A more general example is the mineral vanadium, which people often recommend for those of us with type 2 diabetes. Vanadium might be valuable, but its therapeutic and toxic doses are awfully close together.

Maybe even more common are unforeseen drug interactions. Fortunately, several excellent websites can help identify potential interaction problems. One of my most recent reviews of these sites is in an issue of my Diabetes Update newsletter at mendosa.com/diabetes_update_77.htm.

Dozens of drugs also affect our blood glucose levels. One of the questions I get asked the most often is about drugs that affect blood glucose levels. Some drugs can cause hypoglycemia and others cause hyperglycemia. Others have some effect, although less severe.

Stephen Freed's appendix in Dr. Richard K. Bernstein's Diabetes Solution is what I used to turn to most often to answer that question. But even though I have written articles for print for more than half a century, I am now more of an Internet person. So I asked Stephen if I could host his list on mendosa.com. His reply was even better. Stephen now hosts the list on his Diabetes in Control.com site. It's better because he can keep it up-to-date there. The list is a PDF at http://www.diabetesincontrol.com/issues/issue246/drugs.pdf.

Maybe we have grown too sanguine about the benefits that drugs can offer us. If you are one of those people who unquestioningly takes what your doctor prescribes - or your friend recommends - Worst Pills, Best Pills is for you.

The new 2005 edition is a huge 913-page paperback that lists for a reasonable $19.95 (ISBN 0-7434-9256-0). Public Citizen's Health Research Group put this tome together. Famous consumer advocate Ralph Nader founded this organization.

The book analyzes the 538 drugs we use the most. Of these 181 are on its "do not use" list.

It labels some of these "do not use until seven years after release." This makes a lot of cautious sense. While there are rare breakthrough drugs that are much better than anything we had before, new drugs as a group are the most dangerous because not all that many people have used them. Think Rezulin. The first diabetes drug in a new class, Rezulin killed at least 63 people with diabetes before the FDA yanked it off the market five years ago.

While there is a lot of good stuff in the book, like its recommendation to take psyllium for high cholesterol (which I started to take today), I think that it goes too far in the "worst pills" category.

In diabetes drugs, for example, it says not to use two first-generation sulfonylureas Dymelor and Diabinese (other sulfonylureas, are OK for "limited use"). Generic metformin and brand-name Glucophage are also OK "for limited use." Do not use, the book says, Actos, Avandia, Starlix, or Prandin. Most of us with type 2 diabetes use one of these drugs. If that's you, you might want to read Worst Pills, Best Pills. But don't stop taking them without talking it over with your doctor.

The book doesn't mention two seldom used drugs, Precose and Glycet. And too new to be included are Symlin and Byetta, which some people do consider to be breakthrough drugs, but might well fall out according to the book's seven-year rule. The only diabetes drug the book doesn't have any problem with is insulin. My website has a page about the different diabetes pills at mendosa.com/drugs.htm and the insulins at mendosa.com/insulin.htm.

The current edition of Worst Pills, Best Pills is a revision of a book that Public Citizen has published since 1988. A totally new section this year covers the most common dietary and herbal supplements. What was amazing to me was that among these supplements the book says "do not use" to every single one. Not even Coenzyme Q10, which most authorities say you really need if you are taking metformin, as I am.

My conclusion: The book is extreme, but if you consider it judiciously, it can be a good balance to pharmaceutical propaganda.

David Mendosa
Meet Our Writer
David Mendosa

David Mendosa was a journalist who learned in 1994 that he had type 2 diabetes, which he wrote about exclusively. He died in May 2017 after a short illness unrelated to diabetes. He wrote thousands of diabetes articles, two books about it, created one of the first diabetes websites, and published a monthly newsletter, “Diabetes Update.” His very low-carbohydrate diet, A1C level of 5.3, and BMI of 19.8 kept his diabetes in remission without any drugs until his death.