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Drug tales

May 16, 2012

I started writing this while under the influence of a drug. Now I know that many of my detractors will immediately declare that this usually appears to be the case, but who cares what they think? (One of them once accused me of being a heroin user, the evidence being that I said that it is addictive and I could only have come by this knowledge through personal experience. Yes, there are people who are that stupid.) The drug in question is a treatment for migraine and it got me thinking about two things. (Unlike all those drugs that we hippies have forgotten about taking back in the 60s which caused the takers to think of a multitude of things at once. Sometimes even several multitudes.)

I have again become involved in a discussion about the reality of mental illness. One of the arguments put forward by anti-psychiatry and anti-medicine claimants is that mental illness cannot exist because there is no objective test for it. There is no objective test for migraine either. Apart from asymmetric head pain and a high reported rate of visual aura, migraine sufferers vary in the reports of the phenomena they experience. In my case I experience a heightened sensitivity to light and sound (often coming before any headache, as a warning sign) and, in really severe events, my eyes point in slightly different directions. This last symptom is not a sign of migraine but is instead a relic of untreated childhood amblyopia, or "lazy eye". (When I was very young nobody bothered with eye tests unless the child was obviously suffering from some vision defect. I had one perfect eye which masked the problem in the other one. My brother stumbled into the furniture from the time he started to walk; he has worn glasses since he was two years old and went through the whole "patch over one eye" phase.)

When the "no such thing as mental illness" people are asked if they believe that migraine is a real medical condition they do one of two things. They either ignore the question because they have detected the trap or they expose themselves to charges of inconsistency, or even hypocrisy, by accepting the existence of a condition which relies solely on patients saying that something is happening to them. Most choose to ignore the question or call it a diversion. None of them ever deny the existence of migraine.

The second thought occurred to me while in the pharmacy buying the medication. The pills I take do not need a prescription but the law requires that they must be physically handed to me by a licensed pharmacist who has to warn me of any side effects or drug interactions. The sales assistant who served me placed the packet of tablets on the counter and left me to look at them for about ten minutes while the pharmacist attended to another customer. When she was free she asked me how could she help and I said something like "I need you to tell me how dangerous those tablets are". We then played out our respective parts of the ritual (much like the interaction between airline cabin staff and frequent fliers over the location of exit doors – I have been taking the same tablets for years), the pharmacist handed me the packet and I walked to the cash register where the original sales assistant took my money.

Walking from the dispensary to the front of the shop I passed a large display of the inevitable supplementary, complementary and alternative medicines that seem to infest every pharmacy these days. None of the SCAM medications required the intervention of a licensed pharmacist for the purchase. These products have no package inserts warning of side effects or possible interactions with other medications, but why would they need to when everyone knows that SCAM medications are either broad-spectrum placebos like homeopathy or very natural and therefore safe. Nobody ever had a problem because grapefruit enzymes altered the metabolism rate of  drugs (the most commonly prescribed drugs that interact with grapefruit are cholesterol-lowering atorvastatin and simvastatin, quetiapine for bipolar disorder and nifedipine for angina. There can also be a problem with metformin, something which concerns me because I have T2 diabetes. I also take atorvastatin (as part of diabetes control). I used to love grapefruit, but I can add them to cigarettes as something I'll never use again.), or had their treatment for (non-existent?) depression affected by topping up the Prozac with St John's Wort, or bled to death because the anti-coagulant gingko biloba helped them to remember to take their warfarin tablets. Such things are unimaginable, aren't they? Much safer than my headache tablets which might make me drowsy and shouldn't be mixed with alcohol.

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