An Expert Warns That Visits to the Drugstore Can Be Dangerous to Your Health

updated 09/29/1980 at 01:00 AM EDT

originally published 09/29/1980 01:00AM

Americans spend about $11 billion a year on prescribed drugs and another $5 billion for over-the-counter medications. "That," says Joe Graedon, "is an awful lot of cabbage. " After earning a master's degree in pharmacology at the University of Michigan and working at the New Jersey Neuropsychiatric Institute, Graedon realized that there was also an awful lot of ignorance behind those staggering expenditures. In 1973, while teaching pharmacology in Mexico, Graedon sat down at his portable typewriter and hammered out The People's Pharmacy, a folksy but well-researched handbook crammed with information on drug safety, pharmaceutical advertisements and home cures. It stayed on the New York Times' paperback best-seller list for 42 weeks. Later, disturbed that "the federal government is still not protecting consumers adequately and too many doctors still want to keep patients in the dark, " Graedon and his wife, Teresa, an anthropologist, went to work on The People's Pharmacy-2 (Avon, $5.95). It will be published next month. The author is popularly known as the Ralph Nader of the neighborhood drugstore. "He is a dedicated pharmaceutical evangelist, " concedes Sue Boe, Assistant Vice-President of Consumer Affairs for the Pharmaceutical Manufacturers Association, "and probably has done more to educate consumers about how to buy medicine than any other pharmacist in this country. "A Quaker and conscientious objector during the Vietnam war, Graedon, 35, lives in Durham, N.C., where he writes a twice-weekly syndicated newspaper column. Barbara Rowes interviewed him for PEOPLE.

What's in your medicine cabinet?

No drugs, that's for sure. I know everybody keeps them in the bathroom cabinet, but that's the absolute worst. Nothing can damage drugs faster than heat and humidity, which you generate every time you take a shower—just think of all that steam on the mirror. The best place is a high shelf or closet out of children's reach.

So what do you keep on hand?

The minimums. Plain aspirin. Since it's all the same, we buy the el cheapo brand. For our 5-month-old baby we do have a liquid aspirin substitute containing acetaminophen, because there is no liquid aspirin and babies aren't real good at chewing pills. We have a children's aspirin for our son and some Hold cough medicine, which contains dextromethorphan—an effective cough suppressant—and few unnecessary extras such as pain relievers, alcohol or antihistamines. Robitussin, Romilar Children's Cough Syrup, Silence Is Golden and St. Joseph Cough Syrup for Children are just as good.

What about hygiene products?

We don't use any aerosol deodorants, for health and environmental reasons. As for chemical ingredients, aluminum chlorohydrate is probably the safest and very effective. Several brands list it as the only active ingredient. These products are all identical in terms of strength and effectiveness. We just buy the cheapest one. As for toothpaste, we get whatever's cheapest that has the approval of the American Dental Association. Somebody once gave me a bottle of dandruff shampoo as a birthday present, but I never use it. A healthy scalp is supposed to shed. Dandruff is normal unless very excessive, and seeing it as a social disease is an adman's idea.

And feminine hygiene sprays?

Another adman's dream. They remind me of the old custom among kings and queens of splashing perfume on their bodies to hide the odor from never bathing. If you're using soap and water, that's all you need.

You mentioned aspirin earlier. How useful is it, really?

If you want to talk about "wonder drugs," aspirin is high on the list. In normal doses, it's the most effective, safest and cheapest pain reliever known. In doctor-supervised high doses of 10 to 24 tablets daily, it reduces the tissue inflammation of rheumatoid arthritis less expensively, as effectively and probably more safely than special anti-inflammatory drugs. There's even exciting experimental evidence suggesting that small daily doses of aspirin—maybe as little as a quarter tablet—can help cut down heart attacks by making blood platelets "slippery," preventing them from accumulating on vessel walls. A leading arthritis specialist has said American doctors don't prescribe aspirin often enough, purely because they don't like handing a patient a bill for $50 and then advising him simply to take aspirin.

But isn't there a risk of stomach irritation and even bleeding?

When high doses are involved, yes. People with a history of peptic ulcers should probably take an aspirin substitute. But there are ways to reduce the irritation of aspirin without resorting to more expensive products that are buffered or contain antacids, which speed elimination of the aspirin from your system. Crush the aspirin first and dissolve it in juice, or chew it with a mouthful of milk. Always drink a full eight-ounce glass of liquid afterward. Throwing in a pinch of baking soda also helps, if your diet isn't sodium-restricted.

How effective are over-the-counter sleep remedies?

An excellent, well-controlled study in 1971 found Sominex—which has the same ingredients as almost all the other leading brands—"did not produce any favorable effects in terms of inducing sleep." These products are now on the market with new formulas because of a suspected carcinogen in the old ones. The new ingredient is still being tested for any threat of cancer. Prescription sleeping pills, while more effective, often deprive people of rapid-eye-movement, or dreaming, sleep. Loss of it causes anxiety and depression. Exercise, satisfying sex, a hot bath or a glass of warm milk are all better bets.

Can over-the-counter drugs be presumed safe?

According to the Food and Drug Administration, only about half of the ingredients available in over-the-counter, or OTC, drugs have been demonstrated to meet federal standards of safety and effectiveness. In 1972 the FDA geared up to analyze the ingredients in all OTC products, dividing them up by type. So far, only two panels have had their findings implemented by labeling changes. Half the panels are still investigating, and it will be years before their eventual recommendations take effect.

What products do you recommend avoiding in the meantime?

Doan's Pills are advertised as a "special" remedy for backache, but the active agents are just an ordinary aspirin substitute and a little caffeine. Another is Preparation H. It contains some unusual ingredients, but Medical Letter on Drugs and Therapeutics, a highly respected independent journal, found "no acceptable evidence" that any of them could cure or shrink hemorrhoids.

Any others?

I'm also concerned about time-release capsules. Although the pills in each capsule are coated to extend absorption over 12 hours, not everybody absorbs them at the same rate. Alcohol tends to dissolve the coatings very rapidly, giving people a sudden jolt of medicine, but there's no alcohol warning on most packages. Anyone ingesting alcohol in drinks or in other medicine could be in for serious side effects if he takes these capsules at the same time.

Are there other dangerous combinations?

Many. In fact, dangerous interactions are the most unpredictable and unrecognized drug treatment problem today. Valium and allergy or cold tablets containing antihistamines can create drowsiness that could be lethal if you're driving. Even more unrecognized are interactions between drugs and food. Broccoli, cabbage and spinach can interfere with the action of blood thinners. Licorice can complicate high blood pressure remedies. Brie, cheddar cheese and Camembert can lead to fatal strokes in combination with antidepressants of the monoamine oxidase inhibitor type.

How can you avoid trouble?

Be aware of the danger and question your pharmacist and physician closely, letting him know what vitamins and nonprescription drugs you take.

What else should people be more wary of?

Caffeine, maybe most of all. People don't realize how much they take in. In addition to coffee, they get it in diet pills, headache remedies and cola drinks.

What's wrong with caffeine?

There's very good evidence that women who drink a lot of coffee are more likely to develop benign breast lumps, which in turn may presage cancer. There is concern that caffeine in large amounts can harm fetuses too. Regardless of sex, caffeine raises blood pressure. In one study of relatively healthy medical students, the equivalent of two or three cups of coffee—250 mg of caffeine—raised blood pressure 14 percent.

Do you have a remedy for the common cold?

Chicken soup. Researchers have proven that the hot liquid stimulates mucous secretion in the nose, helping speed the removal of pathogens from the body. It only took medical science a few centuries to catch up with the average grandmother.

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