Unnatural Selection

I had an interesting conversation with my patient, Joe. Joe is a sixty seven year old white gentleman with a history of hyperlipidemia. Hyperlipidemia is doctor speak for elevated cholesterol. During his office visit, he refused to take a medication to treat the problem. “I realize it’s part of your job to recommend it to me, but I just don’t believe in them,” he said. “I’ve been on them in the past, and I got every side effect.”

“Which side effects were they?” I asked.

“I felt tired all the time, my sex drive went down, I had vision problems, I felt confused. You name it, I had it.” He had been previously prescribed a statin medication in the past by his cardiologist and he felt bamboozled by him. He continued that the cardiologist never explained the side effects to him and that after he read the side effects on the handout with the drug, had he known about the them, he would have never bothered taking it in the first place. He argued that it wasn’t “natural” for him to be on a cholesterol medication. I looked down at Joe’s chart and found that his father had quadruple bypass heart surgery and that his brother passed away from a heart attack. His low density lipid, or bad cholesterol, was 200.

It isn’t natural. I love this argument. As if I didn’t know that a pill created by a drug company and manufactured at a factory to create a wanted and needed response from the human body wasn’t “natural.” The natural course of any human being is to be born, live, and die. On the death certificate, doctors have an option of checking natural or unnatural causes. Unnatural causes are relating to trauma, bullets and knives. Natural causes are everything else. Humans die from disease or an inability to adapt to environment. Natural selection is natural. Darwinism is natural. Survival of the fittest is natural.

Some things that are not natural: living well into a ninth decade, surviving a heart attack, having a sexual relationship past seventy. The fact is that medical intervention is never natural. It’s all a giant hack. Doctors are essentially hackers that trick the human body to produce an unnatural response. Imagine a war where a spy is able to sneak behind enemy lines and give the wrong information to the right people leading to the ultimate end. These “unnatural” drugs do something similar, acting as moles and spies to get deep into enemy territory, ultimately trying to end the Great War from within.

Statins work by blocking an enzyme called HMG CoA Reductase that the liver uses to make cholesterol. It’s a hack to try to trick the body into doing something it naturally would not. The problem is that with all medications, there can be unintended side effects. Side effects need to be reported by all drug companies to reduce their culpability in case something goes wrong. Not everyone will experience side effects, but a minority will. And every drug trial that moves forward will usually pass safety parameters before moving into the market. A wise doctor once told me something that I still practice to this day: never be the first to prescribe a medication and never be the last.

Experiencing side effects is not pleasant, but there are ways around them. Taking periodic breaks from certain medications will sometimes be enough to halt them. Changing dose, changing statin, or changing class can also be additional ways to reduce side effects. Taking coenzyme q10 may also be of benefit, but only under the direction of a physician.

Ultimately, it’s up to Joe whether he takes a medication or not. As his physician, I can only give him my recommendations and tell him what I think is the best course of action. After all, it’s in my nature to want to see my patients healthy and live an unnaturally long life.

By: Dr. Juan Borja
Original post: https://yourdoctordad.com/unnatural-selection/

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