By Dr. Ardeshir Z. Hashmi
“Let food be thy medicine and medicine be thy food,” said Hippocrates.
Centuries later, William Osler, another legendary physician, thought differently: “The desire to take medicine is perhaps the greatest feature which distinguishes man from animals.”
Perhaps this paradigm shift in medicine explains the current norm to reach for medications first. Our pill-taking culture may additionally have been influenced by new cures, medical training, patient preference and society’s quest for “quick fixes” or a combination of all these things.
Prevention First
While medications have been the panacea for many illnesses, the adage, “prevention is better than cure” has endured over time, ringing truer as our bodies age. Increased sensitivity to medication side effects or progressive medication ineffectiveness are reflections of normal age-related physiological changes. Our ability to break down medications in the liver and clear them via our kidneys is altered over time.
The travesty is that these changes are not common knowledge, not just for us as patients but more alarmingly, for most physicians. Traditional instruction in medical training has been to cure through pills. When medications are not eliciting the expected response, the tendency is to prescribe more medications in the face of increased complexity. The option of healing by “deprescribing” potentially harmful medication remains a path less taken, remaining the province of either the seasoned geriatrician clinician or one who thinks out of the box.
Non-medication means of healing have evoked an interesting response from allopathic medicine. Labeled “alternative medicine,” these therapies are disdainfully ignored. Sometimes this is well founded when evidence is limited, raising concern for unknown harms. However, there has been increasing evidence for safe non-medication modes of treatment that can supplement medications. An example is psychotherapy paired with antidepressants; the combination is superior to using either by itself.
Many older adults are excluded from medication clinical trials. After exclusions, most remaining eligible participants are often only on the one medication of interest to researchers (and in many cases the funders of the trial). This results in an artificial environment, far removed from the more typical real-life experience of being on multiple medications with high interaction potential.
The tide is turning. Advances in the field of medicine have seen the advent of pharmacogenomics; the ability to predict which medications an individual will likely respond to and which will cause adverse effects, all based on personalized DNA from a simple cheek swab.
In addition to this move towards tailored, precision medicine, there is a resurgence of interest in food as medicine and the maxims of primum non nocere or “first do no harm” in medical training. Music therapy, culinary medicine, and art in medicine are flourishing as educational and clinical offerings. A holistic view is key when balancing medication and non-medication therapies to enable us to live longer and healthier. And prevention-better-than-cure remains the beacon of hope, with vaccines heralding, we pray, the end of a long, hard pandemic winter.
