Virtually every time we turn on the television or pick up a newspaper, we are urged to use drugs of one kind or another. The public is led to believe that drugs are the answer to most ills of mankind but is never told of the dangers inherent in even the most common remedies. They are never told that the excessive use of some vitamins can be toxic; they are not told that the excessive use of aspirin during pregnancy can cause postpartum hemorrhage; they are not told that a widely advertised antacid product has such a high sodium level that it is dangerous for cardiac and hypertensive patients; they are not told that a number of oral cold preparations contain substances that elevate blood pressure, increase blood sugar, and reverse the effect of anti-coagulant drugs. Thoughtful pharmacologists, physicians, and pharmacists are concerned about the overuse and misuse of both over-the-counter remedies and prescription drugs. They are also concerned about the effects of multiple drug use on personal health and even on life itself.
You will recall that when Paul was speaking to the Corinthians he asked: “Know ye not that ye are the temple of God, and that the Spirit of God dwelleth in you?” Without waiting for an answer to his question, Paul continued, “If any man defile the temple of God, him shall God destroy; for the temple of God is holy, which temple ye are.” (1 Cor. 3:16–17.)
Someone once asked Elder Richard L. Evans, “Don’t you think the Ten Commandments should be rewritten?” Elder Evans replied, “No! They should be reread.” This same philosophy should be applied to the Word of Wisdom. Some may feel the Word of Wisdom should be rewritten. I feel it should be reread.
It should be reread within the context of conditions in the most affluent society the world has ever known, a society that ten years after the widely publicized U.S. Surgeon General’s report linking cigarette smoking with a variety of major health problems is smoking more than ever before; 1 a society in which 56 million people smoke, as compared to 50 million in 1964; a society within which 3,000 teenagers are picking up the habit daily; a society in which 68 percent of all people consume alcoholic beverages at a rate of 30 gallons per capita annually; 2 and a society within which approximately one in every 20 individuals is an alcoholic. It should be reread in terms of an overmedicated society that consumes 20 million pounds (10,000 tons) of aspirin annually at a rate of 44 million aspirin tablets every 24 hours; 3 a society that spends 3 billion dollars annually for over-the-counter remedies 4 and one in which 65 percent of the women use drugs excessively during pregnancy; 5 a society with real or imaginary ills that requires 6 billion prescriptions annually; 6 a society that demands 66 percent more antibiotics than is considered necessary, notwithstanding the possibility of developing sensitivity or immunity to such agents; a society that utilizes in the form of various creams, lotions, deodorant sprays, and medicated soaps and consumes in the form of eye drops, mouth washes, toothpastes, multiple vitamins, over-the-counter remedies, prescription drugs, and food additives from 40 to 60 chemicals or drugs each morning before going to work or school. When the Word of Wisdom is reread in view of these conditions, three things are emphasized: (1) Alcohol, tobacco, and hot drinks are still a major problem. Indeed, they are probably an even more important problem today than they were in 1833 when the Word of Wisdom was given to man. (2) We have a tremendous drug utilization control problem, even among the most faithful members of the Church. And (3) it brings into sharp focus the importance of using “wisdom in all things.”
Drug utilization control is a major public health problem. A September 1973 study sponsored by the Utah State Division of Alcohol and Drugs 2 revealed that 84 percent of all people 14 years of age and older used pain medication for headache, backache, and muscle pain; 51 percent use medication for the cure or prevention of serious illness; 26 percent use drugs to calm and relieve nervous tension; 19 percent use medication for sleep; 13 percent use medication to control weight; and 8 percent use medication to relieve a tired feeling or to “pep up.” It is interesting to note that this adds up to 201 percent. Thus, there must be an enormous number of people in the state using multiple drugs each day.
A number of other studies point to an excessive use of drugs in the home. Dr. David A. Knapp, University of Maryland, in a 30-week study of 275 households, found the typical home stocked five prescription drugs and 17 over-the-counter remedies. Ninety-five percent of the homes studied bought drugs during the 30-week study, with an average purchase of nine prescription drugs and five over-the-counter remedies. In 1971, there were four to five prescriptions written for every person in the United States; those over 65 years of age had 12 to 15 prescriptions each during the year. A recent study 7 by the visiting nurses in Salt Lake City showed that homebound patients were taking nine to 15 different prescription drugs every day, which were prescribed by three to five different physicians.
A number of studies also show there is a tremendous overuse of drugs by women during pregnancy. A Scottish study showed that 65 percent of pregnant women take over-the-counter drugs, 85 percent use alcohol, and 57 percent smoke. 8 A similar study among upper and middle-class women in Texas indicated that women take from three to 29 over-the-counter drugs during pregnancy for an average of 10.3 for each woman. 5 Such reckless use of drugs worries thoughtful physicians and pharmacists. Dr. Alan Goldman, pediatrician at the Children’s Hospital in Philadelphia, recently said, “Pediatricians used to be terribly concerned that the child was to be delivered into a sea of bacteria. I am now concerned that the fetus is being incubated in a sea of drugs.” 9
The total effect of such drug overuse on the fetus is unknown. It is known, however, that well over 50 different drugs readily cross the placental barrier and something over 150 are excreted in breast milk. In general the drug concentration in fetal blood is the same as that in the mother’s blood. Accordingly, the newborn infant of a mother on certain drugs may exhibit withdrawal effects. Also, breast-fed infants of mothers taking tetracycline may receive sufficient drug to inhibit bone growth and stain the developing teeth. In this connection, it should be emphasized that a normal dose of a drug for a 110-pound mother is an enormous dose for an infant.
The simultaneous use of over-the-counter remedies and prescription drugs is a more serious problem. 10 An unusual case of this kind of drug misuse was recently seen in the outpatient service of a teaching hospital. During the course of taking the drug history, the clinical pharmacist inquired if the patient was taking any over-the-counter drugs. The patient indicated that she was, but when queried as to what she was taking, she could not remember. A similar answer was given when she was questioned with regard to any prescription medication she was taking. Further discussion extracted the promise that she would bring the drugs she was routinely taking to the clinic on her next visit. When she returned, she brought a basket containing 26 over-the-counter remedies and 25 prescription drugs, a total of 51 drugs that she was taking each day and often simultaneously, including seven depressant drugs and two stimulant drugs.
A number of years ago I demonstrated in laboratory animals that the chronic or repeated administration of drugs that either depress or stimulate the brain results in the development of tolerance to the drug and dependence on its continued administration. After two weeks of chronic administration with a depressant drug, such as meprobamate, pentobarbital, or alcohol, the abrupt termination of drug therapy was followed in 24 to 48 hours by withdrawal effects characterized by increased brain excitability, muscle tremors, and other symptoms of excitability. Conversely, after two weeks of chronic administration of a stimulant drug, such as promazine, the abrupt termination of drug therapy was followed in 24 to 48 hours by withdrawal effects characterized by decreased brain excitability, sleepiness, and other symptoms of depression. Such drug withdrawal effects are now well documented in man, and observations of this kind suggest that whatever one gains from the chronic use of a stimulant or depressant drug must eventually be repaid when the drug is withdrawn. A clinical study by Dr. Evans and associates, Sleep Laboratory, Department of Psychiatry, Royal Edinburgh Hospital, illustrates that this same phenomenon occurs even after the use of a normal dose of a drug. 11 Two women volunteers, after a suitable control period, were given 200 milligrams of a barbiturate at bedtime for 26 consecutive nights. As expected, the women fell asleep more quickly than usual, and the total sleep period was also increased. As also expected in the hypnotic-induced sleep, the onset of rapid eye movement (REM) sleep was delayed and the percentage of time spent in REM sleep was decreased. However, after only five days, REM sleep returned to baseline values; after 12 to 14 days, total sleep time decreased and onset to sleep was lengthened. Thus, tolerance had developed. But what is borrowed must eventually be repaid and often with interest. When the drugs were withdrawn after 26 days, total sleep time fell abruptly for two nights and the onset of sleep was much delayed. Further, REM sleep, which is accompanied by dreaming and sometimes by nightmares and restlessness, came on much sooner and lasted longer. It required two weeks for the REM sleep activity to return to normal. It would appear, therefore, that when sleep is induced by drugs, we sleep now, and pay later. Since sleep disturbances, except for cases of hypnotic addiction or impending psychoses, are usually self-limiting and more uncomfortable than serious, the wisdom of using drugs for this purpose is questionable.
Let me cite an example of the overuse and misuse of prescription drugs and other remedies commonly found in the home. This shows how substances many of us do not consider drugs can seriously interfere with the management of an illness. A hospitalized patient with Parkinson’s disease was carefully medicated with a relatively new drug for this disorder called Levodopa. He responded beautifully; his muscle rigidity was decreased, muscle movement improved, and even the tremors characteristic of this disease were minimal. After his drug dosage was carefully adjusted, he returned home. As the fall season approached, he decided he needed building up, so he purchased a multiple vitamin product from the local drug store. Shortly thereafter the muscle rigidity worsened, muscle movement was more limited, and the tremors returned; he was taken back to the hospital. What happened? The multiple vitamin product he had purchased contained vitamin B6 (pyridoxine), which had increased the metabolism of the Levodopa and reduced its concentration in the blood below that required to control the symptoms of his disease. Consequently he had a relapse and the symptoms of the disease returned. This illustrates how somewhat innocently one can disrupt a carefully planned treatment regimen by the use of another drug.
Not all drug utilization control problems result from the overuse of drugs. A number of studies have shown that from 20 to 82 percent of patients fail to take their prescription medication as directed. 13 The classical study by Drs. Bergman and Werner, entitled Failure ofChildren to Receive Penicillin by Mouth, illustrates this point. 14 In order effectively to treat strep throat it is necessary to give oral penicillin four times a day for ten days, even if the child no longer has a fever and appears to have recovered; otherwise, the infection will return in a few days. In this study 59 children for whom a ten-day course of oral penicillin was prescribed were visited at home, the remaining medication counted, and a urine sample taken three, six, and nine days after diagnosis in the clinic. The families understood the diagnosis, knew what medication was prescribed, were furnished the medication free of charge, and were familiar with the instructions for giving the drug. Nevertheless, the data obtained revealed that 44, 75, and 85 percent of parents had stopped giving the drug by the third, sixth, and ninth day, respectively. Pharmacists and physicians are alarmed by the number of times this occurs and by the number of times it is necessary to re-treat strep throat because the parent fails to give the medication regularly for a full ten days.
What does all this mean in terms of physical suffering and economic loss? Five percent of all hospital admissions are due to the inappropriate use of drugs. From 18 to 30 percent of hospitalized patients develop drug reactions while under treatment for some other condition. 6 Dr. Kenneth L. Melmon, University of California Medical Center, studied the average hospital stay of various patients. He found that the average hospital stay of patients without drug problems was 12 days, whereas those who developed drug problems while in the hospital stayed for 20 days; the overall stay for all patients was 14 days. It would appear, therefore, that one in every seven hospital days is due to the drug utilization control problem. 12
What can one do about the drug problem? “Use wisdom in all things,” and follow the revealed word of the Lord.
“For behold, it is not meet that I should command in all things; for he that is compelled in all things, the same is a slothful and not a wise servant; wherefore he receiveth no reward.” (D&C 58:26.)
In addition, one can follow a few simple guidelines.
1. If you take over-the-counter remedies, use them only for the indicated conditions. Make sure you understand the cautions and directions on the label. If you are not sure how to use these preparations, ask your physician or pharmacist for advice.
2. When you take prescription drugs, don’t take any other drugs unless you consult your physician or pharmacist. Make sure you understand how, when, with what, and how long to take your prescription medication. Take it exactly as directed. Never take a prescription drug that was prescribed for someone else.
3. If there is any question about the effectiveness of a drug in a specific condition, consult your physician or pharmacist. Use wisdom in all things.
President Harold B. Lee, in his book entitled Decisions for Successful Living, used this illustration: “One of the most scenic drives in the State of Arizona is through Oak Creek Canyon that lies between Flagstaff and Jerome. To enter the canyon from Flagstaff, the descent is very steep, requiring expert roadbuilders to construct the winding highway with sharp hairpin turns to get the traveler to the floor of the canyon. Just as with all paths that lead downward, no effort at all is required to get all the way to the bottom; indeed, all the going is so easy that unless you apply your brakes at the dangerous turns, you would meet early disaster. When you arrive at Jerome, however, the situation is just reversed. Before you is a sheer wall of the canyon that can only be surmounted by a series of ladder-like roads constructed on ascending levels. What energy or gasoline you think you saved in coming down, you now must expend, and more, to climb back up. Woe be to the motorist if his gasoline is poor or the sparkplugs are fouled. If a tire should go flat, or if some mechanical defect should develop, Jerome would have an unwilling visitor added to its population.”
The misuse and overuse of over-the-counter remedies, prescription drugs, and almost any drug, is like a trip through Oak Creek Canyon. At first these agents appear to make life easier, to relieve real or imaginary illnesses, but eventually each one of us must pay back whatever we might have gained and face the judgment of God’s inexorable law: “As ye sow, so shall ye reap.”
God created all things for the use of his children here upon the earth. The development of highly selective and potent drugs is one of the choice blessings he has given to this dispensation. When used wisely, modern drugs prevent disease, prolong life, relieve suffering, and benefit all mankind. When misused or overused, they may induce disease, destroy life, cause untold suffering, and weaken society.
Many things in pharmacology strengthen my testimony of the gospel of Jesus Christ. Conversely, many gospel principles enhance my curiosity about pharmacology. When based on truths, each is supportive of the other. The predictable ways drugs act on body functions, the predictable ways body functions respond to drugs, the predictable ways drugs are absorbed, distributed, and bound in the body, the predictable ways drugs interact with each other in the body—all emphasize the unerring accuracy of nature and bear witness of the inexorable law, “As ye sow, so shall ye reap.” These factors also provide valid reasons for each one of us to reread the 89th section of the Doctrine and Covenants [D&C 89] in terms of our personal application of its broader principle—wisdom in all things.
Kushner, D., “What’s Happening to the Tobacco Department?” American Druggist, vol. 169, p. 67.
Chambers, C. D., Inciardi, J. A., and Siegel, H. A., “The Incidence and Prevalence of Drug Use and Alcoholic Beverage Consumption in the State of Utah: Implications and Recommendations,” Resource Planning Corporation, Washington, D.C., September 1973.
Woznicki, J. and Mrtek, R. G., “Aspirin—The Non-Drug Drug,” Illinois Pharmacist, vol. 37, p. 124.
“Summary of 1971 Sales of Drugstore Products,” Drug Topics, vol. 116, p. 21.
Hill, R. M., “Drugs Ingested by Pregnant Women,” Clinical Pharmacology and Therapeutics, vol. 14, p. 654.
Brodie, D. C., Drug Utilization and Drug Utilization Review and Control (Health Services and Mental Health Administration, Dept. HEW, Rockville, Maryland, April 1, 1970).
Marx, J. L., “Drugs During Pregnancy: Do They Affect the Unborn Child?” Science, vol. 180, p. 174.
Solomon, J., “Sea of Drugs,” The Sciences, vol. 13, p. 23.
Turner, J. N., “Some Potential Interactions Between Prescribed Drugs and Over-the-Counter Drug Products,” California Medicine, vol. 117, p. 13.
Evans, J. I., Lewis, S. A., Gibb, I. A. M., and Cheetham, M., “Sleep and Barbiturates: Some Experiments and Observations,” British Medical Journal, vol. 4, p. 291.
Melmon, K. L., “Preventable Drug Reactions—Causes and Cures,” New England Journal of Medicine, vol. 284, p. 1361.
Stewart, R. B., and Cluff, L. E., “A Review of Medication Errors and Compliance in Ambulant Patients,” Clinical Pharmacology and Therapeutics, vol. 13, p. 463.
Bergman, A. B., and Werner, R. J., “Failure of Children to Receive Penicillin by Mouth,” New England Journal of Medicine, vol. 268, p. 1334.