We are making a change in clinic. We ask all new patients to bring ALL the pills they take. Prescription, vitamin, supplement. Most of them don't. So now we are telling patients that they need to bring all pills or they will be rescheduled.
I want to know what my patients are taking. My town is a delightful spectrum mix from very conservative to very liberal and some libertarians thrown in. But I look at the ingredients of the bottles.
With prescription medicines, people will say "I am on metoprolol."
"What strength?" I say, "And is it the short acting, middle or long acting?"
Some patients: "Uh.... it's blue. It's a triangular blue pill."
Eye rolling would be unprofessional. I pick the lowest dose and type in "unsure dose". "Bring it next time."
I examine vitamin bottles. Some contain multiple herbs as well as vitamins. Most people don't seem aware of this. Sometimes people have four different vitamins with vitamin A in them. "The fat soluble vitamins A, E, D and K can build up in your tissues and people have managed to kill themselves. I would recommend you take less then you are taking." And then there are the high dose vitamins: one with 3999% of the recommended daily allowance of vitamin A. Hello. Why is this being sold? I guess people have the right to take things that can kill them. But I wish they wouldn't.
Supplements. I read the ingredients. One ingredient is cow thymus. "This has cow thymus in it." I say.
"Oh." says my patient.
"I am very unenthusiastic about taking cow thymus." I say. "Unless you are working with a naturopath who has prescribed it for a compelling reason. Who prescribed it?"
"Uh, it's not prescribed. It's made by a good company."
Right. Like I trust corporations. Scamming thieves and liars. Sell anything that isn't nailed down in pill form. Including cow thymus. Medicine isn't exactly clear on what the thymus does in people or cows.
My medical philosophy is as few pills as possible. Prescription, vitamin or supplement. Eat food not pills, exercise, make friends, work well, be kind to yourself and others and avoid pills unless necessary. We don't know how cow thymus and metoprolol interact. The FDA considers supplements to be natural, like a carrot. A pill is not a carrot. It doesn't grow on a tree or in the ground. It has to be made by people. The supplement companies do not have to do any testing for medical safety and efficacy and I frankly hate the pills with multiple herbs in them. Also, kidney failure is on the rise from too many pills. Everything is metabolized by either the kidneys or the liver and kidney failure is in the top ten causes of death in the US.
And I don't want to be a guinea pig. I don't want to be the personal home chemistry trial of cow thymus plus metoprolol. No way. I would bet that you don't want to be the personal home chemistry trial guinea pig either.