Joe and Terry Graedon – A Smarter Approach to Pharmacies
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Jonathan: Hey, everyone, Jonathan Bailor back with another bonus Smarter Science of Slim Podcast. Today’s show is going to be an absolute good one. We have two wonderful consumer, health and pharmaceutical advocates with us; two individuals who have literally dedicated their entire lives to helping people avoid a lot of the nonsense and just bad stuff that can pop up when it comes to health care in the country; literally the two leaders in this field; the founders of The People’s Pharmacy, which you can see at PeoplesPharmacy.com; the authors of myriad books, the most recent of which is Top Screwups Doctors Make and How to Avoid Them; and two smiley, awesome people: Joe and Terry Graedon. Welcome to the show.
Terry: Thanks so much, Jonathan.
Joe: Nice to be with you, Jonathan.
Jonathan: Joe and Terry, just to give the listeners who may not have heard about you yet a little bit of background, can you tell us your story and how you got into the advocacy position that you are in today?
Terry: Well, the story starts with me as an anthropology graduate student dragging my newlywed husband off to Mexico so that I could do research in nutrition, community nutrition and health, in Oaxaca City.
Joe: I was a newly-minted pharmacologist. A lot of people are really unfamiliar with pharmacology as a discipline. I am not a pharmacist and could not dispense drugs if my life depended on it. Pharmacology is the study of how drugs work, what they do to us, what they do for us, benefits and risks. Pharmacologists research new drugs, test old drugs. When Terry dragged me off to Oaxaca, Mexico, I wasn’t quite sure what I’d do with myself. Then I met up with the Director of the Medical School in Oaxaca, and he welcomed me to start teaching a laboratory course to second-year medical students in Oaxaca in Spanish.
That sort of got me started thinking about writing a book in the afternoon. Because it was a very different lifestyle from what I was used to at University of Michigan as a graduate student. That began The People’s Pharmacy, a book for consumers dedicated to helping them make wise or hopefully informed decisions about health-care issues. Terry and I have been collaborating now for over 35 years in our syndicated newspaper column, on our syndicated public radio show, as well as books and speaking engagements on the web. We’ve been doing things together in regards to health for a very long time.
Jonathan: Joe and Terry, with so much time and effort, literally a lifetime of effort and attention spent on this issue, I’ve got to imagine that there was some event that happened or maybe a couple that made you say, “I am going to dedicate my life to this.” Because to be very clear, anyone who goes to PeoplesPharmacy.com will see that you are not just putting in your time. This is a calling to you, at least that’s my impression, and that’s why I wanted to have you on this show. What led you to that level of commitment and passion?
Terry: We were headed that direction for sure. We’ve always thought that consumers deserve more information about what they’re taking and how they can improve their own health. I think it really solidified for us in 1990 when we attended a conference in Bolinas, California that was put together by our good friend, Tom Ferguson. It was all about patient-centered medicine.
Joe: Actually, I would probably go back a little earlier than that and say we were home getting ready to go to Mexico. We went to a kind of going-away party, family affair. My aunt Evelyn pulled me aside. She said, “Joe, I am taking this little white pill for depression, it’s called something I don’t even know how to pronounce, and I wonder if I can take this pill and also have a glass of white wine.” For me, that was like a defining moment because all of a sudden I realized, “Wow, here’s my beloved Aunt Evvy taking a medicine and she doesn’t even know what it is.” Certainly nobody told her about side effects or whether or not she could have wine with her pill.
That was kind of the opening salvo in realizing that there wasn’t just one Aunt Evvy; there were probably millions of people just like her all across the country taking their pills, wondering, “What are the side effects? How should I take my medicine? Are there interactions that are dangerous that I should be on the lookout for?” That was what kind of kicked off the book.
I think that our experience in Mexico and Terry’s experiences as a medical anthropologist opened my eyes to what I’ll call natural remedies. Because up until then, I was a big believer in double-blind, placebo-controlled trials, and still am to this day. But Terry kind of had an anthropological perspective that has been incredibly valuable over the last 20 years.
Terry: Well, my research involved me asking people what they did when they got sick and finding out. I discovered that people did a whole lot of things besides just go to the doctor. Sometimes, the things that they were doing helped them quite a bit. As we’ve gone along and I’ve gotten more perspective and more years of experience, we’ve discovered that sometimes it’s the things that people are doing other than go to the doctor, outside of going to the doctor, that make the biggest difference for their health.
Joe: We’ve also discovered that people have become quite suspicious about medication now. Drugs save lives. They cure us when we are ill. When you’ve got pneumonia, antibiotics can make a huge difference. We are not anti-pill, but I think the stories around drugs like Vioxx for arthritis and the thousands of people who may have experienced heart attacks and strokes as a result of that medicine, or the more recent scandal around Avandia, has led people to look for other options, whether it’s to control their blood pressure, their diabetes, their arthritis or dozens of other conditions.
We like to assess both the pros and cons of medications but also give people natural approaches, especially when there is science. We are very big on data whenever it’s available. I guess one of the best examples would be beet juice.
Terry: Well, the exciting thing about beet juice is that there have been now probably more than two dozen research projects conducted showing that beet juice can lower blood pressure quite effectively, just about as well as some blood pressure medications.
Jonathan: Joe and Terry, just one quick thing I wanted to add here, because I am very, very curious to hear your thoughts, is there’s so much misinformation or just of lack of information when it comes to pharmaceutical treatment. Certainly, I think everyone agrees with that. There’s another edge to the sword, and that’s if you go to Google or you go to your favorite search engine and you type in “natural remedies for x,” it seems like there’s as much snake oil out there, there’s as much opportunity for negative and wrong information on the natural side of things as there is on the pharmaceutical side of things. It’s not as if one path is clear-cut and the other is not. How do we navigate the natural path?
Joe: Well, you are absolutely right, Jonathan. The amount of misinformation that’s available from a variety of sources, whether it’s on the web or whether it’s in books or whether it’s in magazines, you just name the media, there is misinformation galore with regard to prescription medicines, over-the-counter drugs, as well as natural. What we have been trying to do over the last 30 years is cut through the misinformation and hopefully give people objective data whenever it’s available. We have a mantra on The People’s Pharmacy: If it might help and it won’t hurt and it doesn’t cost very much, that’s something we are more than willing to talk about.
Terry: Just because something’s natural doesn’t mean it’s safe. There are a lot of natural things that can hurt you pretty much.
Jonathan: I always joke that snake venom sure is natural but that doesn’t mean it’s good for you.
Jonathan: Joe and Terry, I am big fan of whole foods and if it’s found in nature. It seems like now there is this anti-pharmaceutical counterculture, and for good reason, but that people are just willy-nilly slapping “natural,” or the word “natural” is used as if it’s synonymous with good, and that is clearly not true.
What should we be looking for… let’s say regardless of whether it’s natural or synthetic, what are those key characteristics or key questions you tell people to ask? The question is not is it natural or unnatural; the question is what?
Joe: Well, you are absolutely spot on. The natural versus unnatural is a false dichotomy. Poison mushrooms will kill you just as fast as any drug in the pharmacy, maybe even faster. The real question is pros and cons, benefits versus risks, and the cost. You mentioned snake venom. Well, there is a category of medications that are incredibly beneficial called ACE inhibitors, angiotensin-converting enzyme inhibitors. Perhaps the number one most prescribed drug in that category these days is something called Lisinopril. Now, this was derived originally as a result of research into snake venom, the deadly Jararaca snake from Brazil. As an anthropologist, Terry can tell you how they came about discovering this drug.
Terry: Well, it turns out that if you get bitten by the Jararaca snake, you go into shock, your blood pressure drops and you die. Of course, that’s very good for the snake and very bad for you. However, the researchers were interested in exactly what it was in the snake venom that was making blood pressure fall through the floor. What they came up with was the first compound in this class, as Joe said, very, very helpful blood pressure medicines.
Joe: Called Captopril or Capoten. The point here is that here’s this amazing category of drugs taken by tens of millions of people all around the world, saving lives, lowering blood pressure. But it has a number of side effects, one of which is a terrible cough, a cough that can’t be quelled by cough medicine, a cough that can keep you up at night, a cough that can make you pee in your pants, it’s that bad. Anybody who develops a cough on Captopril needs to be taken off that kind of medicine and switched to a different drug. That’s just a demonstration that, you know, sometimes drugs come from nature.
Terry: Jonathan, I think the most important question to ask about any therapy is, “Do I need it; what is it going to do for me?”
Joe: And, “What’s it going to do to me, and are there any alternatives? Can I get my blood pressure down through other mechanisms: Exercise, losing weight.”
Terry: Drinking beet juice.
Joe: Drinking beet juice. Even if it was a natural remedy, in quotes, again something we’d like see eliminated from the lexicon. Even if it was an herb or home remedy, the question is, “Might it help? How much might it help, and what are the risks?” If you are trying to get rid of lice, the last thing you want to do is put kerosene on a kid’s head. A stray match or a spark could be deadly. On the other hand, putting Listerine on a child’s hair and rinsing with that is likely to kill the lice in about five or fifteen minutes. Since people are gargling with it every day, the likelihood it is going to cause very much harm on a child’s head, slim to none.
Jonathan: It sounds like there is a key distinction here, and that is let’s not get so hung up on the specific means; let’s look at the ends we’re after and then find the safest and least negative-effect inducing means possible. Along those lines, if that is correct – please correct me if I am wrong – is something I can tell you personally that trips me up a little bit is this, what I think is a false dichotomy between “drugs” and “non-drugs.”
Because it seems like what we are talking about, like when you exercise, it causes a change in your biochemistry and it causes the change in your brain. When you take certain SSRIs, it causes a similar change in your biochemistry. What we are really talking about is just changing our biochemistry. It seems there is all sorts of things we can do to do that. Drugs are just one set; is that fair?
Terry: I think that sounds like a very good synopsis.
Joe: You have absolutely nailed it. If you were taking St. John’s wort, for example, an herbal approach for depression, it is affecting neurochemistry, just as exercise will affect neurochemistry, just as Prozac, Paxil and Zoloft will affect neurochemistry. You can affect your body, biochemistry, and physiology through a variety of means. It’s not as if one is better than the other; it’s just that what you have to do is find out what works best for you.
If one thing doesn’t work – let’s say it’s arthritis. You have been out exercising, you strained your knee a little bit. Well, you don’t have to just rely on one thing. You might want to rely on turmeric, which is an anti-inflammatory spice, has been in used in India for thousands of years. You might want to add to that some pomegranate juice, which has some anti-inflammatory activities. Then, you might want to take some Aleve, for example, Naproxen. There are a number of things that you can do, and if one doesn’t work, there may be something else.
Jonathan: It seems like the key thing to keep in mind is that nothing – correct me if I am wrong – but nothing we could do, any of those approaches, has un-affect or just one effect; it has a cascade of effects. What we sometimes consider side effects is just a misnomer for the effects we don’t like. But there are just effects.
For example, hypothetically, exercising could help you deal with depression. We have to look at the other effects. It can also reduce your risk of other conditions. It may also make you have more energy. It may also help you sleep better. Then when we say taking something like a Prozac, well that may also help you deal with your depression, but it may have a less-desirable set of other effects. What do you think about the distinction between side effects and just effects? Because I think sometimes, again, there is a false dichotomy there. There is just effects, right?
Terry: Exactly. You need to know which effects are relevant for you. For example, Joe mentioned turmeric for joint pain. That’s something that we frequently recommend. We get a lot of testimonials from people who have tried and find it helpful. However, we always like to caution people that anyone who is taking Warfarin, Coumadin, a blood thinner, should probably stay away from turmeric because it may raise INR levels. That’s a way of measuring how quickly or not your blood is clotting. It makes blood less likely to clot and puts you at risk of bleeding.
Joe: Here’s a natural “product” that has been used for a very long time. It’s the yellow spice and yellow mustard. But if you consume a lot of it in a pill form, for example, it may just thin your blood too much in conjunction with an anti-coagulant like Warfarin. As you said, these are just effects, but one these effects could be life-threatening if you were to have a hemorrhage. That’s why you have to know the full spectrum.
Sometimes there are good effects. Take Viagra, for example. When they stared studying this particular medication for cardiovascular issues, for heart problems, they couldn’t get the medicine back from the guys who were in the clinical trial. They were sort of like, “Usually people give the pills back. Why aren’t these guys giving these pills back; what’s going on here?” Well, they later found out that there was this other effect called erections. They obviously took advantage of that. In fact, the only approval process for the drug is for erectile dysfunction. They just forgot the original purpose of the drug and went with the secondary effect that turned out to be, for many people, very positive.
Terry: Although I think science has found that it also can be helpful for such things as, for example, pulmonary hypertension.
Terry: Some strange conditions that are otherwise difficult to treat.
Jonathan: Well, Terry and Joe, I got to tell you, there’s so many options out there available to us. You have mentioned turmeric, if I am pronouncing that correctly. I can imagine that a listener could hear this and say, “Oh, that’s great. I am going to go to Google and type in, ‘Help me with turmeric,’ or, ‘Find good turmeric,’ or, ‘Cost-effective turmeric.’” And they will literally be deluged with a bunch of marketing and spam and virus-ridden pages. Anything involving any treatment of any kind of condition is a mine field. What should we look for or see through when pursuing treatments for that which ails us?
Joe: Well, a good healthy dose of skepticism. Pretend you are from Missouri, that you have to be shown the data. All you have to do is turn on the evening news and, of course, you will be inundated by prescription-drug commercials. It’s the same thing, except it’s being pushed at you from TV. When you say going to the web and searching for arthritis relief and now, all of a sudden, you are hit by hundreds of spam messages or, “Here, try our particular brand of turmeric,” you’re just going to have to be a little cautious.
Terry: One of the things I like to do when I am looking for information online is separate the information search from the search for a bargain. I don’t want to get the information about the product that I am looking for from the website that’s selling it. I want to get it independently.
Joe: One of our favorite resources is HubMed. That’s the national medical library. If you put turmeric or the active ingredient curcumin into a HubMed search, you will find dozens, hundreds, maybe even thousands of scientific articles. The abstracts are available free of charge. You can do your own survey and your own research and say, “Okay, that makes sense,” or, “Uh-oh, there is a problem.”
Terry: You may need a medical dictionary while you are reading HubMed. Most people can make something out of it, anyway.
Jonathan: Well, I think that takeaway of one, if you can’t find anything in HubMed, which for a lot of these things is probably the case, it’s good to at least do a quick search. Then, also the tip of “Please, listeners, delineate your search for information from your search to purchase.” Because it seems like if you just go out there looking for the information, you will look at much different sources, you will avoid conflicts of interest. To be clear, I think it would be also a false dichotomy to say anyone who might provide you with the product will misinform you; that’s not what we are saying, I think. It’s just to see those as two distinct actions; is that fair?
Terry: Yes, I think so.
Joe: You have absolutely got it right. Because whenever there is a conflict of interest – and there often is, both in the world of medicine and the world of whatever we want to call this alternative or complementary medicine. Whenever there is a seeming conflict of interest where somebody has something to gain, be skeptical.
Jonathan: In terms of skepticism, how do we avoid taking that too far? We talked about you turning on the news and it’s just like, “Oh, if you go to the hospital, they are going to screw everything up, and 20 million people die a year of mistakes.” Certainly, these things are all true. At the same time, we don’t want to be neurotic, or we don’t want to artificially avoid seeking out treatment for that which ails us. How do we find the balance there, that healthy skepticism while still not shutting ourselves off to feeling better?
Joe: Be informed. That’s really what we have been trying to accomplish for, as you said, over 35 years. You need to be prepared to ask difficult questions of both the health food store clerk, who may be trying to sell you a particular brand of fish oil, as well as when you go to see your physician and your doctor is prescribing a new medicine for you. You need to find out what are the benefits and what are the risks. Write them down, and find out how common they are. Then, find out, “Well, when should I start feeling better? And if I don’t start feeling better, what should I do about that?”
You need to be very responsible as a consumer of health information, as well as health products, just as you would be if you were going to buy a new car. Sometimes I think we spend a lot more time on which new TV we are going to shop for and purchase, or which car are we going to get. When it comes to our health, we make snap decisions and we oftentimes don’t do the kind of research that’s necessary in order to have what we think is a really good health outcome.
Jonathan: Joe and Terry, it seems like it’s a bit analogous. When it comes to putting things into our body, it may be interesting to compare that to putting things on our body. What I mean by that is if your buddy has a nice television set and they say, “I have this television set. It’s really nice,” chances are if you buy that television set it might be just as nice for you, maybe. You know that if you have a friend and they say, “This dress or this shirt is very nice for me,” we know that doesn’t necessarily mean it will look good on us, because we have very different bodies externally.
We also have different bodies internally. I think a lot of people also get their information just from when they are waiting at soccer practice or they’re around the water cooler and someone is like, “I just started taking this pill and it’s been great for me.” That person then goes to their doctor or goes on the internet and says, “Well, now, I should take that pill, too.” When in reality, just like we are so different on the outside, we are pretty different on the inside, too. Just doing what other people do may not be a good approach. What do you think?
Terry: Possibly even more different on the inside than we are on the outside. We’re just beginning with the human genome project to appreciate just how many little tiny but very important variations there can be from one of us to the next one.
Joe: When it comes to swallowing an antibiotic, for example, some antibiotics may work far better in some people than other people. We mentioned the blood thinner Warfarin a little earlier and how it could perhaps interact with turmeric. Well, some people metabolize Warfarin differently than other people. As a result, your genetics will have a profound impact not just on prescription drugs and over-the-counter medications, but also on herbal remedies.
Terry: Jonathan, it isn’t just our genes; it’s also everything else we are doing. For example, we all agree that exercise is going to improve our fitness and it’s good for us. That’s sort of a general statement. If we look at exactly how much we can improve our fitness with exercise, some people taking statin medications will not have as much improvement as the rest of us without the statin medications.
Joe: There is a lot going on. It’s what we call both genetics and epigenetics. Epigenetics is our diet, our exercise regimen, the medications we are taking, the chemicals we are exposed to, and it all has the profound impact on our physiology and biochemistry. We need to be both aware of it and also communicating with our health professionals so that they know what we are doing as well.
Jonathan: Joe and Terry, there is so much going on out there in our individual lives. There is so much variation in between individuals. It seems that we always want shortcuts. Sometimes shortcuts can be bad, but also in reality shortcuts can be good. The way the human brain is structured is we often look for shortcuts. We’re like, “Oh, this worked this way in the past, so it will likely work this way in the future.” And we go on to autopilot a little bit because of that.
Just with practicality in mind, I’m wondering if there are any somewhat universal recommendations we could make in this arena. One I am curious to get your thoughts on is that, given how much variation there is, given how much interaction there is between what we ingest and everything else, would it be fair to make a generalization in the sense that the more certain and absolute a website or a person claims to be…
For example, eating wheat grass will cure this in all people. If someone says that, it seems that, to the extent that they are certain and not caveating what their statement is in any way, the more skeptical we should be. Because it seems even in hearing you guys talk, the more I interact with people who are actually experts, the less you hear them say absolutist claims and the more they say, “Well, it depends.” That could be frustrating, but in some ways, I think it’s avoiding a hubris which can lead us to a health-like tower of babble where we try to build this tower to the heavens and it just ends up crumbling over. What do you think?
Joe: We have a tremendous challenge as health consumers in walking through this maze that you are just describing, where some people are absolutely adamant, “This is the path to good health and if you just take this product or avoid this other stuff, then you are going to be home free,” versus the people who can never give you a recommendation because it’s always in flux.
The perfect example would be sodium. We’ve been told for the last 30 years that, “Oh, my gosh, salt is poison and we have to cut back.” Yet, just in the last few weeks, the most prestigious health organization virtually in the world, The Institute of Medicine, a division of the National Academy of Sciences, came out and said, “Well, that severe sodium restriction that everybody has gotten on board with, the Centers for Disease Control and Prevention, the American Heart Association, their target of 1,500 milligrams, which is a very small amount of sodium per day for most people, you know, that probably wasn’t warranted by the evidence.” So I would completely agree with you. When somebody says, “You must. Everybody cut back on sodium for good health,” probably there is a middle road.
Terry: Well, just to follow up on what Joe was saying about sodium and salt, it turns out that, of course, there are people, plenty of people, maybe as many as a quarter or third of the population, that is salt-sensitive, and if they eat too much salt, their blood pressure goes up. There is also probably about 25% of our population that is salt-sensitive on the other side; if they eat too little salt, their blood pressure goes up. This is relatively new information, but it’s completely critical to our good health. We need to know if we belong in one of those categories or the other.
Jonathan: You mentioned the quick fix. I think that whenever you hear about a quick fix or something is supposed to be the answer to all of your health problems, that we would agree with you, run the other way. We saw this with dietary supplements. For a long time, vitamin E was supposed to be “the answer.” Beta carotene was the cool dietary supplement that everybody should be taking. When we actually saw the research, what we learned was separating these ingredients out of food is probably not such a good idea.
Terry: Jonathan, a lot of times people will say, “If it sounds too good to be true, it probably is.” I’ve worked with that one.
Joe: Yes, and that’s true of prescription drugs as well as the dietary supplements we’ve been talking about. Somebody came along and said, “We have got the perfect anti-anxiety pill, it’s called Valium, and whenever you’re feeling stressed or anxious or nervous, here, just take a pill, Mother’s little helper.” It was even in a song that you may remember, going way back.
Clearly, taking a Valium or Diazepam when you are feeling stressed isn’t going to solve the underlying cause of the anxiety or stress, and that sometimes takes some extra work. Whether it’s a sleeping pill or whether it’s an anti-anxiety pill or whatever the pill or the dietary supplement, there really aren’t that many quick fixes out there.
Jonathan: It seems while this can become extremely complex, it might only be complex if what we are relying on are things outside of ourselves. What I mean by that is not, “Let’s ignore all science and just trust our bodies.” What I do mean is – and I am sure, Joe and Terry, you guys get this a lot – people will say, “Should I or should I not do X?” Where X works for some people, it doesn’t work for other people, like most things in the world.
The question I often say back to these people, “Well, assuming X is not poison,” like we talked about earlier, “have you tried it, did it help you or not? And if it did, then keep doing it. And if it didn’t, stop.”
It’s complicated, but on the same level, isn’t it so simple? If it’s not poison, and you can afford it, and there is some reason to believe it could be helpful, try it. If it helps you, that’s good. If it doesn’t, stop. What do you think?
Terry: That sounds like common sense. I think common sense is really… we always say that common sense is the absolute most important ingredient in any of our home remedies.
Joe: What we’d actually say, Jonathan, is that Grandma’s wisdom is the foundation upon which pretty much all health decisions can be made. It has stood the test of time. So what did Grandma say?
Terry: Eat your vegetables.
Joe: Now science has confirmed Grandma was right. The more vegetables you eat, the better off, the more colors, five to seven helpings a day. What else did Grandma say?
Terry: Get a good night’s sleep.
Joe: She didn’t mean five or six hours. She didn’t mean texting your friends at midnight or one o’clock in the morning. She meant seven to eight hours of sleep at night. She also said, “Go out and play,” or, “A little hard work never hurt anyone.” By that she meant, “Go exercise.”
Terry: Move your body.
Joe: If you’re feeling stressed, chop some wood. Go outside. Get some sun on your face. She didn’t know why sun was good, but she basically knew it. She knew that exercise was essential for good health. In the wintertime, she gave her grandchildren cod liver oil. We now know that vitamin D is essential. Then, finally Grandma said something else rather profound, it was self-serving in that it was for Grandma’s benefit, too.
Terry: She said, “Visit your Grandma.” The research now, Jonathan, on social connection and social support is so strong. It’s absolutely elemental to maintaining our good health.
Joe: Isolation is a killer, but community interaction, family, friends, that is the life saver. Grandma understood that. Grandma’s wisdom will stand the test of time. It doesn’t cost very much, that’s the other good thing.
Jonathan: Whenever you can combine science and simplicity, I am on board. It seems that’s right where we are and right where we can end today, because that’s just brilliant. Terry and Joe, thank you so much. This has been absolutely wonderful.
Terry: Our pleasure, Jonathan.
Joe: Thank you, Jonathan.
Jonathan: Folks, if you want to learn more about Terry and Joe, which I hope you will, please check them out at PeoplesPharmacy.com. Also, their most recent book is called Top Screwups Doctors Make and How to Avoid Them. Again, that’s PeoplesPharmacy.com. Our guests today were Terry and Joe Graedon. Please, listeners, this week and every week after, eat smarter, exercise smarter and live better. Talk with you soon.