Sidestep the black box

Philip J. Goscienski, M.D.

July 2009

Every prescription drug has side effects. When the FDA is concerned about a particular risk it requires a black box warning on the label of the bottle. You'll see the same warning in the package insert and even in the print advertising that beckons patients to ask their doctor about prescribing it for them. And aren't you a little frightened hearing the list of side effects on those TV ads?

Prescription drugs are generally safe when taken properly and pharmacists are likely to warn customers in writing and verbally about those that have a lower margin of safety. An enormous number of patients take statins, antidepressants, diabetes medications and pain relievers. Even though the percentage of side effects is low the absolute numbers are large. With nearly half of Americans taking at least one prescription drug every day it's no surprise that thousands of deaths occur every year from medications that are provided for valid medical indications.

Sadly, most of the chronic illnesses that require treatment are lifestyle-related. High blood pressure and coronary heart disease affect more than half the population but they were uncommon barely a century ago. These conditions, including type 2 diabetes and osteoporosis, barely exist among hunter-gatherers.

Lifestyle change won't eliminate the need for all prescription medications but it is certainly possible for most persons to reduce the dosage or the number of medications. The challenge, of course, is that the measures are simple but not easy.

I maintain a file labeled "Examples," a collection of stories about persons that have stopped taking statins, blood pressure and diabetes medications and NSAIDs (non-steroidal anti-inflammatory drugs). They didn't go on a grueling diet or exercise program. Their "prescription" had three components: one to two hours of moderately intense exercise most days of the week, giving up junk food (especially soft drinks) and portion control.

They also shared two qualities: consistency and patience. Success didn't come quickly. Although nearly everyone noted a feeling of well-being after just 3 or 4 weeks of exercise and junk food elimination, coming off prescription drugs usually took months.

A few hours a week of brisk walking is as effective in avoiding full-blown diabetes among pre-diabetics as a prescription drug. About 3 hours weekly of weight-bearing exercise is as effective in increasing bone density as an osteoporosis medication.

And there's no black box on a pair of walking shoes.

Philip J. Goscienski, M.D. is the author of Health Secrets of the Stone Age, Better Life Publishers 2005. Contact him at