Several months ago I developed a stomachache after taking an over-the-counter medication for symptoms suggesting acid reflux.
When I told the doctor about my reaction, she said the medication, which she had prescribed, should not have caused my stomachache.
But the Food and Drug Administration lists stomach pain and upset stomach as among the drug's possible side effects. The episode reminded me that physicians rarely counsel me on side effects when they tell me to take a medication.
Other people feel the same way, I've discovered, lamenting drug side effects and looking for answers and moral support on Internet message boards.
So I started to wonder: How much knowledge do doctors have about medications? What can patients do to educate and protect themselves?
For Liz Awbrey of Oklahoma, finding answers meant finding a new doctor.
Awbrey was in her 50s when a doctor suggested she try a sedative that would allow her to get a better night's sleep and help ease her chronic fatigue syndrome.
She lost 20 pounds and started falling during exercise class. Her doctor said he wouldn't be worried if the weight loss plateaued, which it did.
When she told her doctor she wanted to stop the drug – because it wasn't helping her condition – he didn't warn her about withdrawal. When she developed insomnia, depression and anxiety, the doctor suggested an antidepressant, which she declined.
"I was, like, 'I was fine before I got on it, so it's got to be the drug,' " Awbrey said.
Awbrey, now 60, turned to an organization that helps people get off addictive drugs with tapering suggestions, nutraceuticals (medicinal food products) and other support. The organization suggested supplements, advising her to ask her doctor about them.
She also found a new doctor who talks to her about side effects and often suggests vitamin and supplement alternatives to drugs. She is now back to her old self.
"The doctor who gave me that, he's not a bad doctor," Awbrey said of the physician who prescribed the sedative. "He's a nice man," she said, but added that drug companies may not warn doctors sufficiently about side effects.
Doctors learn about drugs in medical school and later during continuing-education programs. But those programs are often funded by drug companies, according to J. Douglas Bremner, a professor of psychiatry and radiology at Emory University School of Medicine in Atlanta.
Bremner said pharmaceutical companies even reach medical students by influencing those who train them.
"They're not really trained to be scientists, they're trained to be apprentices," Bremner said. "That's what the drug companies know. . . . If they can get the person who trains them to change what they're prescribing, they can get them to."
When Bremner taught continuing-education sessions, the pharmaceutical companies that paid him provided the slides. Because the slides seemed to favor those companies' drugs, he started using his own.
"When I did that several times, they stopped asking me," Bremner said.
Adriane Fugh-Berman, a professor in the Department of Pharmacology and Physiology at Georgetown University Medical Center, said doctors often "prescribe irrationally," pushing branded over generic drugs, new over old, and suggesting medication for diseases invented or exaggerated by drug companies.
"We're in sort of a bad situation now where the people in control of prescribing drugs know the least about the drugs," said Fugh-Berman, who directs PharmedOut at Georgetown, which researches drug marketing and educates health-care professionals about its influence.
But Andrew Powaleny, director of public affairs for PhRMA, said the pharmaceuticals trade group's "Code on Interactions with Healthcare Professionals" says that ethical relationships are needed to provide the latest information about prescription medicines. Information about side effects, Powaleny said, should be included in discussions.
Fugh-Berman said patients need to become their own experts, researching drugs on websites – such as the government database MedlinePlus – that are "free of [the pharmaceutical] industry."
Doctors have a responsibility to listen to their patients about side effects, too, she said.
"I tell medical students: If a patient develops a symptom after they've gone on their drug, it's always the drug's fault until proven otherwise," said Fugh-Berman.
Amy Thompson, a clinical pharmacist and an associate professor at the University of Michigan's College of Pharmacy, said doctors have plenty of knowledge about drugs, but there are so many available they don't know the possible side effects of all of them.
"But they have access to look into it," she said, referring to online databases, continuing education and pharmacists.
"I think it's important the patient understand what the medication is, what they're taking it for, what they should expect to see," Thompson said. "If the medication has some sort of very serious side effect, I would want them to know what to look for."
Marlene Beggelman, founder and chief executive of Enhanced Medical Decisions, a health information technology company in Cambridge, Mass., said the FDA might be underestimating side effects because doctors often don't report them. Although the FDA collects reports on its Adverse Event Reporting System, the reporting is voluntary and adverse reactions are considered underreported. Beggelman described her own experience with side effects in a blog post on KevinMD.com.
Beggelman, an internal medicine physician, said doctors mean well even when the care they deliver has negative consequences.
"I think that very often it's a human quality of not wanting to think that what you're doing to try to help people is actually causing problems," she said.
Awbrey, the woman who took the sedative, said doctors need to do better.