The Smallest Dose

I do not think that anyone likes to take medicine. I’ve never met someone who takes prescription drugs and is happy about it. However, the reality is that most people do regularly use at least one prescription medication, and they have to develop a perspective to help them deal with this. There are two which I commonly encounter in my practice.

The first is the concept of the smallest dose. I have noticed that many people will clarify that the medicine they are taking is a very small dose, implying that that it is so small as to almost be insignificant. While I appreciate the attempt to feel better about having to take a medication (and feel that a positive approach to any therapy always helps), I have three issues with this particular topic.

The first is that most people do not understand that the dosage of medications is generally small in the first place. Because they are almost always single compounds, large doses of pharmaceuticals are not needed to produce biological change.

Second, if a dose of medicine is large enough to help, than it is large enough to hurt as well. It is silly to think that there are no negative effects because the dosage is small. For more on this topic, see my article About Side-Effects.

Third, this entire concept is perpetuated by the pharmaceutical industry, as a way to make people feel less apprehensive about taking their drugs. This has developed over the past several years as more and more serious health conditions have been associated with prescription medications. The biggest shift in this direction occurred after research appeared correlating an increased risk of certain cancers with the use of hormone replacement therapy. After media attention to this topic settled down (when was the last time you even heard anything about this), commercials appeared with women talking about taking hormones at the lowest dose and only for a defined (described as “not forever”) period of time. Unfortunately, doctors caught onto this trend, and have also become responsible for propagating the lowest dose nonsense to patients.

The second concept I frequently encounter has to do with only taking medications that are necessary. I am often told by a person that they are not a medicine taker, but that they really have to take whatever medicine they are using. These medications are of all sorts, not limited to the treatment of only rare and serious diseases. I can only wonder, who takes medicine that is not thought to be really necessary.

Again, I appreciate the attempt to feel better about what one is doing. But the downside to making oneself feel better using these two concepts is that they are not necessarily true, and they can prevent people from seeking treatment (particularly in the form of self-care) that is genuinely less damaging.