I know my blood pressure medicine works for instance because every time I talk to my doctor about reducing it or getting off it, I monitor my blood pressure and it spikes.
I know psuedophredrine works.
And your data is just that, “anecdotal”, it’s no better than the people doing “research” by watching YouTube on the toilet.
It’s best to look at all cause mortality in your example. Many studies have looked at that endpoint if you are curious.
It’s not like I said “I feel better” when taking it. So my blood pressure just magically comes down after I’m taking it?
You posted an anecdote.
But there’s also lots of clinically collected evidence behind blood pressure medicine, right? I don’t see why anyone would have reason to doubt you.
And a “pharmacist” isn’t exactly the best trained person when it comes to knowing how to do a drug research or to know its efficacy for patients compared to even a GP who is monitoring patients and keeping records of blood work and other stats
(Consider: how many problems are there with your body that you’re actually likely to be able to solve with a drug that can be taken safely and correctly at basically any dose, basically any schedule, quitting whenever you like, and without checking for cross-drug interactions? Because those are the requirements for a drug to be OTC. There exist far more OTC drugs than there should, given the number of OTC-able problems, is what I’m saying.)
It seems some people see that placebo's can have effects in a select few paradigms of care and extrapolate that to "all drugs must be placebos." Which is just smooth brain conspiracy talk.
Except for phenylephrine, of course, which only served to teach me how to ask the pharmacist for the good stuff.
It's probably the same for many conditions and medications. Antidepressants don't turn you into someone who is always happy. Painkillers don't make recovering from surgery a joy. I think that people even had the same feelings about COVID vaccines; they wanted "one shot and you'll never be sick again", but all we got was being 90% less likely to get COVID or whatever. None of this makes these things a scam. Rather, they are imperfect technologies that we work to improve. Silver bullets are rare, but they do exist. Just not all the time. (Have you died from strep throat or polio recently? People used to all the time!)
It’s even possible that the negative attitudes of your pharmacist family members toward the medications their patients are taking are affecting their efficacy!
There's an enzyme - catechol-O-methyltransferase - which is coded for by the COMT gene. This enzyme catalyzes the metabolism of dopamine in the brain. COMT has three common variations - AA/AG/GG - which substantially alters how effective the enzyme is at metabolizing dopamine. AA results in significantly reduced enzyme activity, which can result in dopamine built-up in the brain, which results in increased sensitivity to stress, anxiety, and pain, but comes with the bonus of enhanced cognition, motor skills, and memory.
AA genotypes also tend to be "placebo responders", while GG genotypes tend to be non-responders. This tends to imply that placebo responsiveness isn't purely psychological, but physical - and indeed, it turns out that in AA "responders" you can turn off the placebo effect by administrating naloxone (which works by binding to opioid receptors)!
This has really interesting implications for pharmacological research, too - if there are people who are genotypically predisposed towards or against placebo effects, then a drug trial that stacks responders in the trial group and non-responders in the placebo group which would produce a drug efficacy signal that could be just the placebo effect.
Patients are definitely more likely to take a medication than change their behavior. Patients also ask for medication. And then there's the whole pharmaceutical system.
My personal experience is that many older people I've known have a startling number of bottles of medication they take every day.
I also know some older people that have exercise and eating right as part of their regimen and rarely take any medication.
Not to be pedantic, well actually let's be. But this is pretty poor medical thinking. Are patient's not on meds at advanced age because they exercise? Or are they able to exercise because they're otherwise healthy and feel good? This kind of simplifying causes a lot of harm in medicine and a lot of patient blaming.
One thing is for certain - it makes me uncomfortable how many different medications some people take every day.
https://doi.org/10.1371/journal.pmed.0020124
My impression is that the situation has been improving in recent years. Between study pre-registration, larger subject groups, and greater statistical rigor I have a lot more confidence that drugs getting approved now actually do what they say on the label. Of course, this is also part of the reason why it now costs >$1B to bring a new drug to market.
GP specifically mentioned prescriptions, so the customer/patient is not at fault here, if there is a judgment here, it is toward the doctors. And just because something earns you money doesn't mean it is above criticism.
I still don't share GP's opinion in that most medicine don't work. I think some don't work, and some is misused or used preemptively, therefore showing no effect. And I am also dubious about a lot of comfort medicine, but for most people I know who are under proper prescription, it is obvious that it works, it includes psychatric medicine.
"Medicine" never wandered that far from religion, after all.