MAY 2014
Khaas Baat : A Publication for Indian Americans in Florida
Health & Wellness

Are you taking your pills as prescribed? – Part I

Dr. M. P. Ravindra Nathan

By M. P. Ravindra Nathan,

When I was busy with patients in the office one day, an urgent call came from the emergency room (ER). “Your patient Mr. Holder (age 74) is here, looks like he is developing a stroke. His blood pressure (BP) is quite high –about 190/108,” said the ER doctor.

“Really, that’s a surprise,” I said. “He was in my office just two weeks ago and everything was OK then. BP was well controlled at 136 / 84 with two medications.” I was looking at the patient’s chart my nurse had quickly pulled out from the rack.

I went over to the ER and evaluated the status. The neurologist on consult was already there. Then the wife showed up and when questioned she volunteered a critical information. “You know, Larry felt good for the last several days and he decided to stop those BP medicines. You know he doesn’t like to take any medicines. Didn’t he talk to you?”

So, that’s what happened, I surmised. His BP shot up after he quit his meds abruptly; something doctors fear all the time. And the sad part was he chose not to let me know about it either. This is always a recipe for disaster. Many studies have clearly shown that failure to take blood pressure-lowering medicines as directed greatly increases the risk of stroke and death in patients with hypertension.

According to a study, “Compared to those who diligently followed their doctor’s orders, the patients who did not adhere to their prescribed schedule had nearly four times the risk of dying from a stroke by the time they reach the second year after stopping their drugs.” And the risk continues to increase afterwards in non-compliant patients. The same is applicable for most other medications, especially given for chronic diseases. A 68-year-old lady with an artificial heart valve who was asked to stop her blood thinner, “warfarin,” only for two days prior to a colonoscopy forgot to restart the drug after the procedure and ended in the hospital with a clot on her valve!

Non compliance of prescribed medications seems to be all too common these days. An estimated 20 to 50 percent of patients do not take their medications as prescribed and in the setting of chronic medical conditions this is indeed a dangerous trend and often quite frustrating for the physician. Patients’ refusal to follow a treatment regimen also affects the whole nation's healthcare system. "The cost of patient noncompliance is easily in the tens of billions of dollars a year because of the needless complications and hospitalizations," says David B. Nash, MD, MBA, chairman of the Department of Health Policy at Jefferson Medical College in Philadelphia. "If we could improve compliance, we'd be well on our way to fixing the healthcare system regardless of what reforms are ultimately passed."

Some of the recent data show that “up to 11 percent of hospital admissions, 40 percent of nursing home admissions, and about 125,000 deaths a year are due to noncompliance with prescribed medication regimen.” A case in point was an older patient of mine whose diabetes appeared to be way out of control during his office visit. Asked why, he said: “Oh, the cost of Januvia that you prescribed was over $300 a month. I can’t afford that kind of price.” But he failed to notify me his dilemma, which led to a worsening of his condition.

Medicine-taking behavior may not always match the recommendations from the doctor. Some patients are not convinced that they need them and hence start and stop the drugs to see their effect! Needless to say, this is a bad practice. Apart from the harm that can be caused by non-compliance, doctors can also get into trouble with the insurance companies. “Pay- for-performance” program is being promoted by all medical insurance companies, including Centers for Medicare & Medicaid Services (CMS). This would mean “treating physicians will potentially be evaluated and reimbursed on the basis of patient outcomes — meaning that noncompliant patients could drag down doctors.” That’s bad news for the doctors although they are not at fault.

Compliance with medications as well as other recommendations from the treating physician is the key mediator between medical practice and patient outcomes. As our former U.S. Surgeon General C. Everett Koop once lamented, "Drugs don't work in patients who don't take them."

To be continued …..


Turmeric: A healing remedy

Dr. M. P. Ravindra Nathan


Have you ever looked in your spice drawer and wondered if there were other benefits to those colorful powders beyond flavor? I sure have! That's why I am so passionate about discussing a particular spice that has been used by my family and ancient India for ages. The healing power of turmeric has only recently attracted attention by the Western world, but it's no secret.

If this is the first time you're becoming acquainted with turmeric, the spice is beautifully deep yellow, golden or orange with a taste that is distinctly warm and bitter. It is the spice that gives curry powder its color. Turmeric has been used for thousands of years as a powerful medicinal herb in both India and China. The main component that gives turmeric its many health benefits is called curcumin. You may have come across this ingredient in natural health food stores or in various supplements. 

Turmeric has numerous health benefits. One of the most noted benefits is its anti-inflammatory power. Studies show that long-term inflammation is often the cause of many chronic diseases. Furthermore, numerous studies show that turmeric outperforms many pharmaceuticals in its effects against chronic disease and in protecting the body from disease with virtually no side effects. Turmeric is also a potent antioxidant, neutralizing free radicals in the body that typically damage cells and cause aging. In addition, turmeric has antimicrobial properties that help prevent infection and appears to block the division of cancer cells. It has also been shown that turmeric blocks the production of beta-amyloid, the substance that is found in the brains of individuals with Alzheimer's disease. It is a powerful plant that benefits every system in the body. This is just the beginning of many promising studies that are under way.

The content of curcumin in turmeric is about 3 percent by weight, which is not a significant amount. Most research uses extracts of curcumin with dosages exceeding 1 gram. Therefore, it would be difficult to attain this level by using turmeric in the diet alone. However, most people can benefit from this spice by using it in everyday meals to help prevent disease and infection. Those interested in supplementation should look for extracts in dosages of 500 mg to 1000 mg taken one to two times a day or as directed by the product. Turmeric is best in raw form but is most widely used in the ground form. You can sprinkle on salads, vegetables, nuts, or add a spoon to your smoothies or juices. My favorite way to use turmeric is making turmeric tea, especially during the winter months and for the occasional cough. You simply bring 1 to 2 cups of water to a boil and add ¼ to ½ teaspoon of turmeric according to taste. Let the mixture simmer. Mix well and sip away. You can add fresh grated ginger for additional benefits. Like many herbs, turmeric will begin to lose its potency after about six months, so keep your supply fresh.

Turmeric is arguably one of my favorite spices, where a little goes a long way. This is a mere glimpse of the abundance of health benefits it provides. The next time you enjoy a curry dish, think of all the benefits your body is reaping and remember we truly are what we eat. Hippocrates understood this simple truth, saying, "Let food be thy medicine and medicine be thy food."

Reshma Patel, a board-certified internist practicing Integrative Medicine in the Tampa Bay area, can be reached at

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