Is "No Side-effects" Proof Positive of Woo-woo Medicine?

[H3LL]

Just curious and hopeful that a pharmacist or similar could jump in with a reasonable answer.

Every prescribed medicine I have every taken or seen has a description of possible side-effects from the very mild, "may cause headaches", to potentially serious "kidney failure".

My assumption has always been that these side-effects occurred during extensive properly controlled trials and/or their history of use. I also assume that it is partly arse-covering from possible litigants.

Possibly excluding OTC drugs, are there any prescriptive drugs that do not have side-effects?

If so, should a treatment claiming no side-effects be treated with a large dose of scepticism and considered woo-woo until shown otherwise?



ETA: Side-effects such as "homeopathy causes wallet bulimia", though amusing, are less than helpful. Thanks.

[Professor Yaffle]

Anything that has actually gone through clinical trials will pretty much never say "no side effects", even if the drug doesn't cause side effects. They will sometimes say side effects are rare and report the side effects compared to placebo - because people report side effects even with placebo. See this page for example:

http://www.rxlist.com/claritin-drug.htm

They basically have to report anything that occurred in the trial whether it seems to be a side effect or not.

[blutoski]

Anything that has actually gone through clinical trials will pretty much never say "no side effects", even if the drug doesn't cause side effects. They will sometimes say side effects are rare and report the side effects compared to placebo - because people report side effects even with placebo. See this page for example:

http://www.rxlist.com/claritin-drug.htm

They basically have to report anything that occurred in the trial whether it seems to be a side effect or not.

I believe the current standard is to report side effects that are at least 5% more common in the experimental group than in the placebo group. This reduces the chance of spurious reporting.

[blutoski]

Possibly excluding OTC drugs, are there any prescriptive drugs that do not have side-effects?

Prescription medications are classified as such because the side-effects of normal doses are considered serious. OTC will have milder side-effects in normal doses.




If so, should a treatment claiming no side-effects be treated with a large dose of scepticism and considered woo-woo until shown otherwise?

I think it depends on what it's claiming to treat, and what dose is recommended.



Just as an example, if somebody tells me that a tall glass of water has no side-effects as a treatment for mild exercise-induced dehydration (aka "thirst"), it sounds fair, even though I know that an overdose could be fatal.

[Eos of the Eons]

Having no "side" effects is proof that the stuff has NO effect. If you were being treated for sinus infection, then a side effect is anything else it causes. You could get GOOD side effects, depending upon what you figure is good or not, but anything happening beyond killing the microbe causing the infection means that it is a side effect. Let's say it caused your nails to grow longer faster while you are taking it. That side effect may be annoying for men, but most women wouldn't mind.

If there are no side effects, then it's likely having no effect, including not doing anything for the supposed reason you are taking it for. It's hard to have any effect along with 0 side effects. I don't know of anything that has an effect that will not cause "side effects" along with the desired effect.

[Eos of the Eons]

Just as an example, if somebody tells me that a tall glass of water has no side-effects as a treatment for mild exercise-induced dehydration (aka "thirst"), it sounds fair, even though I know that an overdose could be fatal.


Hm. Would a beneficial side effect then be the excretion of waste products (urea) with excess water that was drunk (that can be filtered out by the kidneys)? Death would be the bad side effect if too much excess water was drunk while trying to treat dehydration if no excretion were allowed.

Taking too much of anything would cause bad side effects, for example.

[JJM]

The "no side effects" claim is a hallmark of quackery. I just checked a few, generic OTC products and they all carried a list of "warnings." A warning not to operate heavy equipment is comparable to "may cause drowsiness" which one would call a side effect.

In sCAM, unpleasant side-effects are hailed as evidence the treatment is working. For example, go to www.quackwatch.org and search for escharotics. (Be warned, there are gross pictures.) Otherwise known as black salves, quacks promote them for removing skin tumors. One woman who put it on her nose noted intense burning and inflammation radiating with bright blood vessels one her face around her nose. The quack told her that was the appearance of a crab- symbolic of cancer, and proof she was healing. In the end, she was terribly disfigured.

[paximperium]

If you read some of the double blind randomized controlled trials on rather benign medications, you'll find that even the placebo has side effects.

[Uncayimmy]

I would say a lack of side-effects combined with the inability to overdose are pretty good indicators of woo.

[blutoski]

Hm. Would a beneficial side effect then be the excretion of waste products (urea) with excess water that was drunk (that can be filtered out by the kidneys)? Death would be the bad side effect if too much excess water was drunk while trying to treat dehydration if no excretion were allowed.

Taking too much of anything would cause bad side effects, for example.

That's why I specifically included verbiage about normal doses. Many OTC medicines do not label side-effects expected from absurd overdosing. eg: acetaminophen is fatal in doses around 20-25g, but it's not listed as a 'side-effect' because consumers are told to keep their dose under 4g/24hs.

With this in mind, if an altmed tablet was sold that said it had no side effects if taken as directed, but we discovered that taking 100x the recommended dose was fatal, I wouldn't consider it outright fraud.

An example is those pep pills from the '90s which were sold OTC and advised one to two tablets per day. People were taking 100x the recommended dose (in order to lose weight) and dying. As far as I'm concerned, the manufacturers were not lying when they said there were no side effects if used as directed.

[blutoski]

I would say a lack of side-effects combined with the inability to overdose are pretty good indicators of woo.

This makes sense: the two claims do seem to be incompatible.