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Drugs 101

The illiterate of the 21st century will not be those who cannot read and write, but those who cannot learn, unlearn and relearn.

Alvin Toffler, Rethinking the Future

What is a drug?

In pharmacology---the study of drugs---a drug is defined as a chemical substance used in the treatment, cure, prevention, or diagnosis of disease or used to otherwise enhance physical or mental well-being.

By federal law, a drug is any substance recognized in the official pharmacopoeia or formulary of the nation.

A drug is also variously defined as 1) any article, other than food, intended to affect the structure or any function of the body of humans or other animals 2) any substance intended for use as a component of such a drug, but not a device or a part of a device 3) a habit-forming medicinal or illicit substance, especially a narcotic 4) chemical substances prepared and sold as pharmaceutical items, either by prescription or over the counter 5) personal hygienic items sold in a drugstore, such as toothpaste, mouthwash, etc. 6) any ingredient used in chemistry, pharmacy, dyeing, or the like.

By these definitions, a drug can be just about anything put in or on the body, whether it cures disease, improves health or, in certain cases, even causes health problems. In general, drugs do not include foodstuffs, although the line gets quite blurry when one starts looking at nutritionals, supplements and substances like caffeine. In addition, these definitions make no distinction between drugs synthesized in a laboratory and those derived from natural sources.

Where do drugs come from?

Before the blossoming of synthetic chemistry in the second quarter of the 20th century, all drugs were derived from natural sources, usually plants. In fact, for the vast majority of human history---hundreds of thousands of years that is---humans went directly to plants for medicine. Even today, most drugs are based on some natural compound. These parent compounds are then chemically modified in an effort to improve benefit and/or minimize unwanted side effects.

Beyond our human history, one could argue that we've been using plant medicinals since the beginning of our days as animals. The undeniable evidence of life's evolution shows we've been co-evolving with plants all along, that is, for hundreds of millions of years. Plant compounds are integral to our natural chemical makeup and metabolism. At the very least our everyday diet shows us this. Further evidence lies in the use of medicinal plants by aboriginal peoples, namely the shaman and medicine woman. That's a tradition much older, by tens of thousands of years, than our laboratory medicines.

Medicine or Poison?

Instead of splitting hairs about what a drug is or isn't and making things more complicated than they need to be, I just consider a drug anything we put into or onto our body. I define drugs this way because all substances that interact with our human body and biochemistry, including foods, can do so in helpful or harmful ways depending on how we use them and, more often the case, how much of them we use. And therein lies the difference between a medicine and a poison.

One of the oldest and most basic tenets of pharmacy says quite simply, it's all a matter of dose. This dose-based definition of medicine puts things in a much different, truer perspective. Drugs cannot be simply classified as either good or bad. It doesn't work that way. If you believe there are merely good drugs and bad drugs, you're setting yourself up for trouble.

We all know that too much of anything---no matter how necessary that thing may be---is a bad thing. Now, I purposely say thing because it seems this applies to behaviors and beliefs just as easily as it does to drugs (but that's a whole other topic I attempt to address in other chapters of this book). Likewise, just as too much of something can be bad for you, not enough of any necessary stuff is unhealthy too.

For example, eating too much of the healthiest food or food group will hurt you, even if only by making you gain weight or affecting your body composition. Too much vitamin A---as discovered by early arctic explorers who ate polar bear livers---will immediately kill you. And yet not getting enough vitamin A on a consistent basis will lead to blindness.

Arsenic, commonly considered a poison---which it is, in all but the tiniest amounts---was once the main treatment for syphilis, and in some areas of medicine it's still used today. Some medicines challenge our intuition even further, as in cases where the cause of a disease may also be the cure. Nowhere is this more readily apparent than with our use of vaccines and certain anti-toxins.

Furthermore, when drugs are merely thought of as either good or bad, safe or unsafe, approved or unapproved, there may develop a false sense of security concerning a drug's safety. This may translate into certain absolute types of thinking, such as: If one pill is good, then two is better, or; If my doctor prescribed it, it must be good for me, or; if the FDA has approved it, it must be completely safe, and so on.

Here we are being challenged to reframe our perspective about medicine, to move beyond over-simplistic and often detrimental black-and-white thinking. So whatever it is you're taking, or not taking, or considering taking---whether it's food or chemical, natural or synthetic---it's necessary and beneficial to think in terms of both Should I take this drug? and, If so, how much?

In this expanded and refined frame of reference, the question of medicine or poison? becomes a question of dose...a question of evidence and thoughtful consideration...a question of choice and experience...and ultimately a question of balance.

Individual Differences

We are all unique individuals, and as such we all have our own tastes, preferences, body types, constitutions and so on. Sure, there's a lot of overlap and commonality, but when it gets down to it, what is good for one person is not necessarily good for another.

This is certainly true for drugs, where a particular drug may significantly affect one person and have no effect on another. Codeine for example is an effective pain reliever for many people, while for others it does little to nothing. Individual body chemistry makes it impossible to predict a drug's exact effect on any one person.

For most drugs, the desired effect is not as dependant on the drug itself but rather on proper dosing. This is most obvious with drugs having a low therapeutic index or margin of safety (meaning that a small change in dose might easily kill you). The blood thinner warfarin for example requires highly individualized dosing. Same with thyroid replacement hormones.

So whether it's lifestyle, diet or drug regimens, there's no such thing as one size fits all. As unique individuals, we all have our own balance. Finding which drugs and foods, and how much, are good for your mind-body-spirit is a highly personal matter.

A Question of Balance

Of all the ideas and approaches I've encountered in my own journey, I find the idea and application of balance to be most fundamental and necessary, if not always easy to have, find or allow.

Everywhere we look in the cosmos we find balance, whether in our most obvious experience of night and day, or the most invisible pairings of electrons around atoms. From the yin-yang cosmology of Taoism, the middle way of Buddhism and Aristotle's Golden Mean, to biological homeostasis in modern science and Newton's action-reaction Third Law of physics, our existence is founded and maintained with balance.

Balance is key, both within and between all things...opposites and extremes...order and randomness...stillness and dance...diversity and uniformity...distance and closeness...right and left...birth and death...dark and light---from the most general to the most subtle, balance is basic and universal to creation. Nothing of complexity lasts, for very long anyway, without it.

And the biological system as found in the human is about as complex as it gets, far more so than our most advanced machines and computers. And as much as we've learned about it, and as close as we may think we are to having it all figured out, we are just beginning to unlock the deepest mystery of the human system.