THE PERFECT MEDICATION

Ideally, medications should be extremely specific in their effects, have the same
predictable effect for all patients, never be affected by concomitant food or other
medications, exhibit linear potency, be totally nontoxic in any dosage, and require
only a single dose to effect a permanent cure. Unfortunately, that “perfect” drug has
yet to be discovered. The concept has fascinated pharmacists and physicians since
Galen of Kos expressed it nearly 18 centuries ago.
In reality, most drugs have multiple effects on the host. Those actions may even
vary among hosts, depending upon factors as diverse as genetics and local environments.
A drug is usually taken for one desired pharmacological action, but this is
often accompanied by other, usually undesired, reactions referred to as side effects.
Even drugs genetically engineered and chemically close to an endogenous chemical
may fall short of the ideal profile. Exogenous administration of a “normally occurring
substance” may disturb or fail to match a particular patient’s internal control mechanisms
for homeostasis, the balance of physiology. Part of the interest in natural
products is motivated by the wish to produce a desirable effect with fewer side effects.
However, on a philosophical level, the reality of pharmacology is that all substances
in high amounts, including even oxygen or water, can be toxic. From this viewpoint,
drugs can be likened to poisons that may have desirable side effects. If health professionals
adopt this viewpoint in using, prescribing, or recommending medications,
iatrogenic drug misuse, misadventures, abuse, and nosocomial-medication-related
errors could be minimized. In many cases, knowledge of both the indicated use of a
product and its reported side-effect profile allow the caregiver to select among similar
agents for an individual patient in order to minimize undesired side effects.