Drugs and Time
Could taking steroids change his whole life?
My patient wasn’t thinking about that. He just wanted to have big muscles. Really big.
He had been caught red handed with syringes in his back pack. His parents wanted to know what they were—and why they were there.
Nothing much happening, he told them. Just some anabolic steroids I got from a guy at the gym. Everybody uses them. They’re safe.
His parents did not think so. They knew they were illegal, and feared worse. They sent him to see me.
He was tall, very muscled and very bright. When I told him people did not know the long term effects of these drugs he was unimpressed. As I explained studies showing atherosclerosis, sexual problems, mood changes, he became more interested.
When I told him that the girls did not generally go after guys that looked like the Incredible Hulk, he began pondering stopping the drugs.
And more recent studies demonstrate two things: first, in animals, steroids lead to extra nuclei in the muscles, and permanent abilities to increase muscle size. Second, weight lifters who stopped steroids continue to have athletic advantages years after use. The effects were so large the authors argued for banning all “dopers” from competitive sports—forever.
Drugs do much more than change our lives right now. Drugs change us through time.
When Is That Out of My System?
It’s a common question from many patients. This antibiotic I took for a sinus infection caused me a real headache. It also made me depressed.
Nonsense, their internist tells them. Most antibiotics don’t get into the brain. You can’t get depressed from antibiotics—they’re told.
Okay, the patient responds, when will this stuff be “out of my system?”
Dutifully the internist looks at the half-life—how long it takes for a drug to be “detoxified”—changed in the liver to different, ineffective chemicals, or dumped out through urine and skin.
Many drugs have a half life of only hours. Which means that for something whose half life is eight hours half of it is gone in a third of the day; three quarters in 16 hours; seven-eighths in 24 hours. The internist reassures the patient the drug will be gone “in a couple of days.”
That’s the wrong answer.
Antibiotics are targeted purveyors of genocide. They wipe out whole populations. Mass murder is followed by waves of wars where the prizes are territory and influence.
These "citizens" may lack all human rights. But those does not mean their lives don't affect us.
The hundred trillion bacteria in our guts are now parsed into about 5000 groups. Wipe out major groups of them and the gangland wars that blasted Chicago in the 1920s look like disappearing bubbles in a teacup.
After antibiotic use clostridium difficile may get a bigger toehold in some part of the small bowel. A little too big and it can kill you; about 13,000 Americans die that way each year.
But the longer term effects? Hardly ever looked at. A curious result, as bacterial populations are now linked to autism, depression, MS, allergies and hosts of systemic illnesses.
We now know that fusiform bacteria—planted onto a tiny gut tumor—can promote that tumor and make its growth much faster.
What do antibiotics do to long term health? We don’t know—in part because we have a poor view of time.
Most drugs studies look only over weeks and months. What about their effects over years, decades, and lifetimes?
We know single point exposures—as in asbestos—can cause mesotheliomas decades later. Yet we don’t tend to think the drugs we take—the antibiotics and aspirins, Tylenols and cold remedies, have any effect past the time we use them.
Changing time perspectives changes those results.
Take lithotripsy—shock wave therapy—of gallstones. Decades later it was discovered the treatment markedly increased the incidence of diabetes.
The shockwaves were killing the islets of Langerhans cells that make insulin. Without a long term Mayo Clinic study, no one would know.
Just as fat cells were “only” fat cells—until people realize they churn out hormones and are probably the biggest “endocrine gland” in the body.
And yes, they still store fat.
It’s time to look properly at medical effects over time. Many effects of drugs are probably short lived. But others have quantum like threshold effects.
Steroids make more nuclei in muscle cells—permanently. Antidepressants change the brain for months and years. Antibiotics change the gut with knock on effects that may include cancer and depression. It turns out small shifts in animal’s gut bacteria change their rates of depression and susceptibility to stress.
We don’t know what those thresholds are for us.
Systems of Information
We tend to think of our brains and bodies as similar to the most complicated machines we know. We’re not machines, however. We are systems of information.
Some we give names to—the brain, the GI tract, bone. Others are much more subtle, like the processes by which the many viral genes inside human cells change our susceptibility to cancer and infection.
But all are systems of information, parallel and directly connected. They move endlessly and relentlessly, across place, space, and time.
Which is how we should think of drugs. What are all their indirect effects? Like viruses, do they travel everywhere? Do their effects—not their blood levels, their real effects—last just hours or days?
And does the information they impart change our bodies and their information systems in ways that work over minutes, hours, days, years, and lifetimes?
The truth is the latter. In the Information Age, we need to look at real information—the interactions over space, place, and time that change us.
For a lot longer than we think.