Many years ago, Yale researcher Dr. George Heninger gave a lecture where he threw up a slide of a silicon chip.  The chip displayed   tens of thousands of etched lines.  Making an analogy to scientific research, Heninger pointed to the thousands of patterns and said we understand this one, maybe a few more. 

         Heninger showed the next slide.  Portrayed was the vast rest of the chip.

         ThatÕs where we are understanding medical side effects, whether itÕs from drugs, surgery, or other treatments.  Many side effects are not only poorly understood but often difficult to describe.  If you feel changes in your body you canÕt articulate well, join a very large club. 

         Take my friend Nick.  Several months ago Nick began having odd symptoms.  He would feel pain, sometimes a heavy pressure as if someone were rubbing hard. Sometimes the pain would attack a small linear stretch along his elbow.  Twenty minutes later, that pain/pressure would dissipate, and then quickly reappear around small circular areas of his neck.  Sometimes the pain moved to the back of his neck and his shoulders.  Strange small knots appeared in his calves.

         His doctors were concerned.  Could the knots be thrombophlebitis, inflammation of the veins in his legs?  He was given special hose to wear, and put on aspirin.

         The problems had begun when he started Prilosec, or Omeprazole.

         His doctors could not connect those side effects with Omeprazole.  ItÕs a proton pump inhibitor.  It blocks an enzyme, a sodium potassium ATPase, which makes acid in the stomach.  Side effects from proton pump inhibitors are diarrhea and GI discomfort.  What could these funny muscle aches and vein clots have to do with Omeprazole?

         Plenty.

         Doctors generally think in terms of organ systems Ð a stomach enzyme should effect the stomach, maybe the GI tract.  However, the body is a really a series of different information systems, all communicating with each other, generally below our consciousness.

         Symptoms like NickÕs are usually ascribed to changes in the immune system, the many cells, organs, and parts of organs that help fight infection and rid us of cancer cells. Immune ÒdysfunctionsÓ produce all sorts of strange results.

         The immune system has to recognize us from not us.  Omeprazole is a foreign substance. If the immune system does not like Omeprazole or the chemical changes it produces in our other molecules, it will destroy them, creating inflammation in the process Ð perhaps including the migrating pains and pressure Nick felt everywhere.

         Yet far more than immune effects occur. Omeprazole changes the way enzymes in the liver detoxify drugs and food.  Everything we take in may now be metabolized in very subtle, but different ways.

         Next, sodium potassium ATPases are critical to most living things.  They determine the basic integrity of all cell membranes.  If Omeprazole has even a tiny effect on other ATPases beyond the specific one it normally blocks, including that of other organisms inside, and the effects could be many fold.

         There are 100 trillion non- human organisms lives in your body.  You possess ten trillion cells.  Change the acid bath coming out of the stomach, and you change the mix of those organisms, particularly in the gut.  That ecologic change can potentially modify the immune system, the GI tract, and hormonal organs.
        
Life as Information Flow

         Our lives exist in the nexus between energy and information, and all drugs, and food, pretty much anything that happens to us, is grist for our bodyÕs information system.  There is constant cross talk between kidney and brain, immune cells and the neurological system, the liver and GI tract, the heart and kidneys, and all other organs.  Virtually none of that is understood yet, with even less understood about how those 100 trillion other organisms fit inside the information nexus. 

         Perhaps itÕs better to think of drugs as chemicals that are also information symbols like letters in the alphabet. The effect of some drugs may be a bit like eliminating the letter r from every hundredth word in a book.  Most of the time youÕll clearly understand each word and sentence, but sometimes the meaning will be altered.  Changed meanings can change the information flow. 

         So the next time you get mental effects from antibiotics or feelings Òyou canÕt describe in wordsÓ on beginning a new medication, donÕt be too surprised.  And donÕt be surprised by your doctorÕs often confused, sometimes defensive reaction.  SheÕs trying to make you better, and itÕs amazing how useful treatments can be even when understanding how they work is no more advanced than comprehending a few patterns of the tens of thousands on a silicon chip.

Dr. Matthew Edlund practices sleep medicine and psychiatry in Sarasota.  His new book, Designed To Last, is available online. He can be reached at 365-4308 and via his Web site at doctoredlund.com.