"The side effects are worse than the illness"

Sometimes they are, in the sense that the illness is silent and the side effects aren't. A statin that gives you aching legs is a daily cost against a benefit measured in decades. An antidepressant that flattens your appetite or your sex life is asking a lot for a mood you can no longer remember being bad. The side effects are real and I'm not going to argue you out of feeling them.

Here's what the quiet stop gets wrong about them. The NHS statins page says that if you think your medicine is causing side effects you should talk to a doctor, who may prescribe a different statin or change the dose. That's not a polite formula. There are five statins on the NHS list and they don't all do the same thing to the same person. The antidepressants page says many side effects ease after a couple of weeks as your body gets used to the medicine, that you'll be seen every week or two when you start, and that if you're finding the side effects hard to manage you should talk to your doctor, who can discuss other options. The levothyroxine page says most of its side effects happen when the dose is too high and improve when it's changed.

In each case the side effect is information the prescriber needs, and the quiet stop is the one response that throws it away. Stop without saying anything and the record shows a patient on a statin who's doing fine. The next appointment, if it happens, starts from a false position. Say "the aching started in the second week and I've stopped taking them" and you've given the prescriber something to work with, and probably a different tablet by the end of the week.

There's also the Yellow Card scheme, which the NHS pages mention, for reporting a suspected side effect so that it's counted. You don't need it for the conversation. I mention it because a side effect that gets reported is a side effect that exists somewhere other than your kitchen, and that's the direction this book is pushing everything.