I love medicines. I hate medicines. I prescribe pills; I take pills. I am a physician who recommends drugs for children. I can do a lot of good. I worry I can do a lot of harm. I am not a surgeon; I cannot cure with a scalpel. Orthopedic doctors make children straight; I just try to straighten them out; I prescribe a tincture of time or a dose of some compound that has been shown in countless studies and hundreds of thousands of experiences to help; I think. I sure hope.

There is no question that medicines save lives and eliminate suffering, but it is still a scary moment for me when I pull out my prescription pad to scribble down a name of a chemical that has worked before and will most likely work again. But what if this is the one time? The apprehension is most profound when I write for therapies that have prompted the Food and Drug Administration to label with black boxes. These framed notices warn of occasional very bad consequences reported by others having taken the same medicine. Just the name, black box, invokes images of rescue workers rummaging around smoldering rubble seeking the flight recorder after the crash. What wreck am I going to cause?

The history of healing goes back a long way. Even the ancient title of "medicine man" implies a person dispensing stuff that affected the human body and one who does more than just chant and burn incense. They knew substances of the earth that would make a person better or die trying. The path from the past goes something like: Eat the bitter root, it is good for you; don't take the root; take the pill it is better for you; no, take the bitter root, the pill is worse for you. Because of these fears, there are too many people out there who have stopped their medicines and now wonder why their diabetes is out of control or why their depression is deeper.

However, nothing is ever that simple. Today's pharmacological weapon stockpile is huge and is growing; there are pills for this and that. In fact, it seems like when there is a pill, there becomes a "this" and a "that." Dysfunctions of various types have become everyday domestic disasters when not one but three medicines were patented for the same failure. TV and magazine ads aimed directly at the consumer have added to the increase in diagnosis after the treatment has been found.

This is not to justify those who elevate their nostrils at anyone who takes medicines. Molecules for health conditions are not crutches; lotions and potions in the name of natural or organic are no different, just less defined, often untested, and no less without risks. There is just a touch of inconsistency when purists will swallow a camel of herbs while they choke on a gnat of meds.

Taking medicines daily is hard; it is particularly difficult when there are several pills multiple times a day. We take them sometimes, or we don't when we should. We take them on an empty stomach when it should be full or we take them in the morning when night is best. We can't remember their names or the amount, just that it is the blue one. We take three at a time; one increases our blood pressure and the other two lower it. We run out, or we can't pay the high cost. There are too many prescribed, especially antibiotics, and there are too few taken, especially anti-depressants. We can't live without them and some can't live with them. Drugs can save us and damn us depending on how we use them. Too bad there isn't a pill to clear up this mess.

Joseph Cramer, M.D., is a fellow of the American Academy of Pediatrics, practicing pediatrician for more than 25 years and an adjunct professor of pediatrics at the University of Utah. He can be reached at jgcramermd@yahoo.com.