SIDE EFFECTS ARE MAIN EFFECTS

𝐄𝐯𝐞𝐫𝐲 𝐦𝐞𝐝𝐢𝐜𝐢𝐧𝐞 𝐬𝐩𝐫𝐞𝐚𝐝𝐬 𝐭𝐡𝐫𝐨𝐮𝐠𝐡 𝐭𝐡𝐞 𝐰𝐡𝐨𝐥𝐞 𝐛𝐨𝐝𝐲. 𝐖𝐡𝐚𝐭 𝐰𝐞 𝐜𝐚𝐥𝐥 𝐬𝐢𝐝𝐞 𝐞𝐟𝐟𝐞𝐜𝐭𝐬 𝐚𝐫𝐞 𝐧𝐨𝐭 𝐨𝐧 𝐭𝐡𝐞 𝐬𝐢𝐝𝐞 — 𝐭𝐡𝐞𝐲 𝐚𝐫𝐞 𝐭𝐡𝐞 𝐦𝐚𝐢𝐧 𝐞𝐟𝐟𝐞𝐜𝐭𝐬.

When most people think of medicine, they imagine it like a neat little tool.

You take it for your pain, or your fever, or your acidity — and you expect it to go straight to that one spot and quietly fix it.

Like a key finding its lock.

Like a bullet finding its target.

The comforting thought is: “This tablet will solve my problem, and the rest of my body will not even notice.”

But the truth is not like that.

The moment a medicine enters your body, it enters the blood.

And the blood does not respect your wish.

The blood carries it everywhere — to the brain, to the stomach, to the heart, to the skin, to the liver, to the kidneys.

Every organ that can hear its chemical signal responds.

The body does not know how to separate “main effect” and “side effect.”

That separation exists only in our language, not in reality.

Think about the simplest and most trusted of medicines — paracetamol. Almost every household uses it for fever or pain. People believe it is the safest of tablets. But paracetamol is also one of the most common reasons for liver damage across the world. The very same medicine that lowers fever can, when used repeatedly or in higher doses, injure the liver so badly that people land in intensive care, some even needing liver transplants. For the family standing around the hospital bed, the “side effect” of liver failure became the only effect that mattered.

Or take ranitidine. For years it was one of the most common tablets for acidity. Doctors prescribed it freely, people bought it over the counter, children and old people alike took it without fear. Then one day, news spread that ranitidine was being withdrawn in many countries because it was found to contain cancer-causing impurities when stored for long. Suddenly, the tablet that once felt like water for acidity was remembered for its dark shadow. Was the cancer risk a “side effect”? For those who took it daily for years, that became the main memory of the medicine.

Consider brufen (ibuprofen). It is taken for headaches, joint pain, muscle pain. The relief is real. But at the same time, it quietly irritates the stomach lining. Many people who took brufen regularly for arthritis pain ended up with stomach ulcers that bled. Some even needed emergency surgery. The medicine did reduce pain, yes — but the bleeding ulcer was not on the side, it was at the center of their life.

Or look at chemotherapy. It is given to destroy cancer cells. And it does. But it also destroys hair roots, gut lining, bone marrow. The patient may lose hair, vomit for weeks, and become so weak that infections take over. Families often say: “The treatment was harder than the disease.” In such cases, the side effects define the entire journey more than the main effect ever did.

Even medicines for everyday problems carry this truth. A blood pressure tablet like amlodipine lowers pressure by relaxing blood vessels. But the same relaxation causes fluid to leak into the legs, creating swollen ankles that make walking painful. A person may remember the swelling more than the invisible lowering of pressure.

An antidepressant can lift mood, but it may also disturb sleep, reduce appetite, or kill desire. For some, the emotional relief feels small compared to the weight of these other effects.

What we call “side effects” are not accidents.

They are not mistakes.

They are not secondary.

They are the natural results of the same action that gave the benefit.

The fever drops and the liver suffers.

The acidity calms and the cancer risk rises.

The pain eases and the stomach bleeds.

The tumor shrinks and the body weakens. It is all the same story.

The word “side effect” was created by us — doctors, companies, society — to make things sound simple. It helps in conversation. It helps in selling. It helps in hope. But the body has no such word. The body does not whisper, “this is the main effect, that is the side.” The body only knows chemical action and response. To the body, every effect is a main effect.

And this truth is not limited to medicines. Life itself runs the same way. Coffee sharpens the mind but also creates acidity. Alcohol relaxes but also destroys sleep and liver. Sugar gives a burst of joy but also leaves exhaustion behind. Every action spreads its ripples. Every choice has many consequences. Nothing in life has one pure, isolated effect.

So when we look at medicines, we must see clearly: the benefit and the harm are born together. The main effect and the side effect are twins. One cannot arrive without the other. What we call “side” is simply the part we did not ask for, but the body received it anyway.

The deep truth is this: 𝐞𝐯𝐞𝐫𝐲 𝐞𝐟𝐟𝐞𝐜𝐭 𝐨𝐟 𝐚 𝐦𝐞𝐝𝐢𝐜𝐢𝐧𝐞 𝐢𝐬 𝐚 𝐦𝐚𝐢𝐧 𝐞𝐟𝐟𝐞𝐜𝐭. The division exists only in words, not in biology. And once you see this, you cannot unsee it. You begin to look at every pill, every sip, every choice in life with new eyes — eyes that know that nothing ever comes alone.

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SIDE EFFECTS ARE MAIN EFFECTS

-- A Dialogue with Madhukar at Yelmadagi

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𝐂𝐡𝐚𝐩𝐭𝐞𝐫 𝟏 — 𝐒𝐞𝐭𝐭𝐢𝐧𝐠 𝐭𝐡𝐞 𝐒𝐜𝐞𝐧𝐞

The hills around Yelmadagi were still covered in mist. The eastern sky was pale orange, slowly ripening into gold. Dew glistened on millet fields, and a bullock shook its head near the cowshed. From the kitchen of a mud house, the earthy scent of boiling herbs drifted out.

On the clay stove, a brass vessel simmered with dark leaves. Simarouba Kashaya — bitter, strong, grounding. The bitter steam rose into the cool air, filling the courtyard.

Dr. Madhukar Dama, Lifestyle Scientist, stirred the vessel with care. His homestead was off-grid, quiet except for bird calls and the distant sound of a farmer’s voice.

Today, he was not alone. Three visitors had come: a city doctor, a scientist, and a patient who carried the weight of years of medicines.

The four of them sat in the courtyard on a wooden bench. The rooster crowed in the distance. The brass vessel hissed.

Dr. Madhukar Dama: (smiling) This is Simarouba Kashaya. It is bitter, but it carries strength. Drink slowly. Taste everything it gives.

The morning had begun, and so had the dialogue.

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𝐂𝐡𝐚𝐩𝐭𝐞𝐫 𝟐 — 𝐁𝐫𝐞𝐚𝐤𝐢𝐧𝐠 𝐭𝐡𝐞 𝐌𝐲𝐭𝐡

The patient sipped the Kashaya, his face tightening instantly.

Patient: Bitter. It grips the tongue.

Dr. Madhukar Dama: That bitterness is not on the side. It is part of the medicine. You cannot separate the healing from the bitterness. Both are main.

City Doctor: Patients say the same about tablets. “It helps me, but it troubles me too.” We call those troubles side effects.

Scientist: But the molecule doesn’t know intention. It acts wherever it goes.

Dr. Madhukar Dama: Exactly. The body does not know our words. Once a medicine enters the blood, it goes everywhere. Every place that can respond, responds.

Patient: So the cycle I am caught in — one medicine for relief, another for the effect of the first — it is not bad luck?

Dr. Madhukar Dama: Not bad luck. It is the nature of medicine. Every effect is real, every effect is main.

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𝐂𝐡𝐚𝐩𝐭𝐞𝐫 𝟑 — 𝐂𝐨𝐦𝐦𝐨𝐧 𝐌𝐞𝐝𝐢𝐜𝐢𝐧𝐞𝐬, 𝐂𝐨𝐦𝐦𝐨𝐧 𝐋𝐢𝐯𝐞𝐬

Dr. Madhukar Dama: Think of paracetamol. Trusted in every home. It lowers fever, eases pain. But it also burdens the liver. At higher doses, the liver fails. Across the world, paracetamol poisoning is a leading cause of liver transplants.

Patient: And I thought it was the gentlest tablet.

Scientist: It breaks down into a toxic by-product. Usually cleared, but if the body is overwhelmed, the damage is inevitable.

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Dr. Madhukar Dama: Or ranitidine. For decades, the friendly acidity pill. Then banned, when stored tablets were found to form cancer-causing impurities. Relief and risk were twins all along.

City Doctor: I prescribed it freely. The relief was real. But the danger was real too.

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Dr. Madhukar Dama: And brufen. It eases pain, yes. But it strips the stomach lining, causing ulcers, sometimes bleeding. Long use weakens kidneys. For many, the bleeding ulcer is remembered more than the relief.

Patient: My neighbor ended up vomiting blood. His knees were better, but his stomach was ruined.

Dr. Madhukar Dama: Both were main.

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Dr. Madhukar Dama: Or amlodipine. It lowers pressure by relaxing vessels. But that same relaxation lets fluid leak, swelling ankles. The patient may not feel the invisible drop in pressure, but he feels the swelling every step.

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Dr. Madhukar Dama: And antidepressants. They lift mood by increasing serotonin in the brain. But serotonin also rules sleep, digestion, sexuality. So relief may arrive with nausea, sleeplessness, loss of desire.

Patient: The cure becomes another struggle.

Dr. Madhukar Dama: Both are main.

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𝐂𝐡𝐚𝐩𝐭𝐞𝐫 𝟒 — 𝐖𝐡𝐞𝐧 𝐭𝐡𝐞 𝐓𝐫𝐞𝐚𝐭𝐦𝐞𝐧𝐭 𝐁𝐞𝐜𝐨𝐦𝐞𝐬 𝐭𝐡𝐞 𝐃𝐢𝐬𝐞𝐚𝐬𝐞

Patient: My cousin had chemotherapy. The tumor shrank, yes. But his hair fell, his appetite vanished, his blood weakened. My aunt whispered, “The treatment is harder than the disease.”

Dr. Madhukar Dama: Chemotherapy attacks fast-growing cells. Cancer cells, yes. But also hair roots, gut lining, bone marrow. Vomiting, baldness, infections — all are main effects of the same strike.

City Doctor: Sometimes patients remember the treatment’s suffering more than the disease itself.

Patient: For my cousin, the suffering was the disease.

Dr. Madhukar Dama: This is why I say: side effects are main effects. The body has no sides.

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𝐂𝐡𝐚𝐩𝐭𝐞𝐫 𝟓 — 𝐖𝐡𝐲 𝐭𝐡𝐞 𝐖𝐨𝐫𝐝 𝐄𝐱𝐢𝐬𝐭𝐬

City Doctor: Perhaps we created the word “side effect” to reassure. It softens the truth.

Scientist: In pharmacology, it only means “not intended.” But intention is human. The molecule doesn’t care.

Dr. Madhukar Dama: Exactly. The body does not know this word. To call the ulcer from brufen a “side effect” is like calling the shadow of a tree a “side tree.” The shadow is still part of the tree.

Patient: Then we were living under shadows we refused to name.

Scientist: And sometimes the shadow grows taller than the tree.

Dr. Madhukar Dama: Yes. Language protects, but it also deceives. The body has no edges. Every effect is central.

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𝐂𝐡𝐚𝐩𝐭𝐞𝐫 𝟔 — 𝐁𝐞𝐲𝐨𝐧𝐝 𝐌𝐞𝐝𝐢𝐜𝐢𝐧𝐞𝐬 — 𝐓𝐡𝐞 𝐔𝐧𝐢𝐯𝐞𝐫𝐬𝐚𝐥 𝐋𝐚𝐰

Dr. Madhukar Dama: This law is not limited to tablets. Life itself runs the same way.

Take coffee. It sharpens the mind, but also irritates the stomach, disturbs sleep. Both are main.

Take alcohol. It relaxes, but also destroys liver and memory. Families remember the destruction, not the laughter.

Take sugar. It brings instant joy, but leaves fatigue, and over years, obesity and diabetes. Sweetness and sickness are both main.

Patient: So even joy comes with its shadow.

Dr. Madhukar Dama: Always. Nothing ever comes alone. Every choice spreads its ripples.

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𝐂𝐡𝐚𝐩𝐭𝐞𝐫 𝟕 — 𝐓𝐡𝐞 𝐒𝐜𝐢𝐞𝐧𝐭𝐢𝐬𝐭 𝐏𝐮𝐬𝐡𝐞𝐬 𝐃𝐞𝐞𝐩𝐞𝐫

Scientist: But what about rare effects? Penicillin cures most, but in some it causes violent allergy, even death. That cannot be called a “main effect.”

Dr. Madhukar Dama: For that body, it is main. The immune system reacts fully. To call it “side” is to stand outside the body. For the person living it, it is central.

Scientist: And dose? Small amounts heal, large amounts harm.

Dr. Madhukar Dama: Same mechanism, different scale. Paracetamol lowers fever at one dose, burns liver at another. The warmth and the burning are both main effects of fire.

Patient: So every medicine is like fire. Comfort in a flame, destruction in a blaze.

Dr. Madhukar Dama: Exactly.

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𝐂𝐡𝐚𝐩𝐭𝐞𝐫 𝟖 — 𝐓𝐡𝐞 𝐃𝐨𝐜𝐭𝐨𝐫’𝐬 𝐂𝐨𝐧𝐟𝐥𝐢𝐜𝐭

City Doctor: For years I told patients, “Side effects are rare, don’t worry.” I thought I was protecting them. But perhaps I was protecting myself.

Dr. Madhukar Dama: Words can protect, but truth with compassion protects better. Tell them: “This medicine has many effects. Some you may welcome, some you may not. I will walk with you through them.”

Patient: If you had told me that, I would have trusted you more, not less.

City Doctor: (softly) Then from now on, I will not hide behind the word “side.”

Dr. Madhukar Dama: That is enough. Truth spoken gently heals more than lies spoken sweetly.

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𝐂𝐡𝐚𝐩𝐭𝐞𝐫 𝟗 — 𝐓𝐡𝐞 𝐏𝐚𝐭𝐢𝐞𝐧𝐭’𝐬 𝐀𝐰𝐚𝐤𝐞𝐧𝐢𝐧𝐠

Patient: At home I have a cupboard — paracetamol, ranitidine, brufen, sleeping pills, blood pressure tablets. I thought I was unlucky, cursed with side effects. But now I see — I was not living with sides. I was living with the full effects.

I chased the main — relief from fever, pain, sleeplessness. But I ended up living with what I thought were margins — burning stomach, yellow eyes, swollen ankles. They became my life.

Dr. Madhukar Dama: This is awakening. There are no unlucky bodies, no accidents. Only bodies responding to what they receive.

Patient: Bitter, but freeing. Like this Kashaya.

Dr. Madhukar Dama: Once you see the truth, you cannot unsee it. Once you taste it, you cannot untaste it.

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𝐂𝐡𝐚𝐩𝐭𝐞𝐫 𝟏𝟎 — 𝐓𝐡𝐞 𝐊𝐚𝐬𝐡𝐚𝐲𝐚 𝐑𝐞𝐭𝐮𝐫𝐧𝐬

Dr. Madhukar Dama returned with another pot of Simarouba. The sharp bitterness filled the air again. He poured four tumblers. They sipped, grimaced, then laughed.

Scientist: The bitterness and the warmth — both are main.

City Doctor: If we called the bitterness a side effect, we would be lying.

Patient: Just like medicines. What we call “side” often becomes the center.

Dr. Madhukar Dama: This is the truth: nothing in life comes alone. Every medicine, every sip, every act — all bring a chain of effects. What we call “main” is only what we desire. What we call “side” is what we did not ask for. But the body, the mind, the world — they receive them all equally.

He raised his tumbler, the dark liquid shimmering in the light.

Dr. Madhukar Dama: Once you see this, you cannot unsee it. Once you taste this, you cannot untaste it. Remember always: 𝐒𝐢𝐝𝐞 𝐞𝐟𝐟𝐞𝐜𝐭𝐬 𝐚𝐫𝐞 𝐦𝐚𝐢𝐧 𝐞𝐟𝐟𝐞𝐜𝐭𝐬.

The four men drank in silence. Outside, the fields hummed with voices. Inside the courtyard, a deeper truth had taken root.

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𝐒𝐢𝐝𝐞 𝐄𝐟𝐟𝐞𝐜𝐭𝐬 𝐚𝐫𝐞 𝐌𝐚𝐢𝐧 𝐄𝐟𝐟𝐞𝐜𝐭𝐬

Listen.

I want to tell you something.

It is not sweet.

It is not soft.

It is bitter,

like Simarouba Kashaya,

like neem leaf on the tongue.

But it is true.

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We were taught to believe

a pill is a key.

It finds one lock,

opens one door,

leaves the rest of the house untouched.

But that is a fairy tale.

A pill does not bow politely to your wish.

It does not whisper,

“Excuse me, I will only touch your headache,

not your stomach,

not your liver.”

No.

The moment it enters your blood,

it is everywhere.

It rides your veins

like a river in flood,

knocking on every door:

brain, stomach, heart, skin, kidneys, liver.

Every place that can hear it,

hears it.

And the body,

poor honest body,

does not split the story into “main” and “side.”

The body only knows effects.

Every effect is main.

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Take paracetamol.

It lowers fever,

yes,

you sweat, you cool,

you feel better.

But it also burdens the liver,

quietly, relentlessly.

One strip too many,

one day too many,

and the liver collapses.

All over the world,

men and women lie in ICU beds,

waiting for a liver transplant,

because of this so-called safe pill.

Tell me,

is that a side effect,

or the only effect that now matters?

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Take ranitidine.

The acidity pill.

Mothers gave it to children,

grandfathers carried it in their shirt pocket.

Everyone trusted it.

Then one day it was gone.

Withdrawn.

Found to carry cancer risk.

The relief and the risk

were born together.

We just saw one before the other.

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Take brufen.

The tablet for aching knees,

for the farmer’s back,

for the worker’s muscle.

It calms the pain,

yes.

But it strips the stomach bare,

cuts ulcers into the lining,

sometimes makes a man vomit blood.

I have seen it,

you have seen it.

Neighbors, uncles, aunties —

knees soothed,

but stomach bleeding.

Do you still want to call it a “side” effect?

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Take amlodipine.

Blood pressure comes down,

quietly, invisibly.

But the same relaxation

swells the ankles.

Feet puff like bread,

walking becomes painful.

The patient does not feel the falling pressure,

but he feels the swelling every single step.

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Take antidepressants.

They lift mood,

pull a person from darkness.

But serotonin is not only in the head.

It runs digestion,

it runs sleep,

it runs desire.

So the same pill

brings nausea,

restless nights,

loss of love.

The sadness may fade,

but life loses color in other ways.

Both are main.

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Take chemotherapy.

The sharpest weapon.

Yes, it shrinks tumors.

But it also burns hair,

empties the gut,

weakens the blood.

Patients whisper:

“The treatment is harder than the disease.”

Families remember the vomiting, the bald head,

more than the cancer itself.

Side effect?

No.

It is the full effect.

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Take steroids.

Miracle tablets.

They tame inflammation,

calm asthma,

soothe pain.

But they also swell the face,

thin the bones,

raise the sugar,

leave children fragile.

The cure becomes another disease.

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Take sleeping pills.

They knock you down,

yes,

but they also leave you dull,

forgetful,

hooked like a fish on a line.

One relief,

many chains.

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So tell me, my friends —

children sitting cross-legged in front,

elders leaning on their sticks,

students restless in the back row,

farmers with dust still on their feet,

professors adjusting their spectacles —

do you see?

The word “side” is a trick.

It was made for comfort.

Doctors use it to soften.

Companies use it to sell.

Patients use it to hope.

But the body is not fooled.

The body speaks no English,

no Latin.

The body speaks chemistry.

It receives every signal fully.

Every effect is main.

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And this truth does not stop with medicine.

Coffee.

One sip sharpens the mind,

gives wings to thought.

But it also shakes the hands,

irritates the stomach,

robs the night of sleep.

Alcohol.

One glass loosens the tongue,

brings laughter,

makes a man brave.

But it also hardens the liver,

weakens the brain,

splits the family.

Sugar.

Sweet on the tongue,

sweet on the heart.

But behind the sweetness waits

fatigue,

addiction,

diabetes,

a body slow and heavy.

Even sunlight.

It warms the fields,

feeds the crops,

paints the sky gold.

But it also burns the skin,

cracks the soil,

dries the well.

Would you call burning

a side effect of the sun?

It is the sun itself.

Even fire.

It cooks your food,

keeps you warm.

But it can also scorch,

destroy,

turn a home to ash.

Warmth and burning

are both fire.

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So hear me.

Side effects?

No.

There are no sides.

There is only the whole.

The fever drops,

the liver fails.

The acidity calms,

the cancer risk grows.

The pain fades,

the stomach bleeds.

The tumor shrinks,

the body weakens.

One cannot arrive

without the other.

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And I tell you this:

Once you see it,

you cannot unsee it.

Once you taste it,

you cannot untaste it.

So the next time you swallow a pill,

the next time you sip your coffee,

the next time you pour your drink,

the next time you spoon sugar into your tea —

remember:

𝐒𝐢𝐝𝐞 𝐞𝐟𝐟𝐞𝐜𝐭𝐬 𝐚𝐫𝐞 𝐦𝐚𝐢𝐧 𝐞𝐟𝐟𝐞𝐜𝐭𝐬.

That is the law of the body.

That is the law of life.

Bitter,

like Kashaya.

But healing,

like Kashaya too.

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