Remember Robinson Crusoe? He was the protagonist in a novel written by Daniel Defoe that was published in 1719. Crusoe was stranded on a desert island for 28 years before being rescued. A modern version titled Cast Away was made into a movie starring Tom Hanks. If you were looking to get away from civilization, what would be the best drugs to take to a desert island retreat?
What about if you were stranded in some dystopian future without access to electricity, a hospital or medical supplies? What would be the best drugs to have on hand to deal with common complications?
We Asked the Experts About Their Best Drugs:
Over a decade ago we asked some of our favorite People’s Pharmacy experts to imagine being stranded on a desert island for an indefinite period of time. We described it as a cross between the Robinson Crusoe story and Swiss Family Robinson or TV shows such as Lost or Survivor.
We asked these health professionals what three things they would want to bring along to care for the survivors on this imaginary desert island. The reason for this exercise was to help our readers consider which medications (or nutrients) might be considered most crucial by distinguished health experts.
Some of these items might be worth considering as best drugs for a summer vacation. That would be especially true if you were looking to get away from civilization for a period of time.
You probably won’t need to pack all these medications for your getaway (especially if you’re not really going to be isolated on an island or a mountain trail). However, you do want to be prepared for problems that seem possible or likely.
Robert Califf, MD:
Dr. Robert Califf, a cardiologist and former Commissioner of the Food and Drug Administration, offered these recommendations. For a pleasant island, he’d take aspirin for heart attack prevention and pain relief, a statin to control cholesterol and an ACE inhibitor for blood pressure control. If the island were inhospitable, Dr. Califf would add a steroid to counter inflammation and allergies.
Dean Edell, MD:
Dr. Dean Edell was a renowned media doctor (“America’s Doctor”) before his retirement several years ago. He had a syndicated radio show, reported on health matters for KGO television in San Francisco and hosted his own television show.
We asked Dr. Edell if he had to play Robinson Crusoe, what would be the best drugs he would take to a desert island. He responded:
“Actually, this was a question on an exam in pharmacology class in med school. What drug, only one, would we bring to a desert island? Codeine was the correct answer. I forget exactly why, but probably because it’s good for pain, diarrhea, and cough.”
Stephen Feldman, MD:
Dermatologist Stephen Feldman would want a topical anti-inflammatory drug. He suggested Lidex gel (fluocinonide) because it:
“is pretty strong and would be good for the itchy mosquito bites on the island, along with most other inflammatory skin diseases.”
He would bring along the antibiotic dicloxacillin for skin infections and it “could help with acne, too.”
Karen Frush, MD:
When we contacted Dr. Frush she was chief patient safety officer for Duke University Health Systems and medical director of pediatric emergency medicine there. Dr. Frush is a specialist in pediatric emergency medicine. Her best drugs would include injectable epinephrine for allergy and severe asthma attacks, ibuprofen for fevers and pain and:
“an antibiotic such as Rocephin (ceftriaxone) to stabilize a terrible infection until you could airlift the child out.”
Daniel Hoch, MD, PhD:
Harvard neurologist Daniel Hoch would choose gabapentin for his emergency medical kit. That’s because he treats people with epilepsy. He states:
“It’s not a bad anticonvulsant, and I’ve used it with some benefit in postconcussive syndrome, chronic pain and migraine. All that, and it’s even indicated for painful neuropathy.”
Joanne Jordan, MD:
Dr. Joanne Jordan treats people with arthritis. She would bring along NSAIDs (pills and topical) for pain and inflammation, a capsaicin cream or lotion for sore joints and glucosamine with chondroitin.
Steven Nissen, MD, FACC:
Dr. Steven Nissen is chairman of the Department of Cardiovascular Medicine at the Cleveland Clinic. If he had to treat people on a desert island, Dr. Nissen would want a statin to counteract the effect of palm oil and coconut milk. He would also bring along a defibrillator with a solar charger to rescue people from cardiac arrest. In addition, Dr. Nissen would want a blood pressure cuff and a supply of the diuretic hydrochlorothiazide (HCTZ) for treating hypertension.
Stanley Levy, MD:
Another dermatologist, Stanley Levy, is considered one of the country’s foremost experts on sunscreens and cosmeceuticals. He added his choices for best drugs: sunscreen containing zinc oxide and insect repellent containing DEET. His topical corticosteroid of choice would be clobetasol propionate (Temovate) cream (0.05%). He would also bring along a topical antibiotic such as Bactroban (mupirocin).
Danny Sands, MD:
Dr. Danny Sands is an internist and advocate for participatory medicine. His recommendations include water purification tablets, aspirin for pain relief and heart attack prevention and loperamide to treat diarrhea.
Walter Willett, MD, DrPH:
We also asked Harvard epidemiologist Walter Willett what he would bring:
“This island trip sounds like fun. As the island epidemiologist, my task will be to monitor the health and disease status of the population and to investigate disease outbreaks.
“Assuming there is no electricity, my first need is a pencil and notebook. My second need is a solar-powered hand calculator. Prevention is also a high priority for a public health person, so my third need is a shovel to dig latrines. Number four is soap for hand washing.”
Other Best Drugs on a Desert Island:
We consulted many other experts for this experimental trip. One fellow pharmacologist (David Kroll, PhD) suggested either cannabidiol (CBD) or cannabis. He wrote:
“There is literature to support the efficacy and safety of cannabis for the following indications: anxiety and depression, neuropathic pain, muscle relaxation, analgesia, migraine, seizures, rheumatoid arthritis, appetite stimulation, nausea, asthma, intestinal spasm, secretory diarrhea, gastritis, jaundice, dysmenorrhea, uterine bleeding, premature ejaculation, and malaria. On a desert island, I’d lean toward growing the plant because it would be a self-renewing resource.”
We consulted Jeffrey Lieberman, chairman of the Department of Psychiatry at the College of Physicians and Surgeons at Columbia University. He holds endowed chairs and is one of the country’s leading mental health experts. He kept his list simple:
• Pain medication
Because skin problems are likely to be especially challenging on a desert island, we asked a pediatric dermatologist what he would bring. Dr. Neil Prose suggested:
• Sunscreen with SPF 45
• A strong topical corticosteroid
• The book, Wherever You Go, There you Are, by Jon Kabat-Zinn
We consulted several other distinguished physicians who offered somewhat similar best drugs including broad spectrum antibiotics, codeine and aspirin.
People’s Pharmacy Perspective:
We hope neither you nor your doctor get stranded this summer. We definitely hope that the power does not go out for weeks or months like it did in Puerto Rico.
These recommendations you have seen might provide some ideas about what health professionals would pack on a big adventure. Aggregating the recommendations from such a distinguished panel of health experts is challenging. Here is what we gleaned:
Best Drugs on a Desert Island:
- Aspirin for pain and heart attack prevention
- Codeine for pain, cough and diarrhea
- Topical corticosteroids (clobetasol or fluocinonide)
- Loperamide for diarrhea
- Injectable epinephrine for an acute allergic attack (anaphylaxis) or asthma
- NSAIDs such as ibuprofen or naproxen for pain (or a topical NSAID such as diclofenac)
- Broad spectrum antibiotic for infections (azithromycin, dicloxacillin, doxycycline, ceftriaxone or cephalexin)
We would love to hear about your adventures. Have you ever been stranded somewhere remote? What were your best drugs? What would you have wished for that you didn’t have? Share your experiences in the comment section below.