Mark vs Cancer

Sunday, March 04, 2007

Bad Medicine

" The desire to take medicine is perhaps the greatest feature which distinguishes man from animals."
-- Sir William Osler

"I firmly believe that if the whole material medica could be sunk to the bottom of the sea, it would be all the better for mankind, and all the worse for the fishes."
-- Oliver Wendell Holmes

When I first encountered the above quotations by famous 19th century physicians, I appreciated their wry incrimination of the ineffectiveness of "modern" drugs (such as mercury and arsenic), but not for their applicability to today's pharmaceutically-saturated healthcare environment. Now, as my own medical practice and philosophy mature, I find myself increasingly referencing them as I build a healthy skepticism of the prevailing medical notion that a person needs drugs to become well.

I just returned from a medical conference in Keystone, Colorado, ostensibly an osteopathic conference, but functionally a mainstream medical seminar for busy primary care providers. There were a variety of lectures on diabetes, hypertension, cholesterol, kidney disease, osteoporosis, hormone replacement, etc.-- a potporruri of the most commonly treated chronic diseases in a general practice setting. The review was beneficial, but as the lectures progressed, an all-too-common theme emerged: the only thing that can cure illness in your patients is _________. (Fill in the blank with any of the latest and greatest drugs, most of which were being aggressively marketed by all manner of slick pharmaceutical reps loitering just beyond the room divider.)

For instance, a respected nephrologist (kidney doctor) gave an excellent review of the diagnosis and treatment of chronic kidney disease, but by the end of the lecture, I counted five--five!--drugs that absolutely all patients with Stage 1 kidney disease must be on to prevent progression towards more severe disease. The thing is, most patients at this mild stage have no symptoms; it's typically diagnosed incidentally or caught with routine screening tests. Can you imagine a otherwise healthy patient walking into a routine check-up, feeling just peachy keen, and walking out with a handful of five prescriptions, with the total monthly cost being upwards of $200? It's a totally ridiculous thought, and yet it was what this intelligent doctor was advocating to a roomful of earnest and gullible physicians. In her evidence-based paradigm, the most proven intervention to slow the progression of disease was to throw a fistful of foreign, man-made chemicals into the ailing human organism.

I believe this inclination towards pharmaceutical intervention stems from a modern faith in the supremacy of human scientific endeavor over nature. And who can discredit the enormity of human industrial achievement? We invented cars, rocketships, computers, iPods . . . not to mention surgery, antibiotics, vaccinations and the hundred other proven medical advancements that have enhanced and prolonged human life.

But the human body is divinely different than any human-created machine; it can heal itself--diagnose, repair, restore, regenerate, and all without needing any conscious command or program from its user. It happens spontaneously. Why? Because that is how God--or for the less devout, mother nature--designed us.
Generally speaking, the human body has a healing system that, when nurtured, can overcome disease on its own without the aid of external forces. Dr. Andrew Weil makes an irrefutable, evidence-based case for this natural healing paradigm in his eloquent and easily understood book, Spontaneously Healing. A Harvard-trained M.D., he powerfully challenges the pharmaceutical-based medical culture that our Western healthcare system endorses. It should be required reading for all physicians. As it is, I stumbled across it accidentally after already completing my formal training. But its crystal-clear precepts speak more profoundly to me than anything else I digested and regurgitated in my medical education.
Dr. Weil suggests that a physician's most powerful tool in promoting health and healing is not through external intervention, but rather through accessing and activating the human body's intrinsic healing system. This activation can occur through many forms: modern drugs, osteopathic manipulation, transcendental meditation, acupuncture, herbal supplements. The common thread is not the mode of intervention, but rather the internal, spontaneous healing that the intervention activates.

The unfortunate subtext of modern medical care--that science knows better than mother nature, that unnaturally engineered chemicals are necessary for proper functioning of the human body--transmits directly to patients' expectations, perpetually reinforcing itself through most patient-physician interactions. People are accustomed to paying lots of money for expert advice from a well-trained physician, whom they implicitly trust to guide them towards a quick fix. When the doctor hands them a brand new, cutting edge drug sample, they think they've received the ultimate in modern medicine. "Take these," the doctor recommends, "every day for the rest of your life, and you will be well." The patient is impressed, the doctor has the satisfaction of providing an expert service, and everyone is satisfied. And thus the cycle perpetuates.
But there are problems: that fancy medicine will cost big bucks once the samples are gone, siphoning finite health care dollars that could have otherwise been spent on preventive or emergency care; it will have known toxic side effects on the patient's resilient but delicate physiology; it will have potentially lethal interactions with other medications that patient is concurrently ingesting; and it will further reinforce to the patient's mind the necessity of external drug therapy.

Because the doctor will spend precious time explaining the indications, administration, and side effects of the medicine, he/she will not spend adequate time on the most important medical advice the patient needs to hear: lose fifty pounds, exercise frequently, consume more fruits and vegetables, watch less television, eat less salt and trans fats, and meditate daily. These natural, risk-free, non-pharmaceutical interventions, if emphasized and followed, will cure the patient's diabetes, hypertension, high cholesterol, arthritis, obesity, depression, and kidney disease at a stunningly higher rate than any other combination of drugs, all at a minimal cost.
Why don't physicians devote more time to advocating these natural lifestyle remedies? The reasons are legion: lopsided medical education, academic disdain for natural therapies, financial and social pressures from the pharmaceutical industry, an over-reliance on technology, time constraints (much faster to write a prescription), a false belief in better compliance with drugs than lifestyle interventions (if counseled properly with good follow-up, patients will implement lifestyle interventions at a high rate), medical-legal and quality control measures that evaluate physician performance on easily quantifiable parameters such as prescriptions written versus more nebulous measures such as lifestyle counseling, and on and on. Embarrassingly, I'm as guilty as the next doctor in reaching for the prescription pad all too soon; I suffer equally from all of the above mentioned blockades that are endemic to the system in which I practice. And fairly, I believe that many of these medications are beneficial and safe. But I also believe that, in most cases, they should not be the primary intervention. They should be a last resort, pulled out only when natural remedies are clearly failing.
I may eventually launch a crusade against the whole system; you may see me one day leading protestor chants from the sidewalk of a major drug company, dressed in a symbolic skeleton costume while brandishing a large pill bottle that reads "Danger: Poison." But for now I just want to provide quality health care (as opposed to medical care) for my patients, who come to me with great needs and great trust. My practice has already changed; I now make an increased effort to emphasize to my patients the natural lifestyle interventions that will allow their own healing systems to function optimally and restore them to health. For the most part, I've found that my patients react very favorably to these ideas--they've just never heard a doctor profess them before.
I have had one passive act of defiance, however: I didn't visit a single one of those parasitic drug reps at the conference. You can go pawn your cheap desk clock to some other gullible doctor who's willing to sell his soul to Merck and Co. But not me, sucker. I've got better things to do, like go activate somebody's intrinsic healing system through my positive karma and mystic energy fields.
Or cranial technique. Or placebo. Or whatever it takes. Because the cure doesn't come from the intervention.
It comes from within.
To be continued . . .



7 comments:

Jeff said...

This is awesome. I'm very interested in your developing philosophies. I would like to be your Padwan apprentice and dress as the Grim Reaper who uses his scythe to cut over-sized Rx bottles into pieces. I look forward to more.

Dad said...

Marcus,
You my friend are the epitomy of the Great Ponticicator himself....that would be me.

I wholeheartedly endorse your ramblings and I think it comes down to common sense. Our bodies are truly a miracle and one of the main evidences in my mind that God exists and loves us enough to give us such a machine to dwell in.

What you say makes a lot of sense to me. You oughta write a book, my friend.

However, I do believe there is a place for some of the wonder drugs that have been developed. If you have a ear infection or sinus infection or something like that, all the Karma in the world ain't doing to do what a shot of antibiotics will. I see that as a short term type fix however. It seems to me the kind of stuff you are talking about are longer term conditions that could very well be addressed without medicine at all if individuals just had the will power.

What we want is that magic pill that will do all the work for us. (Lose weight, control our diet, our blood pressure etc) What we as individuals need to do is to pony up our energies and initiatives into taking care of ourselves by losing weight, getting excercise, eating properly, quite stress free time, etc. I truly think I could solve all my problems by just doing thse things and be much more disciplined with my life style decisions. And so it is with many of the people that go to doctors with long term issues as you discribe. They simply don't have the will power or inclination to change life styles and prefer to put their hopes on the magic pill that the doctor will give them and make them better with little effort.

You are right on my find Dr. friend.

Dad

Mom said...

Spark,
Thanks for those excellent thoughts! I recommended that book to Bev recently. I think I'll see hertoday and I'll see what she thinks. I am going to get that book for us! Thanks, Doc

Love, Mom

Matthew said...

I'm glad you touched on the pharmaceutical industry. I wish more people would realize how it exploits some of the fundamental flaws in the health care system to maximize profits.

The most egregious example that comes to mind is the ever-increasing amount of money spent by the drug industry on advertising. Since the government legalized the advertising of prescription drugs in 1997 (what a gift to those poor, starving corporations!) , we've been subjected to an avalanche of idiotic ads telling us to "ask your doctor if Super Drug X is right for you". The pharm reps are equally sickening (no pun intended) -- I've met a few people who do it and my impression is that there is a lot of money to be made if you're good.

How much money are these drug companies wasting on this mind-numbing crap to gain market share for their shareholders? How many "erectile dysfunction" drugs do we really need? Is this really the best use of limited health care resources?

There are tens of millions of people with no health care at all in this country alone, and I'm disgusted at the back-scratching and dirty money that pours from the big drug companies like Merck, Pfizer, GlaxoSmithKline etc. This industry is headed for a train wreck and not only do they not care, they are scooping up as much cash as they can in the remaining time they have before there is some kind of major public upheaval.

I don't know what the answer is, I only know that some industries should not be left entirely to free markets.

Tyler said...

Mark,

I really liked your post and echo much of what was expressed in the comments above. I believe in free-markets, but I too am very annoyed at the drug advertisements that abound in our media. Matt brings up a good point about all that wasted money. Unfortunately, the drug companies do not have patients' best interests at heart, the just want their money, of course. And it is frightening to think how many doctors are sucked (or basically bribed) into being the minions of the drug manufacturers, prescribing drugs that have been pushed on them by a motivated drug rep at some conference.

I think, however, to repeat what Dad said, that some drugs are the first solution and they seem to prevent people from dying from small problems that 50 or 100 years ago would have killed them. But I think you are mainly refering to "lifestyle" drugs that people take for years of their lives to stem off problems created from lives deficient of healthy habits.

I intrinsically have always had an aversion to drugs and medication. I almost never reach for tylenol or ibuprofen when I have a headache or soreness. I can't even remember the last time I had any sort of prescription. Don't get me wrong...I'm not anti-drug, I just like relying on my body's own system to take care of my health problems.

And judging by how often I actually get sick (almost never), I must have one heck of a good immune system!

Danalin said...

You know, as I get older I tend to go the way of less drugs/healthier living. I realize what a gift my body is and that I need to take care of it if I want it to take me through the possibly 60+ years I have on this earth (I had some healthy great-grandparents who lived a long time and all of my grandparents are still kickin').

I feel a big responsibility to teach my kids healthy eating and exercising habits as well. My mom was the "take a pill" kind of mom. She was sold on the prescription hype for a long time, I guess. Like many Americans. She's strayed from that in recent years and is going the way of good health. I remember, though, that if we were ever sick or had a headache and we were complaining, she would ask if we'd taken any medicine. If the answer was no, then she didn't want to hear any more complaining! Just take the medicine!

I am glad that we have a Doc in the family (soon to be many more Docs) to set us straight and teach us the way of light and truth when it comes to medicine and treatment. Not just any Doc, but a D.O. I have a lot of respect for that field!

Anonymous said...

I have a couple of friends in Worland that gave my this site to check out. In reading your thoughts, not your professional experience, I find it as a typical provider response to the medical industry. Meaning, the issue of healthcare costs is associated with the hospital care, doctor costs, drug company costs, and insurance company costs. If all of these so-called caring industries would lower their costs, then healthcare would be affordable and all people would benefit from the medical blessing that the Lord has/is providing to this earth. Your dad does make some good remarks. Listen to him.

We the people want to feel better, look great and live longer. As a drug rep I take great pride in my profession as I bring to the provider medical material that benefits your patients. You see, most docs stop learning or reading current medical journals or articles because of their extremely busy schedule. There are idiot reps as well as lousy doctors. There are also corrupt hospital boards who use providers and brainwash others. There are insurance companies who are increasing their bottom line each year by more than a 25% increase vs previous years. Then there are the providers who cry "help me" because I dont make my triple digit salary but who have a life style that is very expensive and way beyond their means.

Finally, I do call on you and as an LDS bishop you might want to practice a little more humility and be a better example to those you work and associate with. You live in a small community in a glass house. You are no better than anybody else in Worland or any other place you may live.
shaun