When is Medicine a Drug?
“The desire to take medicine is one feature which distinguishes
Man, the animal, from his fellow creatures. Even in minor ailments,
which would yield to dieting or to simple home remedies, the
doctor’s visit is not thought to be complete without the prescription.”
-Sir William Osler
It happens thousands of times every day. A busy middle class individual comes down with a respiratory infection. The children need to be taken to school. There is a deadline to meet at work. The dream vacation that he/she has planned for a year is a week away. Nothing is going right.
The phone call to the doctor gets through.
“Can I have an antibiotic?”
There is very little likelihood that this medication is needed. Yet I get dozens of phone calls every month from patients who are convinced that nothing will help their “sinus infection” other than the ever popular Z pack.
It’s not only about infections. When your mother dies you ask for a tranquilizer. If there is a difficult divorce going on (which one isn’t?) antidepressants are reached for. Prescription narcotic abuse and “diversion” (when a legally prescribed narcotic finds its way to a drug dealer’s cache for resale) is an epidemic of huge proportions.
What happened? When did we choose to live without tears, inconvenience, or pain?
As all of you know a month ago I chose to leave employment with a large health care system in order to once again become my own boss. The challenges have been daunting. The electronic medical record is an irreplaceable part of our armamentarium. Thousands of patient historical facts have to be transferred from one system to the other.
Medication lists are the ones that take the longest to move. For one, this is one place where you absolutely cannot make a mistake on the kind of drug or the dose prescribed. To make matters a bit more complicated, most of my patients take a minimum of ten prescription medications. A lot of typing involved.
I have not done a scientific analysis of my work so far. But it strikes me that close to half of the people are using some form of respiratory drug. An inhaler, or a pill to help breathing tubes expand. These meds are expensive. Very few of them were available fifty years ago. I wonder if they would be needed at all if we didn’t have pollution and cigarettes.
A large majority of patients are taking medicine that in one way or another alters their thought processes. Tranquilizers. Antipsychotics. Mood elevators. Pain medicine. To say nothing of the many who use illegal drugs but of course don’t let me know they are getting high on them.
What happened to us? When did we decide that a healthy diet, exercise, a few well-timed tears and a pat on the back were not enough?
There’s a lot of blame to go around. Pharmaceutical firms have to make a profit. Beginning in the late fifties a number of tranquilizers became available. Legal highs. It started with Equanil (meprobamate) and short-acting barbiturates. None of these are legal any more. People loved them; all of a sudden the challenge of adapting to a rapidly changing society (the overdue liberation of women; children who talked back and rebelled; racial stereotypes that had to be ditched) became less difficult.
We learned to stop talking to our neighbors. We began to eat out more. Television gave us the luxury of being in the same room with our kids without having to hear what they had to say.
The food industry caught on. Cheap, fast gratification. Neatly packaged and well-advertised. The kids loved us, at least for a few minutes. My mom used to spend a lot of time making us fudge and hot chocolate (any of my Hispanic audience remember chocolate Menier?). No more; why bother when we had Quik and Ovaltine?
We moved to the suburbs. We bought cars. The highway developers and auto manufacturers loved it. Encouraged by the politicians. More districts to represent; more occupants of legislatures; therefore more taxes to collect; of course more jobs to support the administrative infrastructure. We stopped walking. Even less of a chance to meet our neighbors.
But there were pills available that controlled appetite (again, all of them illegal now). Why exercise? Plus there was a good show on TV tonight. Who would want to go out?
Now it’s out of control, and not a single soul in a position of power and influence seems to know what to do about it. Half of the individuals who faithfully visit their doctors would have no need for their services if they followed a few common sense rules. Hundreds of billions of dollars are wasted. To the point where many people wonder whether it would make financial sense to make people healthy again. Too many jobs at stake.
I may be cutting my own throat here. I have a fair number of patients who definitely need the kind of medication that I prescribe, but they refuse to take it because of the fears I have expressed above. If you have pneumococcal pneumonia, for God’s sake take that antibiotic. Use the injectable biologic for the arthritis that cripples you. Some people cannot possibly belong to society if they don’t receive an antipsychotic.
I get it. I know it’s hard to decide where lies that line that separates medicine from drug. There are too many individual variations; it’s much less complicated for the doctor to click on that computer to add a new medicine to the long list. Much less of a chance for a lawsuit if we do too much rather than not enough.
And yet, I wonder.
When did we learn not to cry?