No Safety Net

One of the perennial questions docs ask themselves at big medical meetings is: “How come our patients don’t exercise and eat right?” Now let’s admit up front that institutional medicine has given, many times over, conflicting advice about what constitutes a good diet so patients can then ‘eat right.’ Let’s admit further that institutional medicine has even given conflicting advice about what constitutes proper exercise. I want to concede this point to take this objection off the table. It is valid and surely undermines peoples’ confidence in institutional medicine’s recommendations resulting in skepticism and then a sense of futility. Fair enough. Let me grant another point; important but still not the answer to why patients don’t take better care of themselves.

Drugs kill. Pharmaceuticals prescribed every day kill innocent bystanders; those given the drugs hoping for benefit and given instead death or debility. This is not new, as you know, and various credible estimates place iatrogenic- doctor/pharmaceutically caused- death at an annual rate of several hundred thousand. The variable changes depending on how drug deaths are separated from surgical and post surgical complications and care associated problems like hospital acquired pneumonia; the annual range usually given in the United States is from a low 200,000 to as high as 700,000. That is a lot of dead people! These facts, pretty universally acknowledged by institutional medicine, are presented as justified by the touted overall benefit of physicians and pharmacy on the health and well-being of the general public. This brings me to my point.

Outside of ‘crisis medicine’ my profession does more harm than good by creating a sense of dependency on drugs. By the way ‘crisis medicine’ includes things like cancer, ‘my chest hurts, I am having a heart attack’ or my ‘head hurts, I can’t move my arm and my brain is filling up with blood.’ I think you get the idea.

Recent well done medical studies have shown harm from aggressive medical management of diabetes, that drugs to prevent fractures cause fractures, no benefit from several classes of drugs for heart disease, an entire class of blood pressure medicines increasing your chance of obesity and diabetes, another class of blood pressure medications causing an increase in sudden cardiac death and even cancer, further there is mounting evidence that treating blood pressure to as low as traditionally recommended is itself causing an increase in death/stroke/debility (whether this is from the direct effect of the lower blood pressure in a patient setting that needs somewhat higher blood pressure or is a ‘side effect’ of the medications used is unknown); this is a partial list.

The pharmaceutical model which has institutional medicine enthralled is fundamentally flawed. Sure an interest in profits helps pharmaceutical companies develop and market drugs, sure human nature prefers a ‘quick fix’ or ‘magic bullet’ to hard work, sure some docs know that their practice is built from knowing that patients come to them because they can get drugs of various types and that without that inducement the doc might not have as lucrative a medical practice; these things and more besides are true. Still, I will argue, they don’t really get to an important underlying reason both institutional medicine and the general public place their trust in drugs.

Ideas have consequences. ‘The pharmaceutical model’ is based on a very inadequate understanding of the complexity of the human body, on a naive belief that if a number shown to be associated with a bad outcome can be manipulated  by a drug that then by all means,  unless the drug manifestly kills people outright, then we should prescribe it. Drugs are better than life, somehow smarter than our bodies. This idea has consequences; tragic consequences. As long as this belief reigns, researchers will produce drugs that are inadequately tested- for reasons I won’t discuss here it is actually almost impossible to properly test drugs for both their intended effects and long term side effects- patients will delay or avoid taking responsibility for their health and docs will prescribe medications which institutional medicine has touted as appropriate for everything from hang nails to impending death.

There is no safety net. Docs act as if there were. Patients act as if there were. I’m sorry to tell you there is no such thing. You had better start acting as if there is no safety net because there isn’t.

At Tempus we found that most patients in that setting of support and encouragement had a very high degree of what docs call ‘compliance’ to dietary and exercise guidelines; they got better. Yet even here they were resistant to a proven ‘natural’ therapy for enhancing wellness: a sound relaxation/spiritual discipline. We offered Yoga, Tai Chi, massage and other relaxation modalities and still this remained our most difficult sell. I use the term ‘sell’ in a limited sense as most of these services were included in their overall cost so this was not an issue of additional cost. While we had an 80-90% compliance rate with exercise guidelines and a 70-80% compliance to dietary guidelines, spiritual/relaxation saw a 5-10% compliance rate. My point? In that setting, where a select few had seen through to the failings of the pharmaceutical model and actively sought a different approach, even here, stripped of the delusion of the pharmaceutical model, getting people to take complete responsibility for their health was hard. Life is hard. But within that truth getting healthy is nearly impossible if you think there is a safety net. See the doc, take the cure. Not happening.

Smile, Have Fun, God Speed,

Dr. Mike

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