When I was a Drug Dealer

A few years ago I wrote a blog called “Beware of Doctors Peddling Drugs”. In that blog, I detailed the unending tendency for doctors to prescribe drugs.  I was of course guilty of this years ago when I was simply an Internist. I have a long story to tell you about that tendency and one of the aftermaths of it but that has to wait for a very big event in my and hopefully your life which should happen in the very near future.

The truth is, and I have heard this from patients, not doctors, many times a person does not want to start with drugs.  But the time stressed physician sees it as a way of “doing something” and of course getting the patient out of the office.

It wasn’t always this way.  Back in the 80’s and 90’s when I was in practice with my dad I spent as much time as the patient needed.  Most days I left the office between 10 and 11 PM.  I loved the interactions with my patients.  But then dad gave me some sage advice.

He said “You need to get out of here and join a big group.”

He told me this because he was getting older and his practice was dying off. In addition, what had once been a wonderful established neighborhood known as doctors’ row was, like so many small cities, a victim of the “social change”  Translation: it was getting more and more dangerous.  I checked the weekly crime report and was horrified to discover over 50 crimes reported in a few block radius.

His was the last office to close in the old doctor’s row. When he died I somehow managed to do a few hours every night and on my day off from the practice I joined- just to ease the transition for his remaining patients.

Nowadays the old neighborhood is unrecognizable with trash, graffiti and not one business.

The same could be said of medicine as a profession, it has become almost unrecognizable compared to when I started.  Very few of those changes has to do with medical advances by the way!

I cannot tell you the amazing and absolutely unique education I got from working with my dad.  He had a small closet and in that closet, was 90% of the prescription drugs he ever used including pain meds, anti-biotics, hypertension and cardiac meds etc.

He sold them to his patients for a few dollars for a month’s worth.

At first I was horrified!  Look at all the fancy hi tech drugs we had that he was not using! Everything he dispensed was generic and had been so for decades.  Now the generics cost 80% of the branded price.

But my dad managed to get people to the end points that were acceptable in his day.  Though a combination of compassion, sincere interest in people, people understanding their boundaries in dealing with him, and cost containment, my dad achieved something that many doctors would give their eye teeth for.

Patient compliance!

I will not bore you with yet another lecture on the evils of the medical industrial drug company insurance complex that spawned me- at least not today.

But I will tell you that the longer my strictly allopathic MD career went on, the longer the list of drugs my typical patient was on. The same for my partners who were, like me, regarded as among the best doctors in the area.

We relied on drugs then.

I can tell you it is worse now as the typical doctor is even more time stressed and pressured to “do something” for his/her patients.

But that is not the main reason for the almighty prescription drug.  The main reason is the advent of so called “evidence based medicine”. This was a thinly veiled attempt to give doctors a checklist as to when to put people on drugs. Not surprisingly most of the studies advocated tighter and tighter control with lower and lower goal numbers. Most were funded directly or indirectly by drug companies.

It should come as no surprise that cholesterol was the first target and it spread from there.

When I started in medicine a cholesterol of 250 was normal-200 if you had heart disease. Over time it got lower and lower and now aggressive use of statin drugs is recommended to get your “bad cholesterol” under 70 if you’ve had a heart attack.

Even if you never had high cholesterol you will need a drug to get below that number in most cases.

The most recent trend which I am sure will be a recommendation very soon is that every single person over 40 years of age with ANY (and yes, just one is enough) risk factors be automatically placed on statin drugs.

My we’ve come a long way in justifying peddling drugs for the drug companies haven’t we. This is in spite of the fact that the incidence of heart disease was already declining BEFORE statin drugs became available.

The latest arena of drug peddling is high blood pressure.  140/80 used to be normal.  Now “normal” is a moving target that gets lower and lower. A recent global study using meta-analysis* of data going back to the 80’s has suggested we shoot for a systolic blood pressure of 110-115 to minimize the risk of adverse events.

Again, that means that the bulk of men and women in the world should be on high blood pressure medicine.

Along with this the concept of preventative medicine has all but disappeared.

Even some of my anti-aging colleagues have gleefully jumped on the “poly pill” bandwagon. This is where a sub therapeutic dose of a combination of prescription drugs is used to “prevent” the diseases of aging.

Forget about aging being a disease.  Forget about preventative medicine and lifestyle modifications.

Just take drugs!!!!

And maybe, just maybe if our “social change” continues, the bulk of the country will be controlled by the banks and the drug companies.

That could not be a real strategy, could it?!

Well remember at least so far you still have a voice in your future.

In the coming weeks I will be focusing more on non-drug strategies to improve your odds of living to a ripe old age with great health.

But if you don’t do it, the drug dealer is waiting!!!



Dr. Dave

*In the past I have warned about meta analysis being used to make policy.  The problem is very well stated by the old adage “garbage in garbage out”. This adage originally started to describe faulty statistical conclusions that had nothing to do with medicine. It was simply a description of the dangers of relying on computer algorithms to do work that needed to be done by people first. The same holds true in medicine. Pick and chose the studies that show what you want, feed them into the machine and out comes the result you hoped for!  In addition the recent work on high blood pressure goes back to studies done in the 80’s none of which would be admissible as evidence for anything by today’s standards.  I can imagine the blow back I would get if I quoted a fish oil study from the 80’s. Meta analysis are far cheaper than doing a real clinical study. But Worse yet, they allow policy to be made as a result of the finidngs! the very same people who criticize the lack of studies in the supplement industry (the cost is simply prohibitive for most manufacturers unless they are funded by drug companies) allow the same cost containing measures to be the norm for the medical industrial complex.


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