A few years ago, I read that some of South Carolina's poorest counties have the fastest growing population of over-85-year-old folks. A discussion in the Charleston newspaper, The Post and Courier, on Sept.18, 2003, quoted state officials bemoaning the fact that they did not have the funds to provide better health care and medicine to this fast-growing group. Somehow this discussion seemed a bit bizarre to me.
Let's see if I've got this right: People are living to be over 85 years old, and health bureaucrats want to start giving them shots and drugs. I wondered, could the lack of shots and drugs be part of the reason these people have lived so long? Or as a close friend says, "Why go to doctors? They're just going to find something wrong!"
In case there is confusion, the theme of this article is that people are taking too many medicines. Need I bore you with the facts? Should I tell you about the power of the pharmaceutical lobby, (e.g., Medicare Drug Benefit)? How about the doubling of the ratio of drug company representatives to physicians in the past decade (Forbes, May 8, 2006)?
Then there is the statistic in the Forbes article that the top 10 drug companies spend twice as much in marketing and administration as they do for research. Could there be many DCs who are not aware of the surf-and-turf dinners and sterling stethoscopes given to MDs by drug reps, in order to influence prescription-writing behavior? Well, I guess I just told you.
I don't know much about drugs, so I depend on my patients to educate me. That's because they take a lot of drugs. My office intake form asks patients to list their medications; frequently they cannot squeeze in the names of all the drugs on the lines provided. This was not the case many years ago, when I started in practice. It could be that in those days, chiropractic attracted patients looking for a drugless way to take care of their problems. But it also could be there just weren't many effective drugs then, or that drug advertising had not reached the effective sophistication of today. In any case, I know many of my patients are just "really good" consumers of health care and that can include getting chiropractic treatments, and also taking their Prozac.
Many drugs seem to work very well; several are lifesaving. But besides costing a lot, there is one small problem: side effects. Just listen to the TV ads: "Stop taking (pick a drug) if you experience explosive diarrhea, curling of the toes, excessive crying or dripping from the orbits, uncontrollable trembling in the knees, a feeling of existential dread, levitation, sudden ankle inversion or spastic flaring of the nostrils lasting more than four hours."
Side effects have even gotten the recent attention of the Food and Drug Administration. When the FDA is not busy protecting us from taking too many vitamins, it apparently looks at medicines whenever the media discovers too many people dying. After the Vioxx debacle, the FDA felt compelled to assemble a "blue-ribbon" panel of experts to look at the way drugs are developed, and the safety issues inherent in the process. The panel came to the conclusion the FDA was so lax in protecting the public that an "overhaul" was urged.
According to an article in the Los Angeles Times on Sept. 23, 2006, the FDA panel, under the auspices of the National Institutes of Medicine, came up with 25 recommendations. I read them and (as a service to my readers) boiled them down to two issues: 1. What's good for Big Pharma is good for the FDA! 2. Drugs are only 100 percent safe when you don't take them.
Of all the meds out there, none is more mysterious than a drug used for mental health. Not that there isn't a need for them. If any of you has someone with serious clinical depression or schizophrenia in the family, you might agree. But in the dozens of times I have asked patients if their anti-depression or anti-anxiety medicine was working, most of the time I got the reply, "I think so." Well, which is it? Is it working or not? A vast number of my patients are taking these meds and cannot tell me if they are doing anything except turning their underwear yellow.
A new book by David Karp titled, Is It Me Or My Meds? discusses this phenomenon. His premise is that millions of Americans taking psychotropic drugs wonder where their "authentic" self ends and the "drugged" one begins. His conclusion? Well, he comes to no conclusion, since he is unwilling to temporarily quit taking his own anti-depression and anti-anxiety meds. "It ... might just be us, our meds, and the society we live in," he says. I guess I'll have to mull that over.
Some DCs offer arguments that the profession should work toward embracing drug prescription rights. Personally, I don't want the responsibility, although I bet we would not do any worse than our medical colleagues. Thousands of patients die every year from anti-inflammatory meds, and thousands more are doomed to annual liver function tests to make sure their cholesterol-control drugs are not killing them. I don't want to manage that stuff, but I'm glad there are doctors who do.
Meanwhile, I'm looking for role models among my octogenarian patients.
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