Getting Off Your Meds, Part 1

Wait, don’t tell me. You’re taking a constellation of medications and you’d really like to stop. You hear the announcer listing all those side effects in TV commercials. Worse yet, you’re already experiencing some of them. You’re angry that every day of your life you pop a handful of…what is it you take exactly? You’re not positive because you take your meds on faith, really, hoping the motives of your doctor, health insurance company, and the drug industry are of the highest order and in your best interests.

But you do have doubts.

“What are all these drugs going to do to me over the years?” and “Do I really need this?” are among the most common questions my patients ask me. In fact, fully 25% of the new patients we see at WholeHealth Chicago write on their “Reason for Visit” line some variation of “I’d like to get off my medications,” or “Looking for something natural for my…”  And generally–not always, but generally–we can help.

This week we start a series on eliminating prescription drugs, or at least reducing your dependence on them. Individual upcoming Health Tips will focus on families of prescribed drugs, including statins, antidepressants, asthma inhalers, blood pressure meds, and so forth.

If you see a title pop up that’s not something you take, you might want to read it anyway because, and let me break this news gently, you’re aging (is he talking about me?). And given the state of US health care it’s extremely likely that one day you’ll be sitting with your doctor and at the end of your visit she’ll reach for her prescription pad (or, these days, her fingers will fly across her keyboard) as she says to you “I’m sending this prescription over to your pharmacist.”

At that moment you will have officially joined a very American way of life, as detailed here by researchers at Mayo Clinic. Statistically, with every decade that passes you’ll add one and then another drug, an increasingly larger chunk of your budget going to the already vastly overpaid pharmaceutical industry.

Is this really the way you want your life to go?

Worrisome trends

This particular Health Tip was triggered by a couple of worrisome trends that caught my attention. It helps if you understand that the health care system is pretty much controlled by three enormous industries:

• The first two, the insurance and pharmaceutical industries, are for-profit endeavors, meaning their primary obligation is to their shareholders, not the patients who are their customers.
• The third industry, the mega-hospital systems, own not only hospitals, labs, and x-ray facilities, but with every passing week more and more doctors and their practices (though, rest assured, not your WholeHealth Chicago team). These behemoths wear their not-for-profit badges proudly and self-righteously. Your sense of a not-for-profit entity is likely more along the lines of Doctors Without Borders, whose volunteers are struggling to contain the Ebola virus even as the organization is quickly running out of money. Northwestern Memorial Hospital is another kind of not-for-profit altogether, one whose largesse from the public includes occupying Chicago’s best real estate tax-free and which pays its CEO $9 million a year.

The first really troubling trend I noticed came when I opened a fairly thick envelope of computer generated letters sent by a health insurer about you and how often you were refilling your prescriptions. The letters had been written by some company that your health insurer either owns outright or contracted with to monitor your prescription filling and pill swallowing habits.

These letters were phrased in the always dubious, pretend-benevolent language of authority. Typical was this sentence: “As you know, doctor, high cholesterol is associated with premature heart disease, and if your patient is not taking her (insert drug name), she might be at risk. Our computers show she has not filled her (drug) since (date), so you may want to contact her.” In other words, if you haven’t filled your prescription for months, the implication is that I should “call and find out why.” If you’re filling your prescription irregularly, you might not be taking your med correctly, and “(drug name) should be taken daily for best results.”

Pause to ponder the words of French philosopher/social theorist Michel Foucault, as applicable to the scenario just described as any other:

“The real political task in a society such as ours is to criticize the workings of institutions that appear to be both neutral and independent, to criticize and attack them in such a manner that the political violence that has always exercised itself obscurely through them will be unmasked, so that one can fight against them.” 

The patient referred to in these letters might have cleaned up her eating and tossed her smokes and currently be in training for a marathon. In other words, maybe she doesn’t need to take statins at all. But this notion is in no one’s reality system. And please note these letters are devoid of suggestions for nutritional counseling or lifestyle changes.

But things gets worse

As mentioned earlier, the current trend is for physicians to sell their practices to the mega-hospital systems and become salaried employees. These hospital systems are simply collecting as many warm patient bodies as they can, in order to get better reimbursement rates from insurers and suppliers. Your doc is now reporting to some middle manager whose freshly minted degree in “Health Care Management” is still wet with ink and whose only healthcare experience was working as a vet tech after class in  high school.

His preeminent goal is to train your doctor to become a team player. Team players are docs who prescribe in order to get everyone’s cholesterol down to a certain level…to increase reimbursement. Who get everyone’s blood pressures to a certain point…to increase reimbursement. Who move patients off brand-name drugs and onto generics. Who switch them from psychotherapists to generic antidepressants. Whatever works…to increase reimbursement.

Why? Because the middle manager’s job, and your doctor’s, is on the line if there’s no evidence of compliance with the “standards.”  And to get all your numbers under control–your cholesterol below X, your blood sugar below Y, your blood pressure at Z (even if you faint in the process), your mood artificially cheerful (even if sex is a memory and you can’t see your genitals because of your belly)–the pharmaceutical industry supplies pills, pills, and more pills.

How many pills? Picture this. It’s important.

Every few hours, 24/7, from anywhere in the world, just like 95% of physicians practicing today I can open the electronic medical record system of my practice. One of the ubiquitous tabs running across the top of the computer screen is marked RX. It’s for renewing prescriptions, and when I click on it up come all the prescription renewal requests for my patients from pharmacies across the US. Not surprising, dozens and dozens of renewals are requested every day, 24/7.

These renewals represent you…swallowing and swallowing and swallowing pills. You…monitored by nanny-computers making sure you’ve been dutifully standing in line at Walgreen’s and taking everything as commanded.

Although WholeHealth Chicago may look busy when you arrive, in the scheme of things my own practice is definitely on the smallish side. I see 13 or so people a day. Most internists see 30 to 40. And the prescriptions I’m asked to renew are mainly those prescribed by other physicians that my patient and I are in the process of whittling down.

Curiously, when I’ve asked my physician colleagues outside of WHC about their drug renewal systems, virtually all of them say they’ve turned the daunting project of prescription renewal over to their physician assistant or nurse practitioner. “How many rx refills do you receive a day?” I ask. “I don’t know. Dozens. Maybe a hundred. I don’t handle that.”

This is you, people—your lives. If you’re not actively working to trim down or get off your meds altogether, know that nobody else is going to do it for you. And this is why, over the next few Health Tips, I’ll be trying to help extricate you from this system.

Be well,
David Edelberg, MD