The Two-Bag Syndrome

During my training as a physician, and there’s no reason to believe this has appreciably changed for young doctors now, I was taught that if you saw a patient in your office for a medical problem of any sort she’d leave dissatisfied if she didn’t receive a prescription. “Reaching for your prescription pad,” the professor explained to a group of us, “is the universal gesture in medicine that the encounter is drawing to a close. Writing up to three prescriptions is fine. More than that will get your patient worried. Handing her the prescriptions means ‘our visit is over.’ Advise her when she should return and you can move on to your next patient.”

In those distant days, just a fraction of the prescription drugs on the market now were available. We never dreamed back then so many new drugs would be created by the pharmaceutical industry (there are about 80 brands of birth control pills alone). It seems straight out of the pages of a Philip K. Dick novel that committees of physicians appear to be creating new diseases in order to justify FDA approval for new drugs. (“As long as we’ve got Nexium, let’s rename heartburn GERD.”)

Who would have guessed back then that many of today’s professional articles extolling new drugs come from pharmaceutical industry-funded studies that conceal any bad results. Who knew about restless legs syndrome until Mirapex? Fibromyalgia until Lyrica? Social anxiety disorder?

C. Difficile colitis, a condition caused by antibiotic overuse, is now curable with ten days’ use of yet another antibiotic that will set you back about $500. And then this gem,  from the Journal of the American Medical Association (JAMA): Correctly taken prescription drugs are the third leading cause of death. Oh, and by the way, NSAIDs (ibuprofen, etc.) are the major cause of gastrointestinal bleeding and kidney failure, Tylenol overuse the top reason for needing a liver transplant.

So it’s not at all surprising that new patients arrive at WholeHealth Chicago with something I’ve dubbed the “Two-Bag Syndrome.” These are patients who already have their own physician–and they’re generally happy with her–but who realize one morning that they’re taking a very large number of pills. If your doctor was taught, like me, that you’d be dissatisfied without a prescription, over time your medicine chest is going to get pretty crowded.

As you may have already guessed: Bag #1 contains prescription drugs. And Bag #2? Nutritional supplements.

Health history of the Two Baggers

Sometimes the Two Baggers bring medical records, which makes things easier for me. I always include a physical examination because, after all, you don’t want to eliminate blood pressure meds from someone who has high blood pressure.

And then to work.

First, the supplements. As a rule, people take more supplements than they actually need, and often they’ve long since forgotten why they started on them initially. Many of us are enticed by an advertisement that includes a photo of a healthy looking person holding up a bottle, but just as often we succumb to the recommendation of a friend or health food store clerk. Then the magical thinking sets in: “I’m still alive and feel okay. Maybe it’s that vitamin. I’d better not quit taking it.” One of my jobs is to reassure patients that trimming the supplement regimen will not cut life short.

Then we move on to prescription drugs. If you remember, most prescription medications basically cover the damage of an unhealthful lifestyle, so common sense says if you take better care of yourself meds often become unnecessary.

To say these words puts the ball back into my patient’s court. Prescription drugs have a tendency to make us lazy about our health, giving us a false sense of confidence, believing we’ve covered the damage we’ve inflicted and we’ll be fine if we just keep renewing our meds. A good friend of mine (not a patient!) pops a statin for cholesterol and a Glucophage for diabetes, the pair a prelude to his crème brulee. “I’m supposed to take these with food,” he adds, without a whiff of irony.  Well, if that’s your choice the pharmaceutical industry is more than willing to support it to your (early) grave.

This past week in the office was a good one, and the basis for today’s health tip

I saw patients who’ve been taking care of their health responsibly–losing weight, exercising, reducing stress, taking their own blood pressures at home, and trying alternative therapies. And it’s paying off.

The easiest of meds to discontinue are the statins. With a few weeks of meticulous eating and weight loss, your cholesterol and triglycerides can plummet, the drug can be stopped, and side effects end. Meds for diabetes and high blood pressure might take longer to quit, but with good choices both can be tapered or discontinued altogether.

If the events that triggered your depression are now fading into the past, maybe it’s time to taper your antidepressant or replace it with St. John’s wort. Consider trading in your anti-anxiety meds for L-Theanine and regular meditation. Leave your GERD drug behind by eating smaller meals earlier (with less alcohol) and elevating your head during sleep. Perhaps even replacing your birth control pill with an IUD or diaphragm. Oh, and since you know that most respiratory infections are caused by viruses, wash your hands regularly and don’t call your doctor for an antibiotic at the first sneeze.

Of course some medications are absolutely necessary

Many diseases are the result of unlucky genetics rather than unhealthful lifestyles. Some people suffer chronic pain. Some svelte and apparently healthy people actually have diabetes, high blood pressure, or deep-seated depression/anxiety/panic attacks. Chronic conditions like hypothyroidism, certain cancers, and rheumatoid arthritis and other autoimmune diseases like lupus and multiple sclerosis are held in check for years by medications. Obviously, these drugs remain permanently in Bag #1.

Any new patient bringing in her two bags–#1 for prescription, #2 for supplements–will leave with #3, the “you can stop taking these” bag. She’ll invariably also depart with a healing path that includes an appointment with nutritionist Marla Feingold or Seanna Tully and will also hear our mantra about regular daily exercise, stress reduction, and so forth. We’re big advocates of the book UltraPrevention, by Mark Hyman, MD, which lays out a prevention groundwork similar to our own.

We always ask our patients to tell their own doctors about what they’re undertaking and we’ve never (ever) received a call telling us to stop our shenanigans.

This week we were able to discontinue three statin prescriptions, two blood pressure drugs, two diabetes prescriptions, and about 20 unnecessary nutritional supplements. So, in answer to the common question, “Do I have to take these pills forever?” the answer is “Probably not.”

Be well,

David Edelberg, MD