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Doomed to Repeat

July 18, 2013

As I have researched my book on Dr. Freeman Allen I am increasingly struck by the incredible usefulness of the study of history.  Having a spotty and unconventional education I am fuzzy on a whole lot of human history but the more I read the more I realize how much of our modern debates are replays.  I’m going to use the recent widely disseminated article by Tracy Weber and Charles Ornstein of Propublica:

http://www.propublica.org/article/why-you-should-care-about-the-drugs-your-doctor-prescribes

Weber and Ornstein have been reporting on the issue of prescription drugs for a long time, and they have published in the past about patterns they found in Medicare prescribing records, etc.  In this article they review those findings and imply that we should all question our doctors about the things they prescribe.  Here’s what they suggest the average patient should ask:  “Doctor I’ve looked at the data and it appears you are prescribing a medication for me that is much more expensive than your peers, why is that?”.  Or: “Doctor, do you have a financial relationship with the drug company that makes the medication you have prescribed for me?”  Or: “Doctor, my research suggests that you a prescribing a medication that your peers rarely do for this condition.  Can you explain that?”.  Not to mention being exceedingly annoying and insulting, all these questions would take more time to answer in a way that the average person could understand than the average doctor spends on an appendectomy.  I can just imagine doing anesthesia for 10 identical cataract extractions and having each patient ask me if I have a financial interest in the company that makes Remifentanil, why isn’t Fentanyl used since it’s cheaper, and why did the other guy at the other hospital use Propofol instead?  After the semester-long pharmaceutical lecture and the year-long chemistry course to back it up, we’d never get anything done.

It turns out the medical world has had a love-hate relationship with medications for a long, long time.  Dr. Oliver Wendell Holmes, eminent Harvard physician, poet, and founder of the Atlantic Monthly, said in a speech given before the Massachusetts Medical Society in the 1860s:

“What is the honest truth about the medical art?  By far the largest number of diseases which physicians are called to treat will get well at any rate, even in spite of reasonably bad treatment.  Of the other fraction, a certain number will inevitably die,, whatever is done; there remains a small margin of cases where the life of the patient depends on the skill of the physician.  Drugs now and then save life; they often shorten disease and remove symptoms; but they are second in importance to food, air, temperature, and other hygienic influences.”

Of course, back then they didn’t have a whole lot of pharmaceuticals that actually worked to choose from.  At least 15% of all prescribed medications had some form of opium in them.  Whiskey worked for almost anything if you gave enough.  At least half the time the drug being given was not only sold but made by the doctor himself.  People got given things that other doctors didn’t use, that were more expensive than down the street, and that doctors had financial interest in all the time.  Now we have 15 kinds of Ibuprofen.  I’m going to ask my doctor why he’s prescribing Aleve when the guy down the street says go get the Wallgreens variety, and does my doctor have stock in Bayer Pharmaceuticals?

Learn from history.  Or be doomed to repeat it.

 

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