Under the influence

I will never forget when I was an intern and my attending was from England, where they practice a very different type of medicine than we do. He wanted to know why a particular patient had been prescribed so many medications. His comment was so great, it has stuck with me to this day. He said “she’s on so many medications, if you shake her, she will rattle.”

Unfortunately, things haven’t gotten any better since then.

But at least someone is finally acknowledging it. A recent article published in the Annals of Family Medicine examined the notion that the pharmaceutical industry influences the practice of medicine and its guidelines.

Duh! Who do you think comes up with this “evidence-based” medicine anyway? Big Pharma runs the show under the unspoken motto “Use our drugs or get sued for malpractice.” It’s a scary Orwellian world out there and I love when I get to tell you about it.

In this study, the authors looked at more than 100 patients with type 2 diabetes and hypertension from 44 primary care centers in Michigan during 2009 and 2010.

Almost 90 percent of the patients said their doctors (or other practitioners) had prescribed multiple medications. In fact, 51 percent of them were taking five or more medications.

Can you imagine?

Except for a few very rare exceptions, no one ever needs to be on so many medications.

No wonder adverse drug reactions have skyrocketed in recent years (according to the FDA, reports tripled between 1995 and 2005).

But how have things gotten this bad, you might wonder? Well, you can thank constant tinkering with “diagnostic criteria guidelines,” for one thing.

Levels of certain markers that might have been considered “normal” a few years ago keep getting pushed lower and lower. Which means more and more people are being diagnosed with conditions like diabetes and hypertension. And pharmaceutical drugs are mainstream medicine’s go-to protocol for those conditions. (Despite the fact that both of them can be treated safely and effectively with good, old-fashioned diet and exercise.)

Of the 58 clinicians involved in this study, 67 percent said they relied on clinical guidelines when prescribing. (And only four of them questioned the clinical soundness of guidelines.) Every single practitioner reported prescribing at least two drugs for hypertension or diabetes–and 43 percent often combined three or more drugs.

And how do the drug companies fit in to this picture?

Of the 53 clinicians willing to discuss pharmaceutical marketing, 72 percent reported having regular contact with pharmaceutical representatives. In fact, 62 percent of these clinicians reported seeing 10 representatives a week! These are the same doctors who complain about not having time to spend more than 15 minutes with each patient. Yet they have time to see 10 pharmaceutical reps per week. Ludicrous. Who are these so-called health “professionals”? And why do people still go to doctors like that?

The authors of this article concluded, “Individuals with financial conflicts should be excluded from involvement with medical practice guideline writing, regardless of disclosure, and physicians should be discouraged from meeting with drug company representatives.”

Amen to that! Honestly, they can’t even give us pens anymore, so what’s the use of meeting with them anyway?

Don’t get me wrong. I’m not one to shy away from prescribing a medication when it is absolutely necessary. However, in my opinion, drugs should be a last resort. After all, the oath I took was, “first do no harm.” Seems that other people in my profession have forgotten that basic rule.

“The Changing Face of Chronic Illness Management in Primary Care: A Qualitative Study of Underlying Influences and Unintended Outcomes,” Annals of Family Medicine 2012; 10(5):452-460