Why is there so much over-prescribing of medicine and why is there so much unnecessary medicine?

"You did ask why “perfectly healthy” patients with osteopenia are given medications like Fosamax.

From a primary care perspective, many relatively healthy patients are placed on preventative medications if they have even the slightest indication and no obvious contraindications because

1.) This is what primary care physicians do these days.
2.) It’s expensive for the patient but costs the doctor nothing.
3.) Many of our patients EXPECT us to do something when there is an abnormal test.
4.)We try to do everything to reduce the risk of a lawsuit (defensive medicine)."

(Cynical comments in correspondence with a US-based Dr)
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Gary Moller comments:
While I love modern emergency medicine, I am much less a fan of medicine's role in the management of the diseases of modern living, including those associated with ageing. I think medicine's track record is appalling. I think our impressive life expectancies have little to do with modern medicine as one sees practiced in surgeries and hospitals and more to do with wonderful public health measures such as sewage and water projects and road and industrial safety programmes.

I would not like to be a Dr nowadays; especially one in the USA. It is a thankless task and has nothing to do with the practice of medicine and more to do with bland processes that may, by chance, have a positive health outcome. This Dr's comments pretty much sum up how a Dr is between a rock and a hard place - they must choose the path of least risk and that means following the trail of "Best Practice Medicine" and ensuring that the patient leaves the consulting room with a script for a prescription drug or further tests. So long as they stick to best practice guidelines, the chances of being sued are minimal even if the patient is severely maimed by that practice.

A further constraint on the practice of good medicine is the fees structure. Good medicine requires time - up to an hour per patient. The way medical practices are structured, a Dr must process patients at the rate of about one patient per 15 minutes at the longest. If not, the practice is in financial trouble. The sad fact is that 10-15 minutes are just long enough for a quick chat and examination and just enough time to enter the details in the computer and to print out a prescrtiption script. This simply adds up to poor medicine. Sadly, this is the status quo and the solutions are not easy. Nor are they cheap and we would sure need a lot more doctors. But; then again, would we? If Drs spent more time with their patients and practiced real medicine, we might all be healthier; needing fewer visits to the Dr, less need for surgery and less need for drugs that often debilitate and finally kill!

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Keep smokers and fatties out of the country - Doctors

5:00AM Saturday June 30, 2007, By Catherine Masters

Potential immigrants should be screened for obesity and smoking habits because they place such a heavy burden on health services, respiratory specialists have suggested.
Doctors Jeff Garrett and Andy Veale from Middlemore Hospital in South Auckland say obesity is a huge and increasing problem in Counties Manukau but chronic health disorders are not funded adequately. Obesity leads to a range of problems, from diabetes and cancers to respiratory disease and sleep disorders, and severely stretches an already cash-strapped budget, they say.

Their comments follow the death of Samoan mother Folole Muliaga, who was obese. She died after her power was cut off and she could not use her breathing machine.Mrs Muliaga arrived in New Zealand in 2000 and was first treated at Middlemore in 2002. Dr Garrett says South Auckland has more obese patients than most areas. "We've got something like 40 patients who are very similar to her in terms of their needs."
(For the full story, click on the title)
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Gary Moller comments
What is most revealing about the Muliaga case is the woeful inadequacy of modern "industrialised" medicine to deal with the chronic diseases of ageing and lifestyle; especially when there are cultural and language barriers to hurdle.In this case of morbid obesity, the "treatment" of this poor woman's obesity and consequent respiratory failure was to send her home with an oxygen machine. Sure, she might have had a few consultations with a nutritionist and maybe a few visits by a nurse at home; but these are hardly solutions.

As with the usual prescription of drugs to "manage" these lifestyle diseases, the adverse side effects are usually what finishes off the poor patient and not the disease. In this case, the adverse side effect of Mrs Muliaga's oxygen machine was skyrocketing power bills that the family could not keep up with. With the power company turning off the electricity to the home, that was the end of it for her.

Rather than whining about immigration and blaming the victims of their poor medical practices, these doctors who hail from the privileged quarters of society need to take a long hard look at how their own inadequacies as health professionals and consider how they actually contributed to this woman's death by prescribing a really dumb treatment. This trusting woman went to these docotors for help and she ended up dead. The sad truth is that the instruments that doctors have in their hi-tec tool box simply don't work for these kinds of health conditions.

Stereotyped attitudes about these lovely and trusting people also get in the way of providing effective health care.

As the article above says, Middlemore Hospital has about 40 other people with similar health problems. Let's get some proper health care for them.

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Polynesians are fat - a sweeping generalisation

"Pacific Island nations have the most overweight people in the world, according to the most recent estimates by the World Health Organisation (WHO).
Eight out of the ten of the "fattest" countries are in the Pacific, the research found.
The top four - Nauru, Micronesia, the Cook Islands and Tonga - all have more than 90 per cent of their population defined as obese. "
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Gary Moller comments:
There is unquestionably a serious world-wide obesity problem that is only going to get much worse before it gets better and that will not happen for several generations, if the latest crop of kiddies coming online right now are anything to go by. Polynesians are at the top end of the problem - there is no argument about that. But let's kill some stereotypes:

We have discussed BMI in a previous posting about how heavy boned and muscled people are penalised by the one-size fits-all limitations of BMI measures. Polynesians, being among the most naturally well muscled and big boned races on the planet are immediately at a disadvantage with regards to BMI. That does not mean to say Many, if not the majority, have a serious problem with obesity.

The solutions are simple but extremely difficult to implement because one comes up against unhelpful stereotypes and health resources are almost exclusively locked up in the ambulance services (Drugs, surgery, hospitalisation). But, for the moment, let's dispel these broad-brush misconceptions that all Polynesians are fat. There are many, many exceptions that include my immediate and extended family.

Polynesians that exercise regularly and who eat well make exceptional physical specimens that make scrawny people like me very poor examples of humanity. The holiday photos above show Alofa with the kind of food that produce a strong and healthy human. You will see, despite her high BMI, she is thin, but very strong, muscled and in glowing health. She, and the rest of her family, is not the obese and sickly stereotype of the Polynesian. The photo of Alama, our son who will never get skin cancer (btw) is significant because it shows a lean, muscular 7 year old with a narrow waist and a broad barrel chest. Incidentally, outside of Africa, this physique is most unusual nowadays. The swiiming togs he is wearing are sized for a three year old! My, how children have changed!

Good health is not about race - It is all about lifestyle - plenty of sun, exciting and stimulating exercise and lot's of good food. It is about choosing to walk to school and riding a bike to work, rather than to drive. It is about taking responsibility for one's personal health which means becoming informed about traditional and natural therapies and taking control of one's lifestyle - like placing family before work.

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How beta blockers and drugs for anxiety ruin lives and kill

"Like surgeries, drugs are extremely valuable when used correctly. Unfortunately this is NOT how drugs are used in today's "modern" medicine! In fact, most doctors confuse "practicing medicine" with "automatic prescription writing." This hurts everyone except the drug companies.
Even in cases when drugs are beneficial, alternative drug-free treatments should alwaysbe considered first. Because along with chemical drugs come many harmful side effects that can often take years to surface. In fact, since many drugs cause more harm than good...patients wind up with even more prescriptions than what they started out with. It's a perpetual life threatening cycle that needs to stop!" W C Douglas MD

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Gary Moller comments:

The most common reason for going to the doctor in Wellington City is anxiety and depression. The standard treatment is drugs like beta blockers and various other drugs that variously to lower the blood pressure and reduce anxiety. Most of these drugs work by depressing the chemicals that regulate signaling between nerve cells. This means varying degress of brain fog, dry mouth and slowing of the digestive processes including gut peristalsis.

I have written previously about these drugs and soaring dementia rates. Let's talk about peristalsis, the rhythmic contractions of the smooth muscle of the digestive tract that steadily propels through the the digestive process and into the bowel where it is eliminated once or twice daily. Many drugs slow this process and the consequences can be dire. But, first a little about dry mouth.

Many drugs slow the production of digestive juices and this may be show as dry mouth. Have you seen the movie "Me, Myself & Irene"? In the movie, Jim Carrey plays a man with a split personality named Hank. In one really hilarious scene he takes his medication and suffers an excessive dry mouth reaction. While it was totally over the top, it served well to illustrate what millions of people must put up with daily. Interfere with the digestive juices, including saliva and the person tends towards sweet junk foods and what food is eaten is poorly digested.

Poor digestion along with slowed peristalsis leads to chronic malnutrition and diseases associated with putrid partially digested food accumulating in the lower tracts of the digestive system. Diverticulitis, Chrohn's disease, constipation Chronic obstructive bowel disease, bowel cancer and other ailments develop.

These diseases of the digestive tract may take 20 or more years to develop and the association with the offending medication may never be made.

The consequence is many years of ongoing surgery, more and more powerful drugs, chronic infections, colostomy bags, days, weeks and months in hospital and a gradual slide into disability that ends with a slow and undignified death well before time. The cost to the health system is measured in the hundreds of thousands of dollars. The cost to the family is immeasurable.

What often blows me away is that the offending medication - the anti-depressant or the blood pressure medication continues to prescribed although the need for it may be long gone!

Modern drugs do have their place; but not when dealing with issues that are mostly to do with our lifestyles and the natural processes of ageing.

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