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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A fresh warning about the dangers of cortisone injections

I continue to receive inquiries from people who have had cortisone injections to treat injuries to joints, tendons and ligaments, or have recommended that they undergo such treatment. This type of treatment remains disturbingly common and the consequences can be catastrophic.

Read my article here about the dangers of cortisone injections and here.

Photo: Example of chemical excision by cortisone injection causing permanent damage to an important tendon (In this case, tibialis posterior). Only one injection is required to cripple the recipient.

Cortisone is a form of chemical excision. It kills living cells, dissolving living tissue, killing off everything it has contact with. While the relief from pain may be immediate and lasting, the adverse consequences may not appear for weeks or months or even years later. The consequences may be the catastrophic snapping of a tendon or muscle, loss of protective ligaments or the loss of protective cushioning tissue, such as that found in the heel pad. While many people get away without apparent long term consequences, I can tell you that many people definitely are not so fortunate.

Why is it that cortisone continues to be used to widely and for so many different musculoskeletal problems?

• It is cheap, quick and easy and can be done in any medical consulting room
• Relief from pain is instant and it tends to lastJust 1-4 injections seem to do the job which is usually much better and quicker than one would get than other therapies like physio
• If there are any catastrophic consequences, the association with the cortisone injections may never be known and the injecting Dr will never be any the wiser

When a Dr tells you the "risk is 1/1000" bear in mind that this estimation may be based on worthless stats that do not take account the dozens and dozens of unreported adverse side effects that run parallel to each reported case!

If you have an injury that fails to respond to rest and/or medical treatment, or are bothered by chronic pain and treatment with cortisone has been recommended, you are welcome to write to me and I will do my best to assist with helping you with deciding on what is the best course of action to take.

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Commissioner slams Wellington Hospital over man's death

"The Health and Disability Commissioner has slammed Wellington Hospital over the standard of care given to a 50-year-old man who died of pneumonia.

Ron Paterson was investigating a complaint from the man’s family after he was found dead, 40 hours after being admitted to hospital in September 2004.

The patient's chest X-ray and blood tests were not reviewed for almost 30 hours.

Mr Paterson says what happened was inexcusable, that staff provided a poor standard of care and the man was deprived of simple interventions that may have saved his life."
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Gary Moller comments:
This report hardly comes as a surprise and is yet another of a string of awful cases over the years at Wellington Hospital causing unnecessary death and disability.

Reading between the lines of this case, it would appear that this man's bipolar disorder, chronic addiction to smoking and serious chest condition made him a difficult and stroppy patient from the momeent he arrived and the hospital staff took a collective dislike to him. The result was grossly inadequate treatment, bordering on deliberate neglect, that saw him dead in next to no time. It reminds me of a case in Dunedin Hospital many years ago that was never reported:

She was elderly, overweight and demented. She was admitted to hospital to lose weight. Her diet consisted of a glass of water and a piece of white bread with a dollop of Marmite. When she objected to her treatment and peed in her bed, she was isolated in a private room with no sensory stimulation. She did not eat or drink. Within a few days of sensory deprivation, starvation and dehydration she was going ga-ga. The treatment and the isolation continued. By the fifth day, she was dead.

Now this was homicide by willful neglect. Nobody intervened. Everybody just did what they were told and that was to administer the treatment and to do nothing else. The fact the patient died was irrelevant and nobody within the medical team felt responsible - or guilty for that matter. They all knew what was going on and nobody cared a damn about her or the horrific way she died.

I have written about this sort of thing in the past and the advice that I always come back to is this: You must ensure that you always have a strong, informed advocate by your side when you enter hospital; especially if you are elderly, cantankerous by nature or have a mental health condition that affects your behaviour. If the hospital staff take a dislike for you, your life may be at risk.

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Link

Confusion between pathology and symptoms

When it comes to medical treatment, the most common failing I see is the confusion between the true cause (pathology) and the symptoms of an ailment. This is most frequently the case when medicines are prescribed for conditions like heart and circulation disease, depression, overweight, osteoporosis and sexual dysfunction.

A medical professional from overseas recently sent me the following animated parody that illustrates this common treatment failing in an amusing but powerful way.

Click here and enjoy the presentation! The town of allopath

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Cortisone Injections - pain relief at what cost? Followup

Here is some feedback from the runner with the ankle pain that I referred to in my earlier article.

“I'm great... I've been back runnning for about 7 weeks...

“When you told me to start back , you will probably remember I still had the throbbing scenario - after that the ankle was giving me pain in the first few weeks of running. I've crept up slowly in kms and have had to go at a slower pace than I want ... but it's now not throbbing at all and only the very rare day do I feel familiar scary pains here and there.in the ankle... if that happens I get as much rest before the next session or swap sessions around.

So to answer your question yes your intervention did work for me, I was going backwards for many months (9 in total ) with the rehab exercises which I reckon were aggravating it more.

Before I ate healthily but now am using protein (just after a session which I never did before), calcium, minerals and flax will keep going and will keep the joint powder going for a good while yet.

Yes looked at the blog, and that is a great article , I hope it helps others make the right decision, all you need is a perceptive experienced advisor.You are the only person that I saw that wanted the entire background to my running habits and history.... and thank you ! “
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Gary Moller comments:
This very fit woman has made a remarkable return to running training. What she shows is the value of looking at the total person, including her health and exercise history, training programme, diet, physique and biomechanics - and let's not underplay the role of her determination to get back into running!

When attempting to understand how such injuries develop in the first place, it is essential to understand the constant balancing act that is going on inside the body between anabolism and catabolism. Refer to this E-Book here and read the sections about anabolism and catabolism. If an athlete is in a state of chronic catabolism, there is no way that any kind of medical treatment is going to "cure" her.

Although this dedicated runner has made a quick and remarkable recovery, healing and repair should be regarded as a slow and gradual process, taking several months, if not years to fully run their course. Too much therapy is on the basis of a 1/2 dozen visits and, if there is no cure, then more drastic action is recommended like surgery, or cortisone. Of course, these don't work and can leave the athlete with much worse problems over the longterm.

Central to modifying her training and diet and her doing some special exercises, is the moto "Body, heal thyself". This is a phrase all health professionals should constantly mutter away to themselves as a constant reminder that they never heal or cure - it is the patient's body that does that!
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If you have a chronic injury or illness that you are getting nowhere with fast, and if you are in Wellington, I run a private clinic in the central city. Get hold of me to arrange a consultation - I really do enjoy the challenge of working with people like you!

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