Tuesday, March 2, 2010

PLEASE TELL ME, MR. PFIZER: SHOULD I TAKE A DRUG?

As long as we’re talking about people mattering in healthcare, what’s my involvement in my own personal health?

I ask that because I’ve noticed an ominous parallel. As healthcare insidiously became more remote and industrial, which is to say less humane, patients' individual self-images tended in a similar direction.

We’ve largely come to believe, for example, that any discomfort in our life is evidence of a treatable disease. We can thank relentless marketing for that, especially the marketing of pharmaceuticals. Open a popular mag like Newsweek or People and you’ll find a number of two-page drug ads. The first page depicts someone in the horrid grip of the latest Silent Epidemic—depression, insomnia, shyness. “Omigod,” you say to yourself, “that’s me!” The ad, having already guessed your response, suggests you ask your doctor if this medication is right for you. The second page is a torrent of finely printed details, including the drug’s numerous side effects. If BigPharma had its way, this second side wouldn’t be there at all.

Pharmaceutical companies have reaped stunning success from advertising this way for a quarter-century now. Sure, they’re selling more drugs than ever, and at higher prices than ever. But they’ve accomplished even more: they’ve gradually persuaded us that drugs are the preferred response to discomfort, period.

We physicians get this sales pitch in spades. Our licenses require us to obtain so many hours of continuing medical education annually. We can get them via courses, but most of us find it convenient to attend the CME lunches at our local hospital. Many hospitals, though, particularly rural ones, can’t afford a regular CME calendar, so guess who fills in: a prominent medical professor from the University of Pharma. And when drug companies hire eminent physicians to lecture their peers, you can bet that certain brand-name drugs are mentioned.

So Pfizer throws a lunch this week; the rest of the month features GlaxoSmithKline, Merck, and Aventis. Since every drug company has the opportunity to take its turn, this may sound fair. But there’s one outfit that never gets invited: attention to one’s life. Little wonder, then, that as docs absorb these talks over years and decades, many say “drug” after you say “sickness.”

Pharmaceuticals are only a single slice of our hi-tech gadgetry. It seems there’s nothing we can do ourselves that some intricate, God-awful-expensive machine can’t do more accurately. “It's a lot like exploring outer space,” wrote David Callahan, director of Hastings Center, a bioethics think-tank near New York. “The capacity of medicine to provide ever-advanced technologies is endless. No matter how much you spend, you can always spend more.” By the way, he wrote that observation almost twenty years ago.

We’re further along technologically today, but are we commensurately healthier? Many healthcare reform advocates emphasize the breathtaking disparity between our astronomic healthcare expenditure (highest per capita in the world) and our dismal results among all nations.

If there’s any “healthcare crisis,” it’s this: we’re caught in a technology-dependency cycle. It begins when we don’t feel right. Then, ignoring any meaningful connection between, say, our overeating, our obesity, and our type two diabetes, we consult a practitioner, who gives us a prescription for a product that might offer us some relief and possibly side effects as well, but in any case re-convinces us that both our suffering and relief come from outside us.

I half-stole this blog’s title from E.F. Schumacher, author of Small Is Beautiful: Economics as if People Mattered. One of Schumacher’s prime values was what he called “appropriate technology,” the right tool for the job. Sometimes we need fiber-optic surgery, sometimes a touch. If I begin to consider how thoroughly my entire life influences my health, I’ll develop a more acute sense of which technology suits me now and what I need to do for myself.

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