THE DRUGGED SOCIETY

[The original article was submitted for publication in my Art of Healing column 18/8/2013, but was not published].

How dependent have we become on prescription drugs? Considering that for adults above 30, about 50% are hypertensive, 40% have high cholesterol and/or triglycerides, 30% have respiratory problems and 20% have diabetes (my current estimates based on previous national surveys), there are indeed many people on prescription drugs. And that’s not including those who suffer from the other diseases or health problems that will take 3 pages to list.

I am no stranger to controversies, as I have irked some oncologists by highlighting the fact that by evidence-based medical standards, cancer chemotherapy is generally a failure (although some patients do benefit from it). In fact, an oncologist made an official complaint against me to the Malaysian Medical Council for, among others, “promoting unproven therapies” because I have often written about alternative (non-medical) and non-conventional medical therapies in this column. Two of them also wrote a rebuttal to my article which criticized chemotherapy. I welcome opposing views, if backed by evidence and reasoning, as my aim is to educate the public with the correct information about health and medicine. Doctors are often fed by information provided by the drug companies, which are expected to be biased towards championing their drugs. They may also be caught in “conflict of interest” situations when they gain financially from recommending or prescribing the drugs.

The data reaching the doctors can be skewed in many ways. First, some pharma-sponsored studies may not be published at all if the results are not favourable, so we don’t even know about these. Secondly, among those that are published, the results, interpretation and conclusions can be biased according to what the authors wish to promote, bearing in mind that many of these studies are funded by the drug companies. Finally, many of the so-called “independent” studies are not so, because reputable professors and researchers are paid to lend their names and provide credibility to the studies done by the drug companies, and get them published in top journals. This scam was recently exposed in several top medical journals. Letters from other scientists exposing the flaws in the studies or rebutting the findings are often not published. One drug company even asked a top journal to withdraw its editorial piece which was critical of its product! All these are geared to convince the doctors that according to evidence-based medicine, the drugs work, are safe, and should be prescribed, when the reality may not be so.

And to be certain that the drugs are prescribed, some drug companies even pay the doctors directly or indirectly (for some examples, google “pay to prescribe”). The doctors-researchers-industry link is so strong and not necessarily good for the public. In the US, some drug companies have been fined billions of dollars for various fraudulent business practices. There were also many cases where innovative scientists and doctors who developed non-drug therapies were victimized by the government and the medical establishment. For some reports on this scandalous situation, see www.thepublicationplan.com/commentary5.html

I am not blindly against drugs or drug companies. They are very important components of our health system. What I am against is biased and untruthful data or “evidence” and unprofessional tactics being used to influence doctors and their patients. I am all in favour of any drug that is effective, safe and backed by unbiased scientific research. Hopefully the drug is also reasonably priced.

What worries me is how dependent we have become on prescription drugs, and that in most situations these drugs do not heal the patients, but just “control” the readings (BP, blood glucose, cholesterol) or symptoms for as long as the patients remember to take the drugs.

Let us look at what typically happens in a doctor’s clinic. Below (The Doctor and His Patient) I reproduce what I wrote over 5 years ago in The Art of Healing (Fit4Life 20/01/2008), with some editing and additional comments. This is to drive home the message that we are relying too much on drugs that do not heal us.

THE DOCTOR AND HIS PATIENT

Consider the following scenario which many of you can identify with (the patient is a 50 year old man):

Doctor: Uncle, your blood pressure is consistently high over the last 1 week, and in spite of adequate rest, it is still high today. I have to start you on medication. You have a family history of hypertension, heart attack and diabetes. You are only slightly overweight, so you need not lose much, and you should exercise more. Aim for 30 minutes daily brisk walking. If you smoke, stop smoking.

And like most typical Malaysian men past their 40's, the patient finds it difficult to stop smoking; slowly but surely puts on weight (especially around the belly); and hardly exercises.

The patient is then monitored regularly, and at each visit:

Doctor: Uncle, your blood pressure is under control. Take your medicine and see me next month. Take care of your weight and don't forget the brisk walks. If you can't stop smoking, at least reduce.

So both the doctor and patient are happy because the BP is under control. The drug company is also happy because it has a new customer for life. But 1 year later:

Doctor: Uncle, your blood pressure is high again in spite of the medicine. I have to increase the dose. Today your blood test also shows too much bad cholesterol. I have to prescribe another medicine for that. Your weight has also increased. Try to improve your diet and try to exercise.

The patient is then monitored regularly, and at each visit:

Doctor: Uncle, your blood pressure and bad cholesterol are under control. Take your medicines and see me next month. Take care of your weight and don't forget the brisk walks. It’s good that you have stopped smoking.

Both of them are happy that the BP and cholesterol are under control. And so is the drug company.

But 2 years later:

Doctor: Uncle, your blood pressure is high again. I have given the maximum dose of the medicine. Now I have to add a second medicine to control your blood pressure (or give a tablet that has both drugs). Your bad cholesterol is also creeping up. The dose for the medicine for that has to be increased also. Your weight is also increasing. Please watch your weight and don't slacken on your brisk walks.

The patient is then monitored regularly, and at each visit:

Doctor: Uncle, your blood pressure and bad cholesterol are under control. Take your medications and see me next month. Blah..blah..blah…

Both the doctor and the patient are happy that the blood pressure and bad cholesterol are "under control". And of course the drug company is happier too.

But 3 years later:

Doctor: Uncle, your blood pressure is high again, so I have to change to the "latest" (but more expensive) drug. Since high doses of the previous medicines could not control your BP, I will start with the maximum dose of the new drug. Your bad cholesterol is ok but you have to continue the medicine. The last time we reduced the dose, it crept up again. I have another bad news for you. Your blood sugar is high and the glucose-tolerance test confirms that you are now diabetic. I have to start you on medication for diabetes as well. I will also explain to you about your diet. About your chest discomfort, we really need to have a thorough evaluation of your heart. Diabetics are at higher risk of heart disease and stroke. Your hypertension also increases the risk of both.

And so the saga continues. There are thousands of men above 40 and women above 50 out there who have to pop many drug pills everyday to control their blood pressure, bad cholesterol, glucose, and to protect their hearts, keep their coronary vessels open and thin their blood. Many have to take additional medicines just to counter the side-effects of these drugs.

My point is, both the doctor and patient are happy when the blood pressure, bad cholesterol and blood sugar are normal or "under control" under the influence of the drugs. I am not satisfied if the problem is normalized because of the drugs. The aim of the doctor should be to get the patient healthy and normal without drugs. All the while these patients have the diseases roaring inside them, despite the "normal" readings. In fact, the diseases often get worse, as evidenced by the increasingly higher doses required to “control” the diseases over time. All they have to do is to stop their medications for several days to prove what I say is right.

I would also like to reiterate that I did not become a doctor to be a glorified, legal drug-pusher. I want to be a healer who restores the patient to his healthy state whenever possible. And it is possible in many cases when there is discipline in lifestyle, diet, weight control and exercise; optimizing the hormones; and judicious use of nutritional, herbal and other non-drug therapies. There are of course instances when drugs also heal, but most of them don’t when it comes to treating the major chronic diseases like hypertension, diabetes, heart disease and cancer.

With that opening gambit, in the following articles I will discuss some drug-based therapies that warrant a re-look. For my analysis of cancer chemotherapy, and the oncologists’ response, please read Therapy in Cancer (first published in Fit4Life 30/09/2012), Clarifying Chemotherapy (Fit4Life 14/10/2012) and The War on Cancer (Fit4Life 28/10/2012). For cholesterol-lowering statin drugs please read The Cholesterol Controversy (Fit4Life 13/10/2013) and Are Statins Necessary? (publication rejected). Look out for my analysis of diabetes management and anti-diabetic drugs in future. There are also non-drug issues I hope to analyze.

DR AMIR FARID ISAHAK