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Tuesday, November 21, 2017

Chemical Reductionism Prospers as the Morgues Fill Up

The United States is in the midst of a frightening opioid crisis. A story in the New York Times this year states that last year more than 59,000 died from drug overdoses. The story has a graph showing drug overdoses skyrocketing, growing from only 20,000 a year around the year 2000 to more than 59,000 last year.

A CDC site says, "We now know that overdoses from prescription opioids are a driving factor in the 15-year increase in opioid overdose deaths."  Why are so many opioids being prescribed?

Let's consider a viewpoint that is popular among many in the mainstream, a viewpoint that we may call chemical reductionism. The idea is that a person is little more than a bag of chemicals. Chemical reductionism is popular among many doctors and psychiatrists. Psychiatrists sometimes push the idea that mental problems are caused by chemical imbalances. The evidence for this claim is weak.

 Thankfully only a minority of doctors think like this

Let's imagine a doctor has been trained to think along the lines of chemical reductionism. What is he going to do when a patient comes in complaining of some pain? His first inclination will be: prescribe some powerful chemicals to treat the pain.

But there are quite a few alternate techniques for treating pain, techniques that do not involve the risks of prescribing opioids. They include the following:
  • Surgery. Some types of pain (such as dental pain) can be reduced by permanently dulling nerves.
  • Meditation.
  • Hypnosis.
  • Acupuncture. The World Health Organization says acupuncture can be effective in reducing pain.
  • Marijuana. Many states now allow medical marijuana for pain relief. People using it sometimes say they still have the pain, but it doesn't bother them when they use marijuana.
  • Chiropractic care. Chiropractic care can be effective in reducing lower back pain.
  • Massage. Massage can be effective in reducing muscle pain.
  • Exercise.
  • Biofeedback.
  • Guided imagery.
  • Music therapy.
  • Yoga.

With so many non-opioid pain techniques, why have so many doctors tended to prescribe addictive opioids as soon as a patient complains of pain?  One reason is that such an approach is convenient from a profit standpoint. A doctor can write a prescription in just a minute, a much shorter time than the many minutes that might be needed to explain some non-drug program of pain treatment.  The more patients handled in a day, the greater the profit for a clinic.  Another reason is that pharmaceutical companies are constantly influencing doctors, to help keep them thinking that pills are the solution to almost any medical problem not requiring surgery  -- largely because the more medicine is chemistry-centered, the higher the profits of pharmaceutical companies.

The enormous influence that pharmaceutical companies have on doctors is documented in the book “White Coat Black Hat” by Carl Elliott. We learn about the enormous number of pharmaceutical sales reps who often arrive at doctor's offices offering free samples or minor gifts like a box of donuts or perhaps a pizza for the staff. Then there are the pharmaceutical companies that pay for doctors to attend conferences or meetings that may have free food and luxury lodging, which often amount to a kind of bribe to the doctor in the form of a paid travel junket.

Then there are the pharmaceutical companies that pay for “ghost-written” research articles. A doctor may put his name on a scientific paper that was conceived and largely written by some “medical ghost-writer” funded by a pharmaceutical company. The benefit for the doctor is that it is an easy way of increasing his number of published papers (the more published papers, the more prestige for the doctor). A 2009 New York Times article guessed that 11% of New England Journal of Medicine articles used medical ghost-writing. The worst abuse occurred when medical ghost-writing was used to help gin up research studies for the pain-killing drug Vioxx. An NPR article says, “Research published in the medical journal Lancet estimates that 88,000 Americans had heart attacks from taking Vioxx, and 38,000 of them died.”

All these bribes and conditioning from the pharmaceutical companies help reinforce in many a doctor's mind the idea that pills are the only non-surgical way to treat pain. The result has been a great excess of prescriptions for opioid medications, which in turn has led to massive cases of addiction, and tens of thousands of overdose deaths per year. 

Given this situation, it would seem sensible for the government to fund additional research into alternative methods of relieving pain, and for doctors to give greater consideration to such non-chemical alternatives when first hearing a patient's complaint of pain. You will hear some people argue the opposite. They will tell us: just because so many thousands are dying of opioid overdoses, that's no reason for us to pay more attention to alternative medicine or integrative medicine. The question we must always ask such people is: are you receiving any money or benefits from the pharmaceutical industry?

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