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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