Here is another story from Dreamland. A fellow got injured on the job. Nothing major, just a few deep bruises, some soreness. He went to a doctor to get his workers comp paperwork signed, and the doctor handed him a prescription for a month of twice-a-day Oxy.
The fellow took the Oxy for a month and expected just to move on and forget all about it after the pills ran out.
But the moment he stopped taking the pills, he started feeling like absolute hell. Diarrhea, extreme agitation, gut-wrenching pain. The poor guy had no idea what was even happening until somebody finally told him that his condition looked like withdrawal. The man was hopelessly hooked, and the doctor now had a guaranteed long-term patient who would come in like clockwork for his scrip.
Tens of thousands of people got addicted this way and later moved on to heroin. Many of them are now dead of an overdose.
Of course, this fellow carries a large part of responsibility here. He allowed himself to grow so alienated from his own body that he never even questioned the need to take pills for a month when he wasn’t even in pain. He was dishonest with himself about the high he was feeling thanks to the pills. He allowed the doctor to handle him like a mechanic handles a broken car.
Still, though. A heroin addiction is a harsh penalty for people whose only sin is buying into the widespread cultural narratives about individuals’ relationship with their bodies and the godlike powers of the Mighty Pill.
Clarissa's Blog 
You’ll also read about “doctor” Proctor in Dreamland as well. He “pioneered” the specialty “pain clinic” which, in reality, was nothing more than legalized drug dealing.
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This is a great book. I’m enjoying it enormously.
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It get better. When Proctor was prosecuted and went away, there is this mother-daughter tag team who takes over his clinic, then hires lots of dodgy doctors to work in it. There is one guy they hired who prescribed so many pills that they opened their own pharmacy to dispense them because the existing pharmacist refused to fulfill so many of what were obviously bogus prescriptions.
The book does not reflect well on the medical profession.
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“He allowed the doctor to handle him like a mechanic handles a broken car.”
I think I’ve got the soundtrack for your book.
This is a song of 1982; seems like the medical community has been having a problem with professional ethics for quite some time.
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I am not quite as critical of pills/pain medication and psych drugs as you are (I believe that they have an important role to play in health care) but I completely agree that heavy duty pain pills are way over prescribed.
I had a root canal not too long ago and the dentist asked me what type of pain medication I would like prescribed. I said something to the effect of “I prefer not to take acetaminophen. I prefer ibuprofen-based pain medication.” And the dentist said “Oh. I know just what to prescribe.” So I didn’t pay attention and assumed he had prescribed extra-strength ibuprofen. I didn’t fill the prescription at first because I was feeling fine but that evening, I started experiencing a fair amount of pain (though hardly debilitating) and asked my husband to pick up the medication on his way home from work. And my husband returns with an opioid-based medication. That was a much more heavy medication than I wanted or needed. And it was cheap! Cheaper even than the antibiotic I was taking. I never took it at all. I just took 3 Advil and was fine. The opioid pain-killer is still sitting in my medicine cabinet– a strange testament to our current medical zeal for over–prescribing.
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It turns out that there used to be a protoc0l according to which a doctor had to conduct a questioning of a patient to find out whether the patient was likely to get addicted. Of course, such a conversation can’t last less than half an hour, so it was dropped in favor of handing out prescriptions without asking any questions. AS a result, even people who are very likely to get addicted (e.g. those who were addicted in the past) can easily get a prescription.
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I have a family member who volunteers at a homeless shelter–this exact story is how many people end up there, as addicts, often with their children. In addition to U.S. cultural narratives glorifying pills and individuals being unaware of them, I think ones that glorify doctors as infallible experts are also a problem. I had a minor surgery a few years ago and had to fight hard to a) not have full anesthesia b) not have full anesthesia to dull the “pain” of the needle prick for the local anesthesia, and c) not get an opioid prescription afterwards. It was so minor there actually was no pain afterwards, and I was horrified at the pain med pushing for something so minor.
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My teenage sons has several friends who are on antidepressants. His girlfriend, whose father is a doctor, is also on antidepressants. I understand that some people battle chemical imbalance that results in deep depression and really requires meds, but they are probably a small minority. I know the girl, she actually seems cheerful and happy whenever I see her; she’s only 16, why does she have to be on antidepressants before alternatives have been exhausted, such as lots (lots!) of physical activity, talk therapy etc., modifications to diet (I have reason to suspect there’s PCOS going on, so she might benefit from a much lower carb/fat ratio in her diet, but it’s not my place to bring that up).
Pushing drugs on kids is the WORST thing ever. (I know this is tangential, but overmedication for all sorts of reasons is absolutely disgusting.)
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“Pushing drugs on kids is the WORST thing ever.”
Absolutely. I’m horrified that even pre-schoolers get put on psychotropic meds to make them more convenient.
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More convenient for the boring teachers…
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Oh, of course. More convenient for everybody except the miserable child whose brain is addled to please adults. :-((((((((((((
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This is completely off-topic, but did you see this? Watch particularly what happens AFTER the attack. Sigh…
https://m.youtube.com/watch?v=ABEvNOCxxUM
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What on earth is happening? Why doesn’t the mother grab the kid and run? What’s a cachorra? I speak some Spanish but I can’t tell if the woman is saying that the child mustn’t be afraid. It would be a strange thing to say to a child that’s almost been eaten.
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And did you see what the non-mother have done?
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“What’s a cachorra?”
Usually it means puppy or cub (I decided to not watch the vid so not sure how it’s used there)
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Okay I watched it finally and apart from the idiocy of putting the small child in close proximity to an apex predator in the first place the animal handler lady did behave appropriately.
To anyone who’s spent time around animals it’s clear that the cat was not trying to “eat” the small child, the child had attracted the cat’s attention and it was play exploring (though being play explored by a young mountain lion can leave a human being in very bad shape).
The trainer was keeping calm while trying to prevent the mother and child from classic prey behavior (screaming running away) which would have made things much worse. She gently but firmly concentrated on getting the kid out of the cat’s reach while not exciting the cat. Preventing the mother from grabbing the kid and running (classic prey behavior) was part of the de-escalation.
Later she says the cat is a cub (cachorra) just six months old and was playing (which is what it looked like to me). The cat clearly had lost interest by the time it was brought back.
Again, stupid to create the situation in the first place but it was handled well once it started.
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Part of the problem is that Oxycontin and other opiate pain killer drugs were represented as non-addictive. Many people who were prescribed these meds were not told that they could become addicted to them. The company that manufactured Oxycontin, Purdue Pharmaceuticals, threatened to sue newspapers that put it about that Oxycontin was addictive (which it was).
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Exactly. Remember that part where a tiny little letter to a medical journal was presented as “an extensive study” proving that opiates are not addictive? When it wasn’t a study and proved nothing of the kind? The worst part is that everybody was so eager to believe it that nobody even bothered to check.
This is why I never trust any study that I personally haven’t read in its entirety.
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It’s even worse than that …
You can think of it as “studies wars”, where influential organisations and companies seek out researchers who will back-solve to certain desired results.
One case of this comes to mind where a profitable business in a preventive treatment was at risk of being undermined by the use of a cheap, over-the-counter remedy.
Not only were there studies commissioned to “prove” once again that the preventive treatment was a better solution, but also additional studies were commissioned to cast doubts on the efficacy of the cheaper, more accessible alternative.
Eventually an internationally recognised medical journal and a national health care regulator of significance got involved, and they also concluded that the cheap stuff worked, albeit with risks. The amusing part was that the risks were less severe than the risks involved with taking the pharma-promoted preventive treatment.
There are plenty of ways to cast doubts on the validity of research, in other words.
My favourite in terms of its outright audacity comes from diabetes research — “that’s just a rat model”, “that’s just a mouse model”, “that’s just a dog model” …
Of course, they can always say this, because all of the cell-level research can’t be done on humans directly, and anyone who reads any of these studies would conclude that not even the most inhumane of captors would dream of doing so.
Still, I’m looking forward to the rest of the research coming through the pipe over the next decade, especially since it looks like once again a cheap, over-the-counter remedy might prove to be the best preventive, if not a long-term cure …
But of course, right now “that’s just a mouse model”, and as far as people with official standing are concerned, I am absolutely being Mickey Mouse about this.
🙂
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American medicine appears to consist of smacking symptoms with “sticks”, which can be anything from short-term palliatives to long-term “care management”.
It appears to me at least that many Americans are sensible and would prefer not to be “beaten with sticks” by doctors, so they opt for alternative therapies. These include going down to the local “health foods” shop to buy a few remedies.
Except, of course, that there is plenty of moral hazard as well as other hazard lurking within those shelves.
You will not find one bad word about one particular “cure-all” supplement on the likes of Wikipedia and on most accepted-as-mainstream Web sites. That’s because the number one producer of this supplement, an American firm that sells commodities in sizes ranging from packets of powder to large rail-hauled tanker containers, has a small army of “public relations” people on hand to target naysaying through the usual means.
A large Japanese firm known primarily for producing flavour enhancers also produces a large quantity of another supplement “generally regarded as safe”, and again you won’t find much in the way of warnings of potential hazards.
There are plenty of reasons why American doctors engage in “medicine by heuristics”, smacking symptoms with “sticks”, and it has quite a lot to do with risk.
Let’s say you’re an American MD who has finally survived the long ordeal of university, medical training, and at least one unpleasant residency. You have a patient in front of you who, with the right amount of work, could avoid being put on a “care management” pathway that could possibly change the outcome of the rest of his life.
But you’re not going to do that.
That’s because there’s every possibility that the patient will resist the treatment and it will look like your fault, so the best way to get rid of the risk is to make sure it lies somewhere other than with the patient or the physician.
Where all of the pills come in to this is that it is far less risky for the physician to push all of the risk onto the pharma companies who are pushing these solutions. If anyone’s to blame, it’s the researchers and the over-eager pharma sales reps who pushed these physicians into accepting these treatments.
There’s that mortgage to pay, of course, and if you’re in one of the more lucrative specialities, there’s that BMW 7-series begging to be bought, so the last thing you need is another career-threatening lawsuit over something not being done exactly according to the medical textbooks. The risks can be someone else’s problem — it’s just another job otherwise. You don’t really work for the patient since it’s the insurance company that pays most of your fees, so you accept that this alliance is the one you can’t afford to risk.
But from the patient’s perspective, these treatments aren’t all they’re quacked up to be, so why not try to treat yourself with what you can find at the “health foods” shop if that’s an option?
After all, the typical American physician is more concerned about lawsuits than being accused of not providing a specific care solution, preferring to be a good team player who works within a large “provider network”, so if you’re driven to take care of your own needs and to work through the problems on your own, how exactly is a pill pushing pimp of pharma going to help?
Unless there are bones to be set, bullets to be removed from vital areas, and other physical interventions, most of the rest involves pills and injections.
Why pretend that the average American doctor is going to do much more than choose from a menu of options provided by the PDR or Mosby’s and then write scripts for that? Why not optimise that solution as the preferred course of treatment?
Insofar as diagnostics go that would help the average American doctor get things right, these things are done only to the point that it makes it possible for a course of treatment to begin. If a particular diagnostic isn’t routine, then it isn’t ordered. If the insurance company won’t pay for it, then it isn’t ordered.
And so because of this, there are plenty of “LAB TEST IN A JIFFY” kinds of places in America that cater to people who need to get testing done that’s out of the routine, that won’t be paid for by the insurance company, or is otherwise too embarrassing to admit needs to be done.
The only health care system that works in America should be called “System D”, and it came about because the broken health care system is downstream from a broken legal system, which is itself downstream from a broken culture …
Why else would you have some sordid prancing egotist huckster trying to sell Americans on how they can “Make America Great” again?
For that matter, why would you have someone who looks like she could be in need of some immediate health care herself going on about how Americans might wind up losing this wonderful broken system?
Then again, fear is the bitter pill that Americans have learned to love to swallow, and fortunately for Americans, they don’t need a GP to write scripts for it …
[… and for what it’s worth, the NHS often hides a different kind of callousness, and that given my choice, I’ll have my health needs taken care of in Singapore or in Tokyo where I can trust the methods and the results …]
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I thought it was well known that codeine was addictive in some people.I once had some for toothache.It did nothing for the pain but I felt very happy all night,so I realised what it was.That was 30 years ago.All those compound drugs are risky though not everyone gets addicted.
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Back in the USSR codeine was an illegal substance in the 1970s and 1980s. The few people who were fortunate enough to go abroad would smuggle it in.
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