Drugs or lifestyle changes? Are pharmacists pill-happy?

Pharmacy gadfly Dennis Miller is back. The author of two massive critiques of retail chain pharmacy (Pharmacy Exposed: 1,000 Things That Can Go Deadly Wrong At the Drugstore and Chain Drug Stores Are Dangerous: How Their Reckless Obsession with the Bottom Line Places You at Risk for Serious Harm or Death), he returns with a question for pharmacists everywhere: Have pharmacists uncritically accepted the pill-for-every-ill mentality?

It is my impression that many pharmacists are not particularly interested in the prevention of disease, preferring pharmacological solutions to lifestyle changes. For example, in my experience, many pharmacists seem to be far more interested in learning about the (often theoretical) mode of action of a new drug than they are in learning about the enormous potential of disease prevention.

Pharmacists have been taught to view disease in mechanistic and reductionistic terms involving the manipulation of molecules and cells with powerful pharmaceuticals that overwhelm the delicate processes of nature. These are biological processes that Mother Nature has had well in hand for hundreds of thousands of years.

Consider the source

When you are overwhelmed by what seems like a tsunami of prescriptions, ask yourself whether the current system is the most rational approach to health. Modern medicine uses potent drugs to treat health problems that are very often a consequence of the maladaptation of Homo sapiens to modern culture or the mismatch between our genes and our lifestyles. Factors such as sedentary lives, highly processed foods, unrelenting stress, and widespread exposure to synthetic chemicals may be responsible for many of the so-called “diseases of modern civilization” (e.g., hypertension, type 2 diabetes, elevated cholesterol, heart disease, obesity, asthma, many types of cancer, etc.).

Are pharmacists guilty of encouraging the perception that human health is directly proportional to the per capita consumption of pharmaceuticals?

Have pharmacists encouraged the view that the most logical approach to health is to overpower molecular and cellular processes with synthetic agents foreign to human evolution?

A better question

Pharma marketers have indoctrinated the population well with a response to every symptom that boils down to “What drug do I need to treat this?”

In contrast, the more enlightened question would be “How can I change my lifestyle or personal habits so that I can avoid taking so many drugs?”

While your co-workers were filling prescriptions, how many times have you heard them say things like “If people would just get off their butts, lose weight, and eat nutritious food, they wouldn’t need to take so many drugs”?

I once worked in a store in which the nonpharmacist store manager commented to me, “The further we get from the trees, the greater the health problems.” I presume he was saying that the increasing estrangement of Homo sapiens from the natural world is a threat to our wellbeing.

Quick fix for complex problems

My job as a pharmacist was very often unfulfilling, because I disagreed with the disease model based on the dispensing of superficial quick-fix drug solutions for complex health problems deeply rooted in the lifestyles of our customers.

My preference is for a healthcare system based on prevention, in which a focus on lifestyle factors replaces the focus on treatments. We have a healthcare system that is something like 90% treatment and 10% prevention. I think those numbers should be reversed (i.e., 90% prevention and 10% treatment).

Many pharmacists who profess a belief in disease prevention are strong advocates of vitamins, minerals, herbs, and nutritional supplements. Should our customers focus on optimizing their intake of these products? Or should they focus on obtaining a well-balanced diet?

Customers often describe their symptoms to pharmacists and ask us what non-prescription product we can recommend. Pharmacists may instead be inclined to give advice on prevention, but very often they do not have nearly enough staff support to be able to do that. It is much quicker to recommend specific products than to try to educate the public about prevention. The modern chain drugstore is, unfortunately, built around the concepts of fast food and quick fixes.

A review of my book Pharmacy Exposed, posted on Amazon.com by a person who is, I assume, a pharmacist, chastised me for criticizing our quick-fix pill-for-every-ill culture. This reviewer stated:

I was put off by the author's repetitive complaining of how he was sick of hearing the petty complaints of people that he felt were caused by lifestyle issues that they refused to address. I would expect a medical professional to know that constipation, insomnia, cough, etc. can all detract from the quality of life of a person, and are not petty complaints to the person suffering from them. I would also expect a medical professional to understand that there are often deep psychological issues or physical circumstances beyond a person's control that cause a person to live unhealthy lifestyles. An empathetic medical professional would seek to try to understand why the person is making unhealthy lifestyle choices and then help them come up with solutions that would actually be workable in their own life. If the author had understood this, it could have made a great point in his book, that the fast-food pharmacy practice leaves no time for pharmacists to actually help people figure out better lifestyle choices. Instead the author just laments and expresses disgust repeatedly that people don't care and that they only want a "quick" solution to their problem. He seems completely oblivious to the real lives of people - people who often work long hours or multiple jobs while simultaneously caring for children and/or elderly parents, or people who grew up in abusive households and have never had a good example to follow. These people are looking for a "quick" solution, because they honestly don't know what else to do, and they need empathy, not disgust.

Do you agree that pharmacists have uncritically accepted the pill-for-every-ill mentality? Or do you agree with this reviewer that I should not be so critical of people who ask pharmacists for quick fixes?

For those pharmacists who remain skeptical that the medical paradigm may have been oversold in this country, please consider the following critical points.

Preventable diseases

Many, if not most, diseases in modern societies are preventable.

According to Temple and Burkitt in their book Western Diseases¹, many, if not most, of the diseases filling hospital beds and doctors’ offices in North America are potentially preventable:

Doctors are not trained to confront disease with the outlook of Louis Pasteur, who remarked, "Whenever I meditate on a disease, I never think of finding a remedy for it, but rather a means of preventing it." It will require a whole change of outlook for the question: "How can this be prevented?" to acquire anything like equal prominence with: "How can it be cured?"This book [Western Diseases] is an attempt to draw attention not only to the fact that a huge proportion of diseases responsible for death and suffering in the Western world are potentially preventable, but also, in several instances, are actually reversible without recourse to drugs or surgery.

Pharmacists should realize that the potential for prevention is profound. The Merck Manual (16th edition, p. 984) says that most cases of hypertension and Type II diabetes are preventable: “Thus weight reduction will lower the BP [blood pressure] of most hypertensives, often to normal levels, and will allow 75% of type 2 diabetics to discontinue medication.” Ninety percent of diabetics have diagnoses that fall under the heading of type 2.

The Merck Manual (17th edition, pp. 2591-2592) essentially states that up to 90% of cancer is preventable: “Environmental or nutritional factors probably account for up to 90% of human cancers. These factors include smoking; diet; and exposure to sunlight, chemicals, and drugs. Genetic, viral, and radiation factors may cause the rest.”

Expanded lifespan

Modern medicine has played only a modest role in the increase in average lifespan during the last hundred years.

The biggest myth of modern medicine is that the increase in average human lifespan in the last hundred years is primarily due to doctors and drugs. In fact, the increased lifespan is due primarily to the wealth effect (as nations become wealthier, lifespan increases) and public health measures such as better sanitation, better protection from the elements (better housing), better nutrition, greater access to clean water, etc.

Modern medicine has played a role, but that role is modest compared to social, cultural, economic, and political factors. See Thomas McKeown²:

The transformation of health and rapid rise of population in the Western world during the last three centuries have a common explanation: they resulted from a decline of mortality from infectious diseases. The infections declined mainly for two reasons: increased resistance to the diseases due to improved nutrition, and reduced exposure to infection which followed the hygienic measures introduced progressively from the late nineteenth century. The contribution of medical treatment and immunization to the decline of mortality was delayed until the twentieth century, and was small in relation to that of the other influences. [The emphasis is mine.]

The introduction of antibiotics played a much smaller role in the increase in lifespan in the last hundred years than is commonly believed. The death rates from infectious diseases had already fallen to low levels by the time that antibiotics were introduced. See Leonard Sagan, MD³:

The introduction of antibiotics into clinical medicine in the late 1940s and early 1950s was indeed a moment of great historical significance. There can be little doubt that, when properly used, antibiotics can shorten the course of some infectious diseases; they often did so during the early days of the antibiotic era. Yet it is not at all clear that these agents have contributed to the overall fall in mortality from infectious disease. Why is that?As noted earlier, death rates from the infectious diseases had already fallen to low levels by the time that antibiotics were introduced … the decline in infectious disease mortality began long before the appearance of the first antibiotic, penicillin, and even long before the widespread use of the first chemotherapeutic agents, the sulfa drugs. By 1950, when effective antitubercular drugs first became widely available, the death rate from tuberculosis, the major infectious disease of young adults, had already fallen to a small fraction of what it had been in the nineteenth century.

References:

1.     Temple, Norman J., and Burkitt, Denis P., Western Diseases, Totowa, New Jersey: Humana Press, 1994, p. viii.

2.     McKeown, Thomas. The Origins of Human Disease, New York: Basil Blackwell, 1988, p. 89.

3.     Sagan, Leonard. The Health of Nations: True Causes of Sickness and Well-being, New York: Basic Books, 1987, p. 64.

4.     McKinlay, J. B., and McKinlay, S. M. “The Questionable Contribution of Medical Measures to the Decline of Mortality in the United States in the Twentieth Century,” Millbank Memorial Fund Quarterly (Summer), pp. 405-428, 1977.

Dennis Milleris a retired pharmacist living in Delray Beach, Fla. He is the author of two books (Pharmacy Exposed and Chain Drug Stores Are Dangerous), both available at Amazon.com. He welcomes feedback at dmiller1952@aol.com.