June 08, 2014

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A major epidemic in America, which seems to me to have received rather less publicity than its scale would warrant, is the dramatic increase in the number of deaths in the country from overdose of prescription opioids. In 2010, for example, there were 16,500 such deaths, more than four times as many as at the turn of the century. This century so far more than 100,000 people in the United States have died from overdoses of prescription opioids.

Mostly these drugs were prescribed for various kinds of chronic pain, for which they are singularly ineffective. What, then, accounts for their prescription in ever-larger quantities? It is unlikely that the American population is several times more pain-afflicted than it was a few years ago. Moreover, the drugs are not new”€”very similar drugs have been available for a long time.

There are, it seems to me, three main factors. First, drug companies have pushed their products enthusiastically, using the kind of advertising that busy or gullible doctors all too often fall for. Open any medical journal and you will find advertisements for these products, the ad industry having long since found means of lying without actually telling untruths.

“€œA good doctor for such types is one who does exactly what they want him to do, like a butler or shop assistant. The patient is the customer and the customer is never wrong.”€

Then doctors are only too pleased to be able to prescribe something or other in order to bring consultations to a quick end, and thus see more patients than if they linger. Doctors these days are not allowed as they once were knowingly to prescribe harmless placebos, so they have to prescribe something that they think might conceivably work (such as a painkiller for pain), even if it is potentially dangerous and overall does more harm than good. Patients with chronic pain, or who say they have chronic pain”€”not always the same thing”€”are moreover difficult and demanding, and without a prescription a single such patient could easy take up the doctor’s morning or afternoon. As literary theorists would put it, a prescription brings “€œclosure.”€ 

Finally, there are the patients. It is not usual to say anything against patients, of course, because”€”ex officio, as it were”€”they are suffering from something, otherwise they wouldn”€™t be patients. Even people who fake illnesses, provided they do it long and consistently enough, are now said to be suffering from an illness (it isn”€™t easy to escape, evade, or even avoid the compassion of the medical profession). True, the great medieval physician, Maimonides, prayed that he would never see in a patient anything other than a suffering human being; but he practiced more than 700 years ago, and patients”€”or at least some of them”€”have changed since then. 

Quite apart from the fact that many doctors have felt threatened, or even been attacked, by patients of the opioid-enthusiast type, patients are less willing than ever before meekly to accept a doctor’s advice that, say, an opioid would do them no good. If patients don”€™t get what they want these days, they complain not merely to higher authority, if there is one, but on the Internet, that great magnifier of intemperance and instrument of cowardly revenge. A good doctor for such types is one who does exactly what they want him to do, like a butler or shop assistant. The patient is the customer and the customer is never wrong.

The result has been catastrophic, if the deaths of more than 100,000 people count as a catastrophe. Dishonest drug companies, careless, supine and cowardly doctors, and egotistical patients who will not take no for an answer have between them caused an epidemic that, had it been attributable to a bacterium or a virus, would have caused widespread panic and calls for all the research resources of modern medicine to be brought to bear upon the problem.


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