When doctors get it wrong

Medicine is a series of learning curves. Sometimes we land on our face.

We treated syphilis with mercury.

To reduce allergy, we said no to peanuts before the age of three; now we say yes to peanuts as early as you can.

We peddled estrogen to menopausal women as some fountain-of-youth elixir until 2006 when the Women’s Health Initiative showed hormone replacement could increase the very thing we’d tried to prevent – heart attacks.

We pitched a low-fat diet for those looking to lose weight, having high cholesterol or just good health metrics. It turns out the important thing about fat isn’t how much you consume but what type. Decades of high-carbohydrate diets fueled the nation’s obesity endemic. Yet we’ve done such a good job of hammering that message that when the new 2015-2020 Dietary Guidelines called to remove restriction on dietary fat; it had fewer “likes” than Michelle Obama’s mom dance with Jimmy Fallon.

But none compares to the current crisis of prescription painkillers.

In the ‘80s, there was a push to address pain. (Watch the Oct. 23 opioids episode of “Last Week Tonight with John Oliver” on YouTube for a look at prescription painkillers.) Do you remember feeling all weird when the nurse asked you to rank your pain from 0 to 10 during a routine drug refill, blood pressure check, or before the colonoscopy?

The number of opioid prescriptions has quadrupled since 1999 (Americans now consume 80 percent of all narcotic prescriptions in the world). Pain control is no better. But the misuse of prescription painkillers started a new wave of heroin users, according to the American Society of Addiction Medicine.  

All are paying with hard cash or heartaches. Almost half of people know of an addict personally. Each day, Ohio spends an average $5.4 million on work loss and medical care. With that money, every day we could send 211 students to colleges – four years, all expenses paid.

Recently I, among 2.3 million health care providers, received a Dear John/Jane letter from the big boss. Without finger-pointing, Dr. Vivek Murthy, the U.S. Surgeon General, coaxed with facts and empathy: Come on, guys. We now have more prescription narcotic users than smokers. Don’t treat addicts like criminals. Addiction is a chronic brain disorder. Lend them a hand.

A second letter came from the State Medical Board of Ohio. A little less nuanced, it threatened to cut off our mohawks if we didn’t start tracking narcotic prescriptions by the book.

Pain is complex; it’s injury, inflammation, perception, and part of natural aging. To get a handle on most aches and pains, you need regular exercise, stress and weight management, a can-do attitude – and time. Voltaire famously said: "The art of medicine consists of amusing the patient while nature cures the disease."

What’s not amusing: overuse of painkillers. Things will get worse before they get better. But you and I, we can do this. 

A piece of good news: Data from Monitoring the Future showed the rate of 12th-grade, daily smokers had decreased from 24.6 percent in 1997 to 4.8 percent in 2015. We’ve done it. Well, almost.

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Volume 9, Issue 2, Posted 9:39 AM, 01.24.2017