Confessions of a Drug Lord

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My name is Tiberius Julius Aquila.  My parents had a thing for Roman history.  I live in a little rural village somewhere in the middle of nowhere.  I am called a drug lord, drug dealer, drug pusher, drug runner and other things that I prefer not to mention.  My job is to deliver goods and services to gringo customers that mostly live north of the border between the US and Mexico.  I expect my products to meet the highest standards of quality possible and that my deliveries will be on time every time.

I have been asked to tell you something about drugs that most people do not realize or think about.  In my business, I risk my life every day, so it is important that I know what I am doing and understand the ins and outs of the drug business.  In many ways, the drug business is just like any other business.  We buy materials, convert the materials into a product and attempt to sell the product at a price that will bring a profit and enable us to pay our employees.

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Our small village has only one industry.  We do not have high tech businesses or manufacturing businesses or medical businesses in our village.  We are an agricultural community with three excellent resources.  We have plenty of sun, water and soil.  This enables us to grow some of the best marijuana in the world.  Now some of our local farmers look down on the drug business and that is fine with me.  We need to eat, and non-drug farmers provide good crops to feed my soldiers and workers.  But for those in the drug trade, the profits are outstanding, and the work is year-round with guaranteed benefits.

Of course, there is one way that our business differs from other businesses and this gives us a bad reputation.  There is a lot of violence in the drug business.  I wish it were not so but it is true.  You see, if I ran a legal government licensed business, I would be protected by patents, copyrights, trademarks, anti-trust laws and many other laws that protect a legal business.  But in the drug trade, there is no protection.  The police, the army, do not protect my business or my business associates.  Thus, there is always a great temptation by others to take my business away either by stealing my products or killing me outright and taking over my territory.  Because of this I must use guns and violence instead of lawyers and bankers.  This makes the business always risky and dangerous.

Now, I said that I was asked to provide some facts about the drug business.  The first fact is that without customers I would be out of business in a day.  The USA is a land of drug addicts.  The government there does not like to admit it.  Instead they blame the cigarette companies, the pharmaceutical companies, the whisky companies and of course they blame me and my industry.  My industry includes the Mafia, the Camorra, the Columbian Cartels, The Mexican Cartels, the farmers, the mules and anyone else connected with the production and distribution of illegal substances.  Once we have a good network setup, we often branch out to manufacturing and selling other illegal drugs.  Fentanyl has been very popular of late and profitable.  But it is not easy to branch into other drugs.  There is much competition.

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Most of my customers never notice that the popularity of drugs ebbs and flows.  Some years it is heroin, some it is cocaine, some it is marijuana.  In the states, I must compete with the legal drug dealers who seem able to continually come out with new addictive drugs.  Alcohol is not very popular among illegal operations these days because it takes too long to process.  Good quality alcohol must be aged for years to achieve a peak taste.  Drugs do not age and that is both an advantage and disadvantage.  It is an advantage because we can produce a drug and sell it within a month or so of production.  It is a disadvantage because alcohol is still the most popular drug in the world and we are shut out of this market.

“People use drugs, legal and illegal, because their lives are intolerably painful or dull. They hate their work and find no rest in their leisure. They are estranged from their families and their neighbors. It should tell us something that in healthy societies drug use is celebrative, convivial, and occasional, whereas among us it is lonely, shameful, and addictive. We need drugs, apparently, because we have lost each other.” — Wendell Berry, The Art of the Commonplace: The Agrarian Essays

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There are two kinds of drug users.  We can label them as recreational users and abusive users AKA drug addicts.  Recreational users consume modest amounts of drugs for fun, days off and special occasions.  Abusive users let the drugs consume their lives and are totally out of control when it comes to how much of a drug to use or when to use it.  The abusive users or addicts give our industry a very bad name.  I would be happier if there were no addicts, but I cannot control how people use my products.  It is like in the gun industry where they say that “Guns do not kill people, people kill people.”  I guess I would say that drugs don’t abuse people, but people abuse drugs.  You probably won’t buy that argument, but I thought I would try to run it by you anyway.

I know some of you will be offended by my calling the USA, a land of drug abusers but take a look at the following statistics: (From the Addiction Center)

  • Almost 21 million Americans have at least one addiction, yet only 10% of them receive treatment.
  • Drug overdose deaths have more than tripled since 1990.
  • From 1999 to 2017, more than 700,000 Americans died from overdosing on a drug.
  • Alcohol and drug addiction cost the U.S. economy over $600 billion every year.
  • About 20% of Americans who have depression or an anxiety disorder also have a substance use disorder.
  • On average, 30 Americans die every day in an alcohol-related car accident, and six Americans die every day from alcohol poisoning.
  • About 88,000 people die as a result of alcohol every year in the United States.

Are you ready for another fact of the drug trade?  Here it comes.  “There is no drug war.”  It is a phony war.  A war is a battle between two or more armies.  One side kills the other side and few if any prisoners are taken.  The armies use tanks, helicopters, airplanes, missile launchers and rockets to kill as many of the enemy as possible.   No one is attacking my soldiers except enemies within my country.  The competition that wants to take over my trade is the only army that I fear.  I do not worry about the military or the police.  We pay them enough to look the other way and as long as we limit the violence and mayhem to ourselves, they are happy to ignore us.

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Unfortunately, as with some military endeavors, there are often unintended consequences or as the US Army likes to say some people get killed and they are collateral damage.  We often have citizens who become collateral damage.  This usually gets in the newspapers and is very bad for our business.  We do not like bad publicity any more than other businesses would.  We are much happier with satisfied customers who get a quality product and tell others about our goods.  However, as with any industry, a few greedy people can upset the apple cart and then all hell breaks loose.  I think you saw that recently with the opioid crisis in the USA when a few pharmaceutical companies got very greedy and pushed the sale of large amounts of opioids to people whether they really needed them or not.  Another example from some years ago, was the highly popular company called ENRON which set up an energy business but got greedy and used many shady techniques to lie to their customers and inflate their stock prices.  Several senior executives from Enron ended up with prison terms.  In the end, greed will bring you down.

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The last point I want to make about my business concerns the idea that legalization would eliminate most of the illegal activity and violence associated with the trade.  I believe that this is false.  I am not saying this because legalization would put me out of business.  The fact of the matter is that legalization of drugs typically has one big problem.  It is that the government then decides to take a bite out of the profits.  They call this bite, taxes.  Mind you, they don’t just take a small bite, but they take a very big bite.  On average, federal and state excise taxes on cigarettes in the USA contribute to 44.3% of the total retail price of a pack of cigarettes.  Just to take one example for whisky, nearly 60% of every bottle of Bourbon sold goes to federal and state taxes.  When NY State decided to legalize Off Track Betting, it did cut into the illegal activity of bookie betting but not as much as the authorities had hoped for.  The state wanted winners to pay taxes and the mafia was a tax-free payer.  This meant that winners could bring home more money from illegal gambling than from legal gambling.

As long as I can avoid paying taxes, I will be able to provide my products cheaper than legally licensed drug dealers.  If I can provide a quality product at a lower price, I will remain the Walmart of drug dealers.   Perhaps, I should label my trucks with the logo “Always the lowest.”

Two other reasons that I do not worry about legalization concern both the puritanical and pragmatic interests that seem to govern attitudes towards drugs.   The puritanical people feel obligated to ban drugs because they believe that they are the devil’s weapons to destroy people.  Ever since the days of the Pilgrims there were Puritans who did not like to see people having fun.

“Years of research confirm biblical warnings that alcohol use leads to physical, mental, and emotional damage.”  (e.g., Proverbs 23:29-35)

When it comes to pragmatism, it is clear that politicians want to ensure a work force that shows up on time and is dutifully reliable to the time clock.  People using drugs often have a noted propensity for putting the needs of capitalism second to the needs they are focused on while high on drugs.  You may notice in the statistics above the large dollar amount lost to the USA economy that is attributed to drug use.  How this figure is calculated is a mystery but political attitudes towards drugs have always been hostile and show no signs of abating.  Regard the many years it has taken for the legalization of Marijuana to take hold in the USA.

I hope these “facts” of the drug trade have not been too disconcerting or off putting for you.  I believe that there is too much naivety and ignorance about our industry.  It is fostered for some of the reasons that I have noted in my confessions.  There are no doubt issues that I have missed or not mentioned.  If so, I err because of my perspective and not to deceive you.  I would not want to lose any customers.

“If you want to understand a society, take a good look at the drugs it uses. And what can this tell you about American culture? Well, look at the drugs we use. Except for pharmaceutical poison, there are essentially only two drugs that Western civilization tolerates: Caffeine from Monday to Friday to energize you enough to make you a productive member of society, and alcohol from Friday to Monday to keep you too stupid to figure out the prison that you are living in.”  ― Bill Hicks

3613– Monday, June 10, 2019 – Summer, Never Enough Time!

Calvin and Hobbes once described summer as “Never enough time to do all the nothing you want.”  Sometimes life seems the same way.  The older you get the faster time and things flow around, over and under you.  I have been back from Arizona almost six weeks now and after fixing the car, truck, yard, lawn mower and house, we seem to have skipped spring and went right into summer.  It was 85 degrees here yesterday.  I am still waiting to get started on my new business project and trying to motivate myself to be creative, dynamic and inspirational, at least to myself.

Yesterday, I had the opportunity to speak to a student club at Metropolitan State University.  A good friend of mine (Israel) is one of the faculty advisers to the club and each month they try to hold some type of event to help the students with both life and school.  Israel noted in his closing comments to the group that he had realized school was more than just teaching subjects but that the students who went on to become successful in life had learned character and coping skills.  Israel asked me to talk to the group.  The subject of my talk was the role that discipline plays in our life.

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Discipline is often associated with punishment.  The discipline that I discussed is self-discipline.  I view self-discipline as the commitment and ability to respond to our goals and desires in a meaningful way.  Some people say that discipline is not needed but that motivation is needed. I see things more the other way around.  It takes discipline to become good at anything in life including music, art, sports, dance, acting and business.  It helps if you are passionate about what you are doing.  Karen enjoys playing her dulcimer and practices about an hour each day.  The amazing child prodigy Anke Chen practices five hours a day to play the piano.  She is now eight years old but started playing at four.  When you watch Anke, you see someone having fun and thoroughly enjoying what they are doing.

The problem I had when I was young was not realizing the discipline and dedication it took to become great at anything.  Regardless of how much of a genius you are, regardless of how smart you are or how beautiful you are, without discipline you will eventually fail.  You can survive on pure talent for only so long.  The same goes for beauty and brains.  They will only take you so far.  Look around and you can see the “A list” people who have had life too easy and the only way they can stay on top is with drugs.  Too many great artists and performers have succumbed to the perils of drugs.  Self-discipline is a drug free remedy for a happy and fruitful life.

Now that summer is here, my writing class will start again, although our grand instructor (Dr. Carolyn Wedin) will not be attending due to illness.  Carolyn will very much be there in memory.  Her spirit will hover over each writer and guide us in the use of language and syntax.  Over the years, I have leaned a great deal from these classes about writing and life.

Writing is an art that requires great self-discipline.  There are many days when I don’t feel like writing.  It is not always easy to come up with ideas, words, adjectives, descriptions, narrative, characters, plots, settings and action that will be interesting and unique.  No one wants to hear a story that is boring or mundane.  We read something because it takes us our of our life and puts us into the life of another person.  (Of course, we may also read to learn something.)  We can live vicariously in the character of whomever we are reading about.  Today, you are living in my character.  For a few moments, you are absorbed in my thoughts and feelings and to some degree you know what it is like to be me living in Frederic, Wisconsin, the summer of 2019.

And once upon a time, in a time long ago, two hearts met, and the meeting changed the whole world.

Every time, a writer and a reader meet, it is like two hearts meeting and the world can never be the same again.

“We write to taste life twice, in the moment and in retrospect.”  –Anais Nin

 

 

Where did the Drug Crisis Start?

Where did the “Drug Crisis Start?”  Since 1980 deaths from drug overdoses in the USA have steadily increased every year.  In 1999, the per capita rate of drug deaths (Based on 100,000 people) was 6.1 for all drugs while the rate of deaths from opioids was 2.9.  In 2017, the rate was 21.7 for all drugs and 14.9 percent for opioids.

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Why are so many dying from Opioids?

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This article in the Guardian states that the main reason for the increases was the epidemic created by the pharmaceutical industry in pushing drugs for pain relief for very common problems such as arthritis and back pain. 

Thus, while we arrest drug dealers, the real culprits go scott free and become billionaires on the suffering of the US population. 

Certainly there is a causal link between an aging population, increased obesity, back pain, prescription drugs and drug deaths.  But as we should have clearly seen even twenty years ago, the solution is not more PAIN Killers.”

It should have been obvious to the doctors, pharmaceutical executives, FDA and all of our political leaders.  However, truth and reality are too often forgotten when it comes to making profits.  Greed trumps all other considerations and millions of Americans have become hooked on painkillers to alleviate symptoms that can often be treated with much simpler and more effective solutions.

Lucy in the Sky with Diamonds or “How did our drug laws get so crazy?”

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I wrote this blog four years ago about our ignorant policy and attitudes towards drugs and drug users.  I started it with a satire comparing obese people to drug addicts. You may not like the satire but the problem and analogy is spot on. We have an arbitrary drug policy in this country which hurts millions of people. Witness the incarceration rates for drugs. This article is about the reasons for this stupidity and why we need to change our thinking.

Just this week, I heard two candidates for sheriff in my county talk about the need for stronger drug enforcement and more SWOT teams. The answer is always more police and more arrests. When will we wake up and address the real problems of drug addiction and drug abuse?

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Aging Capriciously

Picture yourself in a boat on a river
With tangerine trees and marmalade skies
Somebody calls you, you answer quite slowly
A girl with kaleidoscope eyes  —- (From the Beatles)(Click here to listen)

lucy_in_sky_with_diamonds_by_weirdplushie-d5r2kziHave you ever wondered why we do not arrest obese people?  What if we treated people who abused food like we treated people who abused drugs?  We could argue “Why don’t we arrest obese people since we arrest drug addicts?”  Do not both of them abuse their bodies?  If you look at the five most common reasons given for drug control policy:  Morality, Health, Profit, Discrimination and Social Control, it could be argued that obesity violates at least four of these principles.  As yet, we do not see too many obese people running amok, but who knows, maybe cases of “Crazed” obese people are just being under-reported.

It seems unfair to me that obese people are…

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Is the War on Drugs Real? — Drugs, Medicine and Pharmaceuticals

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Introduction:

Perhaps few subjects are more complex than the relationship between drugs and medicine.  While the word drug often denotes something “illegal”, medicine comes across with very benign connotations.  Drugs are bad for you.  Medicine is good for you.  However, what is the difference between a drug and a medicine?  Do you have to be sick before it is medicine?  Does everyone occasionally need medicine but no one ever needs drugs?  Why are some drugs legal and others illegal?  Why is it that some legal drugs are illegal unless we have a prescription?  In this blog, I will try to provide you some “divergent” views on drugs and medicines and the Pharmaceutical industry.

Pharmaceuticals:

First, we need to define the term pharmaceutical.  We can find the following definition online:

Adjective:  1.  relating to medicinal drugs, or their preparation, use, or sale.

Noun:  1. a compound manufactured for use as a medicinal drug.

It is important to understand the distinction between the medicinal use and the non-medicinal use of drugs.  Obviously, any drug can be used for either purpose.  However, the “moral” authorities which include the government, your neighbors, various religions and others who believe they have a right to dictate human behavior have used this distinction to decide when it is a crime to use drugs and when it is perfectly okay.  Thus, in many states I may now use marijuana but only if it is for a bona fide medicinal purpose.  If I want to simply use it like I use alcohol or caffeine or nicotine for recreational purposes, it is illegal and I will find myself in jail if I get caught.

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This distinction between drugs and medicine is further complicated by the fact that some drugs are simply considered “bad” drugs whether they have a medicinal use or not.  This category of “bad” drugs once included alcohol when (as many of you are aware) the 18th amendment to the US Constitution was passed to ban its legal use.  Prohibition was perhaps one of the most misguided episodes in American history.  However, it does have the unique distinction of being perhaps the only time in our history when a substance was banned strictly on moral terms.  The prohibition against alcohol was primarily based on the idea that drunkenness was a threat to the moral fiber of the nation.   Since then, our “War on Drugs” has been based on several reasons but morality is no longer a major reason.

Let’s get one thing clear from the start.  There is no “War on Drugs” in the USA.  If there were a war on drugs, then bars, cigarette shops, coffee shops, liquor stores, drug stores and doctors’ offices would be raided and closed.  Doctors, baristas, druggists and Pharmaceutical CEO’s would be arrested along with the rest of the drug pushers on the street.  We would need to build an entire prison system to house all the pharmaceutical executives, managers and workers who routinely make and sell drugs.

The “War on Drugs” is a sham, a myth and a hypocrisy of epic proportions.  There are two reasons for this so-called war.  The first is prejudice and the second is monetary.  These two reasons are curiously intertwined.

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Prejudice as a Factor in the Drug Wars:

Our prisons today are overflowing with people who have used or sold illegal street drugs.  Drugs like heroin, cocaine, marijuana and methamphetamines make up the bulk of illegal drugs sold on the street.  The majority of people selling these drugs are poor.  Minorities make up a disproportionate number of the poor in America.   Consider the following facts:

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Poverty rates for blacks and Hispanics greatly exceed the national average. In 2014, 26.2 percent of blacks and 23.6 percent of Hispanics were poor, compared to 10.1 percent of non-Hispanic whites and 12 percent of Asians.National Poverty Center

Of course, if minorities are a large percentage of the poor and if the drug war is really an attack on the poor, then it should follow that minorities will make up a larger percentage of those convicted of drug crimes and sent to prison.  The facts support this:

  • African Americans now constitute nearly 1 million of the total 2.3 million incarcerated population
  • African American and Hispanics comprised 58% of all prisoners in 2008, even though African Americans and Hispanics make up approximately 25% of the US population
  • About 14 million Whites and 2.6 million African Americans report using an illicit drug
  • 5 times as many Whites are using drugs as African Americans, yet African Americans are sent to prison for drug offenses at 10 times the rate of Whites

The facts support that the so-called “War on Drugs” is really a war on the poor.  Why war on the poor?  Because they are regarded as a threat to the lifestyle of the wealthy.  The wealthy in America are of course predominately White.

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“96.1 percent of the 1.2 million households in the top one percent by income were White, a total of about 1,150,000 households. In addition, these families were found to have a median net asset worth of $8.3 million dollars.”  — America’s Financial Divide: The Racial Breakdown of U.S. Wealth in Black and White, Huffington Post, 2015

It is seldom mentioned but wealthy people are fully aware of the fact that healthy non-drug addicted citizens make better workers.  Furthermore, non-drug addicted people who are addicted to hard work are less likely to break into your house in the middle of the night and steal your Gucci purse and your Rolex watch.

On the other hand, if you are poor and uneducated, drugs might seem like a decent way to spend a day rather than knocking on closed doors for a job.  I spent four years in the military from 1964 to 1968.   Any war is an ideal breeding ground for drug use.  Consider the daily effects of stress, confusion, attacks, wounds, death and uncertainty.  The military was rife with drugs when I was in.  Would anyone like to guess how much illegal drug use there was during the Vietnam War?

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“In 1971, a report by the House Select Committee on Crime revealed that from 1966 to 1969, the armed forces had used 225 million tablets of stimulants, mostly Dexedrine (dextroamphetamine), an amphetamine derivative that is nearly twice as strong as the Benzedrine used in the Second World War. The annual consumption of Dexedrine per person was 21.1 pills in the navy, 17.5 in the air force, and 13.8 in the army.”  — The Drugs That Built a Super Soldier, The Atlantic, 2016

 The above article concerns speed only and does not deal with marijuanaMy own personal experience was spending many weekends high on pot mixed with copious amount of whatever liquor we could get our hands on.  Beer would do if liquor was not available.  There were also many who simply sniffed glue and destroyed their brains.  To the best of my knowledge, I knew of no one who was ever busted for drug use on any base I was stationed at.  The moral is that it is okay to use drugs if they help you kill people but not simply to feel good about yourself.

The sanctimonious politicians who make drug laws in this country should be shot.  Am I being too “divergent” in my condemnation of these hypocrites?  Believe me, I could not be too hard on them.  Consider the damage that their greedy misguided policies have done to our nation and our citizens.  Millions of people have languished in jail only to serve their sentence and find that when they come out, they are even worse off than when they went in.

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Consider the effects of a felony record for drugs in America:  A convicted felon in Connecticut faces the following array of restrictions and constraints:

  1. Loses the right to become an elector and cannot vote, hold public office, or run for office, although he can have these rights restored
  2. Is disqualified from jury service for seven years, or while he is a defendant in a pending felony case (CGS § 51-217)
  3. Loses the ability to have firearms
  4. Could lose a professional license or permit,
  5. Employers can ask job applicants whether they have been convicted of a crime although federal anti-discrimination laws place some restrictions on the use of criminal histories.
  6. The State Board of Education (SBE) cannot issue or renew, and must revoke, a certificate, authorization, or permit to someone convicted of certain crimes. The SBE can also take one of these actions if the person is convicted of a crime of moral turpitude or of such a nature that the board feels that allowing the holder to have the credential would impair the credential’s standing.
  7. The Department of Children and Families must deny a license or approval for a foster family or prospective adoptive family if any member of the family’s household was convicted of a crime that falls within certain categories, which can include felonies.
  8. Landlords can evict a tenant who was convicted of a violation of federal, state, or local law that is detrimental to the health, safety, and welfare of other residents. Federal and state law for public housing allows eviction based on conviction of certain felonies. Different rules apply to elderly people.
  9. Someone convicted under federal or state law of a crime involving possession or sale of a controlled substance is not eligible for federal assistance for higher education expenses for certain periods.
  10. State law bars anyone convicted of a drug possession or use felony under federal or state law from receiving benefits under the temporary assistance for needy families or food stamp programs unless the person (1) has completed his court imposed sentence, (2) is satisfactorily serving probation, or (3) completed or will complete a court imposed mandatory substance abuse treatment or testing program (CGS § 17b-112d).

You have served your sentence for possession of a marijuana joint.  You might have served between one and five years.  You are now ready to return to society and be a hard-working honest citizen.  Regard the above list!  No one will hire you. You cannot get a student loan.  You cannot get certain licenses and even some landlords will be legally able to not rent you a place to live.  What would you do?  What would Jesus do?  Well, unfortunately, many of these people are not you and they are not Jesus.  Thus, a life of crime on the street seems to offer more preferences for some than begging for money with a cup.  Besides, every business endeavor has certain risks and the gains from drug dealing may seem to far outweigh the risks, particularly when you consider the alternatives.

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What Role Does Greed Play in the So-Called War on Drugs?

Pharmaceutical companies are huge and make huge profits.  They are consistently listed among the top most profitable companies in America.  Here are the top ten most profitable drug companies by market value:

  • Johnson & Johnson: $276 billion (market value)
  • Novartis: $273 billion
  • Roche: $248 billion
  • Pfizer: $212 billion
  • Merck: $164 billion
  • Sanofi: $134 billion
  • Bayer: $123 billion
  • Novo-Nordisk: $118 billion
  • Bristol-Myers Squibb: $115 billion
  • AbbVie: $110 billion

In 2016, the Pharmaceutical Industry was at the top of the list for most profitable industries.  Forbes, citing data from Factset, recently released its list of the 10 most profitable industries of 2016. “Pharma: Generic” led the way as the most profitable industry with a 30 percent net profit margin”

  1. Pharma: Generic: 30%
  2. Investment managers: 29.1 percent
  3. Tobacco: 27.2 percent
  4. Pharma: major: 25.5 percent
  5. Internet Software and Services: 25 percent
  6. Biotechnology: 24.6 percent
  7. Savings Banks: 24 percent
  8. IT Services: 23 percent
  9. Regional Banks: 23 percent
  10. Major Banks: 22.9 percent

https://www.surepayroll.com/resources/blog/the-10-most-profitable-industries#sthash.rVW6a7fs.dpuf

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Please note where the tobacco industry is on this list.  Now ask yourself this question.  Do you think either big Pharma or Big Tobacco wants competition in the form of legalized drugs?  I hope you answered NO! to this question because there is ample evidence that both industries spend a great deal of money lobbying against drugs that would pose competition to their industries.

“Both pharmaceutical companies and alcohol brands are spending money to keep prohibition around, too.  As we reported last year, certain anti-cannabis academics are funded by big pharma.  Alcohol companies are also lobbying against legalization.  In one example, the California Beer & Beverage Distributors made campaign contributions to a committee dedicated to preventing marijuana legalization and taxation. 

 To summarize, police unions, prison guard unions, for-profit prisons, and drug and alcohol companies spend huge sums of money each year to keep cannabis illegal, and why?  Because it ensures job security and profits.”  — The Top 5 Industries Lobbying Against Cannabis Legalization Will Infuriate You by Sara Lilley in Leafly

Perhaps you are inclined to think that the prejudice and greed fueling the drug industry is not that bad.  Perhaps you do not mind that America has one of the highest rates of incarceration of any developed country.  Perhaps you do not mind that millions of your citizens are in jail for smoking or selling a joint.  Perhaps you are happy smoking and drinking and do not want any other drugs.  Maybe you feel that “Big Pharma” is on your side and helps you with all the new medicines they have coming down the pipeline.  If so, you are living in a fools’ paradise.  Big Pharma is more likely to steal from you and or kill you than the drug pusher on your street corner.  In fact, they do so every single day.

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They steal from you with exorbitant profits.  Who do you think pays for all their advertising and research?  They actually spend more money on advertising than they do on research.

“Prescription drug companies aren’t putting a lot of resources toward new, groundbreaking medication, according to a recent report in BMJ, a medical journal based in London. Instead, it’s more profitable for them to simply to create a bunch of products that are only slightly different from drugs already on the market, the reports authors said.  The authors go on to say that for every dollar pharmaceutical companies spend on “basic research,” $19 goes toward promotion and marketing.” — Pharmaceutical Companies Spent 19 Times More On Self-Promotion Than Basic Research: by Alexander Eichler

Big Pharma also leads all industries in spending your money on lobbying.  From 1998 to 2016, they spent over 3.5 billion dollars on lobbying.  This was more than a billion dollars higher than for the next highest industry which was insurance.  — Top Industries.

ee545df3eb331cc722ed7088791e9a5eAre you still wondering why drug costs are so high? Did you really think it was all research and development costs?  The three major factors are:  Profits, lobbying and Marketing.  How much do you think these all add to the costs of your prescription drugs?

Well, perhaps you still do not care.  After all, if the drugs do their job, what do you care if they cost a lot.  Perhaps your insurance pays it all anyway.  Well friend, what if you knew some of these drugs were going to kill you?  Do you think I am exaggerating?

Here are some examples of potentially lethal side effects:

“Baycol, which lowers cholesterol, was strongly linked to a potentially fatal breakdown of muscle tissue.  Approved in 1997, it was voluntarily withdrawn four years later.  The anti-inflammatory drug Duract spent just one year on the market. Approved as a strictly short-term use product, the FDA found serious liver problems with people taking the drug for longer than what was recommended.

In 1985, employees of two drug companies were fined and/or sentenced to community service for not reporting adverse events involving the blood pressure drug Selacryn and arthritis drug Oraflex.” — Drug Side Effects Explained

Of course, drug companies do not want to kill you because that could result in costly litigation and even worse, bad publicity.  Thus, most drugs come with a lengthy disclaimer and long list of potential side effects.  These are more designed to protect the drug company than you or your health.  You will probably not be able to read the small print on the label and even if you are able, you will probably not have a clue what they are talking about.  On the odd chance that you do know what it all means, it would not matter anyway, since what is your recourse?  If you are in pain and have gone through the process of obtaining your prescription how likely are you to decide that you will not take the risks associated with the drug?  But, and here is the important “but”, all drugs, even over the counter drugs have potential side effects.

viagra

And this brings us to another major factor affecting the cost of drugs.  This is the cost for Big Pharma to cover its butt when caught doing something wrong.  A report by Pubic Citizen noted the following information:

In December 2010, Public Citizen published a report that, for the first time, documented all major financial settlements and court judgments between pharmaceutical manufacturers and the federal and state governments since 1991.  At the time of the report’s publication, almost $20 billion had been paid out by the pharmaceutical industry to settle allegations of numerous violations, including illegal, off-label marketing and the deliberate overcharging of taxpayer-funded health programs, such as Medicare and Medicaid.  Three-fourths of the settlements and accompanying financial penalties had occurred in just the five-year period prior to 2010.  At the time of the report’s publication, there was no indication that this upward trend was subsiding.

adhdThere are many other egregious practices that go on in Big Pharma and which are beyond the scope of this blog.  My point in writing this was first to help alert you to the hypocrisy of the so-called drug wars and second to bring to your attention the inordinate amount of effort and money that Big Pharma spends in trying to get you to buy their drugs.  If you watch TV or read any mainstream magazines, you cannot help but become inundated with ads for drugs to cure any problem you can think of.

larrythecableguyprilosecThe drug companies are the biggest pushers of drugs in the world today and all for a profit.  The fact that these drugs may help your condition is very secondary to Big Pharma’s primary goal which is profits.  The fact that many drugs should not be taken long-term and may have life threatening side effects is also not particularly important to the drug industry.  Between the ignorance of many medical doctors anxious to provide a fast treatment and the greed of the drug industry, you had best become a very informed and cautious consumer of any drugs you are going to take.  You should also be skeptical of any information provided by the drug industry.

Time for Questions:

What medications do you take?  Why?  What has been your history with drugs?  How informative has the drug information you have received been?  What do you think about all the drug advertising on TV and in magazines?  Do you think we live in an addicted society? Do you think the Drug War is real?

Life is just beginning.

 “People use drugs, legal and illegal, because their lives are intolerably painful or dull. They hate their work and find no rest in their leisure. They are estranged from their families and their neighbors. It should tell us something that in healthy societies drug use is celebrative, convivial, and occasional, whereas among us it is lonely, shameful, and addictive. We need drugs, apparently, because we have lost each other.”  ― Wendell BerryThe Art of the Commonplace: The Agrarian Essays

 

 

 

 

 

Is Chiropractic an Art or a Science? 

When I grew up on the East Coast, I had little or no contact with chiropractors.  Back then, most people I knew and most medical centers did not regard them as real medical practitioners.  Years later, after I came out to the Mid-West, I found a much wider acceptance of chiropractors.  Over the past 40 years of living in Minnesota and Wisconsin, I have known many people who have gone to chiropractors and who firmly believe that they were being helped.  Most of the people I have known were suffering from back problems.  Here is one comment regarding chiropractors from an obviously very satisfied patient:

“I go to a chiropractor irregularly, usually when my neck is bothering me.  He uses heat, ultrasound, and massage therapy to undo the tension in my back and neck, caused by two vertebrae in my back that have been out of alignment since I was 16.  I go away, and am usually good for another 6 months.

I’ve never had a chiropractor offer to cure anything, from gallstones to depression by cracking my back; I’ve never had one suggest I needed to try any homeopathic remedies; I’ve never had one claim my bipolar disorder was all due to a misaligned spine. When I did have gall bladder trouble, my then chiropractor told me to see my primary care doctor post-haste.”

reno-chiropractor-940x627

If chiropractic medicine has any single claim to fame it is in dealing with back and skeletal muscle problems.  Chiropractors are famous for treating such problems with spinal manipulation and “adjustments.”  Often the diagnosis given to the patient will include the claim that the patient has a “pinched” nerve or some type of “subluxation”.  The patient spends an hour or so with the doctor getting an adjustment to treat the problem.  Many patients will then leave feeling much better then when they arrived.  They will also be out between 65 to 200 dollars per visit.  In most states, Chiropractic medicine is recognized and eligible for insurance reimbursement.

“Medicare does cover medically necessary chiropractic services.  According to the CMS,  Medicare Part B now covers 80% of the cost for ‘manipulation of the spine if medically necessary to correct a subluxation.’  There is no cap on the number of medically necessary visits to a chiropractor.”  — Does Medicare Cover Acupuncture or Chiropractic?, Senior 65

OK, so far, we have happy patients, insurance reimbursement in most states and Medicare coverage for chiropractic service, so what is my problem with chiropractors?  What if it is an art, what’s wrong with that?  Well, an art is something that as opposed to a science does not have objective reproducibility.  There is little or no evidence for cause and effect in an artistic relationship.  From an art, we would expect a much wider variation of results then we would get from something that has demonstrated scientific reproducibility.

“Chiropractic theory and practice are not based on the body of knowledge related to health, disease, and health care that has been widely accepted by the scientific community.

 Most chiropractors believe that spinal problems, which they call “subluxations,” cause ill health and that fixing them by “adjusting” the spine will promote and restore health. The extent of this belief varies from chiropractor to chiropractor. Some believe that subluxations are the primary cause of ill health; others consider them an underlying cause.” —- Twenty Things Most Chiropractors Won’t Tell You  by Dr. Preston H. Long

Another way of looking at the difference between and an art and a science lies in the ability to assign risk factors.  With a science, we should be able to assign a probably of risk in terms of outcomes.  With an art, we cannot reliably assign risk factors since they have no bearing in empirical outcomes.  What difference does this make to a potential chiropractic patient?  It should make a great difference since their chances of getting an accurate diagnosis for many potential problems is much less with chiropractic medicine than with traditional medicine.  Here are two comments from people who have gone to chiropractors.  These comments are from the http://www.spine-health.com forum and website.  The subject was: “Does chiropractic treatment help with pinched nerves:”

“Chiropractic “medicine” deals with the musculoskeletal system. However, many chiropractic offices use TENS therapy, which stimulates the nerves. Most of my back problems come from nerve issues and I have personally never found relief from chiropractic, in fact, it made me worse. But this is only my personal experience. My portable TENS unit helps me; I would ask the doctor who is managing your condition if TENS therapy may be right for you. Good luck!”

“In my case, I made the biggest mistake in my life, I was complaining about little pain in my knee but my chiropractor damaged my upper back T5 and T6 which I’m suffering now with a lot of symptoms nerve pain in between my shoulder, legs , arms , headache ….., I’ll never advise anybody to go to the chiropractor , and this is my own  experience.”

Anecdotes and grievances do not prove a case against chiropractic.  However neither do testimonials from satisfied patients prove the efficacy of chiropractic treatment.  It can be argued that the placebo effect will explain much of chiropractic’s reported success.  I have often argued that massage therapy will produce the same results with lower cost.  Some evidence exists to support my contention.

“A study called Patterns and Perceptions of Care for Treatment of Back and Neck Pain appeared in 2003. The studied questioned over 2,000 people on how they dealt with their aches and pains. Massage took home the gold with people preferring it to chiropractic for any kind of back pain or general body pain, but chiropractic led the race in upper-back pain and neck pain. Even with these results, visits to chiropractors were much more common than visits to massage therapists.”  — Chiropractor Vs. Massage

The above study notes that more people go to chiropractors than massage therapists.  You might wonder why?  Especially since seeing a massage therapist will cost you about 1/2 to 1/3 the cost of seeing a chiropractor.  I propose that the reasons for this propensity of people to prefer chiropractors to massage therapists lies in the more successful lobbying and marketing that chiropractors have done.  A second and related reason is that massage therapy will generally not be covered by most insurance plans or Medicare.  The following applies to Medicare coverage for massage reimbursement:

“Original Medicare does not cover massage therapy. Services that are not covered by Medicare are the sole responsibility of the patient.  In some cases, Medicare Part B will cover chiropractic services if they are medically necessary and are meant to correct a subluxation of the spine. In most cases, Original Medicare pays 80% of the cost for this treatment, but the patient is responsible for the other 20% and all other tests and services performed by the chiropractor.” —  Does Medicare Cover Massage Therapy?

Note that in the above description that chiropractic care is covered but massage therapy is not.  The lobby for chiropractors is much more powerful than the lobby for massage therapists.  This latter fact demonstrates that the type of medical care and medical coverage you are eligible for will be determined not by objective scientific facts but by political persuasion and money spent by lobbyists.  How does that make you feel?  But let’s get back to chiropractic treatments and look more specifically at “adjustments”.  This is the bread and butter treatment for chiropractic patients.  Do you need them?  Will they help you?

Chiropractic Adjustments:

chiro with an adjustmentIf homo sapiens have a weak link in their skeletal structure it is the back.  It has been argued that the problem arose when we switched from hanging in trees to walking upright.  Whatever the cause, back problems are easily the most common and perhaps one of the most painful problems faced by Americans today.  I have heard it said that the “opioid epidemic” is really a “pain epidemic” as more people age and have to deal with back problems, knee problems and hip problems.  No one beset by continuous pain can be blamed for wanting to find an escape from that pain.  However, as I noted in the previous blog, this desire to escape pain often leads to bad choices.  Surgery is too often prescribed when other treatment modalities would be more effective with less side effects.  This brings us to the issue of chiropractic adjustments for back pain.  How effective are they?  Here is another comment from Dr. Preston H. Long regarding the effectiveness of spinal manipulation:

“Research studies that look at spinal manipulation are generally done under strict protocols that protect patients from harm. The results reflect what happens when manipulation is done on patients who are appropriately screened—usually by medical teams that exclude people with conditions that would make manipulation dangerous. The results do not reflect what typically happens when patients select chiropractors on their own. The chiropractic marketplace is a mess because most chiropractors ignore research findings and subject their patients to procedures that are unnecessary and/or senseless.”Chiropractic Abuse: An Insider’s Lament Paperback – 8 Oct 2013, by  PhD. Preston H Long D.C

abuse

I highly recommend you read the book by Dr. Long.  If you are going to go to a chiropractor, you should have a realistic assessment of finding out your chances of getting help and relief.  Too many people leave their medical treatment entirely in the hands of so-called experts.  This is a big mistake.  I will discuss this later in another blog, but you need to be a strong advocate for your health care and not trust any one medical practitioner too much.  How much is too much?

 

  • It is too much if you are uninformed and have done little or no research into the causes and treatments of your illness.
  • It is too much if you expect that your treatment will take the place of discipline and hard work on your part.
  •  It is too much if you would rather get surgery than lose weight or exercise.
  •  It is too much if you expect that your doctor will advise you to pursue less invasive treatments before surgery or pills.
  •  It is too much if your doctor is overweight, has no exercise program of his/her own or smokes.
  •  It is too much if you have not pursued a second or third opinion.
  •  It is too much if your doctor cannot show you fairly persuasive evidence of a diagnosis and an empirically related treatment modality.

Conclusions:

For the record, I have no vendetta or grudge against chiropractors.  However, it has been my observation that they often treat many problems that they are not competent to treat or that have not had a proper diagnosis.  I have seen too many friends go to a chiropractor and not have a long-term fix to their pain or problem.  Chiropractors may offer a good short term fix to some pain problems but usually no long-term fix.  For the record though, massage, surgery and pills do not usually provide a long-term fix and with surgery, there will usually be consequences that the patient was probably not aware of.

(For more facts on the pro’s and con’s of chiropractic treatment see “Evidence for Chiropractic Treatment“) 

Chiropractors are no better than regular medical doctors when it comes to dealing with the underlying cause of pain.  Sadly, some of the problem for hasty diagnosis must be laid on the patient’s doorstep.  Many pain sufferers want either instant relief or relief that will entail little or no effort on their part.  Doctors too readily give into this desire either because of the financial remuneration that awaits them for treatment or laziness or perhaps simple ignorance.  My skeptical side says that giving a patient an exercise program or diet program is not nearly as lucrative as treating the patient with adjustments or surgery.  Back surgery will generally cost between 50k and 100k.  Spinal adjustments may take place for up to 6 months and final costs may total nearly $5000 dollars (computed as 50 treatments multiplied by an average cost of $65 dollars per treatment.)

On the positive side, there are many chiropractors who offer an alternative to the pills and surgeries so often recommended by mainstream medical doctors.  Perhaps because they have been viewed as less professional by traditional medicine, many chiropractors have considered a variety of non-traditional treatment options.  Many of these treatments are not very scientific or have no proven scientific effectiveness but this does not mean that they may not be effective.  Scientific proof has often taken many years to prove things that traditional folk medicine long knew was true.  However, there is a drawback in delaying some treatments to pursue unscientific remedies.  For instance, when I was diagnosed with prostate cancer, I decided to pursue a “wait and see” or “active surveillance” policy.  I was not ready to accept either the PSA reading or the biopsy or even the MRI results.

During my wait and see time, I opted to try some herbal remedies that were reported to have some success with prostate cancer.  I started taking several of these remedies each day in the hopes that a future biopsy would show a decrease in cancer cells or even the disappearance of my cancer.  No luck.  My next biopsy and a third biopsy all showed increases.  In addition, my Gleason score and PSA scores kept going up.  I now risked the danger that the cancer would spread out of my prostate and migrate to other organs.  It was time for surgery.  Not to pursue surgery at this point would have been foolish and even hopeless.

Thus, there is an ever-present danger that pursuing treatment programs that are a dead end might endanger your life and prevent you from going down more fruitful paths.  There is a reason that many people pursue such options.  It is called “hopefulness.”  I cannot blame anyone for this outlook.  I too was hopeful that I could keep my prostate and continue to pursue a normal life.  Many people go to chiropractors rather than medical doctors in the hope that they will find a cure beyond pills and surgeries.  Some do and some don’t.

Time for Questions:

Have you ever been to a chiropractor?  Why or why not?  Did you find them helpful?  Why?  What evidence did your doctor provide to show why he/she gave you the diagnosis you received?  What kind of exercise program do you follow?  Do you think people without an exercise program are higher risks for medical problems and pain?

Life is just beginning.

“The doctor of the future will give no medicine, but will interest his patients in the care of the human frame, in diet and in the cause and prevention of disease.” – Thomas A. Edison

 

 

 

 

 

 

 

 

 

 

 

 

Should We Be Cautious When Seeing Our Family Doctor?

can you trust your doctor

This is the first of the ten perspectives I am going to discuss about medical care in the United States in the 21st Century.  Before I begin, I have already warned you that if you regard physicians as gods or if you love your MD for saving your life and cannot bear to hear anything wrong about the medical profession, you should probably not read what I am going to say.  One of my friends on Facebook sent me this message or caveat:

“I practiced medicine for 30 years. Be careful about generalizing. I got burned out, I cared. I saw the whole person. I’m not unusual. Medicine is hard. You are always looking over your shoulder. Afraid to be sued. We go into this not for money but to help. Really. Believe it.”

I am quite sure that what she says is true.  True for some.  Not true for others.  Is it the majority?  I don’t know.  But there are a lot for whom the medical system is not working and even more importantly for whom it is dangerous and harmful.  Let’s start with some specifics.

After writing and publishing this blog, a good friend of mine reviewed it.  He had a very different perspective on things than I present.  Together, we are like the Yin and Yang. I see the negative side of things and he sees the positive side of things in the medical profession.  It is my belief that we need to see more of the problems with our medical practices and bring them out so that they are more transparent.  Nevertheless, I realize that there are thousands of medical people who work hard and try to do their best to help their patients.  Thus, I am going to print Fred’s letter to me following my comments.  I hope this will “balance” out my negativity somewhat and create a more balanced view of American medical practice in the 21st century.  (Thank You Fred for taking the time to send us your thoughts.)

  1. Number of Needless Surgeries that are Done

There are many people who are enamored with surgery.  There are an equal number of doctors who are enamored with surgery.  When anyone in the first group goes to anyone in the second group, you can bet that surgery will be the answer to all their problems.  AbracadabraAnd like magic, their hip pains, knee pains and back pains will go away.  The patients are joyous, (unless they die on the operating table like my friend did last summer after going in for a hip replacement).  The doctors are joyous since they are thousands of dollars richer and of course the hospitals are also joyous since they too are also thousands of dollars richer.

signs-that-you-should-see-a-doctor-physical-therapyHave you ever heard of a doctor turning anyone down for back surgery, knee surgery or hip surgery by telling them that they are overweight and would be better served by an exercise program or by physical therapy?  If so, I can guarantee they are not typical of most medical practitioners.  How many doctors look at the major cause of back, knee and hip problems and try to deal with that?  Impossible, because doctors do not treat you over a lifetime.  You don’t see a doctor until you have a problem and by then it may be too late.  Surgery is the fastest solution because exercise, dieting and physical therapy take discipline and time.  Doctors do not want to tell you the truth because it is an inconvenient truth but many problems should not be treated by surgery until it is a last resort.  Too often, it is the first resort.

  • Data show that 10% to 20% of some common surgeries are done unnecessarily – USA Today – June 20th, 2013
  • “I think there’s a higher percentage who are not well trained or not competent to determine when surgery is necessary, Santa says. ‘Then you have a big group who are more businessmen than medical professionals — doctors who look at those gray cases and say, ‘Well, I have enough here to justify surgery, so I’m going to do it.” — USA Today

Here per the study reported by USA Today are the six leading surgeries that often performed and just as often not needed:

  • Cardiac Angioplasty, Stents
  • Cardiac Pacemakers

Pacemakers are used to correct heartbeat irregularities, but research shows that more than 22 percent of these implants may be unnecessary.

  • Spinal Fusion Back Surgery

lumbar-spine-surgeryIf you have low back pain and see different specialists you will get different tests: rheumatologists will order blood tests, neurologists will order nerve impulse tests, and surgeons will order MRIs and CT scans. But no matter what tests you get, you’ll probably end up with a spinal fusion because it’s one of the “more lucrative procedures in medicine,” author Shannon Brownlee says – even though the best success rate for spinal fusions is only 25 percent!

  • Hysterectomy
  • Knee and Hip Replacement, and Arthroscopic Knee Surgery

Patients who were informed about joint replacements and alternative treatments had 26 percent fewer hip replacements and 38 percent fewer knee replacements than those who did not. Arthroscopic knee surgery for osteoarthritis is also one of the most unnecessary surgeries performed today, as it works no better than a placebo surgery.

Proof of this is a double-blind placebo-controlled multi-center (including Harvard’s Mass General Hospital) study published in one of the most well-respected medical journals on the planet, the New England Journal of Medicine (NEJM) over 10 years ago.

knee surgeryRecent research has also shown arthroscopic knee surgery works no better than placebo surgery, and when comparing treatments for knee pain, physical therapy was found to be just as effective as surgery, but at significantly reduced cost and risk. And yet another study showed exercise is just as effective as surgery for people with chronic pain in the front part of their knee, known as chronic patellofemoral syndrome (PFPS), which is also frequently treated unnecessarily with arthroscopic surgery.

  • Cesarean Section

According to the World Health Organization, no country is justified in having a cesarean rate greater than 10 percent to 15 percent. The US rate, at nearly 32 percent, is the highest rate ever reported in the US and is higher than in most other developed countries.

The USA Today article went on to talk about many diagnoses that were based on limited medical knowledge and that doctors often lacked the expertise to explore alternative treatment modes.  This is an issue of incompetence and it seems to be a major problem in the medical field with many doctors getting their information from their pharmaceutical representatives.

I have not even touched on the issue of malpractice.  But I will say a few words about this.  No one is perfect.  Everyone makes mistakes.  Medical treatment and diagnosis is a very difficult process.  I will not blame any doctor for an honest error committed with good intentions and not simply out of ignorance or greed.  This is one area where I sympathize with the doctors and hospitals more than I do the lawyers.  Nevertheless, there are some egregious examples of medical practice and a lawsuit might be the only recourse for such cases.

I use the information from the USA Today article, but none of it surprises me.  I have had many friends who have undergone surgery for the situations noted above. I have often tried to counsel them as to other solutions but it is generally a waste of time.  I have had two notable successes though and they have both expressed their gratitude to me for sharing my opinions and thoughts with them and preventing them from getting surgery.

drugs

  1. Pills, Pills and more Pills

If life were fair, many doctors would be in jail right alongside of other drug dealers.  Doctors do not have the violence associated with illegal drugs because they have a license to prescribe drugs.  However, doctors prescribe drugs that are no more needed than heroin or cocaine and at much greater rates than your street drug pusher.

The size of the illicit drug trade (2012 data) in the USA including Marijuana, Heroin, Cocaine and Methamphetamines was estimated to be about 100 billion dollars a year.  —- How Big is the U.S. Market for Illegal Drugs?  We can assume that street dealers and drug pushers are responsible for most of these drugs.  So how much do doctors push?

If we look at the following fact, we can extrapolate from it the total amount of prescription drugs sold each year in the USA.

“In 2013, per capita spending on prescription drugs was $858 compared with an average of $400 for 19 other industrialized nations. In the United States, prescription medications now comprise an estimated 17% of overall personal health care services. —  The High Cost of Prescription Drugs in the United States (2016). 

deaths from over druggingSo if we assume roughly 326,000,000 (USA Population in 2016) people and we multiply that by $858 dollars per capita, the total amount should equal the total amount spent on prescription drugs.  This amount equals = $279,708,000,000.  This is almost three times what is being spent on illegal drugs.  I am not even going to talk about caffeine, alcohol, nicotine, and other “legal” drugs.  Given that doctors love to prescribe pills and many patients love to take them, is there any wonder that we have or are currently experiencing an opioid epidemic in the US.

“Americans are in more pain than any other population around the world. At least, that’s the conclusion that can be drawn from one startling number from recent years: Approximately 80 percent of the global opioid supply is consumed in the United States…. The 300 million pain prescriptions equal a $24 billion market.”  — Americans consume vast majority of the world’s opioids (2016).

I say again that if life were fair, many doctors would be called drug pushers or DP’s rather than MD.’s   They would also be in jail.  Who should be responsible for the opiate epidemic if not doctors.  When and where do they stand their ground.  Even if people are stupid or lazy enough to want surgeries to cure problems of obesity and diet or if they want pain killers to mask the problems from their obesity and lack of exercise, who is the expert here?  Do parents give their children everything they ask for?  You go to an expert on medicine to get help and not to have them take advantage of you for their own benefit or pander to you because they are afraid to tell you the inconvenient truth.  What is this inconvenient truth?  I will talk more about this truth later in this series but to be quite direct and blunt it is this:

“British businesswoman and columnist Katie Hopkins has a controversial view on the obesity epidemic: that the solution is simply to eat less and exercise more — and that fat people have no one to blame for their weight issues but themselves.” — I gained 43 pounds to prove obese people are lazy

I had a friend that I used to ride motorcycles with.  He died in a motorcycle crash a few years back.  He was a great guy.  He always had a smile and something nice to say to someone.  His name was Gary.  He was also obese and exercised little.  He had chicken legs and bad knees.  Well, what would you expect if you weighed 100 lbs. more than you should and you let your leg muscles go to hell.  Of course, he went in to see his doctor with knee pains.  The doctor was more than happy to suggest Gary should lose some weight but in the meantime, he would schedule the surgery for knee replacement.  To my mind, this is criminal, irresponsible and ignorant behavior on the part of his doctor.  Gary got the surgery.  Never lost much weight and died not too long after from other causes.

Doctors pushing pills, pushing surgery.  It is like the Yin-Yang of American medical practice.  Throw into the mix a lot of lazy people who do not exercise or take care of themselves and you have a health care system spending tons of money on acute care when preventive care would be a much more sensible solution.

  1. Me Doctor, Me Busy.  Who are You?

Some of you might remember the skit on Saturday Night Live with Martin Short playing a doctor.  When asked what his badge that said MD meant, he would reply somewhat superciliously “Me Doctor, You Patient.”  When I was working as a consultant to some hospitals, it was not uncommon to hear nurses complain that doctors were like gods whose every word should be obeyed.  They seldom came to team meetings because “their time was too valuable.”

I will stay away from the subject of how much money doctors rake in since they often ascribe their high incomes to the length of time it takes to finish medical school and all of the attendant costs.  This sounds like a reasonable explanation but an alternative theory might mention the strangle hold that the AMA had on medical admissions and the role that restricting the supply of doctors has had on the cost of their services.  The law of supply and demand says that if you have fewer doctors, the cost per care will be higher.  For years, the AMA did all they could to help keep the supply of doctors down.

  • But the entities that will be most injurious to the nation’s health are not so much in the evil-mongers’ group but the first group, including the American Medical Association–a doctors’ cartel that has controlled the medical labor market in the U.S. like its personal fiefdom for a century. — The Evil-Mongering Of The American Medical Association (2012)

So, doctors come to regard themselves as the elite who know more than you do and who must be smarter than you since they make a great deal more money than most of their patients.  Doctors used to do house calls many years ago; back then, a doctor might have known something about your family and you personally.   My wife Karen told me the following story about her family doctor.   It generated the following conversation:

Karen —

“When I was married, and raising four children, my ex-husband Ron and I became good friends with a local White Bear doctor.  He became a family friend as well as our family doctor.  We knew him for over thirty years and he knew me and my family personally and really cared about us.” 

John —

“Okay, so now you have been seeing a doctor in Frederic for about seven years.  How much does she know about you personally or really care about you?”

Karen —

“I think she really cares about me.”

John —

“But how much does she know about you personally.  Your goals.  Your dreams.  What you did this past winter?”

Karen —

“Well, at first, she used to take more time to talk to me but the past few years she has seemed much busier and anxious to keep our meetings short.  I suppose the clinic has a quota for how much time she can spend with a patient.” 

Again, there are numerous anecdotes and articles describing the lack of time doctors have to spend today with patients.   Here is an excerpt from one:

“Joan Eisenstodt didn’t have a stopwatch when she went to see an ear, nose and throat specialist recently, but she is certain the physician was not in the exam room with her for more than three or four minutes.

‘He looked up my nose, said it was inflamed, told me to see the nurse for a prescription and was gone,’ said the 66-year-old Washington, D.C., consultant, who was suffering from an acute sinus infection.

When she started protesting the doctor’s choice of medication, “He just cut me off totally,” she said. “I’ve never been in and out from a visit faster.” — You’re on the clock.  Doctors rush patients out the door (2014)

I can guarantee you that if your doctor only takes a few minutes with you, once or twice per year, there is not much they can know about you personally regardless of how caring and concerned they are.  You might ask “well, why is this important.”   Here is the reason stated very well I think in Wikipedia:

“The quality of the patient–physician relationship is important to both parties. The better the relationship in terms of mutual respect, knowledge, trust, shared values and perspectives about disease and life, and time available, the better will be the amount and quality of information about the patient’s disease transferred in both directions, enhancing accuracy of diagnosis and increasing the patient’s knowledge about the disease. Where such a relationship is poor the physician’s ability to make a full assessment is compromised and the patient is more likely to distrust the diagnosis and proposed treatment, causing decreased compliance to actually follow the medical advice.”  — Wikipedia

Conclusions:

I promised some solutions to each truth that I am telling you.  Here are some that might help you to deal with this first truth.

  1. Get a second opinion for any surgery.
  2. Use the Internet to search for alternative treatment modes. Get advice if you are not Internet savvy. Remember, there are many opinions and not all are right.
  3. Exercise and have a health care plan. Follow it.
  4. Don’t take any pills unless you must. Try to unwean or get off them as soon as possible.
  5. Beware side effects from pills. Every pill has a side effect.  Make sure you are aware of any that might affect you and be cognizant of any changes in your life while taking these pills.
  6. Take a friend with you whenever you go in for an appointment or treatment. Talk to your friends to get their insights and opinions.
  7. Don’t assume your doctor is God and knows what is best for you. Be a skeptic but be realistic.  Modern medicine is better than sorcery but not always much better.
  8. Don’t assume that your doctor is your friend or has your best interests at heart. They might not have enough time to care.

Fred’s letter to me:

I read your blog on medical practice and it was indeed thought provoking.

I’ve had good results with doctors over my lifetime. Not always perfect but usually satisfactory and in some cases, it was excellent.

Medical care is a process and requires the same attention as any process. It seems especially complex today because of how rapidly technology and all the stakeholder’s needs and expectations are changing.

Overall, it’s greatly improved in its capabilities. My main concern for medicine is the same as I’ve had for years in business. My business life became more and more controlled by the bean counters and the lawyers. The same is true of medicine. Blaming doctors is blaming people, which is always a red flag to me as one who has a bad habit of judging others without knowing them. Like the driver for quality improvement, expectations always move to higher and higher expectations. And based on what I’ve heard from friends over my life, expectations are often unrealistic.

A friend recently died. He was an old school, oil field production engineer and didn’t trust any of his doctors. He’d get pissed at one and then begin to “doctor hop”; never telling one what the other had done or prescribed. I questioned him many times, always inquiring why he’d not share his history. His reply: “I ain’t telling them anything.  They make good money and are supposed to tell me what’s wrong.”

I see the process much as we viewed our manufacturing and service processes ..with customers, suppliers, inputs and outputs being carefully considered. A critical output is the result when your illness is diagnosed and this is too often a major problem source. My friend tends to expect this to be an exact outcome but in reality it isn’t. It’s only a statistical prediction that too many older doctors failed to point out to naive, uneducated patients.

In recent years, our doctors point out the statistics and involve us in the decisions for corrective action. My wife’s breast cancer surgery was a good example. Years ago, the doctor would have made the decision for which surgery, mastectomy or lumpectomy. Sandra made the decision armed with various study statistics and discussion with the Doctor. The Internet was a source for me to verify the statistics but that isn’t easy because there are often many studies,

The surgeries are complex and the statistics often work out for the worst. Records on lawsuits and doctor reviews are more readily available today. I recall a bad experience with my dad years ago. Our family doctor became a friend from making many house calls as 3 kids were raised. Dad was a merchant seaman and would provide Porte Rico rum for our good doctor. They were the best of buddies and talked about the old days during visits. Dad visited him yearly but when dad’s tobacco tarred lungs became late stage cancerous it was too late. Doctor “Tom” as an individual practitioner didn’t have the computer technology that red flags today’s doctors. Doctor Tom was as heartbroken as my dad. He and his wife nurse apologized that they’d not x rayed dad 6 months earlier. We probably could have sued but dad would never have agreed to such.

The body of knowledge has expanded too much for any one doctor to master it all, so now we have multiple knowledge based “Specialists” having to deal with the directives from medical organization bean counters and their lawyers.

I consider our medical providers to be leading edge. They seem to focus on continuously improving to meet customer expectations. I’m hoping, but doubt the doctors and staff will be given additional support. They track customer satisfaction inputs so I should be more confident.

I can email any of my doctors and I can access historical results. I especially like being able to take a picture of a physical observation and sent it in.  A couple of years ago, I tore a muscle on the back of my leg and a huge blue area surfaced overnight.  It scared the heck out of me. I emailed a picture and he emailed back telling me what it probably was, how to treat it and to see a doctor if it didn’t heal. My expectations are now at an even higher level which puts more load on the doctor. He not only has to live up to corporate standards on office visits but he must respond to patient emails. Just yesterday I received a corporate email announcing that they have decided to do “Face Time” appointments for $25!

Overall, I have concerns for the profession but I think problems are “process” related. To think otherwise would go against what I’ve believed for a long time.

Fred

Time for Questions:

How satisfied are you with your medical care?  Why or why not?  Have you ever had a loved one die?  How were they treated by the medical profession?  What do you think could be done to improve medical care for you and your family?  What would you like to change in the American medical care system?

Life is just beginning.

“We have really good data that show when you take patients and you really inform them about their choices, patients make more frugal choices. They pick more efficient choices than the health care system does.” — Donald Berwick

 

 

 

 

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