Have you ever wondered why American doctors prescribe pills so eagerly? I have given this question a lot of thought, and here is what I’ve come up with.
[1] Physicians genuinely believe pills are the best road to health.
When I was in pharmacy school and during my first years after graduation, I was blown away seeing the massive prescribing of pills in America. Surely, I felt, this is a game. Just as surely, physicians and pharmacists felt the same way but have simply agreed to play along because the prescribing and dispensing of pills provide a nice income.
I slowly realized that I was wrong. I now feel that most physicians and pharmacists truly believe in all the pills they prescribe/dispense and truly believe those pills (not prevention) are the most logical approach to illness.
Of course, there are many physicians and pharmacists who privately have serious doubts about the massive prescribing of pills in our society. But I don’t often hear such sentiments expressed openly by health professionals.
Yes, I’ve heard pharmacists make comments to our technicians such as “If people would just eat better, exercise, lose weight and stop smoking, they wouldn’t need nearly so many pills.” Nevertheless, such pharmacists almost never express these sentiments when customers ask us questions (as they do often) about the possible side effects associated with the pills they’re taking or have just been prescribed.
It would exact a heavy toll on the psyche of health professionals (“cognitive dissonance”) to maintain serious doubts about many of the pills they prescribe/dispense, and to have doubts about whether the quick-fix pill for every ill approach is the best one, and yet engage in that activity every hour of every workday. Thus it is easier to sublimate those unsettling views and fully embrace the pill juggernaut in America.
[2] The prescribing of pills convinces the public that the physician has a decisive and unambiguous solution for every health problem.
It has been said that the prescribing of pills solves two problems: the physician’s and the patient’s. The physician’s problem is “What pill do I prescribe?” And the patient’s problem is “What pill do I need?” A prescription is tangible, whereas a physician’s verbal advice may be viewed as ephemeral.
In fact, many people feel shortchanged if they don’t receive a prescription from their physician. In addition, people are not willing to pay physicians handsomely for advice that we can get free from our grandmothers (for example, eat plenty of fruits and vegetables, avoid being sedentary, avoid tobacco and alcohol).
When doctors prescribe pills, the patient gets a message that the appointment is over and that therefore the patient needs to leave the office.
[3] Physicians assume that the FDA is doing an adequate job keeping unsafe drugs off the market.
From my perspective, physicians think the FDA is doing an adequate job keeping unsafe and ineffective drugs off the market. Physicians seem to think that if a drug is still on the market, then the FDA basically thinks it’s safe and that, therefore, all the precautions, warnings, adverse effects, etc. in the Physicians’ Desk Reference are not that important, nothing to get bent out of shape over.
[4] Defensive medicine very often drives physicians’ prescribing habits.
Doctors fear being sued for failure to adequately treat a condition. For example, in the occurrence of a death from heart disease, doctors might be sued for failure to aggressively treat elevated blood pressure or elevated cholesterol. This puts pressure on physicians to prescribe pills. In contrast, I wish the onus were on doctors to do everything possible to try to prevent these preventable diseases of modern civilization (through aggressive dietary/nutritional and lifestyle changes) first. That way, perhaps we wouldn’t have doctors prescribe pills quite so often for those conditions.
[5] Insurance companies have awesome power to determine the shape of our health care system.
Insurance companies would greatly prefer to pay for pharmaceuticals rather than verbal advice from physicians. For example, the insurance companies would rather pay for generic Prozac rather than months or years of talk therapy or psychoanalysis.
Insurance reimbursement rates mean that doctors must herd patients through their offices rather than engage in long discussions about non-drug ways to prevent and treat diseases of modern civilization such as elevated blood pressure, elevated cholesterol, and elevated blood sugar (in type 2 diabetes).
The massive prescribing of pills facilitates the assembly line model of health that benefits the insurance industry. Can you imagine an insurance industry based on the prevention of illness through dietary/nutritional and lifestyle changes? Our insurance industry is sickness-based rather than health-based.
Physicians try to get positive patient ratings to please the various health plans. Patients are often upset when physicians refuse to prescribe a drug that the patient sees advertised on TV. To avoid a negative rating, doctors prescribe pills that are advertised even though another drug or no drug may be the better option.
[6] Drug advertisements on TV create a population eager to accept pill solutions for every health problem.
The public has been primed by drug advertisements on TV to expect a pill for every ill. These TV drug advertisements reinforce a quick-fix solution and thereby create demand for physicians’ services. Thus the medical profession gets free advertising for their pill-based brand of medicine.
One might assume that the long lists of potentially scary side effects in these advertisements might dissuade people from such enthusiastic use of pharmaceuticals, or that it might prompt people to redouble their efforts to prevent disease through dietary/nutritional and lifestyle changes so that pharmaceuticals would not be necessary.
But many people naively tell themselves, “Yeah. The side effect occurs in one patient in a million so the drug companies are forced to list it in their advertising even though it is very rare.” Perhaps people view these lists of potential adverse effects as abstract concepts that apply only to people on TV and are unlikely to affect them personally.
[7] Attractive young drug sales people work to cultivate “high volume” prescribers.
Drug company sales people (“detailmen” and “detailwomen”) create a “gift relationship” by providing physicians with free lunches for the entire staff, generous speaking fees, vacations to exotic destinations (often in the guise of continuing education), free tickets to sporting events, etc. The “gift relationship” is intended to create a conscious or subconscious desire for the physician to reciprocate by prescribing that company’s drugs. Free samples are intended to create long-term consumers. Those are the patients. But the drug company’s real customers are doctors who prescribe pills.
[8] People don’t know how easily science is distorted and corrupted for commercial gain.
Our society has an unquestioning or naive belief and trust in science. The public is largely unaware that much science is distorted beyond recognition in the service of the drug industry, often with manipulative concepts that hide a drug’s safety by citing its “relative risk” rather than its “absolute risk.” The public has a hard time believing that the pharmaceutical industry is as corrupt as many health professionals know it is.
[9] Medical schools have adopted a mechanistic and reductionist view of the human body that bolsters and reinforces the pharmaceutical industry.
Medical schools have adopted a view of the human body that is analogous to a rickety old car that is constantly subject to breakdown and in need of shoring up with synthetic substances known as pharmaceuticals. Thus, medical schools reinforce the message of the pharmaceutical industry. If medical schools were to give priority to prevention instead of pills, that would be a severe blow to the pharmaceutical industry.
[10] Prescribing drugs has deep political significance because it reinforces the status quo power hierarchy in society.
Medical sociologists might say that the prescribing of drugs tells the population that pathology exists within each individual, not in the broader society. For example,
—Prescribing chemotherapy tells patients that the pathology is within their own body, not in our society in which toxic and carcinogenic substances are pervasive.
—Prescribing antidepressants tells people that the pathology exists within their own body as a chemical imbalance in their brain. This diverts attention from explanations that are a threat to the corporate elite, such as the real possibility that depression may be a result of extremely unfulfilling and exploitative jobs with deadeningly repetitive tasks, etc. It also diverts attention from uncomfortable explanations such as this: Depression can be a result of abuse by one’s spouse, the lifetime scars resulting from parental abuse of children, unemployment, poverty, etc.
—Prescribing drugs for type 2 diabetes diverts attention from the highly synthetic and processed foods in the typical supermarket which are loaded with sugar.
Thus, when doctors prescribe pills, they reinforce the status quo, rather than causing people to fundamentally question the society in which they live. The massive prescribing of drugs has elements of deep political significance because it reinforces the existing power structure in society and causes people to look inward for pathology, rather than rebel against exploitative forces in society.
Feel free to agree or disagree with any of these points in the comments. Why do you think doctors prescribe pills so freely?
