Who motivates the prescribing habits of doctors?

According to the April 26, 2007 issue of the New England Journal of Medicine, a survey revealed that about 94 percent of doctors have "some type of relationship" with the pharmaceutical industry. See the article, "NEJM -- A National Survey of Physician-Industry Relationships."

Nutritionists want to know why doctors don't prescribe more nutrition-based pain killers for milder symptoms? Nutritionists working with integrated health physicians are interested in researching the prescribing habits of most doctors as well as the most prestigious doctor's knowledge of nutrition and biochemistry.

They want to know to whom their doctors listen, and it seems to be prestigious medical school faculty hired part-time by some of the drug companies to give lectures to other doctors that promote and market certain drugs.

The question nutritionists want answered is how much training in nutrition and biochemistry do these prestigious medical school faculty doctors have? For example, there are numerous nutrition-based remedies for arthritis pain compared to some pain killer drugs that some doctors prescribe.

Do the doctors on the faculty of the most prestigious medical schools have validated, conclusive research when it comes to finding the root causes of various symptoms that may be related to nutritional or hormonal imbalances and lifestyles? Nutritionists want to know because these doctors influence other doctors listening to the marketing speeches of some prestigious medical school faculty members.

Or do the most prestigious medical school faculty giving marketing speeches paid by drug corporations lack nutrition training based on biochemistry research, but instead, are steeped in commercial drug marketing literature? Consumers ask which remedies--food or drugs--have the least side effects and do the most good to balance bodies at the metabolic and cellular levels?

Nutritionists want to know the prescribing habits of doctors that are influenced by their peers from prestigious medical school faculty. And what nutritionists want to know also relates to questions consumers also want answered.

Some doctors now are paid by drug and/or medical device companies amounts exceeding five figures to give marketing speeches at dinners or luncheons. Other doctors are invited. The luncheons could be in a restaurant or at a medical conference where other doctors are gathered.

Some highly-trained, long-experienced doctors, including medical school faculty members held in high esteem by other doctors, are hired to write marketing-related or promotional articles about specific drugs that other doctors supposedly will read. Some doctors speak or write for several different drug or medical device companies in addition to earning their usual income practicing medicine as doctors in their regular full-time jobs.

Does this type of 'moonlighting' influence patient care, physician's prescribing habits, and raise the cost of treatment? Maybe, but some doctors have huge loans taken out to pay medical school bills and families to support, let alone the insurance bills. What really influences patient care, the large pharmaceutical companies or patients' requests that their physicians be trained in complementary care?

Medical schools are not happy about their prestigious faculty members giving marketing speeches and promotional talks for drug companies. Is it ethical for doctors that teach other doctors to become specialists or generalists in medicine to promote drugs to colleagues who then pass the drugs on to their patients? The problem also is the use of private firms that "act as conduits" between pharmaceutical companies and university doctors.

There's a conflict of interest. Sometimes those conduits can be freelance medical writers who write the marketing copy for pharmaceutical firms that are read by doctors. But freelance marketing writers that write the ads that go into magazines and pharmaceutical publications are not influential unless they're ghostwriting articles in scientific journals under a physician's name.

Diagnosis and prescription could be reduced to a free-association word game played by doctors to reduce work stress, but discussing how doctors unwittingly create addicts by writing too many opioid painkiller prescriptions is serious. Patients take drugs in the first place to be in control of their bodies.

See the World News broadcast transcript, "Doctors Concerned About Rise in People Addicted to Painkillers," (The World Today), an Australian program that reminds doctors to be aware and concerned about the dramatic increase in the number of patients addicted to prescription (and sometimes over the counter) painkillers.

In the old days, many large, USA pharmaceutical corporations wined and dined doctors while paying for their trips to medical conventions in palm-latitude resort hotels or in Europe. Currently, there's a new twist. See the article, "Drug Firms Wine, Dine, and Pay Up for Doctors' Speeches, at the Health & Fitness site posted January 12, 2009.

Much more prestigious and influential are medical school faculty from schools held in high-esteem that are hired part-time by drug companies to give talks and/or to write articles. If anyone has credibility in the eyes of many doctors, it's the medical school faculty--colleagues or alumni, including faculty from those prestigious medical schools that doctors listening to the speeches wished they could have attended.

Doctors with the highest reputations and rank on the faculties of medical schools are recruited by drug companies to moonlight. They're hired to give speeches promoting or marketing drugs to other doctors over dinners, banquets, or luncheons in plush restaurants or at medical conventions.University doctors, medical faculty, whose job is to teach in medical schools are very influential on the prescribing habits of other doctors.

Medical conventions and conferences are run somewhat different from dinners where doctors sit and listen to another doctor act as a spokesperson for a drug company. The type of marketing or promotional lectures about drugs given at medical conferences are presented as serious learning forums for doctors and other healthcare professionals.

The specific and serious problem with the prescribing habits of doctors is the surging number of people addicted to certain prescription painkillers such as the opioid painkillers. Examples are morphine and Oxycodone. Why are some teenagers (when brought to some doctors' offices with their parents) still offered potent prescription drugs such as vicodin for mild sprains when simpler pain-relieving solutions also work? For the past decade a steadily increasing number of prescription painkillers have been prescribed by doctors to average patients as well as to the rich and famous.

In the early 1990s I attended several medical conventions as a medical news correspondent for a magazine to cover conferences of doctors and nurses discussing and debating pain control strategies. At that time nurses felt responsible for controlling pain in a face-to-face hands-on environment with patients that have been prescribed painkillers by their physicians. Nurses were required to fill out endless paperwork while monitoring patients, sometimes standing in place of what should have been a counselor, but had no control over what painkillers outpatients collected once out of the office or hospital.

Nurses at the medical conference were the key speakers on the subject of pain control, expressing deep concern about the hoarding of painkillers by patients that might be pharmacy shopping. There were no pharmacists speaking, and doctors reiterated being trained to diagnose and prescribe. Each speaker approached pain control from the box he or she had been trained. No speaker stepped out of that box or mentioned turning to high technology for pain control rather than pharmaceutical solutions.

Currently, more than a decade later, the subject of pain control includes a media storm about the dramatic rise in the number of painkillers being consumed globally by all levels of the population of the USA and other industrialized countries, for example, Australia. The facts point to a rising number of prescription drug overdose deaths.

Adverse reactions from prescription medicines of all types is the number three reason in the USA for emergency room visits, and sometimes deaths result from adverse reactions or allergies to some prescription drugs that the patient's doctor prescribed in good faith to relieve pain or in other ways to heal the patient. You never know how your body will respond to a painkiller until you're given that drug, but most people given painkillers do survive safe doses that are not mixed with other drugs that have known interactions.

A person can become allergic to a drug at any time without knowing it or have an adverse reaction. One alternative solution to chronic, serious pain might be an implant that prevents pain by stopping the nerve impulse that's delivering the pain from reaching its goal. Another solution is physical therapy, including high-tech approaches to pain control such as low-level lasers and infra-red treatments, but not everyone can afford physical or occupational therapy.

Pain control is big business and necessary. Most often, pain control becomes the day-to-day, 24-hour monitoring responsibility of the caregiver in the home or the nurse in the hospital.

The problem is that deaths from prescription painkillers and other potent prescription drugs are outnumbering street drug overdose deaths, for example, deaths from heroin overdoses. The gap is widening. And sometimes doctors feel their hands are tied when they're caught between patients coming in to the office to relieve chronic pain and what happens when the patient becomes addicted to ever increasing doses when the drug no longer works at the lower or safer dose.

If doctors are accidently creating drug addicts by over-prescribing potent painkillers and other drugs such as numerous anti-depressants, barbituates, and anti-anxiety medicines, patients are turning to nurses to discuss pain control alternatives.

When reporters ask the doctors whether they think they're creating drug addicts and setting up patients for potential overdosing either on painkillers or anti-depressants, doctors often reply that they're unaware of it but want to see more information, such as databases with statistics and studies. When you question physicians about what drug is most often overdosed, usually the answer usually is methadone, a drug that is increasingly in demand in the USA and in other countries.

And methadone is prescribed for various purposes, one being to get people already addicted to other drugs such as heroin, off those drugs. Methadone also is taken by patients for other reasons than former addiction to heroin. The problem is that methadone when combined with other painkillers could be lethal.

Competition as far as demand exists between prescribed medicines and street drugs. Pharmacy shopping and doctor shopping are common ways people accumulate pills. It's not only people with wealth and fame acquiring prescription painkillers. Famous names in the papers are frequently linked to prescription painkillers overdoses going back to the 1960s. Before that, the drug of choice to overdose on had been sleeping pills, particularly barbituates.

In some areas of the USA, people without insurance, savings, or income have a very difficult time getting an affordabe prescription for painkillers or at least the type of painkillers that work for them. The only way to find out whether requested painkillers are actually given to those without funds is to interview the patients. Many complain that their doctors aren't giving them pain medication post surgery or for serious pain.

The demand for prescription painkillers is one factor. Another is the drug manufacturers that try to make their medicines available to those who don't have medical insurance. Doctors want to look at emerging trends, but information is difficult to find online or in most medical journals.

Doctors that have treated heroin addicts with methodone may not realize that they could be creating addicts from some average patients that would never dream of taking a recreational or street drug. These patients are looking for relief for chronic pain such as the pain from a broken bone or from post-surgery pain.

If you look at the majority of employed people with reliable and credible histories and middle-class lifestyles, it's easy to become addicted to prescription painkillers just by putting your life into the hands of your doctor. You figure that you have to trust your doctor to prescribe what will take the pain away and heal you. After a time, the prescription painkillers don't work, and the dosage has to be increased.

At some point, the patient becomes addicted because the dose needed has become so high to relieve pain, that toxic results are inevitable. When safe doses no longer work, it's up to the doctor to remind the patient that a different approach must be taken, perhaps a pain implant, physical therapy, or other medicines that are less likely to addict the prescription drug user. The patient at that point might blame the doctor for creating drug addicts with prescriptions meant only to heal or relieve pain.

If addiction to prescription painkillers becomes the problem, the patient tends to blame the doctor for creating a drug addict by increasing the dosages of pain medications or other prescription drugs that the patient is told are legal and will help control what is out of control inside the patient's body.

As a person's body gets used to the medicine, higher doses are needed to control the pain. At that point, the patient realizes that he or she is addicted to prescription painkillers. Alternatives need to be offered before legal prescriptions create an addict.

The patient feels caught off-balance when the physician or the pharmaceutical corporations let the patient think that the drugs are not addictive. One result could be pharmacy shopping or doctor shopping where the patient visits several doctors to collect prescriptions. The media is full of sensational news stories on celebrities in rehabilitation for prescription drug addiction, usually for painkillers.

Physicians remind patients that what's out of control in their bodies must be put under control with prescriptions. But the cause of being out of control usually is a chemical imbalance due to a problem not related to a deficiency of drugs. Why would a patient be told he or she will have to remain on a specific drug life-long when the drug may be putting a bandage on a symptom rather than finding the cause of the imbalance? It's easier on the patient to look at frequent test results.

It's a loop that keeps on recycling. The loop starts with pain, increased dosages, more testing, addiction, overdose, new drugs, or new doctor. Too many patients think that doctors have to treat their addiction to painkillers in the same way as society treats heroin addicts. But the approach needs to change. Pain control is a problem to solve, and the approach has to be different and based on information easily available to doctors on why prescription drug overdosing and addiction is increasing so rapidly around the world.

At medical conferences reporters listen to nurses that have approached doctors for improved solutions that get measurable results. Pain control, especially of cancer patients, is a deep and continuing concern of caregivers. And doctors say their deepest needs are for finding information in databases. Doctors want to see prescription addiction statistics.

Patients are demanding higher and stronger doses of painkillers due to changes in their brain chemistry. Why aren't doctors considering prescription addiction? This has become a topic for family discussion. The doctor who delivered me at birth is my cousin. My son is a physician as is my daughter's husband. My grandchildren are studying to become physicians. Their friends are mostly physicians. At family reunions the doctors socialize with the friends with whom they went to medical school.

As a group, the doctors as relatives and friends repeat the same types of answers to me that they give to their patients, "In medical school, we were taught to diagnose diseases and write prescriptions." We got to talking about choices patients have when patients ask for help and the doctor responds with, "All I can offer you is conventional medicine."

I asked them, "Were any of you ever taught in medical school to think outside of that box?" They often smile and answer, "No."

My children and other relatives that are physicians still attend medical conventions in different cities and almost automatically respond with the name of a drug when a symptom or disease is mentioned. It's a game we play at the dinner table. I say, "enlarged prostate," and automatically, my son-in-law, the internal medicine physician, pops out the word for one of the prescribed drugs, "Adovart." Sometimes they use the generic name, but that's when we play scrabble.

We play free association medical word games at dinner. Name a symptom or a disease, and out comes the word in a split-second, the name of a drug as a free association response. And that's the time the conversation around the dinner table changes to what are the latest materials they've read in the field of integrative, functional, preventive, or complementary medicine.

Who else might influence from behind the scenes the prescribing habits of doctors? It's the medical clinical trials ghostwriter and/or the medical marketing writer. The American Medical Writers Association's job listings database for members might show recruiting (job listings) at Jobs Online for freelance ghostwriting for medical journal articles with a physician's byline and for full-time pharmaceutical marketing and advertising writers and editors. Medical marketing writers come from a wide variety of education combining life sciences with communications courses and experience.

If doctors are unknowingly creating prescription drug addicts, they're practicing what they've been taught in medical school. Look at what is influencing the doctors' prescribing habits. It's using familiar faces or reputations, prestigious medical school faculty as speakers to market or promote drugs for the pharmaceutical firms. To change the situation, start at the roots, the medical school where doctors could be trained in offering patients a wider variety of safer choices that work better.

Should a patient pop a pill, take an infa-red sauna, eat a 50 percent raw veggie and fruit diet, or check out low-level laser treatment and high technology, for example? Are implants better than drugs for pain control? Or are there many other solutions often hidden from average consumers? After all, the goal of all types of drugs is to control (as in control the pain, the high blood pressure, the feelings, the tremors, the behavior, or the symptoms). Patients want, above all, to be in control of their health care choices by finding the cause, not only covering the symptom.

One possible alternative painkiller is neurostimulation, a removable therapy that delivers precisely controlled, low-voltage electrical stimulation to the spinal cord through a carefully placed insulated medical wire called a "lead." The lead is connected to an implantable pulse generator that has a battery and electronics. The stimulation blocks pain messages from reaching the brain. Instead of pain, the patient feels a "tingling" sensation. According to the site, most HMO's insurance covers the approximately $10,000 cost.

According to the article, Jerry's Story, On April 20th, 2002, celebrity, Jerry Lewis had a permanent neurostimulation system implanted by Dr. Ben Venger, a neurosurgeon in Las Vegas. Research this alternative. For further information on the details, see the Jerry's Story site and view the Video Interview with Jerry Lewis.

Remember, every patient is different. According to the Jerry's Story site, "Jerry takes no othannehart.tripod.comer pain medication and has suffered no side effects, but side effects are possible and can happen. Because the system is surgically placed, risks of infections do exist. Device complications, such as lead displacement causing an interruption in pain relief, also exist."

The point is there are alternatives. If one solution doesn't work, there may be another out there as yet hidden from the average consumer. The goal is to find what works for a particular individual. Hopefully, the future will bring non-invasive solutions through technology.

For more info: browse my books, Neurotechnology with Culinary Memoirs (2009), or How Nutrigenomics Fights Childhood Type 2 Diabetes & Weight Issues (2009) or Predictive Medicine for Rookies (2005). Or see my books, How to Safely Tailor Your Foods, Medicines, & Cosmetics to Your Genes (2003) or How to Interpret Family History & Ancestry DNA Test Results for Beginners (2004) or How to Open DNA-driven Genealogy Reporting & Interpreting Businesses. (2007). Check out my free audio lecture on Internet Archive, How nutrigenomics fights childhood type 2 diabetes. Photo credits: iUniverse, Inc.