Saturday, April 11, 2009


A Thought Experiment

Greetings all. I would much appreciate your responses to the following hypothetical situation.

Assume all drugs with the exception of relatively few (say the WHO list of "essential drugs") disappeared. And, as would follow, there would be no advertising for these in any medium.

1. Would this change the way you acted with regard to health, illness, and wellness? In what ways?

2. How about the next generation, growing up in such a situation. Do you imagine their actions relative to health, illness, and wellness would be different from yours? How so?

3. Do you think the ways you thought about health, illness, and wellness--how and where they "fit" within your life in general--would be different? How so?

4. Again, the same question for a next generation growing up in this situation?

5. In general, would the meaning of being a "patient" change in this situation?

Thank you for your reflections.


  1. Click on WHO to view the Model List of Medicines.

  2. Thanks, WHO.

    I didn't intend to make the WHO list the "decider," but it was one example of a much stripped down list.

    The larger question is what individual healthcare decisions and thinking might "look like" in a less pharma-centric system, particularly via the ways we thought about "risk reduction" as opposed to treatment of a diagnosed condition, as well as the number of conditions we considered illnesses that called for medical intervention (pharma or otherwise) at all.

  3. So let me take a shot at my own questions.

    For those for whom health/wellness was a value priority, one would expect to see more focus on diet/lifestyle/stress reduction stategies--not simply as "preventive" but as rewarding in their own right. That is, it simply feels better to most people to be "fit." One need not be a "health nazi" to experience this, and be into it.

    Similarly, at least for such people, health would not be defited as the brief intervals of "peace" (if there even are such intervals these days)--in other words, a neutral zone--but a positive state of well-being.

    Again, for some, my guess is that that state might spill-over into more active engagement in areas that had nothing to do with health--citizenship initiatives, public service, etc.--in part because there would be less absorption with one's physiology. (Of course, many "sick" people are also activists of various kinds).

    In any event, rather than a precondition for other occupations and preoccupations, health might be thought of as one of many things involved, including, for example: faith-based commitments, a supportive community, etc.

    Without going overboard, the role of non-physiological health-related dimensions--especially those related to the natural and communal environment, family and friendship ties, social class, etc., might also start to gain more attention. Again, not just because they "contribute to wellness" but because there might be more likelihood of "noticing" and more fully engaging them.

  4. Justice, we are assuming then that the tidal wave of drugs we've seen in past few years do actually provide an appreciable positive state of well-being.

    I wonder what percentage of new drugs, say in the past 10 years, are ones that we could have lived without and not experienced a measurable reduction in well being.

    Given the national total dollars spent on drugs in the past 10 years and a perceived measure of well-being in the past ten years (if such a thing could be known)we could calculate a measure of cost of well being.

    I wonder if that ratio of $/well-being is increasing or decreasing over time especially in the past 5 years.

  5. I don't have the numbers, and obviously a lot of judgment calls. Still, I'm sure some folks have done analyses, and probably conflicting ones.

    In any event, I wasn't primarily thinking about the number of drugs (although that is part of it), but the extent to which medicine has become _about_ drugs and technologies (even though most docs get an amazingly small arount of training related to prescribing or drug impacts).

    Along with quantity, DTCA and related would certainly be part of the extent to which our thinking about health, illness, wellness has become entwined with pill-taking.

  6. p.s. There are some social science folks who have come up with "well being" indexes, but, of course, whatever change could be attributed to a zillion different factors.

    In medicine, "well being" is (perhaps surprisingly) only very loosely correlated with one's health status. It is much more closely associated with feeling a strong collaborative relationship with relevant docs, sensing that the doc cares one way or other, and that there is some version of a rational plan to deal with whatever ails....or doesn't. So it is much more the interpersonal and wider context of healthcare than whatever diagnosis we happen to carry.

  7. Justice, my thoughts in response to your questions:

    1. The lack of advertising would not change the way I acted regarding health, illness, and wellness. I always believed that nutrition and lifestyle had a lot to do with good health. Medicine was always a last resort.

    2. Without drug ads to hamper them, the next generation would have a natural sense of well-being and good health.

    3. I try not to let drug advertising affect the way I think about health, illness and wellness. However it would be wonderful not to be bombarded constantly by fear-mongering ads about diseases and conditions.

    4. The next generation would grow up with a sense of wellness and self confidence/reliance, rather than “eventual illness.”

    5. The meaning of “patient” would change from “customer” to “fellow human being.”

    I wonder how many lives are changed, or lost, due to patients being prescribed medicines that looked good to their doctors who believed reports they read in top medical journals, but, in fact, were bogus. How many people could have been, or can be, spared illness, heartache, worry, depression, and death due to prescribed drugs? What’s the good/bad ratio?

    Unless a drug has been around for a long while, with a well documented good track record, why take the risk?

  8. Thanks, Mrs. D. BTW, are you the same Mrs. D. who used to contribute to the "spine" group? Always appreciated your input.


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