“Monday Musings” for Monday October 15, 2012
Volume 2. No. 37/89
Contemplation On Several Current Topics
By Assad Meymandi, MD, PhD, DLFAPA*
Alcohol and College Sports
While prohibition is often counterproductive, I believe the answer to binging, abuse and unreasonable use of alcohol is education. The answer also lies in curtailing greed and hunger for money. The university leaders ought to cut out advertising of beer from all TV sports. It is sheer greed to have alcohol products sponsoring sports events, and it is sheer hypocrisy for university leaders to tolerate this practice because it produces revenue for their institutions. Ban alcohol ads from all television sports.
Medical Care in America
The fairly comprehensive article “Prescription for Addiction”, WSJ, (Sat/Sun Oct 6-7) was commendable. Our healthcare establishment is dysfunctional. American medicine is expensive. Nearly 20% of Gross Domestic Product (GDP) is spent on health care. US medicine is deluged with waste, duplication and overuse. Patients with no medical home use the most expensive form of medical care, the emergency rooms, and get repeated and often unnecessary scans for every symptoms they present. I do not blame the emergency room (ER) physicians because they are hounded by malpractice threats. Over-testing and over-treatment are norms in America. In my daily practice, I see many patients with brown bags full of medications prescribed by different physicians, ERs, and clinics, each medication prescribed for a symptom, many for treatment of pain. The patients are often given many other medications that actually cause depression feeding into the pain cycle. In our culture, we medicalize our social problems and turn to MDs for chemicals for solution which only complicates the problem. We should be aware of iatrogenic addiction, as your article suggests.
On another matter, While my heart goes out to the Kathryn Gullo and her family (news story, N&O, September 11, 2012), I admire her intelligence, intuition and courage to stand up to the healthcare establishment and demand what the additional information the requested MRI would provide to help her baby. There is no question that American medicine is deluged with waste, duplication and overuse. Patients with no medical home, use the most expensive form of medicine, emergency rooms, and get repeated and often unnecessary scans for every symptoms they present. I do not blame the ER physicians because they are hounded by malpractice threats. I also, commend the N&O for running another story in the same issue “ Stop testing healthy women for ovarian cancer” which further illustrates over-testing and over-treatment. Although early detection and prevention are the best form of medical practice, they do not justify overuse and abuse of medical diagnostic tests and procedures. Kathryn Gullo is right, before you agree to a test, insist upon knowing what additional information the test provides to help bring solution to
The essay by my learned colleague, Dr. Dan Blazer, “Substance Abuse Disorder in Later Life”, Psychiatric News, August 17, 2012, was most welcome. I wish to add one more often neglected etiology: iatrogenic. In their busy practices, colleagues with little time to spend with their patients, seem to prescribe a pill for every symptom. In my practice, I frequently see patients come in with large brown bags of pills prescribed by one or more physicians. Often the drug-drug interactions and side effects of prescribed medications go unnoticed. Addiction to prescribed medications should be addressed seriously in any strategy to combat substance abuse.
The heartwarming story of Royce Jones (June 12) compels me to inform his parents that Johannes Kepler (1571-1630) was born prematurely. Kepler was obsessed with measurement. His obsession made him calculate his own gestational period to the minute, 224 days, 9 hours, 53 minutes. So, don’t fret, Royce’s mama may have given birth to a Kepler.
*The writer is a Distinguished Life Fellow American Psychiatric Association, Adjunct Professor of Psychiatry, University of North Carolina School of Medicine at Chapel Hill. He is the Founding Editor and Editor in chief, Wake County Physician Magazine (1995-2012)