Monday, November 26, 2012

Don't Ask Your Doctor

We’ve seen and heard so many of those drug commercials that they’ve almost become a punch line:  “Ask your doctor if [fill-in-the-blank drug] is right for you.”  This is an attempt by pharmaceutical companies to bypass doctors and increase sales by appealing directly to Americans with a demonstrated weakness in the area of discipline.

Discipline is about doing the work to achieve a desired result instead of seeking the easy way out, the path of least resistance.  In finances it’s about our tendency to spend money now on the things we want, choosing immediate satisfaction rather than delaying gratification, even if it means putting our home ownership at risk.  When it comes time to pay for college or retire, we look for some government program to ease the pain, the consequences of our inability to save.  In business it’s about emphasizing short-term results over the long-term benefits, the relentless pursuit of “doing more with less,” which results in lower morale and reduced innovation.  Business managers search for only fully qualified applicants to avoid training costs as well as the harder, but higher-value work of coaching and mentoring.  All these choices represent failures in discipline.

In healthcare it’s about the tendency to downplay risks and warnings and to look for a pill, a supplement or a simple operation to make us feel better.  If a doctor recommends more exercise, quitting smoking or other lifestyle change, we favor the pill to fix us up quickly, so we can go on living the same way, making the same choices as before.  Even a simple requirement like adding more fiber to our diet spawns a host of alternatives.  We grab a cup of coffee and a donut for breakfast, relying instead on a supplement to provide the needed fiber.  We don’t take the little extra time for a bowl of cereal, despite knowing that “fiber should come from plant foods, according to the American Dietetic Association, rather than fiber supplements.”  We take recommendations from friends and co-workers despite knowing that supplements are not regulated by the FDA, “and the formulations can vary from one manufacturer to another, so you can never be sure that what you're taking is really the same substance that others are writing or talking about.”  Instead of getting enough sleep, increasing numbers of Americans turn to energy drinks with potentially dangerous levels of caffeine.  (The annual number of emergency room visits linked to energy drinks jumped tenfold from 2005 to 2009.)  A lot of risk accompanies these failures in discipline.

When we ask our doctors, we put them on the spot.  The drug may not be the best choice.  At this point the doctor can give us the lecture about how we should take better care of ourselves, or else take the easy way out for them by writing a prescription.  They must choose between disappointing or angering a patient/customer or just giving in.  The drug companies count on this pressure, betting that some proportion of doctors will choose to avoid the often-fruitless argument.  So when we hear that “prescriptions for painkilling drugs have nearly tripled in two decades, and unintentional overdose deaths from these drugs now exceed those from heroin and cocaine combined,” it shouldn’t come as a surprise.  It’s just another symptom of America’s need to improve overall behavior in the dimension of discipline. 

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