Drug Dealer, MD

Welcome to this edition of Jeff’s Notes, a very short summary of great books about science written by women. Jeff’s Notes: Because Cliff’s Notes are just too darn long.

This edition of Jeff’s Notes examines the book Drug Dealer, MD: How Doctors Were Duped, Patients Got Hooked, and Why It’s So Hard To Stop by Anna Lembke.

This book is a systemic analysis of the systemic failure of our health care system in regards to the opioid epidemic currently gripping the United States. A perfect storm of events all happened to line up, leading to this epidemic.

It started with a noble goal. The medical establishment was nearly unanimous in agreement that the pain that patients experience is real and awful, and that, as healers, doctors should be doing everything that they can in their practice to reduce the pain of their patients.

Enter some drug manufacturers with a few like-minded researchers who could at least pose as subject matter experts in treating pain. These alleged subject matter experts became the Johnny Appleseed’s of narcotic pain medication. Their studies seemed to prove (if you didn’t read the methodology section of the study or question the funding) that narcotic pain medication was extremely effective at treating pain, and that there was very little risk of addiction.

What these “experts” were essentially saying to doctors was, “We have this class of drugs that work exactly like morphine, but don’t worry they’re not addictive, except in extremely rare cases.” If I told you that I invented something that’s exactly like ice cream, but you can eat as much as you want without ever getting fat except in extremely rare cases, what would you think? I know that I’d want to believe that. That’s the root of the problem for the medical establishment. They wanted to treat pain better. They wanted to believe these “experts”.

Couple that with a medical environment where doctors are increasingly treated like factory workers being paid in piece work, where writing a prescription for a five minute visit pays substantially more than a half hour addiction counseling session, and you have our current situation. The perverse incentives in reimbursement rates paid by insurance companies (including government health insurance) reward doctors for just refilling opioid prescriptions. In this day of managed care, doctors literally can’t afford to care.

My only criticism of this book is that even though Dr. Lembke never says that all mental health or pain medication use is wrong, I worry that some who read this book may get the wrong impression and question effective and likely appropriate medication regiments. Otherwise, Dr. Lembke lays out a great case. The question is will anyone care. Will any of her suggested reforms be implemented or even considered? Sadly, I think that the answer is no.

Up Next: The Poisoner’s Handbook: Murder and the Birth of Forensic Medicine in Jazz Age New York by Deborah Blum