Most doctors don’t like prescribing pills

I am a medical doctor.  I am also called an allopath, someone who practices “Western medicine.”

We allopaths like data, proof, science, randomized, double-blind, placebo-controlled trials.  We want to know the “mechanism of action.”  We want someone to prove that yoga or medication or some procedure actually helps your depression or blood pressure or back pain and that these treatments are safe before we prescribe them.  We feel more confident about our treatment plan that way, and let’s be honest, we’re less likely to lose a lawsuit if something goes awry.

Here’s something you might not know.  Most of us don’t like prescribing pills.  If there is a safe, natural, noninvasive solution to your problem, we’d prefer to use that.  Shocked?  Consider this:  the more pills you take, the more potential adverse reactions are possible, the more responsible we are for a bad outcome.

It surprised me recently when a well educated accountant accused me of being a pill pusher.  He said, “We all know you doctors get a kick back from the drug companies for every prescription you write.”  What? Not only is that extremely immoral, it’s illegal.

Actually, the more medications we prescribe, the more money we lose.  Think about the time involved in deliberating  the risks vs benefits of prescribing a medication for someone.  Then consider the time involved in evaluating possible drug interactions with your other medications.  Then consider the liability we assume for the possibility that you might have an unforeseen reaction to the medication which results in injury or death.  And don’t forget the time and hassle of writing and faxing and calling them into your pharmacy and then haggling with your insurance company.  Prescribing medication is not a money maker.

Occasionally prescribing medication is gratifying, when you see a severe infection resolve or watch someone’s pain improve.  I am sure the oncologist feels great when a patient’s chemotherapy cures his cancer, or it is gratifying to the rheumatologist when her patient’s rheumatoid arthritis improves.  Medications are absolutely crucial to treating and occasionally curing disease.

In my opinion, most medications prescribed in the primary care setting just allow people to avoid taking responsibility for their own well-being.   Those cholesterol, blood pressure, and blood sugar pills can prolong your life, but they won’t make you happy or well.

I don’t have any randomized, double-blind, placebo-controlled trials to back me up, but I am willing to go out on a limb here.  I believe that most people don’t need more pills.

What they really need is permission to live long, healthy, happy lives.  Sounds silly, right?  Yet I’ve seen it over and over.  My clients and patients repeatedly sabotage their best efforts to adopt healthy lifestyles because they just don’t believe they can or deserve to be happy and well.  They’re waiting for someone to give them permission, for someone to say, “Yes!  You absolutely deserve it!”  So until you can give that permission to yourself, I am writing you a prescription:  a healthy dose of joy, wellness, inner peace, and satisfaction to be taken as many times a day as needed.  Number of refills:  infinite.

Melanie Lane is a family physician who blogs at The Doctor Weighs In.

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  • stargirl65

    Most patients seem to want to take pills. They refuse to take responsibility for their life. They complain they can’t lose weight, wonder why their bp is high, their sugars high, they are tired all the time, etc but do nothing to promote their own health. They refuse to exercise even when encouraged to do so. “I’m too busy” “My knees hurt” “I don’t like exercise”. They prefer to eat whatever they would like. Then they say, “just give me the pill, then I can eat steak and ice cream whenever I want.” It would be nice to see people WANT to be well.

    • Melanie Lane MD

      I hear your frustration. What you are seeing are people trapped in victim perspective, and it can be hard to maintain your patience with them.

      One of the many ways I help them get around this and generate that desire to be well is to have them step back from the little details about how much they hate vegetables or don’t like being sweaty and ask them what they really, deeply want to accomplish in life. Invite them to envision the big picture. Maybe they want to travel the world or pursue a hobby for nature photography or serve the community in a unique way. Once they’ve generated a little inspiration, ask them how having a healthier body serves that aim.

      All by themselves those little questions may not solve the problem, but for some people, who are tired of being tired and overweight, the answers to those questions may motivate them to try something new or seek help.

      In the meantime, I’ll be right there with you wanting them to want to be well.

  • HJ

    The only thing my family physician does for my health is provide me with presciptions and referrals.

    “Those cholesterol, blood pressure, and blood sugar pills can prolong your life, but they won’t make you happy or well.”

    Of course, there is a pill that will make you happy…I have lost track of how many times a doctor has offered me antidepressants…and the lecture I get when I refuse.

    • Melanie Lane MD

      Obviously you are unsatisfied with your relationship with your FP. What is it that you would like from him that you are not getting?

  • PharmerJoshua

    You not want to prescribe pills, but the literature suggests it doesn’t matter. Physicians cave more to the demands of patients for specific drugs, especially the ones patients see on TV or the ones physicians see on pens and coffee mugs.

    What is shocking is that if physicians don’t want to prescribe, then why does the AMA insist upon restricting/denying limited prescribing rights for other HC professionals across the country? I agree with you on limiting the amount of medications a person takes, but there are so many medications out there (including OTC and supplements) that it is impossible for you to determine/know all of the drug interactions.

    What I am getting at is that limited prescribing rights for pharmacists (the drug experts) under collaboration with a PCP helps optimize the results and spread the risk. I can’t tell you how many times in my clinical experience I have had to help patients get off drugs because the PCP doesn’t have the time/expertise to optimize a drug regimen. Physician groups now that have a pharmacist on staff now get to worry about this less and it frees them up to do more productive things with their time.


    • Melanie Lane MD

      When I had the opportunity to work with PharmDs I loved it. I asked for their input all the time. Unfortunately, a small practice doesn’t generate the income to afford one.

      A lot of this frustration around the prescribing (or not) of medication is driven by money concerns. Physicians are getting squeezed tighter and tighter, yet it feels as though we are the ones taking all of the blame for everyone else’s unhappiness.

      I also think that all parties involved feel as though they aren’t being heard, which is why we’re here on this blog.

      My point isn’t so much about prescribing; it’s a call for patients to take responsibility for their own health. If they don’t want to be caught up in the healthcare machine, they need to be eating their veggies, exercising, and getting plenty of rest. That’s the best medicine there is.

      • HJ

        ” If they don’t want to be caught up in the healthcare machine, they need to be eating their veggies, exercising, and getting plenty of rest. ”

        I exercise, eat my veggies and get enough rest…it is about prescribing…

        • Melanie Lane MD

          Hi HJ,

          I am sure you may have heard this before, but there are many alternatives to allopathic medicine. There is not a one fix fits all for depression or anything else.

          You could see a different MD, a naturopath, an accupuncturist, a therapist, a spiritual advisor, or a life coach. You could try martial arts or seek a support group or start a blog.

          If you don’t feel that you are getting appropriate care for your situation, keep looking. I’ll be the first to admit, MDs and DOs don’t know everything.

          • HJ

            You seem to miss my point…my FP can prescibe medication or refer me to another provider. She doesn’t have the qualification or the time to do anything about depression except prescribe medication. That’s the reality. Without blatant lifestyle recommendations…that’s usually the reality for me

  • Payne Hertz

    Here’s something you might not know. Most of us don’t like prescribing pills

    The pharmaceutical industry does over $300 billion a year in sales in the US. The evidence strongly suggests otherwise.

    I can’t count the number of times I’ve been accused of “non-compliance” for refusing to take meds, often meds I’ve already tried and which either didn’t work or didn’t work and caused intolerable adverse effects. One doctor even sent me a certified letter after my first visit when I refused to take blood pressure meds, requesting that I sign off on the fact that he had offered them and had refused to take them. After just one visit and with no knowledge of whether the HPB was a regular problem or just temporary.

    Many doctors prescribe meds because they’re convenient and easier than educating patients on the alternatives. And yes, drug companies have been indicted for giving kickbacks to doctors for prescribing meds, though obviously not every doc is getting a kickback for every med. Many doctors are heavily influenced by aggressive marketing tactics whether they realize it or not. The pharmaceutical industry wouldn’t spend $30 billion a year on marketing if it didn’t work.

    • Melanie Lane MD

      I will agree with your point that doctors sometimes cave in and write a prescription because it is more convenient than arguing with their patients. Drug seekers are well aware of this weakness and make the most of it by trying to be the last patient of the day, when they know you’re tired.

      I am not justifying the practice, but there are a few reasons why a doctor just might cave in and write a prescription without taking the time to explain alternatives.

      He’s already running late because prior patients were late or complicated or demanding, and he doesn’t want to get even further behind lecturing a patient whom he knows won’t listen.

      He doesn’t get paid for it. I’m sorry, running a medical practice is a very expensive business.

      The patient is difficult; sometimes they get combative.

      The doctor’s exhausted; we’re human.

      If you have an elevated BP, and the doctor doesn’t document some sort of intervention, and you go home and die of a stroke, he’s likely to lose a law suit. Just because you appreciated his recommendations for diet and exercise alone does not mean that your widow/widower will.

      Not all doctors are mindless automatons. I can’t tell you the number of people I have irritated, even enraged, by refusing to give an antibiotic for a common cold.

      Frequently, the major deciding factor in my prescribing does not come down to what’s best for the patient, but what’s most affordable for her. I am pretty sure that I have never written a prescription based upon the drug logo on the pen in my hand or the Subway sandwich some pharmaceutical rep brought me at lunch time. I graduated from training in 2003; in my short career, those are the biggest kickbacks I ever got.

      • Payne Hertz

        I do appreciate the fact that you don’t give antibiotics for colds, but over 41 million scripts are written for colds every year in America, even though indiscriminate use of antibiotics not only poses an enormous risk to the patient, but to society as well. That’s one script for every 8 Americans, every year. That is but a fraction of the unnecessary script-writing that goes on. This is totally irresponsible. I doubt many doctors would admit to being influenced by drug company marketing, but Big Pharma isn’t spending $30 billion a year on pens and pads alone. There’s a bit more involved and the drug companies know their business well enough to know what works and doesn’t work. Drug marketing to doctors is a biggger business than General Motors.

        You can blame fatigue, “drug-seekers,” “difficult,” or “complicated” patients for this kind of behavior, but at the end of the day, the signature on the prescription is yours. “Personal responsibility” also applies to doctors, and doctors are ultimately responsible for every script that gets written in this country. While I am sure some patients can be excessively contentious and you have every right to be frustrated, you also need to keep things in perspective and recognize that sick, scared people aren’t always on their best behavior. Doctors on the whole have no problem denying necessary pain meds for legitimate chronic pain patients who often get falsely labeled as “drug-seekers” for seeking such treatment. Imagine being on the receiving end of that particular misdiagnosis and being unable to get your pain treated anywhere because of it. Is it unreasonable to expect a little restraint for unnecessary scripts particularly when the meds in question are often dangerous and deadly?

        Seeing a doctor isn’t cheap, and most of us walk in the door with the expectation that our doctors will take our problems seriously and only prescribe what is medically necessary, rather than what is expedient for them. We expect they will also respect our right to refuse those drugs. If you need to document that fact then fine, but don’t waste our time with excessive paranoia over suits.

        Yes, you are human, and make mistakes, but your mistakes can cost people their health and their lives. The mistakes your patients make cost you only a little time and aggravation, yet you seem to be unwilling to allow for your patients’ human foibles, such as their inability to lose weight. Given that fewer than 5 percent of overweight people can successfully lose weight and keep it off for more than 5 years, isn’t it time to acknowledge that perhaps it is a little unreasonable to assume a patient’s failure to lose weight is the result of not trying or lack of will to get better, rather than the rather obvious fact that the majority of humans simply cannot overcome biology by losing weight and keeping it off? It seems rather pointless to get frustrated over something that most people can’t seem to control.

        • Melanie Lane MD

          In my attempt to explain some physicians’ behavior, I have given the impression that I am excusing sketchy prescribing practices. It was not my intent to point fingers or blame anybody for the huge problem this country faces with prescription drugs.

          The original point that I was trying to make with my blog post is that everyone, doctor and patient alike, deserves health and happiness, but he or she has to believe that, accept it, and take action for that to manifest. (no blame attached) The current paradigm guiding our healthcare system leads to total disempowerment of providers and patients. It will take a radical shift in thinking for us to find a way out. I do not accept that most people “simply cannot overcome biology.” Our nation is not overweight because we can’t overcome biology; our genes don’t evolve that fast.

          What people need is somebody offering to help them look at their challenges from a different angle. Some, not all, may find another way to create a healthier lifestyle outside of the current healthcare model. Some, not all, may need prescription medication. I, for one, will accept responsibility for my emotions, thoughts, and well-being and look for ways to continue improving. Hopefully, from this place of personal empowerment, I can act as a role model and support to others.

          You obviously feel very passionately about this. What do you see as the solution, which has not yet been brought to the table?

          • Payne Hertz

            I would hope that you would also accept responsibility for your feelings and attitudes towards your patients, which are more about you then they are about them, as is often the case with our emotions. I have dealt with hundreds if not thousands of chronic pain patients for years as the contact person for a support group and am intimately familiar with their stories. Although I am emotionally burned out now from hearing so many stories involving so much intense suffering, at no point have I ever adopted the judgmental attitudes that people with pain so commonly experience from the medical profession. Quite the contrary, I have come to see pain patients not as losers or weaklings who refuse to get better, but as toughened survivors who have often endured tremendous hardship and suffering and yet have continued to hold their lives and their families together under incredible physical and financial strain. I marvel at the strength of some people and the obstacles they have overcome to survive.

            Yet these same people walk into a doctor’s office and more often than not are treated abusively and dismissively by doctors who have absolutely no idea what they have struggled with and what they have endured yet they are comfortable making snap judgments about their character and motivations. Some doctors see a patient who has failed to overcome his or her challenges, and assume that the patient has never tried. It is remarkably ignorant, arrogant and counterproductive behavior that creates an adversarial relationship between the doctor and the patient that will invariably be blamed on the patient. Of course, some doctors are quite understanding, collaborative and appreciative of what their patients are going through, and in my opinion, these are the kind of doctors who are more likely to positively influence the behavior of their patients.

            I don’t pretend to have the answers to every medical problem such as chronic pain and obesity, but if you ask me what should be changed about this system, the first thing would be doctors’ attitudes.

            As J.T. Wenting has said many doctor need to stop seeing patients as the enemy and start owning their end of the doctor patient relationship. Doctors need to learn to see their patients as individuals, not as cardboard caricatures based on ridiculous political or ideological tropes. If the current weight loss paradigm is unable to get the majority of people to lose weight, then the solution is not to build a better patient, but to build a different paradigm. Judgmental attitudes based on ignorance and lack of awareness are less than useless.

            In my opinion the main reason Americans are so fat has nothing to do with “personal responsibility” and everything to do with the fact our food is loaded with refined carbohydrates and hormones. If this stuff makes farm animals fat, it makes us fat, too. Our genes did not change overnight, our diet did. The medically-approved high-carbohydrate, low calorie diet doesn’t work for most people. The French eat a high-fat diet and yet tend to be thin, we eat a high carb diet and tend to be fat. This is called the “French Paradox,” as if the experience of the French is some weird anomaly. I see it as a nation’s worth of evidence that our weight control paradigm in the US is seriously flawed.

          • Melanie Lane MD

            Dear Payne Hertz,

            I’m not sure where this reply will land as there was no option to reply to your last comment beneath it.

            I agree that some doctors could use a change in attitude. But hanging our hopes and expectations for the resolution of something we feel so passionately about on somebody else leaves us powerless. We can only control ourselves and our own attitudes.

            I have no argument with your statement that we need a huge paradigm shift. In actuality, this blog was a token attempt at introducing that.

            “I believe that most people don’t need more pills.
            What they really need is permission to live long, healthy, happy lives. ”

            You might call that hokey or condescending, but that’s been my own personal story and my experience in working with obese to morbidly obese people.

            Despite the fact that we are bombarded constantly by the media, that our foods are engineered for addictive consumption, and our culture supports eating biggie sized fries 24 hours a day, each of us is still responsible for everything we put in our mouths. It takes a lot of resolve and commitment to personal wellness to eat healthy in america, but it can be learned. I’ve done it, and I’ve seen a lot of other people do it too.

            I have seen your blog and understand that you care very much about people suffering with chronic pain. If you want to get doctors to change their attitudes, keep commenting. I’d suggest choosing a tone that is less aggressive. When people feel attacked, they’re likely to get angry, and the dialogue is likely to devolve into an unproductive argument.

            These comments help:
            “I have come to see pain patients not as losers or weaklings who refuse to get better, but as toughened survivors who have often endured tremendous hardship and suffering and yet have continued to hold their lives and their families together under incredible physical and financial strain. I marvel at the strength of some people and the obstacles they have overcome to survive.

            Some doctors see a patient who has failed to overcome his or her challenges, and assume that the patient has never tried. ”

            These are not:
            “It is remarkably ignorant, arrogant and counterproductive behavior.

            Doctors need to stop seeing patients as the enemy and start owning their end of the doctor patient relationship.”

            I may be remarkably ignorant and arrogant, but telling me so isn’t likely to inspire me to adopt your cause. I have never seen my patients as enemies and to imply that does not inspire me to support your cause.

            In turn, I will be much more judicious about using the words drug seeker.

  • Melanie Lane MD

    Hi HJ,

    Obviously you are unsatisfied with your relationship with your FP. What is it that you would like from him that you are not getting?

    • HJ

      “Obviously you are unsatisfied with your relationship with your FP. ”

      I like my current FP. She manages my medications quite well. She doesn’t push the antidepressants like other doctors I have seen-but she also isn’t involved in my treatment for depression.

  • Annie Stith

    Hey, Dr. Lane!

    I just have to say it again on this blog (nothing personal)…

    Despite some patients’ (including mine) best efforts, eating all our veggies and exercising (in my case, the best I can) and using meditation/visualization and other alt techniques and OTC supplements, some of us still don’t lose weight or experience lower triglycerides or “bad” cholesterol or increased “good” cholesterol or lower BP or balanced blood sugar…

    My PCP believes my weight is genetic at this point, especially as all the women on my mother’s side had both obesity of the same shape with onset at the same age, and hypothyroidism (which, in my case, took years for a Dx because my previous PCP’s wouldn’t believe I was doing my part). And despite following an appropriate diet and taking my fish oil and Trilipix, I still have problems with all three types of cholesterol.

    Some of us do our very best. Some of us hate meds, but understand when they’re necessary, and so end up taking them. Some of us are the ones that notice the drug interactions before our physicians, remember which ones were ineffective, and which ones we had adverse effects with, without even looking at our charts because we pay attention and care.

    We’re not all noncompliant, lazy, pill hungry patients.

    ‘Nuff said.


    • J.T. Wenting

      you’re lucky your doctor recognises that your weight isn’t necessarilly caused by you being a glutton.
      She’s one of the very few in that… Most of her colleagues just won’t listen to patients, not when their preconceptions are being challenged in this.
      When my father gained 10 kilos on a starvation diet he was put on in hospital, all his doctors (he had 5 at the time I believe), nurses, and dieticians would not believe he wasn’t sneaking off to the hospital giftshop for candy and snacks when they weren’t looking. That he had 3 IV drips and a catheter inside of him so it was rather impossible for him to leave his bed didn’t matter a thing, he must somehow be “cheating” on their diet plan for him if it didn’t work.

      I no longer go to my doc for many problems, it’s useless. All he ever says is “if you just eat less, you loose weight and all your problems will go away”, never mind whether that’s my chronic back pain, flu, or whatever.
      He does then go and prescribe me some painkillers, which I can get cheaper at the supermarket (Naproxen is no longer barred from over the counter sales, but still available on prescription).

  • Melanie Lane MD

    Hi Annie.

    I hear your point. I’m walking a tight rope here, it seems. I know that sometimes people are working very hard and doing their part, and they still have pain or metabolic abnormalities.

    Sometimes prescription medication is the answer to that, and sometimes not. I do not believe that all patients are lazy and pill hungry, and I do not advocate that physicians parade around with that assumption in their heads.

    My point to another writer is that WAY more often than not, patients are not interested in their own health. They frequently don’t listen, don’t participate, and want to blame their doctors when they don’t feel better or get well. I think a lot of doctors are jaded by this.

    It is hard some days, as a physician, to walk fresh into each room and start over with the perspective that this patient will listen to me. I personally did my best, but it can be real a struggle.

    The original point of the blog was to empower people. In my career as a life coach, working with morbidly obese people, I frequently see people sabotaging their best efforts to achieve a healthier weight, because they don’t believe they can or deserve to be healthy. I believe they can and do and sometimes they need someone else to say it out loud for them.

    It sounds like you personally empower yourself and take an active role in promoting your health. I can’t tell you how relieving and wonderful that is to hear; you are an exception. Please keep sharing your wisdom and experience.

    • HJ

      “you are an exception.”

      I just want to point out that those that care about their health and are successful don’t walk into you office. To make blanket statements about patients based on your experiences isn’t scientific.

      • J.T. Wenting

        yah. Typical doctor attitude if there ever were one, considering the patient to be the enemy who wants to prevent the doctor from treating them efficiently and has to be tricked or bullied into taking his pills.

        That’s the attitude that causes patients to get hostile towards their doctors, causes them to question whether the doctor has their best interest in mind or wants to keep them sick as long as possible in order to sell them more pills, more tests, more hours of consultation.

        • Melanie Lane MD

          “I believe that most people don’t need more pills.

          What they really need is permission to live long, healthy, happy lives. Sounds silly, right? Yet I’ve seen it over and over. My clients and patients repeatedly sabotage their best efforts to adopt healthy lifestyles because they just don’t believe they can or deserve to be happy and well. They’re waiting for someone to give them permission, for someone to say, “Yes! You absolutely deserve it!” So until you can give that permission to yourself, I am writing you a prescription: a healthy dose of joy, wellness, inner peace, and satisfaction to be taken as many times a day as needed. Number of refills: infinite.”

  • Annie Stith

    Hey, Dr. Lane!

    I wasn’t fishing for a compliment or affirmation, but thank you. It does feel good to be recognized.

    Sometimes the generalizations get to me, and I feel a need to speak up. That goes for what’s being said about physicians, as well as patients. ;-)


  • Annie Stith

    Hey, Dr. Lane!

    This is how I see “the big picture.”

    I would refer to what we currently are dealing with as The Insurance- & Government-Driven Paradigm. I believe this grew out of the Industrial Revolution, the Depression, WWII. Labor was paid so little that to pay their own doctor bills just simply wasn’t feasible. And the burden of paying for the health insurance was placed on the employers, probably by the labor unions.

    Then there were significant changes in medicine, as well. Doctors (at least in the cities) were able to treat more complicated injuries and illnesses. Since one doctor couldn’t retain that much information, the old country doctor was out and specialists were in.

    Patients felt overwhelmed by the advancement of medical science as soon as the country doctor (and the old Wise Woman with her herbs). Doctors were taught in Medical School that, as specialists, they would be dealing with patients that didn’t have the ability to comprehend modern treatments. And the Insurance Companies had snatched control of treatment decisions, based on their right to earn a profit.

    So, doctors didn’t explain, and patients didn’t ask, and insurance companies did whatever they wanted. The divisions between doctor and patient and insurance grew into a chasms.

    Now, we’re into the “Boomers” into their late 50′s and early 60′s, and they’re asking questions about their hearts and lungs and joints. And the up-and-comers, the “Shadow Generation,” were raised by the Boomers to question authority, so they’re questioning everything.

    Doctors are Boomers and Shadow Generation, too, but they’re also still highly educated people who have been run thru a Medical School system where the culture may be lagging behind because their instructors went thru the system when doctors weren’t questioned. They may still be teaching that physicians are to be held in high esteem and not questioned.

    So, the Question Authority patients, who now have access to detailed information about their Dx’s on the ‘net, sometimes clashing with the Highly Educated So Don’t Ask physicians, who don’t really have the time to explain anyway, and probably don’t want to admit how much they’re not in control of the treatment choices because the I Have To Make A Profit Insurance Companies now have the final say.

    What needs to happen? We need to move into a “Mutual
    Respect and Trust”

    • The insurance companies need to respect the decisions made by the physicians, who are not only educated, but know what meds the patients are already on, know what’s already been tried, know their patient’s tolerance for side effects, etc. Formularies should be junked. All generics should be covered at the lowest level, and all brand names at a higher level (or something similarly simple). Diagnostic tests, procedures, surgeries, hospitalizations (and whatever I left out) should be covered at the doctor’s discretion.

    • Doctors need to adjust to the fact that patients have access to much more information than in previous times, whether thru the ‘net or advertising by pharmaceutical companies or simply because there are more conditions with less shame attached and so are talked about among family and friends. Doctors are going to have to trust that patients are truthful when reporting symptoms and compliance with treatments. There has to be an equitable way found for doctors to be paid what they’re worth (and not driven by insurance at 50%, or not at all driven by insurance, actually), and at the same time to spend more time with patients where the poor aren’t being given a lower-quality of treatment. (Salaried? Pay-for-Performance at annual reviews? Other?)

    • Pharmaceutical companies need to responsibly limit their profits, tho I’m not sure how. Ideas are: drop the program of giving out samples to doctors (use coupon programs instead so the patients don’t lose out); limit advertising to a percentage of the R&D for a specific product, or profit for the previous year, or total R&D for the previous year; stop being allowed to put off a medication being produced generically by changing a molecule (or other means); other ideas?

    • The gov’t needs to back off. The FDA needs to start accepting clinical trials and approvals in other countries as adequate for the US, expediting the release of new, beneficial meds. The gov’t needs to ensure there’s appropriate licensing of doctors, pharmacists, insurance companies, pharmaceutical companies, etc. There do need to be regulations about the release of meds based on safety, but there needs to be much less red tape than there is now. Other ideas?

    • Patients need to earn the trust of their doctors by being consistently honest about symptoms, side effects of meds, and compliance with and benefits of treatments. They need To respect the value of their doctor’s time by not making any last minute cancellations, showing up for appointments on time, and being prepared for appointments prior to showing up. Patients need to trust that the other companies and agencies are being compliant. Other suggestions?

    That’s what I see as a starting point, anyway.


  • Melanie Lane MD

    This isn’t the big picture, it’s the HUGE picture. I really enjoy the way you’ve broken it down.

    I would love to have other comments and suggestions for you about convincing pharmaceutical companies to limit their profits, getting insurance companies to back out of the doctor-patient decision making process, or a simple way to ensure that physicians are fairly compensated. The system is broken in so many ways that makes my head spin.

    The trouble is that in every single one of these scenarios, human beings have to put aside their smaller selves (the ones driven by what’s in it for me?) in favor of the greater good.

    Honesty, compassion, patience, responsibility, the drive to better one’s self all have to be present. Some people are there, and some are not. I don’t know how to affect that kind of change on such a grand scale.

    I left practice, because the whole environment felt completely disempowering to me, for patients and providers. I wanted to find a way to empower people towards longer, healthier, happier lives, which I find impossible within the current healthcare model we have today.

    I’m creating my own little paradigm shift. I have a small wellness center with nutrition, exercise, stress reduction, and personal empowerment coaching. Many of the doctors I know think it’s a fabulous idea but tell me nobody will pay for it. Of course insurance companies don’t want to pay for it; it’s preventive care. And many people turn away from our services when they find out they can’t get them paid for by somebody else.

    Still, I believe that having a good solid healthy living plan that addresses mind, heart, and soul, as well as the body, is the best way to limit the amount of exposure to a very toxic system.

    Now, as you’ve just heard me say, just because others don’t believe I’ll make it doesn’t mean I won’t or that I shouldn’t try. Just because I can’t see from here just how your suggestions could actually work on large scale, doesn’t mean they won’t and that you shouldn’t try to get them out there.

    Besides eloquently sharing your ideas on this blog, what else are you doing to affect the Insurance & Government Driven Paradigm? How might I help you achieve that aim?

  • gzuckier

    I have always felt that placebos are grossly underprescribed, based on the literature demonstrating their efficacy.

  • Molly Ciliberti, RN

    Great post! I have come to the conclusion that I am overweight because I eat more than I move. If I ate less and moved around more I would be thin. But most people would prefer an easy out, take a pill, buy this video, etc. We have become a nation with ADD, the nation of the fast fix, the nation that wants it now with no responsibility for anything. And if all else fails, I can blame my doctor!

    • Melanie Lane MD

      Hi Ms Ciliberti,

      If you need more help with your weight, my website is I have a blog and a resources page listing some really great books that have helped me on my wellness journey.

  • LisM

    I recently went to my doctor to discuss swirching from a proton pump inhibitor to a non protom pump inhibitor. I am on an aromatase inhibitor and both meds can cause osteoporosis. I wanted to try to minimize the osteoporosis problem by getting off the PPI.He gave me a sample packet of a new drug to try and I went home to look it up. It was a proton pump inhibitor. So I decided to go off the PPI to see what happens. I have had to take a maalox tab 4x in 3 weeks but otherwise I have had no heart burn. Plus I have figured out pretty much what causes my heart burn and I eleminated that from my diet.

    Although he has been my doctor for 30 years, I think he is just burnt out and I am now looking for a new primary care.

  • PharmerJoshua

    If any patients are reading this, I was wondering what you might pay out of pocket for a personalized consultation with a pharmacist in an office environment outside of a typical drug store environment. It would be 30min-1 hour and help optimize your medications from all of your doctors. This includes a medication review (interactions/safety), how to best take your meds, and recommendation sent to your doctors about potential cost savings and more effective therapy, if available. This would include analysis of any OTC or herbal supplements you may use. Also practices in how to increase your adherence and lifestyle changes, like quitting smoking or losing weight. There are a few more things to it, but you get the picture.

    If you could put a value on it, how much would you pay for 30 minutes for a consult like this for you or a parent? Prefer an hour? I need to know so that I can go back to school if people don’t need patient-focused pharmacists anymore. Thanks for the input!

  • Annie Stith

    Hey, Dr. Lane!

    I wish I had answers for more actions to help change the paradigm, too. In my dreams:

    Some of it could be legislated:
    (boy, I hope these formatting codes work!)

    the loopholes in meds not going generic on schedule;
    the acceptance of at least some other countries’ standards being acceptable for use in the US;
    insurance companies having to comply with Doctors’ orders, especially when it comes to Rx’s;
    very high taxes on very high profits, including the profits of CEO’s and other executive’s bonuses;
    insurance coverage being mandatory and equal coverage for:
    mental health,
    preventive care,
    chiropractic care,
    Dental care,
    Eye doctor care,
    Naturopathic care [licensed],
    acupuncturist/acupressurist care [licensed], …
    [and I'm sure I'm forgetting others]

    with some kind of referral or proof of “medical necessity,” changing the definition of “medically necessary” to include pain relief for both acute and chronic conditions…

    People generally don’t like to be legislated even more than they already are.

    Many of the people I know, especially those in medical support groups, are also people who are (there are lots of ways to put this) “taking consciousness to a higher level.” Almost always this includes compassion and an understanding we are responsible for the care of everybody else on the planet. Mostly, this is fairly flighty, or seen as people starving in other countries. I’m hoping it will begin to mature into helping our actual neighbors, as well.

    My power in those situations is to continue to pray, meditate, visualize, talk, write, and post. (And work on legislature often by the same means.)


    (P.S. And now I have your web addy! Expect me to pass it around.)

    • Melanie Lane MD

      Hi Annie,

      Thanks for your kind reply. Please “continue to pray, meditate, visualize, talk, write, and post.” I do believe there is powerful healing in all of those activities – for you and others. That was what I was trying to do with this post. I will keep doing the same on my end.


  • Annie Stith

    Hey, PharmerJoshua!

    I have been an e-patient for so long, and have gotten into the habit of checking that information for myself, that I wouldn’t personally use such a service. Part of that’s because I have a Nurse’s pill book here at home, which includes reactions with the more well-used herbal remedies on the market. (And I’m one of those that actually reads the information sheets that are included with each Rx.)

    I can see where others could use your service, tho. People who don’t read the info sheets, or have a simpler pill book that doesn’t include herbals, or people who are simply worried about the number of meds they’re on, probably moreso seniors or some mental health patients who are limited in their cognitive functions due to medication side effects and/or caused by the illness itself. (Some could use a fundamental “which pills go where?” in their weekly med boxes, even. I’ve done that for a lot of friends, including which ones to eat with or not.)


  • Patrick W. Hisel MD

    Thank you Dr. Lane. You have put alot of effort into this and your message is very positive and diplomatic. Keep if up. I appreciate your soft approach to dialogue.

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