There is NOT a pill for everything
The sooner we learn this the better
No better time to have this discussion than the beginning of the New Year.
So let’s think thru this concept as it may change how you approach your health now and in the future.
Let’s approach this with a real story or two, all true.
I graduated medical school over 30 years ago. That’s a long time. I began to realize how long it has been when children I saw when I was a “young doctor” now have kids of their own. But that is also the nice part of being in practice this long. The ability to develop long and trusting relationships with so many people is priceless.
Things have changed over the years especially in healthcare and treatment styles/options. I tried the Traditional thing of looking to wave my magic prescription pad and prescribe the newest and latest miracle pill to cure the latest malady. That got old but it did take about 10 years to get there.
Somehow most of these new medications also become old and rarely used within a few years. That should really make you go Hmmmmm. It had that effect on me the more times it occurred. The blinders of Traditional Healthcare were slowly coming off. And when they came off it was blinding.
Back when I began my career, as an employee in a small group practice, I was excited as I saw the practice grow around me and I got busier and busier. The growth was great as I discovered that I was able to build a practice. People actually wanted to come and see the young new doctor with the sarcastic wit. Well at least that is what I thought.
When I was young I truly enjoyed wielding my prescription pad. Wow what power it had. All those years in medical school finally paid off. I had the ability that very few people had to prescribe a medication and then have the patient come back for follow-up. Hopefully they improved somewhat, and ka-ching ka-ching for the practice. A Win-Win. Patient improves and practice gets paid. The more prescriptions I wrote the more patients came back. It was like the prescription pad was a groomer for increasing patient load.
I started saying to myself that people who returned often for follow-up and refills were "Professional Patients". It was like their second or third job to have to make an appointment, fill the prescriptions, take the prescriptions daily and then follow back up in the office for refills.
At some point though I started believing that was incorrect and unsustainable. It took time though.
I was young back then.
I must have been naive.
So please forgive me for being young and naive back then.
I was probably like most docs today just waiting for Big Pharma to come to the rescue with the next big breakthrough pill/treatment. But I began to question the narrative of Big Pharma to the rescue as little by little Big Pharma overplayed their hand.
Direct to Consumer advertising became legal and the airways were flooded with commercials. The media ad revenues went up quickly and so the media was now captured by Big Pharma $$.
Who doesn't remember the first, second or third Pfizer-Riser commercial?
I am not sure if all of the above were actually real ads or just spoofs. Let me know what you think.
I started going to more medical conferences, all the traditional ones at least as I needed my CME’s, continuing medical education credits to maintain my medical license.
Who do ya think sponsored many of the educational lectures and seminars?
Many days there would be more Pharma reps in my office than patients. And somehow they always knew whether I was prescribing their drugs, almost like my prescribing patterns were being stalked. Honestly it was kind of disturbing. I almost felt professionally violated. But at least I got free pens and paper tablets along with an occasional lunch. {sarcasm}
The reps with small budgets would bring in a pizza. This was before I realized I needed to be Gluten Free. The reps with the big budgets would bring in nice catered trays, enough for the whole office staff, which was larger back then. The free meals were not worth it as I would have to fake listen/smile to their sales pitch. This is when ADHD is a positive as it is an easy distraction from listening to topics of little interest. I would just nod and say “That’s interesting”, or “Wow, thanks for sharing”, and then “Oooh neat, can I have that fancy pen?”. Back then it was almost like a rite of passage to get the free meals and swag from sales people. On the positive they did provide plenty of free medication samples that I could then give out to patients who needed.
I did though have some fun, often at the Pharma reps expense. It’s not what you think. Here is a quick story.
One rep who often came to the office, His name was I William Toot, who went by Will, asked if he could bring his manager in to meet me. It was more so his manager, F Art Somemore, could see him discuss his drugs benefits to me, and since I was a nice young doc, it would make the rep look good. FYI- while I don’t trust Big Pharma, I know the reps have a sales job to do, and I try to separate the person from the profession. But back to the fun. I told Will Toot that I would only see F Art Somemore if I could play a little joke or prank him. This is totally true but names have been changed to protect privacy.
So it went like this.
Back then I always wore my white doctor lab coat with the big pockets. So I put a small fart machine in the pocket with the remote control hidden in my hand. I then went out to talk to the rep and the manager. After about 30 seconds of the reps presentation I pressed the remote for a short fart noise. I acted like nothing happened and let the rep continue, of course while watching closely the managers face who definitely reacted to the sound. But Big Pharma employees are well trained to always be nice to the docs and never ever argue or embarrass them. So the rep continued the presentation. After another 30 seconds I acted like I got a page and excused myself. When I turned around with my back to the rep and manager I pressed the remote again, but this time for a long juicy sounding toot. As I did this I walked through a doorway and shut the door. Of course I also listened closely at the door to hear the manager and the rep laughing to themselves. A minute later I walked back and asked them to resume and just as they started I hit the remote again. This time we all laughed hysterically and they asked where the fart machine was.
I said “fart machine, really!” and walked away.
I think the manager turned pale at that moment, then I laughed and let him in on it.
I think that was the last time I Will Toot and FArt Somemore came to my office.
So that was my best ever interaction with a Big Pharma rep. It was my way of showing them that I could pass as much hot air as they could.
FYI- While I did partake in Big Pharma presentations and sales pitches many years back, I never let it sway individual treatment approaches. Everything still needed to be proven and verified for safety and efficacy before using. It was not trust but verify, but instead verify, verify, question and then consider. Trust would never truly occur with medications until many years went by. Think about that statement for a moment as it is very important.
I do not trust any new treatment whether medication, surgical technique or vaccine until it has been used for a few years on enough people that we know true safety and efficacy.
I think my thought processes changed quickly when I transitioned out of Traditional practice towards Direct Primary Care (DPC) in 2008. DPC allowed me more time to research, read and think through treatment approaches.
I discovered that much of what I had been doing for 15 years of Traditional practice was mainly making markers of disease processes look better on paper, but that the disease processes still advanced.
Example: Prescribing statin drugs to lower cholesterol did a great job lowering cholesterol.
But my patients who used them without any other diet/lifestyle changes still progressed to developing heart disease, along with increasing Obesity and Metabolic issues such as Diabetes, among other potential side effects.
So I was getting disillusioned with Traditional practice as I felt it was not really PREVENTING much of anything. Traditional practice is still very good at serious acute illness such as if you are having a Heart attack, Asthma flare or Appendicitis. But I began to ask myself,
"Are the traditional treatment regimens preventing or reversing any of these disease processes?"
Generally the answer was a Big NOPE.
It seemed like Traditional healthcare regimens were relying on using medications to improve markers of disease without actually reversing or curing the disease. People just became chronic users of medications. Again, this did not appear to me to be healthy or sustainable.
So around that time I learned about the Paleo diet/lifestyle. This then morphed into Autoimmune, Keto and Carnivore diet/lifestyle. When I had my patients use these diet/lifestyle interventions not only did their health improve, they reversed the progression of many of their disease processes. They also started getting off of many medications that the Traditional system said they would probably be on for life.
Let me tell ya something.
De-prescribing medications due to positive results from diet/lifestyle changes is probably the most rewarding aspect of my practice and career in healthcare.
If a day goes by when I can not help to lower someone’s medication, well that is a wasted day at the office.
I enjoyed this newfound diet/lifestyle approach so much I wanted to take it further. So about 6-7 years ago I started and completed a Functional Medicine Fellowship. I did it mostly because I wanted more letters after my name.
So now instead of Steven Horvitz, D.O.,
I am Steven Horvitz, D.O., ABAARM, FAAMM
How fancy that sounds.
Don't ask me what that means as I always forget. But it does indicate that I completed a Fellowship in Functional Medicine which further solidified my journey towards helping people understand better their health and wellness, and where their health is moving in the wrong direction, and then helping to redirect them in as natural a way as possible towards improved health and healthier aging process.
There were so many more options now to choose from. I could now utilize the best of both Traditional and Functional Medicine. Sometimes this was with diet/lifestyle. Sometimes it was with nutrients and supplements. Sometimes it could be bio-identical hormones and prescription medications. But whatever it was, it was being used so that each unique individual could better understand why their health was not yet optimal, and what they could do to right the ship, to improve and speed up their journey in the direction of optimal health.
I learned that people don’t suffer from Lipitor deficiencies. Lipitor is one of the most widely used cholesterol lowering medications ever.
Getting back to the topic of this Substack.
Throughout my medical practice journey, I have learned that it is better to help people with less medications than with more.
Perhaps Big Pharma no longer likes me. I don’t really care. I do know they are no longer stalking me. I work for you, not for Big Pharma, Big Government, Big Insurers or Big Corporations.
Prescribing more and more medications to keep a patients health under control is NOT a win. It's more like just tapping on the breaks of a car moving towards a wall. You are still going to end up hitting the wall. But if instead you fix the root cause of the health issue, you not only stop the car moving towards the wall, but you can even turn the car around and move toward a healthier life, without all the baggage, side effects and drug interactions of poly-pharmacy (many medications at one time).
So I started today writing what I thought would be a short paragraph seems to have become a story of how to think thru improving your health, with less medications, more healthy lifestyle choices, and how NOT to become a professional patient.
At least that is how I like to be treated when I am the patient.
That is how I plan on working with everyone in my practice.
When it comes to Big Pharma, Less is usually more.
There is NOT a pill for everything.
The sooner we learn this the better.
You are my FAV!!! Thanks for who you are!!
Grateful!!
Thanks Doc. FABULOUS read. 🙋🏻♀️