Today I read the Toronto Sun article by Dr. Ken Walker (who writes using the name Dr. Gifford Jones) titled Did you hear about the North American wimp epidemic? It appeared in my Google news feed and after consciously trying to ignore it a few times I found myself clicking on the link.
I was expect one of two things. The first was an article about how “men” in North America have become emotionally more expressive as they tap into the well feminine energy in an attempt to become more progressive. The second was an article that outlined the hormonal changes that are associated with consuming too much soy protein as our culture moves away from eating animal protein. It was neither of these, which says a lot about me.
The article was about pain medication and how people in North America consume a lot of it. Based on a study that was referenced but not cited – Opioid Prescribing After Surgery in the United States, Canada, and Sweden – the author talks about the finding that people in Sweden are less likely to fulfill their prescription for opioid medication after keyhole surgery when compared to people in the US and Canada.
The results were shocking. It showed that 79% of Canadians and 76% of Americans used opioid prescription drugs following these procedures. But only 11% of patients in Sweden needed an opioid drug! You do not need to be a statistician to surmise that something has gone awry in North America.Dr. W. Gifford-Jones
As the article continues, he coins the term “pillitis” as a symptom of our mania for pills. For this, he places the blame on three groups:
The first is big pharma who have a fiduciary responsibility to their shareholders to make as much money as possible. They manufacture and market chemical solutions to the problems that people have, and, as such, they have a conflict of interest when it comes to the truth. If they can sell the problem and the solution, they’ll beat earnings projections which translates into greater divided-ends and larger bonuses for the C level personnel.
The second group is the doctors who prescribe the medicine to their patients. Their motivation is to reduce suffering while doing no harm to the people they are helping. Being the only people in the equation who have the legal authority to say who can buy and consume most medication, they are the gatekeepers who basically introduce the end user to the drug dealers. This introduction comes in the form of a prescription, a dosing recommendation, and their blessing.
The final group are the people who consume more medication than their counterparts in Sweden. These are the “wimps” that Dr. Gifford-Jones is talking about. We are the ones suffering from pillitis, unwilling or incapable of enduring any sort of pain and only too happy to shell out cash to buy whatever magic coloured pill that has been invented to alleviate the symptoms of whatever medical condition happens to be making our life a little bit less than ideal.
While I happen to agree with a lot of what the author is saying – that many of the medical problems that people suffer from are not problems per-say, and are actually symptoms of a series of poor life choices – I have difficulty with how he goes about saying it and what he does to get the message out.
According to the JAMA article that he references, around 8 of 10 people in North America who get surgery will fulfill the prescription for pain medication that their doctors gave them. In Sweden, this number is around 1 in ten. Using logic and hyperbole, the conclusion is drawn that people in North America are wimps and the folks in Sweden are tough.
This is a little rich, particularly for a medical professional. It’s the kind of thing that I would expect from a blogger, copy writer, or pundit who has a vested interest in pushing a particular point of view. It is the very thing that kind of has me try to ignore sensationalist headlines and avoid consuming the articles they are trying to promote. It is more understandable when a writer, marketer or talking head does it as they may not see themselves having any other choice. It is a different story when a doctor does it.
This I say while agreeing with most of what the author is stating. Too many people rely on pills or medication to treat the symptoms of a problem that the person could solve if they just took some different actions – eating more whole food and more fresh vegetables, and consuming lower amounts of food will go a long way in eliminating the “need” to take heart burn medication. The body is doing its best to process the crappy food-like stuff that is being pushed into the stomach, which means making and releasing more than a reasonable amount of digestive acid. More acid dumped into a full stomach means that some of this acid is going to find it way to the top and begin to leak out. There is a very good chance that your daily heartburn would disappear if you ate less in general and consumed more things that are easy to breakdown.
As evidence that North Americans are wimps, our constant indigestion does not meet the mark. It is more likely evidence of a different condition that is not medical – it indicates that we make chronically bad choices and find the consumption of various food-like products to be so rewarding that we cannot stop ourselves from eating them.
That same thing might apply to the filling of the post-surgery opioid drug prescriptions that the doctors write. This one is a little tougher though given that very few people are doctors and that most people are compliant or obedient when it comes to the recommendations of authority figures. When the doctor hands over a prescription it is natural for a patient to be motivated to get it filled and to follow the doctors’ orders. This is the case for almost all medications and for most people, and it is behaviour that is instilled in us when we are young and any time we hear someone say something about antibiotic resistant bacteria. Super bugs are primarily created through the over use of antibiotics in animal farming and, to a much lower extent, by people not completing the entire course of antibiotics. However, since most people are not farmers, our civic duty is to take ALL of the medication the doctor prescribes and to consume it exactly how they outline.
If you do not want to be a bad person and end up ruining the future for your children you WILL do what the doctor says. Factor this into a health care system that doesn’t afford the doctor a whole lot of time to get into the ins and outs of opioid pain killers and you have the perfect recipe for the creation of a continent of wimps. The doctor told me to take the medication every 6 hours so I took the medication every six hours. And by the way, the doctor cut a couple of holes into me, pumped the area full of CO2, and scrapped or cut out stuff that wasn’t supposed to be there. Sure, when compared to the old school method of slicing a 14 inch cut just below the rib cage and having the doctor and three surgery assistants put their hand inside feeling around in your guts, laparoscopic surgery isn’t much of anything. But it is still “surgery,” albeit a much less invasive form of cutting someone open.
I don’t think this makes people wimps – at least it does not necessarily make us wimps. People in North America are much more likely to get their opioid prescriptions filled, and according to the JAMA article, are going to be prescribed a greater quantity of medication when compared to Sweden. Does this mean that doctors, as the middle people between the drug seller and the drug user, are the ones who are writing the prescriptions and are therefore in near complete control over who gets access and the quantity that they get access to? It does, but it is the wimps who are following the doctors’ orders. Does it also mean that people in Sweden are much less likely to listen to what their doctors say and to ignore the medical advice that they dispense? It does, but that is because they are not wimps like we are in North America.
Here’s the rub, and it bothers me a lot. First off, I agree with what the doctor is saying about over prescribing medication, particularly opioid pain killers. These drugs are a potential problem because they have the quality of eliminating psychological pain as well as most physical pain. Life can be tough, it can even be painful. Maybe you come home from work and your back hurts from lifting something. Maybe you come home and your spirit hurts from the realization that you are the lackey who must dance when your boss grinds out a tune on the organ. Both of these things are a version of pain, both will disappear if you take some oxy, and maybe both should be experienced because they are a symptom of something not working for your body. The ability to experience pain evolved for a reason, we eliminate it at our own peril. Not wanting to experience pain does not make someone a wimp, it indicates that the system is working correctly and that the person is psychologically well adjusted. Pain is there to motivate us to avoid something. The truth is, post-surgery pain is an indication that the surgery should be avoided and that you should avoid surgeons. That is true in so far as their interventions DID cause the pain but it is not true because when we take a long view, their actions actually reduce long term suffering.
My annoyance comes from the title of his article and on who he blames for the abundant filling of post-surgery pain prescriptions. As a doctor, he isn’t going to come out and say “surgeons in North America are prescribing more pain medication than is necessary and this is helping to line the pockets of drug companies” because it would be professionally risky and while it might be technically true, doing so isn’t on their radar. The intention of a surgeon is to reduce suffering and allow people to live with less pain and without the need for pain medication once healing has taken place. All of that being said, the JAMA article was not about people who went out and bought pain medication on the black market, it is about people for which a medical doctor prescribed the medication and that the patients bought through a well-established and legal system.
The author has a point of view and has an obligation to the publisher of the Toronto Sun to create content that will generate page views. While his article was a less than perfect marriage of these two things, it was moderately successful at the first and very successful at the second. He seems to believe that people should be more tolerate of pain and have a willingness to alter their behaviour to eliminate some of the discomfort associated with making poor choices. He also seems to believe that doctors should not be prescribing opioid medications as frequently or in the amounts that they are. But in order to get people to consume these messages, he creates an outrageous title that implies that wimpiness is the newest epidemic to hit North America.
This makes me wonder, would he have gotten as many page views if he had selected the title “Thousands Ignore Medical Advice In Epidemic Of Swedish Masochism?” I have to concede that I would have clicked on that link INSTANTLY and would have laughed at the tactic to trigger my interest and capture my attention.
Headlines matter because they act to prime the reader for what they are about to consume. Their psychological purpose is to activate particular circuits and power-up mental processes that will influence the experience of the reader. An outrageous headline activates a lot of unconscious brain activity that readies the reader to engage in in-group / out-group thinking, virtue signalling behaviour, toxic empathy, and a version of the selection bias that has them ignore or disregard anything that would serve to mitigate the outrage. It suppresses objectivity and rational though by hijacking the brain of the reader. A feel good headline on the other hand offers so much less to the brain of the reader. No problem is presented and since no one is being victimized, the moral high-ground is not so clearly found. The absence of an obvious “right” and “wrong” offers little incentive to the brain of a potential reader. Unconsciously, we KNOW that there is nothing in it for us and while we may feel good after reading it, we will not feel activated and alive in nearly the same way as we do when we read about Trumps latest tweet – regardless of the side of the fence you find yourself on, Trump’s tweets satisfy everyone because they are either outrageous or how people respond to them will be.
I do not fault the doctor for any of this. He is both a doctor and a writer, and the identity of each requires a different set of skills and behaviours. The lines are blurred a little bit with his “wimp” article because he’s using a tactic of a writer to get people to consume his medical opinion. Getting people to read anything is a tough task, so maybe he had little choice when it came down to it. However, after reading his article and the original JAMA study, I’m left wondering if it was worth the time and effort.
And that is the point of this post. Headlines are used to capture people’s attention and trick them into reading something that they would normally ignore because they trigger seeking behaviour that is, in many ways, very similar to the moves drug addicts make as the effects of their last hit begin to fade. But just like the cravings of a drug addict, we do not need to give-in to the desires that are launched by an extreme headline. These decisions to not indulge will, overtime, reduce and eventually eliminate the intrusive thoughts that lead to the impulsive behaviour of clicking to read things that we actually do not care about or that we were tricked into believing mattered to us.