Too many people take too many pills
economist.com
economist.com
I noticed that taking pain-killers is a very common thing in american TV shows. The main protagonist (male hero) gets hurt, goes to the bathroom, hastily pours a handful of pills into his hand and pops them into the mouth. Not one, but a hand full of pills, cleary too many. I've seen it so much, I'm starting to wonder if it's a TV trope.
I'm wondering if pharmaceutical companies are sponsoring this. It's akin to product placement.
It’s no accident that they code a loop with no termination condition (except the implicit emptying of the bottle). Really boosts sales!
It just feels cleaner. I assume it's because the additives in the shampoo become overloaded on the first use, and are active on the second.
I was thinking about this when watching The Shape of Water, Michael Shannon's character is in his car, arms shaking, pouring the whole pill bottle on his face ...
It's a dramatic trope.
It was the source of many jokes in sitcoms in the 1960s, too, not just the 80s, including notably what we think of today as a "kid's show" (despite being a primetime show when aired) in that it was a recurring thing in The Flintstones.
A version of the drug habit/self abuse trope that used to be demonstrated with late nights alone with booze bottles in some depressing living room.
A blazing modern signal that the protagonist is hurt but continues anyway, to distinguish him from some impervious Superman or unfeeling Terminator clone.
The writers are mildly concerned about the plot discontinuity and rushing him to the next scene. See also the bullet wound self-care with improvised extraction and bandage from ripped clothing, which leads to miraculous physical rebound. No debilitating blood loss, nerve damage, or torn connective tissue in this plot!
In books, you get "chewing asprin without the water." So yes, it's dramatic, but not realistic. It's just a way of conveying through action "Ouch, that really freaking hurts."
...acetaminophen itself is what kills your liver in an overdose, there is no "toxin they put in tylenol"
In other places tylenol must mean what we think of as tylenol 3
Some studies out there linking acetaminophen to reduced empathy.
That is not sponsorship by gun companies. It is TV.
if I may ask - and this is very much on topic - who won the 2020 election, and do covid vaccines contain nanobots?
But pain pills don’t ring a bell. The classic move is strongly taking a swig of hard alcohol and then pouring it over a wound and wincing.
In my opinion, people shown to be taking pills are usually portrayed as weak or digging themselves into a hole.
Perhaps with some exceptions to people shown taking pills which I interpreted as a display of competence and experience more than anything.
Spent millions foolishly, genius engineer - horrible story. Easily fixed.
If you have a health problem, you should do your best to get exercise, eat healthy, etc. However, that doesn't mean medicines are wasteful or pointless. People often greatly benefit from them.
I've struggled with ADHD, depression, and anxiety my whole life. And indeed, yes, the best treatment I've found is diet, weight training, and long-duration cardio. Which I do.
But people who are "in the hole" need medicines to dig them out. And also, people with kids/multiple jobs don't have as much time as I do. And these habits take years to finally stick. And I still need ADHD medication.
And the best treatment for things like this is to try every treatment you can together, but don't overwhelm yourself in the process (and it takes wisdom to not overwhelm yourself).
People on Twitter opine about this kind of stuff piss me off. They think their vague notions about what is right for society--that they have no experience with--should take precedence over my decades of (informal) research and lived experience. It's okay to have opinions and discuss things, but don't try to bully the people who actually know what they're talking about.
That said, there are way too many people out there who have no experience with conditions which require medication, who seem to think that those things are a substitute for medication rather than a baseline that must be kept up alongside medication.
I’m no psychologist, but I tend to assume that a driver to thinking this way might be the sense of safety that comes with self-righteousness. Similar to victim-blaming in crimes, where people pick at the personal faults of crime victims (however slight) in order to reassure themselves that a similar thing couldn’t happen to them. Imo it’s a coping mechanism for a world where long-term suffering can be brought on totally at random.
It is complicated. Some people have mental health conditions which are always going to require medication. Some people have mental health conditions which are never going to require medication. And some people have mental health conditions where it depends on environmental circumstances. For that last group, lack of sleep/diet/exercise/etc can be part of the environmental circumstances which makes medication required, so fixing that can make medication less required, and may even go some way towards making it no longer required. Even if certain other things can make medication no longer required, sometimes it is still helpful in the short-to-medium term to give you the space to implement those things
> but I tend to assume that a driver to thinking this way might be the sense of safety that comes with self-righteousness
There are serious concerns about iatrogenic harm in mental health due to overdiagnosis, misdiagnosis and overprescribing. Some people who are critical of medication are approaching the issue, not from some sense of superiority, but rather from negative personal experiences with the topic, for themselves and/or family members.
Taking psychiatric medication and being critical of it are not mutually exclusive-I myself do both. Medication is the least worst thing for me right now, but I hope one day I can solve some other problems in my life and remove some stressors and I may eventually wean myself off it. And simultaneously I believe a lot of people out there are being harmed by being prescribed the wrong medications. For example, the widespread prescribing of antipsychotics to adults and children without psychosis, by prescribers who are ignorant of the risks of brain atrophy [0] and who don’t communicate those risks to patients/parents. If you have schizophrenia, those risks may be the lesser evil; if you have a kindergartener with Aspergian traits and mildly violent behaviour, I’m not convinced it is. Maybe as a last resort once you’ve exhausted every alternative, but I know clinicians for whom risperidone is their first resort for such a patient not their last
[0] https://journals.sagepub.com/doi/10.1177/0004867418797419
That summer after my first year of college, I spent my days moving stuff around in a furniture store and golfing 9 holes after work was done, and weaned myself off of it. I haven't relapsed into the hospital in two decades since, despite more than a few high risk periods I've gone through over that time, and a lapse during fatherhood in my ability to keep up with exercise as much as would be ideal. I don't know whether my brain was sufficiently re-wired by those 9 months of pills or what, but it's a bit strange to me that essentially every psychiatrist would have insisted something like this was impossible.
Bipolar disorder disappears in some people spontaneously. Around 10% of people who have a first bipolar episode will not go on to have a second one, even if they permanently discontinue medication. And some people who have a second episode will never have a third, even if they stop taking medication, although I don't have an actual statistic on that. Let's suppose it is 1% of all bipolar cases – which is a figure I just made up, but probably in the right ballpark. Since bipolar is around 1% of the population, people like you would be around 0.01% of the population. That sounds insignificant, but in a country like the US there would be over 30,000 people like you, and worldwide could be over 700,000.
I think the psychiatrists who told you this is "impossible" probably knew that it actually wasn't. It is just that it is rare, and they don't want to give patients and their families false hope or encourage non-compliance with treatment, so instead of telling you the truth that it is 10% or 1% or whatever of all cases, they tell you a "white lie"/"simplification" that it is 0%. 90-99% of the time, their lie turns out to be true for the person they told it to.
In terms of whether 9 months of medication "rewired your brain" – it is impossible to say. It is possible that without medication you would not have gone into remission, and would have had further episodes. It is also possible that you were always going to remit anyway, and still would have even without medication. Nobody really knows. The fact is, for just about all psychiatric disorders, our knowledge of what causes them, and how the medications work, is extremely incomplete, and we don't know enough to answer those questions in individual cases.
This is key. As someone with bipolar disorder, I'm forever stuck in a cycle of stable with good habits -> episode happens -> can't keep the habits -> get worse -> medication changes/episode passes on its own -> I go back to good habits -> stable...
With mental illness you never know when it's going to act up and ruin your life, so the least you can do is use your energy - when you have it - to keep your body in a decent baseline.
Thankfully, this cycle takes many months to start again, so I live a decent life most of the time.
> To this day
> He is a stick of TNT lit from both ends
> Could describe to you in detail the way the sky bends
> In the moments before it’s about to fall
> And despite an army of friends
> Who all call him an inspiration
> He remains a conversation piece between people
> Who can’t understand
> Sometimes becoming drug free
> Has less to do with addiction
> And more to do with sanity
- To this day, Shane KoyczanOPs description of his friend ruining his life by not taking his meds seems more like bipolar.
Maybe because there are dependents that needed that money for school, shelter, clothing, or food.
There was a story in the news recently about a guy who spontaneously gave away $200k by throwing bills out of his car window. Seemed like a feel-good story, at first. It turns out that he gave away his family's life-savings and they're now destitute.[1]
Money can absolutely be wasted and spent foolishly.
[1] https://www.nbc15.com/2023/04/13/man-throws-200k-cash-out-ca...
I currently have untreated inappropriate sinus tach where my heart rate is continually 100+ BPM. This will require a cardiologist to sign-off, probably for ivabradine since beta blockers are giving me depression. And it's my understanding that node ablation has a low success rate and I'm not interested in a pacemaker.
In fact, these medications can worsen a patient's condition.
What's common is to prescribe SSRIs and similar medication for all kinds of psychiatric illnesses, including BPD. The evidence that this would help in the long-term is vague to non-existant, and I'd avoid trusting it (as with almost all research on anti depressants).
The best-researched facts about SSRI antidepressants are the increase in suicide rates and the "side effects", which are still often underreported, and include problems with basically all bodily systems, because serotonine is an importat t neurotransmitter. Not to forget about
https://en.wikipedia.org/wiki/Post-SSRI_sexual_dysfunction
SSRIs can also reduce life expectancy.
Personally, after being on an antidepressant (Effexor) for 6 years, I can also say that they massively reduced mental stability and self-awareness for me.
There are many meta-studies about this by now, somehow ADs are still seen aa evidende-based medicine comparable to insuline for diabetes. This is far from the truth, the mechanisms of action are poorly understood and effectiveness has been painted in an unrealistic way by pharma companies who make these pills.
I despise generalized statements like "xyz medication is over prescribed" because it is also in some ways probably underprescribed. I didn't seek treatment for a dibilitating illness for many years because I was repeatedly told that the medication was abused and all I needed were lifestyle changes. For me, the medication was underprescribed.
- 30 minutes of cardio, 3x a week is a bare minimum. The more cardio the better, so consider endurance sports.
- Resistance training is necessary too, and can be done at home with no equipment
- Get at least 10 minutes of sunlight right after you get up or right after the sun comes rises, even if it’s cloudy, if possible
- Don’t drink more than 2 drinks in a day
- Try to reduce stress as much as possible
- Get plenty of sleep
- Cut out digital distractions
- In general try to eat as many natural foods as you can, especially more fruits and vegetables. Avoid eating chemicals if you can, hydrogenated oils, etc.
Now you’ve heard it, as well as everyone else reading this thread. It’s up to you to do it. But odds are, for the most part, you’ve heard it before and don’t need reminding.
If you’re confused about any of the details on this list, you are all people who are in the top quartile (at least) in learning things on the internet, and can figure the rest out yourselves.
And I actually do all of that. Not because anyone told me to, or because I should, but because that's just how my life ended up being arranged.
Not sure how that's related to my point, though.
I think a doctor absolutely should gently remind people that those things improve a variety of conditions, and occasionally push a little harder in certain situations (you need to start doing X now or your condition is going to be a big problem). Many of them already do, of course.
What I was saying is that if I go see a doctor for a condition, and the proper way to resolve that condition is to make a lifestyle change, then that is what I want the doctor to tell me.
What I don't want the doctor to do is to just give me a prescription if the actual treatment is to behave differently in some way.
Everything else is either a straightforward treatment, is untreatable, or has a lifestyle change that the doctor will tell you about (like with IBS and a low FODMAP diet for instance).
Retail managers have the lowest suicide rates.
I don't trust them either.
Just to clarify, because this one tripped me up: you specifically mean alcohol, right?
The research vehemently disagrees with you, especially if you’re a woman.
5 hours at 3 MET (a 2.5 mph walk is 3 MET) a week lowers your risk of cardiac disease by 70%. It’s not affected by gender for the basic numbers. This is from one of the bigger meta analyses I’ve ever read. The US’s exercise guidelines are based on it.
Can’t speak for the recommendation of endurance sports. Definitely not a requirement. The research does show that, in general, the more cardio the better.
only stretching back a few decades, my grandfather was working his own land as a subsistence farmer without much "automation"...probably doing the equivalent of three hours of CrossFit a day, basically every day. looking back at pics of him now...he was strapped, even in his late 70s (what was also known as "normal").
my genetics probably come from hundreds of generations of people who led similar lives, yours too
I achieved my "normal" body weight with a minimum of two+ hours per day, every day, of exercise...just like all of my ancestors who shaped my genes
90 mins a week is probably not enough to even slow down weight gain, we are dramatically underestimating how much exercise we need, and dramatically underestimating how much we need to clean up our diets...in 1880 basically anyone doing subsistence farming (most people) was the equivalent of a CrossFit nut with a "clean" diet...everyone
Glad you’ve found something that works for you though
In general more is better, but it’s diminishing returns, and you could argue that more time than this could be better spent doing other healthy tasks.
Patients refuse treatment all the time. I’m not so sure it ought to be a doctor’s job to cater to the patient’s every whim.
In the end, it’s the patients right to have the treatment they want and can afford so long as it’s efficacious.
How you gonna make lifestyle changes without permission from your lords and masters who write your paychecks?
While I did manage to eat decently I also had the benefit of years of working in kitchens and I opted for vegetarianism years prior so I had to delve into a novel culinary discipline which served to broaden my horizons both in what I considered a meal, and what I was willing to eat, and how I was willing to eat. Looking at the rest of the cohort: yeah, it was bad. A lot of industries we interfaced with had a lot of very evident cases of poor diet. I expect among the whole the chronically single and childless were the few that could manage their health in the context of that schedule or any modern American regime, really.
Beyond diet it's physically taxing, especially considering that my industry, and every industry touching it worked some variation of swing shifts and if not that, 24/7 on-call. That alone is extremely taxing and has prolific long-term implications. Alcohol and drug abuse are commonplace, whether licit or illicit substances. And there's a huge emotional layer to it as well, if that isn't obvious. Mind you these are the people paid by the companies that keep your lights and heat on, transport all your food and fuel...
But even outside of that extreme edge case the other jobs I've had can have their own sets of challenges. It's not always overeating that gets you, but undereating is a hazard as well. And workplace injuries are not so avoidable as the institutions like to profess. If you're pressured, your peers are pressured, your customers are pressured, etc... the culture itself becomes go fast or die trying — they'll tell you to work safe but God forbid if you do you'll be punished for it, ask me how I know. And that's without factoring in RSIs, which in some occupations are virtually inextricable.
>Beyond diet it's physically taxing, especially considering that my industry, and every industry touching it worked some variation of swing shifts and if not that, 24/7 on-call. That alone is extremely taxing and has prolific long-term implications. Alcohol and drug abuse are commonplace, whether licit or illicit substances. And there's a huge emotional layer to it as well, if that isn't obvious. Mind you these are the people paid by the companies that keep your lights and heat on, transport all your food and fuel...
Looked at your profile and see your admission from "someone who sorta bootstrapped from a pretty shitty starting position"
Really there's not much difference between overwork to recover more completely from disaster, compared with ambition to make faster progress when opportunity exists.
This is the kind of situation where things like drugs are never the answer, seems like sometimes the toxic effects of chemicals are on steroids when the "setting" does not allow for much recovery between toxic exposures. If the medical benefit were not clearly in excess of the toxic load or significant side-effects I would not want to take the pill.
Each pharmaceutical is like any other consumer product. It didn't used to be as bad when mass-marketing direct to patients was still widely recognized as too unethical for serious consideration.
Once a consumer product reaches the most satisfying rapid market saturation on its own merit, the main way to continue the bonanza is to create desire among the nonengaged consumers who don't actually need the product but who can be convinced that it might be nice to have anyway for some reason or another. By then anybody with any interest at all knows it's already popular and accepted.
Then after the drugmakers and insurers got into a fortuitous spiral (for the corporations) on prices the incentive got even more extreme. Even though the insurers have to pay more for each dose, they just raise the premiums and "everybody wins".
Plus there are still really not enough doctors to go around but it used to much worse. However in the 21st century I think doctors are much more likely to recommend a simple pill (or more than one these days) rather than a more complex treatment.
Also when doctors were spread much thinner people went to them much less often, long ago it was like only going to the doctor when you needed to be cured of a cold or flu or broken arm or something.
So they got the exam, took one bottle of medication, got over the cold, and they were cured.
Then it was discovered there was no cure for the common cold. OTC approaches to treat symptoms proliferated with mass-media television and it was seen consumers would continuously purchase more pills on their own initiative to treat the same disorders which had not had that scale of returns in the form of doctors' prescriptions.
The prescription-industrial complex was going to have to advertise to compete.
Attitudes began the gradual change to continuing visits and ongoing treatment for more & more conditions, not just the things that would be expected to require a continuing lifetime of medication, such as insulin.
And a whole generation of doctors who have been influenced by very persuasive drug companies that have carefully built a reality distortion field where any tendency to discontinue medication once prescribed has been de-emphasized like never before.
>I opted for vegetarianism
I don't think the full risk is known when it comes to steroids in meat or pesticides in vegetables, but looks like vegetarians these days are more conscious of avoiding toxic additives than average, so this may be the safer move for that reason alone.
Those who do have far bigger problems than regular exercise.
How come? They certainly don't work any fewer hours than Westerners do.
Diet/sleep/exercise/sunlight are always the first step, and if you don’t at least get those, you’ll be hard-pressed to feel decent no matter what else you do, regardless of whether you have other medication-dependent conditions.
That said, there are way too many people out there who have no experience with conditions which require medication, who seem to think that those things are a substitute for medication rather than a baseline that must be kept up alongside medication.
I’m no psychologist, but I tend to assume that a driver to thinking this way might be the sense of safety that comes with self-righteousness. Similar to victim-blaming in crimes, where people pick at the personal faults of crime victims (however slight) in order to reassure themselves that a similar thing couldn’t happen to them. Imo it’s a coping mechanism for a world where long-term suffering can be brought on totally at random.
The surgeon and intake nurse both independently double-checked that my list was complete. They told me that it's almost unheard of for someone of my age to have no ongoing prescriptions and they wanted to be sure a mistake wasn't made.
I was very surprised by this. I was even more surprised when I surveyed my friends and discovered that every single one of them has at least one ongoing prescription.
I had no idea!
I suspect that, rather than being a role model, I just drew a lucky number in the genetic lottery.
On the reverse, how many doctors or pharmacists actually recommend lifestyle and supplementation changes before resorting to a prescription through observation? My experience has been quite disappointing and I lose faith every time I get a checkup.
For what it is worth, I’m not on any prescriptions and actively refuse recommended prescriptions when only seen for 30 minutes every half year. It always feels like an up sell when all you want is to be sent on your way with an acknowledgment that you’re healthy.
I have no doubt that there are too many people who take too many pills, but there are also too many people who should be taking medication and are not. The article does not make a strong case that, for a given age group, we are being over medicated.
> Shoot to thrill, play to kill, Too many women with too many pills
There was lots of over-prescription targeting "house-wives" before the opioid crisis e.g. diet pills, sleeping pills and tranquillizers. Your 80s doctor would ply you with all sorts of amphetamines, barbiturates, quaaludes etc. Lots of these have since been withdrawn due to causing medical problems. Marilyn Monroe dying from a barbiturate overdose in the 60s.
Society has for a long time felt that women's "hysterics" have warranted "medicating".
I'm also reminded of Rolling Stones 1965 "Mother's Little Helper" which was about women and prescription pills:
Myself, friends and family all have untreated conditions and aren't getting preventative care because the out-of-pocket cost of meds and treatments are more than their total earnings. Due for Shingles vaccine? $400. Need an inpatient visit to resolve something before it becomes serious? $2800.
Five hundred here, $5000 there and pretty soon healthcare becomes an alternative to housing.
They if you need to go to a doctor regularly and you don't have a proper diagnosis you might just like going to a doctor