We Never Learn by Steven Mussey MD

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When will we learn?

We doctors are sometimes our own worst enemies. We repeat the same errors over and over again because we know we can’t possibly make the mistakes our less informed predecessors made.

The latest debacle: Proton Pump Inhibitors.

I’m dating myself, but I vividly recall the “good old days” when all we had was Tagamet and Zantac.

When Losec (Omeprazole) hit the scene, we were afraid of it.

It seemed “too strong!” It almost abolished acid secretion. ABOLISHED!

Wow! Is that a good idea? Won’t that cause trouble down the road?

Common sense screamed: “It may be reasonable for a month or two, but this is a BAD IDEA!”

For a couple of years, most of us even followed protocols: Omeprazole for no more than a month and then switch back to Ranitidine.

But the forces of drug marketing combined with reports of amazing symptom relief from GERD made us forget our concerns.

Soon, PPI’s became as safe in our heads as Vitamins, Fiber, and other good things.

Even frustrating insurance prior authorization demands do not deter us from keeping people on PPI’s for THE REST OF THEIR LIVES!!!

So, is it a good idea to totally eliminate gastric acid forever?

Go ahead: Search the literature on PPI’s.

Be afraid. Be very afraid.

We don’t learn.

Yes, I know… Association does not equal cause and effect… BUT, COME ON PEOPLE!!!

USE YOUR BRAINS!!! (Speaking to the ones not on PPI’s, of course….)

What’s the next debacle?

Diabetes drugs?

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  5 comments for “We Never Learn by Steven Mussey MD

  1. Madelyn Sieraski
    February 25, 2016 at 11:44 am

    Last night (before I read this article) I got sick of the number of medicines I was taking. I choose my PPI to stop.

  2. Melinda
    February 23, 2016 at 4:12 pm

    I was on omeprazole for 2 years and suddenly started having vague symptoms–pain everywhere, especially distal limbs and joints, headaches constantly, facial flushing, dulled thinking (“brain fog”), weakness, orthostatic hypotension, and exhaustion. Nobody could figure out what what wrong. A brilliant immunologist thought it might be food sensitivities–I thought that was ridiculous since most symptoms seemed constant and the intermittent symptoms did not correlate with eating. He had me keep a food and symptoms diary and I did, and it seemed to show nothing. Until a neurologist’s checklist reminded me that I had been drinking a lot of orange juice lately. I cut it out and within days felt a bit better. It made me consider the possibility and I thought I would go on the rice diet to clean out my system. I instantly got much worse! This proved to me that it was food-related, so I went back to a random diet except cut out dairy entirely. Within days, again I was noticeably better, though I still had a way to go to feel halfway decent.

    To make a long story shorter, by the time I figured it all out, I felt normal again, as long as I completely avoided even trace levels of dairy, sugar, nightshades, citrus, corn syrup, turkey, lamb, mutton, preserved meats, cantaloupe, cauliflower, red dye 40, maltodextrin, white rice, brown rice, basmati rice, bananas, eggs, and citric acid. The reason the problems had originally been constant rather than food-related was simply because virtually everything I ate had something on that list, so the reactions constantly overlapped. At first I also could not have beef or chicken or pork, but I was able to “get those back” with help from a naturopath. With my system cleaned out, I felt normal but now if I ate anything on this list, I would begin to hurt (mostly wrists, elbows, knees and ankles, a “reactive arthritis”) about an hour after I ate it, and would then hurt for three days. I didn’t even have to know that I had eaten it–I would just begin to hurt and pay for the mistake.

    The naturopath also felt that I should not be on omeprazole, that I needed MORE stomach acid rather than less. He said that the real reason for most GERD was that in many older people there is not enough stomach acid, causing food to take longer to digest and the pylorus not to let it through yet because it isn’t ready so the stomach sloshes it around a lot and some goes back up the esophagus, and there IS enough acid to burn, so the medical response is generally to give medication to decrease the acid. He said what is really needed is MORE acid, so food is digested quickly and moves along. This used to be common folk knowledge, hence the pickle spear with your meal–to increase acid and help you digest. He switched me from omeprazole to1 tsp apple cider vinegar with meals, and things were definitely much better in my digestive tract. Still, I lived with all of these food sensitivities for 3 more years.

    About the time my reaction list was all figured out (2003), my immunologist brought me a new article that said PPIs had been linked to the development of food sensitivities. Apparently the leaky gut syndrome has some validity, at least in my case.

    The short term use of PPIs is one thing, but to use them daily endlessly is more of a problem than doctors realize. I wonder how many cases of Fibromyalgia and Chronic Fatigue Syndrome are really food sensitivities that no one even considered or the patient didn’t have the self-discipline to really eliminate the foods.

  3. February 21, 2016 at 3:58 pm

    I’ve had friends on those PPI’s for years and have long expressed my concern for them and the long term side-effects. What they tell me is that they’ve tried to get off and find the pain so debilitating that they immediately start taking them again. What a horrible situation for them–time bombs in the making.

    As for me–I’m 66 and take not one single medication except an occasional aspirin for muscle aches and even more occasional antihistamine for allergies, but I restrict myself to two a week as even those are hard to get out of the system. I work hard to stay healthy as I just don’t want to get into the “here take this medication and then take these five medications for the side effects of the first medication” cycle.

  4. Steve O'
    February 21, 2016 at 10:14 am

    Just to zip quickly onto another tangent about drugs – it is a stunning comment on our society to consider the psychopathology within the story of Bill Cosby. He is accused of giving drugs to women to render them unconscious, or at least incapable of consenting or refusing sexual activity. If there is truth to the allegation, it points to a psychological derangement in Mr. Cosby.
    The assertion was that this young, handsome, intelligent, rich and witty African-American celebrity was, during the 1960’s and 1970’s, was anxious about obtaining a consenting partner for sexual activity, or one who would accommodate his peculiar fetish, of having the female sexual partner seem unaroused and unresponsive. I suspect his anxiety was unfounded in reality. Had the game been finding someone who would feign a derangement of consciousness, I doubt that it would have been unattainable for Mr. Cosby.
    Nevertheless, if true, the culture of power hushed up this predatory behavior for years and years, accommodating, as this society very frequently does, the sexual abuse of the powerless by the powerful. Now, at the twilight of his career when the culture of power has passed him by, he is called to account for these allegations.
    Aren’t the parallels to prescription narcotic abuse noteworthy? If the allegations are true, Mr. Cosby repeatedly chose to commit an obvious felony that endangered the lives of his targets. Societies make things crimes for a reason, and intends them to be universally enforced, regardless of the public stature of the perpetrator or victim. Ours, most assuredly, does not. The perpetrators “have a problem.” The issue is ignored until it is noticed upon the shift of power away from the perpetrator. It is, in short, swept under the rug.
    Would Mr. Cosby have benefited from “no-rape” guidelines, or mandatory education of young male comics about the problems with committing rape? Was this perversion “stigmatized” to the point where he could not seek health? What of this pitiful statement by Daniel Blaney-Koen, JD, would have been useful in addressing Mr. Cosby’s alleged problem?
    I would say, ‘none.’ I would say that Daniel Blaney-Koen, JD is one and the same with the onlookers who keep kicking the can of celebrity crimes down the road for the benefit of the powerful. Both are social corruption; both are to some degree our society’s choice to be hypocritical. Neither will solve the problem, but it is conceded from the beginning that the problem cannot be solved – it just needs the proper window-dressing.

  5. Steve O'
    February 21, 2016 at 9:49 am

    Drugs have risks. Drugs have benefits. The proper use of drugs is to treat a condition, a disease. Companies that make drugs, market them to patients without offering a means to prudently balance risk vs. benefit. Customers are trained to demand products that catch their eye; for the clerk/physician to delay their sales order is met with impatient complaint.

    The chief ATTORNEY for the AMA has put forth this statement to governors of the states:
    “It is time to put an end to this epidemic’s hold on our country. Many states have already taken steps, and many physicians and medical societies have partnered in those efforts. But collectively, we must do more. We must demonstrate the leadership it takes to make meaningful changes that will have a lasting impact. Not only is it our job, as governors and physicians, but also our responsibility to the American people.”
    The statement goes on, and sounds more and more like a document of negotiated surrender in war:

    “…education about effective pain management, substance use disorder and related areas should begin in medical school and continue throughout a physician’s career.
    That means physicians who prescribe opioids and other controlled substances must be sure they have the most up-to-date training and education to prescribe and administer those substances safely and effectively…
    -prescribing medications excessively or “just in case” is not acceptable and continues to fuel this growing epidemic.
    -Guidelines are an important tool to prevent over-prescribing and identify the signs of addiction…
    -We must prioritize treatment for substance use disorder, a medical disease that needs our care and compassion. Millions of Americans need help overcoming this disease, but the challenge lies in closing the treatment gap. That gap exists because of a lack of resources combined with too few physicians trained to provide medication-assisted treatment…
    – The epidemic will continue to rage unless we expand our treatment systems and address the stigma that prevents so many individuals and families from seeking help….
    -In addition, we must continue to promote overdose prevention and education efforts…”
    In case you’ve been on a colony on Mars, these have been the mainstay of our current system of prescription opiate monitoring. They are, in fact, not working, because they do not touch upon the causes of the problem. Is the role of physician in individual care to enact educated judgment and plan of care, OR to concede to a patient’s demanded plan of care? Until we decide one or the other, we are wasting everyone’s time.
    Imagine laws regarding car sales that allow you to keep the car, free, if you like it during a test drive. However, we should educate car sales personnel why they should NOT encourage what was once called Grand Theft Auto. Sales personnel should sit through seminars, and be given guidelines. But as long as the “like it, drive off” rule exists, there will be car thefts, no matter how educated the sales staff is about “car dependency disorder.”
    The problem is that, as a society, we are loony. Many physicians view chronic pain control with distaste, and welcome the pain patient with apprehension. Running things on a narrow, politicized track, benefits neither the genuine patient nor the fraud.

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