THE OTHER SIDE OF THE LEDGER

Intelligent, rich, handsome and famous, a young actor alone in a big city feels dreadful. He can’t sleep. His body aches. He goes to the doctor for advice and comes away with prescriptions for oxycodone, hydrocodone, diazepam, temazepam, alprazolam and doxylamine. He takes one or more of each and goes to sleep.

Heath Ledger was a poor player in a tragedy that continues to be played out daily in countless surgeries and pharmacies across Australia, ‘The Tragedy of the Drug Prescription’.

In the sleepy seaside suburb of Lesswell* there’s a doctor who provides his customers with similar cocktails. If he’s reading this article he may recall prescribing one of them with Aropax, Epilim, Valium and morphine, all at the same time. He may also recall prescribing 50 Valium tablets one day and another 50 four days later to the same customer. He’s very lucky he hasn’t been had up for manslaughter, for his customer, who ended up in hospital in a coma, lived to tell the tale.

Some of his customers treat his surgery as a pharmaceutical super market where they can get access to whatever they want, when ever they want. All they need to do is stack on a turn and they’re off to the chemists. (If you want more morphine, just tell him you’ve got a crook back.)

The local chemist turns a blind eye, his slice of the action coming from the onerous task of counting out the pills, typing up a label, sticking it on a bottle and putting the script into a box under the counter.

The medical staff at the local hospital turn a blind eye as well. Maybe it’s a business decision! The prescribing doctor never turns up at the hospital to check out the results of his handy work and the hospital staff are too callow to dob him in. This behaviour provides the content for another episode in the long-running Dr Death saga.

The State’s Medical Board gets an alert from a concerned party and fires off a ‘please explain’ to the doctor. It’s not important enough to send someone down to investigate.

The doctor sends back a response which the Medical Board accepts – after all, doctor knows best. The concerned party gets the brush off. Apparently it’s not the Medical Board's responsibility to investigate issues of malpractice.

The rest of the local doctors turn their heads the other way. In fact they palm their worst customers off onto Dr Feelgood. It keeps their noses clean and the riffraff out of their waiting rooms. 

But while it’s business as usual in Lesswell, the Health Ledger tragedy is pointing to serious system failures in the medical and pharmaceutical industries.

For starters we’re in the midst of an epidemic of poor medical diagnosis and prescription. We’re living in the junk medical era where common (but definitely not best) practice is to mask symptoms of body system dysfunctions with drugs rather than prescribe treatments that stimulate the body’s own recuperative power. It’s why the health of Australians is getting worse.

Like Heath Ledger, a significant proportion of people who front up to surgeries around Australia feeling dreadful, tired, lacking energy and having trouble sleeping, come away with a prescription for an anti-depressant and a sleeping tablet. Because there’s a high and positive correlation between feeling dreadful and musculo-skeletal dysfunction, they’ll probably also leave with a script for Celebrex and Panadeine Forte. And if they’re over 50, over weight and under fit they’ll receive a repeat for the Lipitor, Prilosec, Avpro and Metformin they’ve been on for the last 5 years.

A woman goes to her doctor for a check up and while she’s there they have a little chat and she has a little cry (as one does). The doctor presumes she’s depressed and starts to write out a prescription for a packet of mother’s little helpers. The woman says she’s not depressed, just very upset because her marriage is in the process of  breaking down. In this case there have been no scientific tests to see whether in fact she is clinically depressed, just the reflex action to reach for the pad.

The woman politely takes her leave of the doctor and then her business elsewhere. 99.99% of people would have trusted their doctor’s diagnosis, accepted the script and traipsed down to the chemist shop.

In this country the sad, grieving, angry, hopeless and insomniac get prescribed a pill that dulls their senses so they lose the inclination to confront and deal with whatever it is that’s causing their distress. As soon as the distress and the pain are relieved they think they’re better. For the doctor it’s mission accomplished. In reality it’s just another exhibition of the tawdry practice of junk medicine.

Those in pain from body systems that are out of alignment, whether they be metabolic, musculo-skeletal or psychological, never get those systems back into alignment. Junk medicine rarely restores poor function to good - another reason why the health of Australians is getting worse.

The Government supports this selective-evidence-based medicine and picks up the lion’s share of the bill, for both the consultation and the pill.

So who’s supervising these prescriptions?

Certainly not the chemists who stay focused on counting, typing, pasting and filing.

In actual fact it seems odd that the prescriptions are being created by those on the lowest rung of the pharmaceutical knowledge ladder, whose principal sources of information come from adverts in medical journals and drug company freebies. One would think that it was more appropriate for doctors to provide the diagnosis and leave the prescription of any medication to the expert in the chemist shop.

A big system failure is the sectionalization of the health industry workforce – divided as it is into silos.

There are many prescriptions beside the drug prescription that contribute to better health, among them the exercise, diet, relaxation and personal development prescriptions.

More people need to be brought into the diagnostic loop before the drug prescription is made. It’s a prescription of last resort, not first.

For starters there’s the fitness practitioner at the local gym who’s the expert in fitness assessment and exercise prescription. We know that poor physical condition and feeling dreadful go hand in hand.

Next it’s off to the pathologist to determine whether there are any chemical deficiencies that may be causing distress. What’s the point in prescribing a selective serotonin reuptake inhibitor if the if the brain doesn’t have a serotonin problem?

From there it’s over to the naturopath who’ll have a fair idea about what to include in a diet to achieve the right chemical balance. A diet that’s deficient in essential nutrients plays havoc with all body systems. The diet prescription will also alert our customer to the fact that if they want to feel better they should stop filling themselves up on flour, sugar, caffeine and alcohol – the four major food groups in this country!

Then it’s the turn of the psychologist. In the light of current circumstances there’s a strong case for the drug prescription to be delayed until an assessment has been made by a psychologist and, based on time spent studying the mind, an equally strong case can be mounted to provide psychologists with the keys to the medicine chest. Not only are they better qualified to provide a more accurate diagnosis than the doctor they are also in a better position to write out a personal development prescription. 

Another system failure is that of a lack of accountability.

My heart goes out to the Ledger family. Heath Ledger died at the hand of a medical industry that’s running amok with the drug prescription pad. Alarm bells are ringing, guns are smoking.

Minister, put an end to this nonsense.

*Name changed to protect both the innocent and the guilty.