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Alternative Reality
A friend of mine owns a pharmacy. With mail-order pharmacies taking a big cut of his business, the cost of regulatory compliance skyrocketing, and tightening margins on most of his inventory to compete with Walmart, etc., he is always looking for ways to generate revenue. He sells canes and walkers now. And CPAP supplies. And vitamins that I’ve never heard of. Well, now, he’s gotten into CBD oil. He has marketing brochures on display in his shop and I find them fascinating:
First, check out the strategy of the layout. At the top, it asks, “Do you suffer from any of these disorders?” And then it lists lots of popular conditions, which have nothing to do with one another. The only thing these conditions have in common is that they cannot be objectively measured (with the exception of diabetes). They vary from things that everybody has to a certain degree (anxiety, insomnia, chronic pain, etc.) to things that are scary (cancer and Alzheimer’s disease) to things that are frequently in the news now (addiction to, well, anything). You’re probably thinking, “Wow! It’s remarkable that one drug can cure all these different diseases! What an incredible claim!”
Right. Well, notice the next line: “Have you heard about CBD?” That would have been a good place to point out that CBD cures all the diseases they list. But they don’t do that. That interrogative is followed by this paragraph:
Cannabidiol (CBD) is the most abundant non-psychoactive cannabinoid found in hemp and is being scientifically investigated for numerous indications. CBD possesses superior anti-oxidant and anti-inflammatory properties and has been found to have numerous positive effects on the body, providing balance through its interaction with receptors and other systems.
One notes that the paragraph does not reference any of the diseases listed at the top of the brochure. It also does not reference any data to prove that it successfully treats, well, anything at all. Allow me to reprint that paragraph, with my comments in bold, in parentheses:
Cannabidiol (CBD) is the most abundant (What a happy, plentiful, environmentally conscious, woke word. Irrelevant, but happy.) non-psychoactive cannabinoid found in hemp (Not marijuana – nudge wink…) and is being scientifically investigated (The less something has to do with science the more important it becomes to use the word science.) for numerous indications (Like what? The indications listed above? Doesn’t say.). CBD possesses superior anti-oxidant and anti-inflammatory properties (Superior to what? And with what objective benefit?) and has been found to have numerous positive effects on the body (What positive effects? Numerous? Too many to list them all, I suppose.), providing balance through its interaction with receptors and other systems (I do this for a living, and I have no idea what that means.).
This is different than, say, statins. The data on the lifesaving benefits of statins is so consistent, and so overwhelming, that it has become unethical to do a placebo trial on statins. This is America – you’re not allowed to intentionally kill people in research studies, so you can’t deny half the study participants a drug that you know can save their life. It took decades, and thousands of studies, done by hundreds of organizations around the world, to reach that point.
And despite such overwhelming data, I can’t get some of my patients to take statins.
Oddly, many of those patients who refuse statins will then put on their sustainable, living-wage, alpaca sweater and drive their Prius down to my friend’s pharmacy to spend $300 on a bottle of CBD oil, which has nothing recommending it except the above brochure which basically says, “This doesn’t work!!!”
I’m fascinated by alternative medicine. Or, actually, I’m fascinated by the fact that there are no alternative dentists. This really is an interesting phenomenon.
Part of it, I think, is simply an expression of the horrifyingly bad education that most people get in the sciences during their schooling. They memorize the periodic table but don’t understand chemistry. It takes years of training to have such a poor understanding of science. And the more meaningless certifications our schoolteachers are required to get, the more you frustrate and drive away prospective teachers who actually know something about, say, chemistry. They go do something more rewarding and with fewer regulations. Like work in the pharmaceutical industry. And we’re left with teachers who have a doctorate in education and don’t understand their subject matter.
Second, science is sort of treated like a black art. I think since so many people don’t understand it, they view it almost like magic. Every movie has an evil scientist. Science is used to make supernaturally powerful weapons to blow up the world, not to grow enough grain to feed the world’s population.
Third, we seem to worship the amateur and disdain the expert in today’s society. Before buying something on Amazon, you don’t read about it in expert journals, you read the reviews written by amateurs with no particular expertise – people you’ve never met who use bad grammar and lots of emojis. The lack of data behind CBD makes it more attractive to some people, sort of like the economic theories of Alexandria Ocasio-Cortez are more attractive to some people precisely because she doesn’t understand economics. I don’t understand this. But I seek out user reviews of products like everybody else. So there you go.
This is all fine with me, really. I’m a little uncomfortable with the ethics of some of these companies, but they’re always careful with their claims. They don’t say, “Lowers blood glucose by 23%.” They say, “Provides balance through its interaction with receptors and other systems.” So the company is not lying, they’re just not saying anything. And they’d better not say anything – the FDA would stomp on them.
So the company is just trying to be slick. Not to be insensitive, but if you get fooled by that, that’s your own fault.
So I’m not angry about this stuff, I just don’t understand it. I won’t take a medicine until I understand the specific risks and benefits. If those risks and benefits are not clearly understood, I’ll take something else, thank you very much.
But my pharmacist friend says he can’t keep these $300 bottles on the shelf. His customers complain that their penicillin costs $10 instead of $5. But they gladly pay $300 for a bottle of, well, a bottle of they’re not sure what. And they go home happy.
And they vote.
The whole point of this article, in case I was unclear, is that if Republicans think they can win elections by discussing real problems and explaining logical solutions to them, they’re bonkers. That’s not how most voters think. Or perhaps feel. Make decisions, I should say.
So what should Republicans do? Should they come up with their own version of rainbows and unicorn dust (and CBD oil), to directly compete with the Democrats’ approach?
I don’t think so. Somebody has to be the grown-ups here. Somebody has to remain rooted in reality.
But this is going to be hard.
There is no one so blind as he who will not see. And we have to show them reality. Something they go to great lengths to avoid seeing.
Good luck.
Published in General
ok – so, with respect to CBD, I think it is something worth studying. I’ve taken CBD (in gummy form) and I’ve given it to my mom, who suffers from a somewhat generic (as in, not sure if it’s really the hip or something else, but it’s pretty severe) hip pain at times. What I discovered is that it does indeed have some effect. I’d compare it to Advil. It is more than a placebo, but it is certainly not a panacea.
I think the reason these sorts of advertisements are around is because CBD does in fact have a positive effect, but it is not very well studied. So, we don’t know to what extent it has a positive effect, and of course we don’t know what the tradeoffs are. It is one of those things that I would like to see studied more extensively. It is obviously massively oversold, and there is nothing that really guarantees quality – in other words, maybe the $8 bottle of gummies I tried contained X amount of CBD, and it is quite possible that a $300 bottle of oil contained a fraction of that. Surely it varies from state to state, and because it is pretty much un-studied, manufacturers can claim really anything that they want.
In summary – don’t be too quick to write it off. But, as with virtually anything, take a realistic approach and be responsible. I would be very interested to see actual tests and studies.
And if I might add – there are far too many doctors out there who prescribe statins to all of their patients, whether they are needed or not. Had 2 of them want to put me on them before they had even seen my cholesterol numbers (which are ship shape, btw). Another said that he needed to get me on the max dose of statins. When I asked why, he said “Well, they recommend that all Type 2 diabetics take them”. I then asked “Who recommends that?” He responded “Ah, um, er, the American Diabetes Association?” Gee, you don’t suppose that Association receives any funding from the companies that sell said statins, do you? Oh, and I keep my A1C at 5.9 to 6.1 without ANY drugs – diet and exercise only.
So I would suggest that a huge contributing factor in the reluctance many people have to blindly believing everything the doc says is lazy a** docs.
If Big Pharma does the studies, I would be surprised if the results showed anything to be gained from CBD oil or cannibinoids. Conventional chemo and radiation treatments cost $ 80,000 a year, with the profits to the cancer industry being astronomical. Meanwhile CBD oil and/or cannibinoid use costs around 6K for six months. Often patients don’t use the products for more than those six months.
Right now, there are compendiums of testimonies from people who came from all over the country to use CBD oil here in California. Often they came here after they had been written off by the health profession, with doctors telling them their cancer was terminal and no more chemo or radiation treatments would be offered. Yet despite the terminal diagnosis, they tried CBD and they found their cancers going into remission. In some cases they were cured.
Here is an interesting published study regarding cannabinoids and glioblastomas:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5964193/
And here is a report on the profits gleaned off the cancer treatments Americans need:
https://www.forbes.com/sites/matthewherper/2015/05/05/cancer-drug-sales-approach-100-billion-and-could-increase-50-by-2018/#162efbc32dc6
A very good friend of mine has lately been claiming that her vet recommends it for the extreme pain experienced by her dog.
Snake oil.
So before lunch I spend 45 minutes pounding out a comparison between medical data analysis and voter behavior. Kinda cool, maybe, but nothing earth shattering. I probably should have saved it and cleaned it up later, to clarify my point.
I post it, and then go to a dentist appointment. I spend an awful nearly three hours in the dentist’s chair, and then come back and read a bunch of comments about heart disease.
I thought that using marijuana to make my point might be a mistake because people would get hung up on pot heads, rather than focusing on my actual point. But no. It was Lipitor. Heck, this is Ricochet, right? Why not?
Ok. I’m taking some Tylenol and going to bed. But just real quick:
I speak to doctors’ groups all over the country about heart disease, and one of my recurring themes is my hatred for guidelines, because they discourage independent thought. But this guideline actually makes sense. Statins aren’t great cholesterol drugs, but they’re fantastic heart drugs. They should be used to treat heart disease, not cholesterol. And diabetics have the same risk of a heart attack as someone who has already had a heart attack. Borderline diabetics have the same risk – it doesn’t matter if their sugar is high – it’s the insulin resistance, not the glucose level. Diabetics don’t usually have high cholesterol, due to a particle size phenomenon. So many docs wouldn’t use statins, because the cholesterol usually isn’t that high in diabetics. But if you don’t put a diabetic on a statin, that really is malpractice. That person is a walking heart attack, and you don’t bother to treat them? So putting all diabetics on statins is one guideline can support.
I have never heard a discussion about the role of statins for heart disease apart from cholesterol lowering. My doc once said they lower inflammation and left it at that. He did recommend CoQ10 along with statins.
Doc,
Anecdotal only.
My wife suffers from non-diabetic neuropathy in both feet. For the past coupla years, every night, no matter where I was in the house, I’d hear the thump, thump, thump of her banging her heels on the floor, “just so I know my feet are still there.”
She described walking as “stepping carefully from hornet’s nest to hornet’s nest” in the sting/shock sensation she had in her feet.
For two years, her and her team (about three docs) have been trying to figure out why it’s there, what it is, and how to treat it.
BTW: The Lovely And Talented Mrs. Mongo is a high-speed, low-drag RN (aka, Super Nurse) who has been a clinical risk manager for the last ten years.
Skeptical is her middle name. I mean, not just when I come staggering in post-midnight smelling of booze and seemingly magically cursed with some sort of “glitter” in my hair, on my skin and adhering to my clothes. Very conservative when it comes to any new meds or recommendations of any kind of invasive procedure.
As a Hail, Mary, let’s throw this (too) up against the wall and see if it sticks, her Doc put her on CBD oil. Knowing the studies and trials weren’t in place.
Her Doc found a legit manufacturer (“I’ll not have you buying CBD oil from the guy in the Volkswagen van in front of the diner”) and they tried it.
The Lovely and talented Mrs. Mongo reports her…pain isn’t right, although it’s there…distraction level has gone from an 8 to a 2. We’re waiting for the new (higher dose) order to arrive.
I doubt she’s susceptible to the placebo effect.
The oil really does seem to have given her some relief.
I don’t like guidelines but I like guidelines.
Yeah, okay. We’ll go with that.
Here is a site that discusses the tremendous role that hemp played in our economy. Before our society had plastic, we had hemp. It was the product that made the sails for our big sailing ships. People’s clothing was made of it. I once saw a photo of two gorgeous women’s outfits, circa 1835, and neither had been corrupted by either wear and tear or moths. It was much sturdier than cotton and much more comfortable than wool. Many of the things we buy now that are made of plastic had been made of hemp.
Since it was grown as a crop ubiquitously, it stands to reason that farmers fed it to their animals. It also grew on its own in meadows and ditches where no one had planted it.
Keep holding on to that doctor; he or she is exceptional. Much of the muscle weakness and ALS would not occur if the doctors who recommend statins also insisted on the CoQ10.
I don’t like to say it, but there are some jobs American snakes just won’t do.
Interesting point, thanks.
We believe in trade-offs; they believe the man is trying to prevent them from natural bliss.
My doc, when I was 55, tried to get me on statins.
I told him to pound sand.
When I was done with my tirade, I asked him what my # was. Turns out it was “a little high but acceptable”. So at 55 I’m going to go on medication for umpteen years to extend my life (I’ve seen the last few years – they ain’t pretty and you can keep them)
The same doctor shrugged at my husband’s wrist pain and said “you have arthritis”. CBD oil has helped. The same doc he can’t a referral from for an orthopeditist even though he looks like Yosemite Sam.
So sorry, Doc. I’m sure you’re a terrific doctor and I’d probably be happy if you were mine. But lately every single person I know leaves the doctor’s office with a prescription. And not just people my age (though at 60, and drug free, I caused quite the fuss at the eye doctor), but young people as well.
Anxiety? Worry? Depression? Stress? Not sure what sex you are? We’ve got something for that.
Maybe if doctors didn’t act like drug pushers, we wouldn’t listen to other drug pushers.
When my sister had debilitating morning sickness and turned to wrist bands for relief, her doc told her it was the placebo effect.
She replied: Ask me if I care. I’m not barfing 27 times a day.
Good luck and I hope the higher dosage gets her to 0. I know a couple of people with her ailment, and I’ll be sharing this story.
Annefy, here is Dr Kendricks and his analysis of numbers posted by the WHO on statins and the link to ALS:
https://drmalcolmkendrick.org/2018/04/09/statins-and-amyotrophic-lateral-sclerosis/
In short, in a population of fifty million people, who are not taking statins, we can calculate that around 1,250 would develop ALS every year.
On the other hand, in a population of fifty million people taking
statins (atorvastatin and simvastatin) we can expect that figure
to be multiplied by around twenty. Now instead of 1,250 people
developing ALS, we can expect to see 20 x 1,250 = 25,000.
####
I know in the last ten years, I battled two extremely frustrating hard-to-diagnose conditions. And one of my main frustrations was how eager doctors, even specialists were, to talk to me about statins. I mean, I am paying somebody a big wad of cash to examine my body for quite specific health reasons, and all they want to do is get me to sign on with statins. And my cholesterol readings never go higher than 160 or so. I can’t help but think they are getting kick backs from Big Pharma for this nonsense.
Carol –
Look, you’re welcome to make a fool of yourself with one absurd statement after another. Note that it would be easy for me to make you look silly by debating any one of your points about ALS, or heart disease, or marijuana, or any other topic that you know nothing about. But also note that I do not do that. I leave that to you. Again, you are welcome to make a fool of yourself.
You are not welcome, however, to accuse me of intentionally hurting my patients for illegal kickbacks from drug companies. That crosses a line.
It’s hard for someone like you to understand. But for someone like me, that suggestion is a vicious insult which cannot simply be dismissed like the rest of your statements.
You’ve been here long enough to know that a I play nice. I treat people the way I would like to be treated. I come here to learn from other people, and being nasty to those people doesn’t help. So I don’t flame people.
But I would appreciate it if you would refocus your efforts on making yourself look silly, and stop attacking others. That is unacceptable.
Be very careful, fellow Ricochet members, in bashing doctors and their advice in sensationalist tones. This has been upsetting me ever since I joined Ricochet. Somewhere out there in our membership, someone is reading this post and its comments and is heading to a doctor today, and when that doctor prescribes a life-saving statin, that patient is going to decline it because of the doubts sown here.
I have had nothing but the finest medical care, and there is no one I have more respect for than the doctors who have treated me and my family. I could not do what they do–accept responsibility for others’ lives.
If people have had bad experiences with doctors, just keep looking for someone you can work with. I have worked with probably at least a hundred doctors over the course of my lifetime. I have so much respect for them and the responsibility they assume.
A friend of mine has been in treatment at the Lahey Clinic, north of Boston, for prostate cancer, and the doctors he’s had have been absolutely perfect and amazing.
I read too, and doctors always answer my many mostly stupid questions patiently.
Just be careful what you say in public forums like this.
Are statins for lowering cholesterol? Some recommend the Red Yeast rice (in capsule)? They recommend at my doctor’s office.
That is an amazing story!!
The list of ailments that CBD can mitigate, or do away with as illustrated is rather optimistic. I always look for; Triple Distilled, or Single Malt, on the label when it comes to self-medication. I’ve found that a martini before dinner is a good appetite enhancer.
Tequila should carry a disclaimer; “Excessive consumption may lead user to believe that they are invisible”. This would be especially helpful for college students that descend on Florida beaches like locusts on Spring Break.
Wow! Another amazing story – this post is revealing some interesting things. Has your wife tried chiropractic? She may have some pinching so when she lays down it translates to her feet? Stretching exercises for legs too and knees? God bless her –
As Metallica put it, “Everyone’s got to have the sickness / because everyone seems to need the cure.”
My sister is a physician. I’ve got nothing against doctors or prescription medications. But Americans sign up for drug subscriptions, not just prescriptions. At least by age 45, if not by 25, it’s common and possibly normal for Americans to take prescribed pills daily. Many people won’t even endure a headache occasionally without rushing to over-the-counter drugs that stress organs over time. Does your back or shoulder ache? Take two more pills.
It reflects not just expectations among medical professions but expectations among patients. People in a privileged affluent society exhibit ever lower tolerances for pains and maladies. Ever fewer acknowledge the tradeoffs of constant, comprehensive medical attention. It’s one reason why medical costs are rising and why there is a demand for socialist medicine.
Dr. Bastiat: The whole point of this article, in case I was unclear, is that if Republicans think they can win elections by discussing real problems and explaining logical solutions to them, they’re bonkers. That’s not how most voters think. Or perhaps feel. Make decisions, I should say.
Um, what? Dems have been campaigning on issues for decades while Republicans campaign on principles, and I was told that by a Democrat legislator…well, minus the logic.
What you have outlined, however, is a failure in marketing communications. The AMA, or whichever professional association you may belong, has completely failed it’s membership. How is it that a bunch of well paid scientists can’t mount a marketing campaign to inform the consumer of available products and services that can heal their ills.
Yes. This.
If you don’t you think you can trust your doctor, find one you CAN trust. It’s important!
This is the crux I think. Patients and doctors don’t want identical things. Patients want relief and health/longevity but are not invested in the details. Doctors have to be invested in the details both for the sake of what we can loosly call science, but is really more about being sure the job is done and done right the first time. The doctor is also made to care about a plethora of things that the State and AMALGBTQ insist should be important (sometimes rightly, often presumptuously, always tediously).
Communications. That’s what it’s all about, isn’t it?
For the most part I have been well served by the assumption that if I am not being correctly understood it is MY failure to express myself in ways the hearer can understand.
Having said that, I remember a church where 3/4 of the Diaconate were attempting to remove the Pastor. In a meeting over the points of dispute the Pastor made an excellent defense. With references he demonstrated the historical understanding. With references he gave Scriptural support. He took up the opposite viewpoint and the references his opponents were using and demonstrated their error, again using both historical and scriptural references. He brought to the argument a vast cloud of witnesses both old and new.
At the end, the spokesman for his opponents said, “Does that mean you won’t change your mind?” There are some that are blind because “they will not see” – and a few of those folk vote.
That’s easier said than done. I had trouble finding a primary physician after my long-time doctor quit his private practice during all of the Obama-induced consolidations. Some of the good ones don’t take Medicare patients. Even though I have very good secondary coverage, they just don’t want to mess with Medicare. I did go to one guy that I decided not to go back to. I don’t know if I should have trusted him or not, but I didn’t. I won’t explain why in a public forum. Finally, there was a newbie just starting her practice in the local system who was accepting new patients, and I’ve been going there. It’s OK. I listen to her, but decide for myself which prescriptions/recommendations to accept. So far it has worked out OK, and we communicate OK. My medication list is still empty, other than what I took for a week after an ER visit for Bell’s Palsy a few weeks ago.
Easier said than done, and I’m afraid I simply don’t have the time or resources to wander through the wilderness through that mess again. The doc I currently have is tolerable – we agree to disagree on a couple of things, but he respects my wish to remain drug free. But to find him I had to go through 3 others (favorite quote – when I was diagnosed with diabetes I asked how I could try to control my glucose #s through diet & exercise. Her response “Everyone says that.” Okaaaay.)
In the past I’ve had to have my toenails removed due to a staff infection picked up during acromioplasty on my shoulder. I also know for a fact that an inhaler given to my father for his emphysema shortened his life by at least 6 months. I also know that there was a cardiologist who prescribed a bunch of crap for my mother 10 years ago and now refuses to respond to any inquiries about them – from my mother, me (I have POA), or any of her other docs.
So no, I don’t cut doctors a lot of slack. Too many of them have violated my trust to blindly ascribe it to anyone else. In my view they’ve got a gigantic PR problem that they’re totally oblivious to.
Understood.
And where a person lives may make a difference as well. We live well out in the boonies and choices are limited. It was our choice, and we just decided we didn’t need to live forever. So when we need a doctor, we drive an hour on a highway – but he’s reduced or eliminated my medication dosages and although his bedside manner is cringeworthy we are quite satisfied.
Do know a couple of recommendable doctors (both locally and in Houston) that the cloud of regulations and rules and insurance hoops have driven out of the profession.