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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
Doc, I swallow a “tincture” of marijuana (THC) and CBD each night about two hours before bedtime to help me sleep. There is no doubt in my mind that it helps me. The mix is about 50/50.
I’m not at all interested in the”high” of the marijuana. In fact, THC doesn’t make me high, though it makes me a bit dizzy. I’ve been something of an insomniac for decades, and this THC/CBD mix is the only thing I’ve ever found that works.
This would make an interesting post – my sister’s small town in Maryland has seen two hospitals combine and doctors leave the area – the best you can get is a PA – is this all because of Obamacare?
Carol – my friend’s dog needs that oil – where does she get it? Vet? Pharmacy and if the vet is unfamiliar? This is new territory. How much of a dosage?
You and Mr. She must be related in some weird Western PA South Side sort of way. He went through three or four iterations of generations, and we’ve given up. Reached a point where the state of his cholesterol is almost the least of his problems. Good luck.
I think some experts in the field started conversations on this some time ago. The ones I know actually had the genesis of their departure prior to Obamacare, that was just the coup-de-grace.
No where did I call you a fool. I spoke of my experience with drs I saw. The problem for me with this continual harassment of patients by docs as to what is good for them or not good for them is it comes with two separate price tags for the patients.
With regards to statins, Price tag number one is the price of the visits, in terms of time and money.
Secondly there is personal physical cost of having to deal with ailments that could be solved except the medical industry is hell bent on their vaccine schedule and the statin issue.
We are not talking about one single, one minute presentation of statins. Sometimes the promoting of the statin issue took up half the time spent in the doctor’s office. My condition was gluten intolerance. For 2 & a half years it made my life miserable. Luckily I was insured, so continual testing to see why I was in excruciating pain was picked up by insurers. But it still cost a bundle which the insurance industry has to pass on as its cost examiners must raise the insurance prices. If just one of the specialists I had seen was actually interested in hearing my complaint, maybe it would have taken less time to solve this mystery?
But specialists were more interested in telling me about statins. They were not concerned about my symptoms, & my friends & my spouse have had the same experience. (Although they visited specialists for other reasons.) I cannot help feeling maybe if one of the specialists had listened to me to begin with, I could have avoided 2 years of endless doctor appointments, and 2 years of tests. (Perhaps $ 20K worth of tests.)
You have expertise as a doctor. Maybe you are a better doctor than the ones I saw, and you listen to a patient before going off on them abt statins. You don’t seem to have expertise as a patient. Maybe someday the coin will be flipped and you will be in the predicament that so many of us are in as patients, that the soup du jour from Big Pharma takes precedence over our actual needs.
When you need a specialist, you get whomever the doctor in yr insurance plan refers you to. I live in rural Calif – we were absolutely slammed with new patient sign ups as over 1 million newly insured folks needed doctors all at once. I could deal with the GP doctor I had, or go without. That doctor left the practice some three yrs after my major experience with being in continual pain. He was a decent guy, but the hospital he was affiliated with had specialists who were sub par. When he left the practice, I was without a doctor for 18 months.
Also when an ailment is totally debilitating and you are older and on you own, it is hard to figure anything out. I mean, it is always easy to say “do this or do that,” and “why not shop for a doctor?” but I was sometimes in so much pain that 5 hydrocodone would only dull it somewhat. There are excellent doctors in Davis, but needing as many pain meds as I needed, I could hardly drive an hour an a half to get there.
My mother filled the statin perscription, never to a pill, and her cholesterol went down. Dr. was happy it was working so well, was never the wiser or didn’t let on. Anecdotally, I know, but she didn’t want to fight with the dr. There was an endocrinologist that wrote a book “the last well patient” or something like that, that believed statins were over prescribed.
On an aside, I didn’t think pharmacists could have anything to do with marijuana because the DEA governs them, and marijuana is an federally illegal drug. My pharmacy tech module a few years ago said they could lose their license for telling people where to get it. I guess it must have changed or made complex with state legalization.
I sympathize. I end up in the Boston hospitals because some of the specialty areas on Cape Cod are not very good.
That said, they are much better than they were when we first moved here thirty years ago. My grandparents who lived here at the time and their friends were used to the Boston hospital standards of care, and through the local Council of Churches and the Cape Cod elder services organization, they worked hard to improve our local hospitals, labs, and clinics. They brought about a miracle here. I’m very grateful for the work and sacrifices they made to improve health care on Cape Cod.
I avoid most conversations about drugs and treatments; if you let it, it will take over a conversation and I won’t be able to show off pics of my grandkids. I was with all my brothers and sisters last week – along with a large group of similarly aged people – and I had to change the subject at least three times.
Because of this Rico convo I reached out to my family (9 adults, 50-60); every single one of them has had statins recommended to them. We are all blessed with good health (thanks mom!) and the conversation with the docs was during check ups or something specific, like a sports injury. And most of them met with some stubbornness from the doc when they politely declined.
I advise all young mothers to nod sagely and thank the pediatrician for advise. Then go home and call their mother, auntie or older sister.
Your experience could help others – you may want to write a post about it. It is true that doctors are limited in their dietary recommendations or the effects of modern food on people – they aren’t trained in it – it’s mainly symptoms and cures – drugs or surgery. I had 3 med students as roommates once and realized that. There are so many allergies these days – soy, dairy and wheat for me – in spite of having good medical care all my life, not one diagnosed those. It was process of elimination.
This may have been asked out commented on already, but my mother was talking to her naturopath who told her that CBD needs the THC to get the CBD to do its thing. Which means the hand cream she got with only CBD will not provide any of the supposed benefits.
I had occasion to scroll back through this post, and I feel the need to take a macro view of what’s been discussed.
I would never disparage the medical community. As mentioned, my dad lived well past his sell date thanks to wonderful healthcare and treatment. I have a brother in law who should have been dead over ten years ago who is enjoying his grand children and still working thanks to modern pharmaceuticals.
That said – there’s great docs and great research and great drugs. Just like there are great teachers. Just like there are great political leaders.
I’m sorry, but all doctors don’t get benefit of my opinion about the outstanding few. A member of my family has been recommended for puberty blocking drugs … by a doctor. My husband, years ago, was getting handed prescriptions for Vicodin like they were candy. I met with a vendor last week who I didn’t recognize. He was recovering from a burst appendix, weeks in the hospital whacked out on oxi. And then they sent him home. He shared with me that he was begging his girlfriend to get him something … anything. Lucky for him he got through it, thanks to his GF and family. No thanks to any doc.
So yeah, there are some great docs out there. When I had my C-section I thanked the good lord I benefited from modern science. Not long ago either baby or I would have been dead.
I’m grateful for the great teachers out there – that doesn’t and will not stop me from disparaging the crappy ones.
And if someone questions the recommendation of their doctor … well, that’s not such a bad thing. Nothing wrong with not taking everything on faith. Everyone needs an advocate, and sometimes we need to be our own.
As previously mentioned, I’ve seen the last five or eight years of a few people’s lives when the heart is ticking and the BP is down and the diabetes is under control thanks to drugs. But the brain has long since checked out.
Not the years I want to add to my life.
Someone invents a drug to add a few years to my 30s or 40s? I’ll be the first to sign up.
To be clear, I don’t think CBD is a panacea. I doubt it can do even a small fraction of what it’s advocates claim. But I’ve taken it, and it certainly doesn’t have zero effect, either. As I said, I’d describe it as something kind of like Advil when used for muscular pain. Not a cure-all, but not complete nonsense, either.
I am very skeptical of its having any effect in topical form. Sounds a bit too much like “essential oils” to me.
Whatever. My mother was convinced her arthritis was helped by cod liver oil and eating parsley. All of her doctors rolled their eyes. But she went from not driving to being able to drive, and she was more spry in her 80s than she was in her 60s.
It’s a big world and there’s room for all of us. What works for some might not work for others. We’re blessed to benefit from modern science and modern drugs, but they’re not the be all and end all.
But if I get arthritis, cod liver oil will be my go to. And funny you should mention essential oils? Guess what is giving my husband – and me – a decent night’s sleep sans snoring?