Biochemical Oversimplification

A Minute with Dr. Hancur...

I was troubled to learn last week about the Florida teen who

crashed his small plane into a skyscraper, leaving a note explaining

his action and purportedly supporting Osama Bin Laden. As is

usually the case, historical information about the young man began

to surface in the media and it develops that he hod been

prescribed Accutane for his acne. lmmediately, speculation about

a possible link between the use of Accutane and the suicide were

reported on TV, on the radio and in the newspapers. lt seemed to

me to be very reminiscent of stories years ago about Prozac and

violence.

Several issues ore raised by this story, and others like it, for our

consideration and discussion. But first, a bit of background. As you

know, pharmaceutical companies hove been marketing some of

their prescription drugs directly to consumers, thereby creating a

patient-initiated demand for the products with the caveat: "ask

your doctor if (blank) is right for you". ln these commercials, patients

ore usually portrayed as being transformed from debilitating anxiety

or depression to lives of stress-free happiness after taking these

wonderful medications. There ls no evidence of discussion about

the specific problems the patient is encountering or about changes

that the patient might be making in how they are conducting their

Iives. No mention of family dynamics or relationship issues. No

exploration or admonition about substance use. No. Just take the

medicine and live happily ever after.

ln my view, modern healthcare hos become too enamored of

biochemistry. And with it, a vast oversimplification of the

complicated process involved in decision-making. The unfortunate

youth mentioned above may indeed hove experienced on

increase in depressed feeling as a result of using Accutane but does

anyone, other than a defense attorney, really belleve that the use of

Accutane alone caused him to identify with Osama bin Laden, write

a note explaining his actions, secure a plane and then fly it into a

building? Yet, the drug company commercials create and support

the notion that the complexity of human action con be reduced to

relatively simple biochemical reactions. Explaining behavior in this

way con lead us to treat each symptom as if it were a discrete

problem and to follow the identification of the symptom with a

specific medication targeted to it without reference to its

relationship with other behaviors. And so, it is not uncommon for a

patient to be prescribed on anti-anxiety drug for their anxiety, an

antidepressant for their depression and o sleep inducing medication

for insomnia. This thinking is also in evidence in general medicine

where o patient may be prescribed on anti-hypertensive for high

blood pressure, on antacid for hyperacidity and on anti-inflammatory

for low back pain because each problem is viewed as

discrete. What is missing is an inclusive statement (diagnosis) and a

treatment plan that addresses the person as a whole rather than a

cluster of discrete symptoms, each with its own pharmacologic

treatment. Patients are much more than the sum of their parts.

Treating symptoms as though they were the result of a

biochemically defective part risks losing sight of the whole person

and worse can create drug interactions which become problems in

their own right.

lncreasingly, I hear patients complaining that their healthcare today

consists of medication exclusively. Unlike the message in the

commercials, medicine alone is rarely enough. Changes in attitude

and behavior are necessary for real improvement. And such

change requires understanding the patient in a way that is far

deeper and takes much longer than the identification and

treatment of symptoms. With our modern over-reliance on

biochemistry, it is no wonder that the utilization and cost of

medications hos risen so dramatically in recent years; so much so

that the cost of medication threatens the financial stability of

patients and insurers alike. One only wishes that the benefits of the

medications always justified their cost, not only in dollars but in

quality of life. I believe strongly that we, in healthcare, hove lost our

way and are rapidly reshaping America into a nation of sick people.

Who among us is not toking o medication for something. And

many, if not most, are toking multiple medications. Children, once

immune from most of the psychotropics, are toking them all.

lndeed, it seems as if there is a medication for every problem and

that every person with a problem needs a medication. Managed

care hos contributed to this situation by almost requiring that

patients toke medication to establish medical necessity and

psychiatric hospitalization today consists largely of medication trials

to achieve stabilization. Though I om not anti-medication, I believe

that medicines should almost never be stand-alone treatments and

that our modern belief that behavior con be so easily reduced to

biochemical reactions has skewed our view of illness and of health.

I welcome your thoughts.

I must have written this sometime in 2000 i.e before 911. As with other articles, the message is as relevant today as it was then. Disappointing.