There are many articles that advise you about which questions to ask your doctor. However, although some of those questions may be useful, they fail to include these 3 most important questions. If you remember nothing else, remember these 3 questions. Most doctors will not bring these up themselves, so you have to ask them clearly and re-assess if you want to accept their proposed treatment or not.
1. What is the NNT?
Your doctor tells you your “bad” cholesterol is a little high, which is associated with cardiovascular disease and stroke, so they tell you that they would like to give you a drug, known as a statin. This will lower your cholesterol. You’ve maybe heard of statins, as they are the most widely prescribed drugs in the world today and you may even know people who take them. So you say, “Why not, give me the statin…” But there’s that one question you should ask for. A statistic that doctors and pharma companies don’t enjoy talking about. The NNT. “NNT” stands for “number-needed-to-treat”The NNT is a measurement that estimates how many patients need to take a drug, go undergo surgery or a medical procedure in order to have impact on a single patient. At this point you may think it’s a silly question to ask, as the number should certainly be 1 or at the very least be very close to it. Well here’s where you are wrong, very wrong.
It is estimated that 90% of all drugs work on only 30-50% of the people who take them(GlaxoSmithKline). Well you may say, “that’s pretty bad, but the statins probably fall in that range, so I’ll take the risk.” But according to medical research, an estimated 300 people have to take the drug in order for one stroke, heart attack or adverse effect to be prevented (NyTimes). And if at this point you are still debating whether to take the drug, it should bring you to question two.
2. Are there any side effects or long term effects to this drug, surgery or procedure?
As obvious as it seems, a majority of the people aren’t asking this question. They are assuming their doctor has weighted all the pros and cons and that they are giving you the best option. This nearly always is not the case. Even the simplest of drugs have long lists of side effects, some of which you truly don’t want to risk getting. Getting an answer to this question may not be pleasant but it will give you an idea whether other options may be more viable.
To go back to our statin scenario, this particular drug has a 5% chance of side effects. These include debilitating pains in your joints and muscles, gastrointestinal distress and more. Before you play the lottery, let’s crunch the numbers so far. While 1 in 300 will experience improvement with this drug, 5% or 15 of those people will have side-effects. So after paying for and taking this drug for a year, you are 15 times more likely to be harmed by it than helped. Does that sound like a reasonable deal? This is not to advise you whether to take this particular drug or not, it’s to advise you to have this conversation with your doctor regarding any drug prescribed to you.
3. Do you receive any kickbacks or incentives for prescribing this drug?
Money taints everything far and wide. But for some reason, people assume although expensive, medicine and doctors are somehow immune to this “plague”. To some this up best, here’s John Oliver on Last Week Tonight.
That same doctor that prescribed you the cholesterol lowering drugs, may have been swayed by pharmaceutical companies to do so. After going through gruesome research, clinical trials, approvals, etc, drug companies have to compete in crowded and fragile markets to sell their drug in order to make money. This is why drug companies spend 4 billion dollars in marketing to consumers. But who wields the power when it comes to making a sale? Doctors. The number spent marketing to doctors – $24 billlion a year. A study showed that 9 out of 10 pharma companies spent more money on marketing than they did on research and development. Which could explain the astounding number of drugs sold every year and the little positive effect they actually have on their patients.
So let’s get back to marketing to doctors. Pharmaceutical companies have promotional events which sometimes look more like rock concerts, as seen in the video. The pharmaceutical sales reps and their instructors often have little to no scientific background, which in turn means that they have no clue how the drug actually works. Their focus is selling the drug, rather than properly educating the doctors about its safety or efficacy. Many doctors should know this, but instead, in the video, a sales rep describes a situation where a doctor was actually asking her for medical advice for her patient. She was a political science major. Another sneaky tactic that sales reps use is buying lunches for doctors. Seems innocent enough, but during these interactions sales reps use that time to pitch their drugs. Who knows if the doctor who prescribed you the statin wasn’t swayed by a good looking, smooth talking sales rep during an expensive lunch?
This is why question three is so important. But the great news is, you can also check yourself, as pharmaceutical and medical device companies are now required to release their payments to doctors. Dollars for Docs is a website that allows you to see how much your doctor received from these types of companies. For example, Surata Narayan, a family doctor, received a modest sum of 41 million dollars for a promotional speech for Topera Inc. Is it likely that this doctor will favor this company when making a decision on your next prescription? (NPR, Last Week Tonight).
Don’t be afraid to ask these questions, your health depends on it.
Choosing The Right Doctor
Going to google and typing in doctor and your city or going to the nearest walk-in clinic may not be your best bet. For better or worse, your doctor can change your health and life forever. Choosing the best doctor for surgery is obviously important, but what about when you have something less serious? Given all the facts above, it may seem that it’s still equally as important. Go to Healthgrades and type in the type of doctor you are looking for and you can find many doctors with ratings in your area. You can type in something like “naturopathy”, “alternative medicine” or “ACL surgery”.
Personally, my best experiences were with naturopathic doctors (or NDs) as they tended to focus on prevention, treating the root of the problem and had full knowledge of natural alternatives as well as typical medical treatments. I feel like the quote “if the only tool you have is a hammer, every problem will look like a nail” is true for regular doctors in the way they prescribe drugs. A walk-in clinic or a regular doctor may rush you out the door with a handful of drugs or a recommendation to get an expensive lab test. On the other hand, I have found that naturopathic doctors took their time to get to know the full situation and have had more tools to work with. Sometimes the solution was as simple as avoiding a food or taking a vitamin. My wallet and my health prefers the latter. Look for “Naturopathic Doctor” or “ND” in your area. Holistic, integrative and alternative are also some of the keywords these doctors can be found by.
However, be cautious in your search for naturopathic doctors. There are many practitioners who claim to be “naturopaths.” And while these practitioners may be able to help somewhat with health-related matters, they do not have the spectrum and depth of training as a licensed naturopathic doctor who graduated from an accredited, 4-year medical program. To find a licensed naturopathic doctor in your area, visit the website for the American Association of Naturopathic Physicians (http://www.naturopathic.org/) and click the “Find A Doctor” tab.