Dear Dr. John,
It’s with a heavy heart that I say this. We’ve been together for so long. I can’t remember the first time you saw my naked body. And now that I’ve passed 50 years, you want to move to the anal stuff. I mean, it’s not that I’m not looking forward to our kinky new play—because I am—but I feel we’ve grown in different directions, and I know that while I’m going to continue to see you for the rest of my life, I’m also going to have to see other doctors—not the least of whom is that cardiologist that you recently brought in for a sick three-way.
I know this has got to come as a shock to you. Let me set your heart at ease: It’s not you, it’s me.
No. Fuck it. It’s you.
I don’t know when I realized that there was something flawed about our liaison. It might have been the very first time I came into your office, and you looked at me so lasciviously. “Brian, your blood pressure is a little high, why don’t we put you on some meds to bring it down.” “Well, I’d rather lose a little weight and handle it that way.” “I can’t tell you how many times I’ve heard that, but I’ve never, never seen anyone actually maintain control for the rest of their life through diet and exercise.”
But I did—for more than a decade now. Then there was the time you wanted my gall bladder removed because I had constant heartburn. Turned out my belt was too tight. Thank goodness my friend John Murphy mentioned the possibility to me. It seems like you should have known something about that. And then there was the diabetes. The spats we had over that one: “I think I can fix it with diet and exercise, doc.” “Oh, just have a little bit of this Metformin, it’ll make it easier to take the weight off.” Of course, it turns out that Metformin causes something called “peripheral neuropathy,” pins and needles in the hands and feet. I can truly say you made me tingle. Fortunately, just a week off the Metformin, and the tingling’s already fading. I never was diagnosed “diabetic,” but I did fight the “metabolic syndrome” to a standstill—despite the horrible advice from friends and lovers—and now I daresay with a Hemoglobin A1c of 4.7, my numbers are better than yours.
And now it’s the heart. It started as a little tiff over whether I’d take statins, based on the results of a bad blood test. “People who take statins live longer” was the argument that finally sold me. I took one, simvastatin, and it damned near did me in. Angry at work, unable to sleep, forgetful, distracted—a recipe for destruction for a journalist who requires a certain level of attention to detail.
Oh, you tease! “So go get a Cardiac CT scan, and prove to me you don’t need to take them; let’s see if you’re not in the bottom 10 percent. You’re making me look bad, the other doctors would say, ‘Are you crazy? This guy should be on statins.’”
So I got the scan. I paid for it out of my pocket since insurance wouldn’t.
And that’s when you broke my heart: Athrosclerosis. That’s quite literally a death sentence without an execution date. In fact, cardiovascular disease is the No. 1 killer in America, with more than 800,000 deaths in 2005, according to WebMD. Unless I die in an accident, I will die of atherosclerosis. Probably not today (not before I finish this letter, anyway), but it’s about 50-50 that I’ll have an “event” in the next 10 years. It may be called a stroke or it may be called a heart attack, but it’ll be from these calcified arteries. “No,” you said, “there is nothing that will remove the blockages, but statins will help prevent it from getting worse.”
And you know the funny part, Dr. John? My most recent blood test showed numbers that, again, are better than yours. Just to remind you, my total cholesterol 152; triglycerides 117; HDL 45; VLDL 23; LDL 84. Barely even surprising, since—again, according to WebMD, “a 2001 study of 262 apparently healthy people’s hearts [showed] 51.9 percent had some atherosclerosis, [and] atherosclerosis was present in 85 percent of those older than 50.” Heck, 17 percent of teenagers have atherosclerosis.
Get it? You probably have it, too. And are you on statins? I thought not.
But that death sentence. Man, that kind of stuff will really mess with a guy’s head, particularly a guy who believes he can fix things, control things, particularly himself. Think I couldn’t concentrate on my work while taking statins? Think I didn’t know the first Earth Day was in April 1970? Tell a guy who exercises regularly and strenuously that “events” often start with exercise if you want to discourage exercise. Or tell an editor to reduce his stress. Or how about the old saw that arthrosclerosis is the main cause of erectile dysfunction? That would be like Magic Johnson not being able to play basketball. ED, doc? Me? Have you seen my dick?
Of course you have. Who hasn’t?
You know that joke that starts out with the mother saying, “If you don’t stop that, you’ll go blind,” to which the adolescent boy replies, “But can I just do it til I need glasses?”?
Well, I’m going to try to cure my incurable atherosclerosis until I need Lasik.
Breaking up is hard to do
Looking back, it seems our relationship was doomed from the start. You were so good at some things. Trauma. Dude, remember when I threw my back out? You were right there with the Flexerils and Lorazepam. Pneumonia and bronchitis: You gave me amoxicillin like you were pouring me a fine glass of red. A mere 12 hours later, and I was no longer coughing blood. Broken toe? You were right there with the cotton.
Blood tests. That’s another one you’re really good at. You order the test, and all I have to do is look at the bolded parts, and I can see if I’m a little out of whack. But you’re really good at interpreting that stuff.
But that’s kind of your job, isn’t it? It’s not like you really care about me, although I do feel a certain friendly connection to you. It’s like, I wouldn’t mind hanging out with you or playing a little racquetball, if you would just give me your email address. Why won’t you give me your email address? That would be like dating and not having me over to your house.
I know we’re both going to have to go out and find people who are more suited to where we are in our lives now. You’re an allopath. That means you prescribe drugs: Aspirin for headaches; antibiotics for flus; statins for cholesterol; beta-blockers for high blood pressure. I don’t mean to dismiss what you do, because I know you work hard every day, but this is pretty much it, right? You give drugs to treat symptoms.
For example, we know that the disease caused by an incorrect insulin response is “diabetes,” but the symptom is wacky blood sugars. So you treat the symptom. Am I getting that right? The disease is hypertension, but you treat the symptom of high blood pressure by either relaxing the heart and blood vessels or decreasing the volume of blood with diuretics.
But there are lots of kinds of doctors. Osteopaths are supposed to be more systemic, recognizing the body’s ability to heal itself. Sounds like magic to me. But you have to know, when I look at things like diabetes, high blood pressure, atherosclerosis, obesity, gout—you know, those First World diseases we get from our higher standard of living—I think they must be related. Must somehow be systemic. But, that’s just another one of those communication breakdowns that have me running to another’s arms.
The surgeon, for example. He’s the guy who’s going to help me when things get really bad. He’ll likely have to cut out a big fat vein from my leg and detour the blockages on the right aorta. The Cardiac CT showed there are like eight or nine of them. But when he lies me down on that bed and slides his fingers along my inner thigh before he cracks my chest like some psychotic cupid, you know I’m going to be like putty in his hands.
But look, Doc, there are all kinds of health-care workers in Reno, and there are others who don’t have conventional M.D.s, but somehow they seem to be just as concerned about my body. There’s that ayurvedic doctor, Harish Aggarwal at Everlasting Health in the Sports West Shopping Center. The guy over at Truckee Meadows Herbs on Wells Avenue knows a lot. In fact, anything he says has a lot of proponents on the web. And have you seen the selection of vitamins, minerals and herbs over at Whole Foods?
No, no, no. Please. Don’t be pathetic. Don’t beg, and don’t enlist your friends to harass me. Don’t talk shit about my new doctors. I’ll miss you, too, but attacking people who are different than you just because you don’t know how to say what’s really in your heart will only get you blocked from my phone. That is, Doc, if I had your phone number. Why don’t I have your phone number? It’s because even though you know me intimately, you’re not really my friend. I’m just a customer. And don’t even ask about Facebook.
Love is communication
Speaking of things we don’t talk about, let’s talk about vitamins and herbs. It’s pretty obvious to me that I either have too much of something or too little of something in my internal environment. From your point of view, I guess, I would have a deficiency of Zocor.
I’ve thought about this for a while now. We know there are natural treatments for things that are just as effective as those drugs you so lovingly push. For example, niacin for lowering cholesterol.
In the report, Cholesterol: Niacin vs. Statins, Margy Squires wrote: “Harvey Simon, M.D., responds to a niacin question in the Harvard Health Publication by saying, “In the doses needed to improve cholesterol, niacin is a drug and a potent one. On average, it can lower LDL cholesterol by 10-25 percent. Statins and other lipid-lowering drugs do even better, but niacin outshines them all for lowering triglycerides levels (down 20-50 percent) and raising HDL cholesterol levels (up 15-35 percent).”
So, is lowering total cholesterol the goal? Nope. Is lowering triglycerides and raising HDL cholesterol the goal? Yep.
Doesn’t it make sense if those numbers are off, maybe it’s because a natural nutrient is scarce in the body? Like maybe somebody is suffering from a Vitamin B3 deficiency? I’m not a doctor or anything, and a person would be a fool to act on anything I say, but doesn’t it make sense?
But here’s the deal. As in most matters of the heart, it’s money that matters. In the American system of medicine, we have a method for drug approval through the U.S. Food and Drug Administration. We’ve all heard how Vioxx, Baycol and Fen-phen got approved for consumption. We’ve all heard how much it costs to bring a drug to market: A Slate.com article pointed out that while pharmaceutical companies claim it costs almost a billion dollars to bring a drug to market, the true cost is closer to $55 million.
The real problem is that pharmaceutical companies can’t patent natural substances, like niacin, so they can’t make billions of dollars off it. But that’s just one strand of the conspiracy. Natural substances—vitamins, minerals, amino acids, herbs—have little government regulation—none as far as efficacy goes. And any time some government busybody suggests a bit of regulation to protect consumers, the pharmaceutical companies and the supplement manufacturers howl.
The supplement manufacturers scream because they don’t want the government cooking the books and making their natural drugs look less effective against the manufactured drugs. Some scream because they’re selling fairy dust, and they don’t want to be exposed as frauds who risk people’s health for profit.
The pharmaceutical companies howl because they don’t want people to know there are effective natural treatments for many diseases, and they don’t want to be exposed as frauds who risk people’s health for profit.
And for you and me, Doc, there’s no objective way for us to compare, to discover drug contraindications, no way to discern what is real and what would work best for my health. It all boils down to a matter of faith: Do you believe the drug companies and the government, or do you believe the supplement companies? Maybe some people believe the witch doctors or faith healers. Remember the whole laetrile controversy when people were eating peach pits in desperate hope of surviving cancer and yet still dying like flies?
It’s all big business, Doc, and the last time I was in your office, we said a great many things. You said I was to do the thinking for both of us. Well, I’ve done a lot of it since then, and it all adds up to one thing: I’m going to have to do the experimentation on my own body and trust in the findings. What’s the worst thing that could happen? Other than my premature death because the people who would profit off my prolonged life would prefer I don’t have the information to make real choices.
For example, two-time Nobel Prize winner Linus Pauling claimed he solved atherosclerosis with a combination of Vitamin C and amino acids back in the ’80s. It seems if this were true, the drug companies would eschew some profits in order to help people live longer, better lives. Unfortunately, statins are among the most prescribed drugs on the planet. We Americans spent $19 billion on statins last year.
Well, Dr. John, I feel I’m rambling. I’ve valued our relationship over the years, but I’ve got to admit honestly that I often felt that I was doing most of the giving, and you were doing most of the taking, and if it wasn’t you, it was the insurance company.
I’m sorry I had to do this in a letter, but I’m afraid your fear of commitment to my health was our undoing. I do hope you understand about me seeing other doctors, but I’ll continue to see you when I need an antibiotic, a stitch or a scrip for a blood test.
I just hope we can stay friends.