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Gatekeeper Drugs: Drugs that Require Gatekeepers

Posted Oct 03 2009 10:00pm

A friend of mine suffered from depression. Like so many depressed persons, he went to sleep very late — maybe 3 am. I told him that was a very bad sign, no one should go to sleep that late. He starting going to sleep earlier and waking up earlier and felt better. He wondered why none of the many psychologists and psychiatrists he’d seen about his problem had told him what I said. The first time he asked I think my answer was that I cared more than they did about the relation of depression and sleep.

Recently he asked again: Why didn’t they tell him something so simple and helpful? Maybe I learned something in the intervening years because my answer was different. I said all health care professionals — not just doctors, all therapists/healers, mainstream, alternative, Western, non-Western — have no interest in treatments that they are not needed to administer. If all you need to do is to get up earlier in the morning, you don’t need a psychiatrist. Therefore a psychiatrist won’t tell you to do that. The only advice they are likely to give is advice they are needed to administer.

I could give dozens of examples. Does the Chinese herbalist tell my friend with an infection to eat fermented foods to boost his immune system? No, because that wouldn’t involve the herbalist. Instead he prescribes herbs that probably do the same thing. Does a dermatologist tell a teenager that his acne is caused by diet? No, dermatologists make the absurd claim that diet isn’t involved. Because if it were you wouldn’t need them. You’d just figure out what foods are causing your acne, and avoid those foods. Why do medical schools fail to teach nutrition? Because you don’t need a doctor to eat better. Why is prevention almost completely ignored? Because prevention doesn’t require any gatekeepers.

The economic term is rent seeking: health care professionals act in ways that require you to pay them. The usual economic examples of rent-seeking cause a kind of overhead you have to pay but the rent-seeking engaged in by the entire health care industry shortens our lives. Simple cheap safe solutions are ignored in favor of expensive and dangerous ones that don’t work as well. Our entire health system centers on gatekeeper drugs: drugs that require gatekeepers. The usual name is prescription drugs; their danger is part of their appeal to the doctors that prescribe them. Because it makes the doctor necessary.

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