Counterpoint from Denmark that has the same movements of “wrap your kid in bubble wrap” and “it’s offensive to wear sombreros”, we don’t see an overuse of opioids or penecilum because the medical system isn’t for profit and you aren’t a customer, you are a patient. Show up saying you feel a flu coming on and would like some penicillin to curb it? The doctor will laugh at you and tell you to come back when you visibly sick, and even then she’ll tell you to just try sleeping it off. Only as a last resort do they actually prescribe harder drugs. Also, you need prescriptions even for larger packs of ibuprofen and paracetamol.

The issue in USA really seems to me to be drive in large by the fact that people are customes who want drugs and doctors are salespeople who want to sell drugs. With opioids it just so happens that the legal barrier got lowered enough that everyone who wanted it for all the wrong reasons could justify buying it anyway, and then they did.

More people in the US also can't take time off, or are at least discouraged to do so. I have also found that many over the counter drugs for e.g. a cold that you find in Scandinavia aren't readily available in the US. Instead they suggest all kinds of fun/scary things that have been banned back home for many years.

I don't think it's about money, more that the Danish government has control over healthcare and they're incentivized to not over-prescribe medication.

We don’t make money by prescribing drugs. Those of us on risk sharing contracts - most of us, directly or indirectly, to a greater or lesser extent - lose money by prescribing drugs.

Your comment has little factual basis.

The patients don't, but doctors[0][1][2][3][4] and drug manufacturers[5][6][7] and distributors[8] do.

[0]: https://edition.cnn.com/2018/03/11/health/prescription-opioi...

[1]: https://www.healthleadersmedia.com/strategy/doctor-tied-insy...

[2]: http://www.waff.com/2018/08/22/doctors-indicted-overprescrib...

[3]: https://www.kansascity.com/latest-news/article214834685.html

[4]: https://www.hsph.harvard.edu/news/hsph-in-the-news/opioids-d...

[5]: https://www.vox.com/science-and-health/2018/9/7/17831710/ric...

[6]: https://www.masslive.com/news/index.ssf/2018/06/mayors_join_...

[7]: https://www.usnews.com/news/politics/articles/2018-05-16/6-m...

[8]: https://www.theatlantic.com/business/archive/2017/09/opioid-...

So much truth in this.

In Germany doctors have a "budget" per quarter allotted by the public insurers for every patient they treat.

All meds and treatments they prescribe come out of that budget, if at the end of the quarter the doctor ends up being above that budget, then he's stuck with those costs and has pay from his own profits.

In a setup like that, the doctor is held personally responsible for not overprescribing.

Just like insurers only pay a certain amount for meds for certain conditions/treatments. Creating pressure on the pharma industry to also offer smaller packages of drugs, instead of forcing wisdom teeth patients to buy a whole 50 pill bottles.

It's not perfect because it suffers from a bit of the opposite problem of underprescription and doctors being shy about prescribing expensive treatments even when they are needed.

But if that really becomes an issue then patients can just change the doctor, they are always free to do that and never forced to visit a specific doctor.

"The two doctors made no secret of who they blamed for “this preventable cause of death and disability”. “It’s about money. Money has influence, and it influenced the joint commission,” said Lucas."

See also: https://www.nytimes.com/2018/05/29/health/purdue-opioids-oxy...

And: https://www.forbes.com/sites/alexmorrell/2015/07/01/the-oxyc...

This isn't new.

The "sanatorium" concept was lost somewhere in the 20th century. The sanatorium idea was the cure by the gradual restoration of health.

Today is almost medication every time. Zero to little attention to physical and mental health restoration. It's like plastic surgery.

We have that still when called for - it is called rehab. Medicines fix things as well in many cases - at times far less gradual.

No one likes to hear "too bad, deal with it" as the response to their perceived problem, but I'm afraid we as a society are losing the essential skill of "dealing with" accidents, injustices, or just plain bad luck in favor or making someone else shoulder the blame.

Losing it? I personally doubt we had it in the first place. Just look at the rich and very not new history of scapegoating.

Blame the victim rather than admit a problem. Leprosy is a result of your sin. Smallpox however is blameless because it could happen to anyone. Lash out at the vulnerable rather than the source of the problem.

Survival bias is what leads to the perception of this lost golden era. Where all of the pioneer's children are healthy without doctors - nevermind the graves of the seven children and two other wives. We didn't have PTSD before WW1 just ignore all of the self medicating civil war veterans. This tendency isn't a moral component so much as a result of exposure and memory. Possibly a survival bias itself that remembering everything would be really bad for mental health.

Alternative explanation: the quality of care has been declining, for instance because of the ridiculously higher administrative spending in healthcare.

And the thing about painkillers is that they "fix" (to the patients' satisfaction) a hell of a lot of problems ... while bringing in extra money for the doctor and hospital. Any incompetent doctor, or just one that doesn't get the time to diagnose (administrators need to be paid, and that's justified by "productivity" of doctors. Productivity mostly means faster diagnoses. One very effective way to do that, of course, is just to make incomplete diagnoses)

Secondly giving a painkiller is almost never a stupidly wrong decision (unlike taking out a kidney that then in a biopsy turns out to be fully healthy, regardless of how many symptoms matched). So it's ALSO low risk ! And I assure you, there are no words in the universe that cause administrators to drool half as much as the words "low risk".

Didn't we want market-based medicine ? Well, this is one instance where the market based choice is blatantly obvious.

Secondly I fear like now we're seeing the opposite reaction: people are acting against patients that have chronic pain and would not be able to function without constant painkillers. These patients will go back to self-medication (ie. alcohol and/or cocaine, both "decent" painkillers) like people did 50 years ago. It is not a good evolution to replace morphine with alcohol or cocaine.

Just "dealing with" injustices is enabling injustice through. And I am fully willing to help people in accident or bad luck assuming they will help me in bad luck.

You have never experienced real pain.

I agree, although I think it is important to keep in mind that everyone has different levels at which "deal with it" is appropriate. I've heard people say that about patients fresh out of back surgery, which I find to be ludicrous. I think this should be something between only a person and their doctor.

Eventually, the economy will crash, or at least the cheap energy will run out, and then people will be forced to get tough again.

These arent the same issue, though I agree we shouldnt take medication lightly for depression or pain but there still exists a massive industry specialized for american consumers to have these products pushed on them from all angles.

It's hypocritical that you don't just accept this as the way it is and move on.