Drug Dealer, M.D. | Anna Lembke | TEDxStanford

Drug Dealer, M.D. | Anna Lembke | TEDxStanford

[Applause] if we want to solve a problem we first have to figure out what's causing it especially if we're talking about about a problem that's happening over and over again just like if we wanted to fix a leaky dam we'd have to find the leaks first we are in the midst of the worst opioid epidemic in US history and this opioid epidemic is first and foremost an epidemic of over prescribing prior to 1980 doctors were very reluctant to prescribe opioids for their patients because they were worried about addiction by 1990 or the late 1990s doctors were dispensing opioids like vending machines to anybody that came in and said I have pain today doctors prescribed more than two hundred and thirty million prescriptions annually and just to put that in perspective the United States consumes over 80% of the world's supply of opioid pain pills despite constituting less than 5% of the world's population so the question is how did healers how do healers become dealers right and I'm sure you've heard about the role that Big Pharma's played in this in this public health crisis that we're facing and I'm sure you've heard about pill mill doctors these are willfully nefarious doctors exchanging prescriptions for cash and they both of those elements have played a huge role right Big Pharma really is to blame and there are really greedy doctors out there but the truth is that big pharma existed well before this public health crisis and frankly the term quack dates back to the 17th century so the question is why this drug and why now to really be able to understand this problem we have to recognize but this current opioid epidemic is a symptom of a faltering health care system and a culture that has demonized pain and it's perpetrated not by a small subset of pill mill doctors but by doctors like me compassionate doctors meaning to do well caught in a system gone awry harming patients who are showing up who really want help so in order to understand what caused this epidemic we need to be aware of three invisible forces inside of the healthcare system that are driving this problem the first force is the industrialization of Medicine or what I call the Toyota ization of Medicine right over the last three decades there has been a huge migration of physicians outside of private practice and physician led practices into large integrated healthcare systems we are now salaried employees of health care factories and what this means is we practice assembly-line medicine the throughput of body parts is more important than whole patient health there's tremendous pressure on doctors to palliate pain prescribe pills and perform procedures because that's what pays and to please patients because patients have become customers guess what opioids are a pretty good solution to that problem we have primary care doctors who have to see more than 40 patients a day less than five minutes per patients a couple of years ago my then 11 year old son googled my name on the internet and he came up with one of these internet doctor rating sites and he called me over you said mom is this you and there I was I only had one rating on this site one out of four stars and there was a comment about me in the comments said seeing this doctor made me wish I had never sought help in the first place wrong diagnosis wrong medication seek help from someone else I very sheepishly had to admit to my son that that was me and I was filled with shame I go around the country and have done so for years now encouraging doctors to prescribe fewer opioids and what they say to me is I'll prescribe fewer opioids when you can promise me that my patients will still give me a good rating on the satisfaction survey right so this is what we're dealing with right now now the good news is my son came up to me about 10 minutes later and said mom don't worry I gave you 4 out of 4 stars twice okay the second big invisible force driving this opioid epidemic is the medicalization of poverty over the last three decades doctors have increasingly been faced with having to cope with not just the biological illnesses that are afflicting their patients but also their socio-economic and psychosocial distress and yet they haven't been given the tools or the resources to handle those problems so what do they do they have to biology's problems that aren't really biological shoehorn them into our diagnostic codes in order to get insurance companies to pay for it and in the face of those overwhelming problems unemployment multi-generational trauma homelessness right doctors are left feeling not only overwhelmed but feeling like well what can I do at least I can prescribe this pill right at least for the short term my patient will feel better and indeed patients do go home and take the pill the opioid and describe feeling like they're being held or covered by a warm blanket they come back later and say thank you doctor you really helped me and the doctor gets to experience gratitude right why they went into medicine in the first place and yet this really is a false god so not only are doctors incentivized to prescribe pills in order to take care of non biological problems we now have patients who are incentivized to adopt the patient role in order to pay the bills we have over 13 million people in this country on disability the number two reasons for disability or chronic pain and mental health in the 1950s we had less than a million people in this country and disability and the number two reasons were heart disease and cancer why is that it's not because we're getting sicker it's because patients have figured out or people have figured out that by adopting the stick roll and signing up for disability they can pay their bills and yet in order to validate their sick roll status they have to participate in the health care system which also means taking certain types of pills Karl Marx said religion is the opium of the masses we are at a point in our history where opium has become the religion of the masses the third invisible force driving the opioid epidemic illness narratives in particular narratives about pain today we believe in the health care system that pain is dangerous so not only is pain painful in the moment but if we experience pain we are setting ourselves up for pain in the future how does that work because pain in the moment can leave a neurological scar which centralizes pain and makes us vulnerable to more pain in the form of a chronic pain condition this is a very modern concept and it's essentially borrowed from the mental health field right this idea that if we experience psychological pain we might develop post-traumatic stress disorder in the future all sort of stemming from Freud's original conception that what happens to us in childhood sets us up for neuroses as adults but 150 years ago doctors didn't think this way about pain they in fact thought that pain was salutary that pain could boost the immune response that it could boost your cardiovascular system that what doesn't kill you makes you stronger and in fact now we're finding that people who take opioids heal more slowly than people who don't people who get surgery with minimal opioids heal faster than people who receive a lot of opioids doing stirring surgery these three invisible forces are what is driving this opioid epidemic so the real question is how can we do better how can we fix this problem number one the Toyota ization of Medicine assembly-line care works great for some medical problems a knee replacement a heart attack a cataract surgery but it's terrible for chronic relapsing and remitting illnesses like chronic pain and like addiction so what's the solution we need to build an infrastructure inside the house of medicine that can take care of chronic illnesses and we have to reprioritize the doctor patient relationship we have to incentive i incentivize doctors to spend time with their patients to discuss these complex issues we need there to be a relationship through time so that opioids don't have to be a proxy for a doctor-patient relationship that means we have to build an infrastructure inside medicine to provide care to patients for chronic pain that doesn't just involve opioids right we need to build an infrastructure to take care of addiction and embrace it as a disease and insist that insurance companies pay to treat it the medicalization of poverty how do we fix that problem if we have decided as a society that medicine is our social safety net then we need to give doctors the resources to take care of the problems that patients really have and not biologies problems that aren't really biological how about narratives can we bring back some of the narratives from 150 years ago is it time to do that how about people are resilient how about the body can heal itself how about pain is inevitable and there may even be some times when some sorts of pain can serve a useful purpose in our lives if only to remind us what joy looks like and possibly most importantly that doctors are limited in what they can fix once it's broken the future of health care depends upon closing this gap between increasingly industrialized medicalised healthcare care delivery and the growing psychosocial psychosocial needs of our patients thank [Applause]

27 thoughts on “Drug Dealer, M.D. | Anna Lembke | TEDxStanford”

  1. Yes… We ARE getting sicker, Dr. Lembke. And YES, pain is dangerous. I feel like 95% of psychologists, sociologists and anthropologists would be driven through the roof by this woman's damaging message. Shameful.

  2. Spiritual Medium Clayton Roque

    This woman is incredibly warped!! What are people who have severe chronic pain supposed to do without medication. Boooooo!!! Get off the stage and shut the F up!!

  3. This is Anne lemkbe attempt to defame MD’s who rx out of pts need! I might add with her 60’s bell bottoms on!

  4. It infuriates me when people like this woman pull stats out of a hat and run with it! Chronic pain was highly undertreated until the 90s when doctors realized that when the whole person was treated including pain they healed faster. Also, addiction and dependence are two totally different things and less than .05% of people become addicted and those that do become addicted already had underlying issues.

  5. Raymond DeFlaviis

    This woman is public enemy number one, along with Andrew Kolodny, in the chronic pain community! She is a high functioning sociopath, devoid of empathy. It's more difficult to rank high status sociopaths than the low functioning one's, who usually end up in prison.

  6. This doctor is NUTS. I think doctors have gotten far away from RELIEVING SUFFERING which besides curing SOME diseases and fixing trauma, is all they can really do! There are plenty of diseases that cannot be cured, that is chronic and cannot be cured. I think this woman is a bit crazy.

  7. This is a 10 minute talk that is very focused on one overall point. Read the book. She is very understanding of the needs of patients in chronic pain.

  8. Religion is the opium of the masses.We have reached a point where opium is the religion of the masses

    That really struck me. As a matter of fact, this whole talk touched me. What an intelligent, articulate, empathetic woman.

  9. Remind everyone taking opioids for chronic pain what Anna Lembke has said: 'There are people suffering chronic pain for whom a regimen of daily opioids is incredibly helpful and life-changing.” That's a word-for-word quote, and as long as Lembke rails against using opioids to treat chronic pain, remember that she is speaking out of both sides of her mouth and her conclusions are meaningless.


  11. Read "Drug Dealer, MD" twice; have seen Dr. Lembke one time on television. The book is either written by more than one person, or the good doctor has , well, I don't know. I'll watch this video and may be back.

  12. You need to touch on Suboxone treatment for opiate addiction. You mentioned going through pain as a learning experience, a way to reach some sort a Nirvana; that is a lot of "hogwash' Dr. Pain and addiction are both treatable today, although it is highly expensive. You should crusade on that issue both with physician and big pharma!

  13. Dr. Anna has also spoken about the spiritual growth gained from being in pain. I'm thinking she's just a religious fanatic with a pain fetish.

  14. How about those of us who have osteo arthritis, for example and have chronic pain each & every day??? Are you saying we should be made to suffer because a few idiots abuse the pills which others need? You left that part out.

  15. I wish she spoke a bit on the rise of severe, chronic autoimmune diseases in America and the world, in which many doctors just guess at treatments (most biologic and chemotherapy treatments being possibly very dangerous in the future). So with a rare, "weird" autoimmune disease with chronic pain…what are my options?

  16. The current American "Health Care" system should be boycotted.
    Root cause medicine is the wave of the future. Put the current system out of business by taking care of your health, no customers no profit.

  17. There are a lot of chronic pain conditions wherein there is no other alternative to opiates. Every single person I have met who says they had chronic back pain and were taking opiates before they finally got some kind of surgery to relieve the pain has said that the surgery did little or nothing for the pain and sometimes made it worse. There is also a move in psychiatry to use opiates to treat chronic depression if all other pharmaceuticals have failed. Give people the opiates they need and deserve so they can at least have a quality of life worth living.

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