What a year 2004 has been. All kinds of truly dramatic things have happened. The Boston Red Sox won the World Series, the Republicans ran the political table, and the FDA and Merck & Company will take the rap for the biggest drug debacle in the history of medicine. What the impact of these momentous events will be is, I guess, one of the reasons for visiting 2005 and the many years that follow. Certainly the Boston fans can curtail their bouts of depression, alcohol abuse, and high priced psychiatric care that has become almost ritualistic for the past eighty-four years. Baseball fans can from this year onward consider the nearly inconceivable question: Now that the Curse of the Babe is broken, how will the Sox handle success? The Red Sox have become so good at making excuses, blowing easy outs, and hating the Yankees that I can’t wait to see what they come up with next. It will be fun just to watch 2005 unfold.

As for the Republican victories of nearly every election except that of the Papacy, there is an ambient schizophrenia in the political nuthouse. They are delighted that Big GW has become president for another term and taxes are likely not to rise. On the other hand, the deficit is likely to kill any chance of buying anything with cash except a two dollar gallon of gas. The war in Iraq has becoming the “Mother of all Messes,” and there seems to be no end in sight. Political pendants ask, “What kind of message does the re-election of Mr. Bush send to the world?” How about: “You got us into this, fella; now you get us out!!” In the years that follow, we all will be certainly watching (and praying) for a Texas sized bit of luck and good fortune to repair the deficit and bring stability to the Middle East. If neither happens in the coming years, the Republicans will be taking lessons in depression management from the Red Sox fans.

As for the tsunami that hit the FDA, Merck, and likely other big drug companies in 2004, there is a real possibility that the future of the drug industry, and more importantly the entire drug culture of America, will change in the coming year and the foreseeable future. Did I say “drug culture”? This is a term from the tumultuous sixties. What happened in 2004 to the FDA and the pharmaceutical industry is nothing less than Woodstock, Watergate, or the Challenger disaster because the American public looks at a pillar of its culture in a different light. Prior to 2004, if we had an ache, a pain, an elevated blood sugar, a weight problem, nervousness, high blood pressure, high cholesterol, heartburn, asthma, or a cough, we simply went to the doctor and got a pill. What could be easier? There you have the dynamics of the last fifty years of medical care.

There has been a continuous and profitable shower of drugs made available to the public because that is what we have demanded. Physicians and other health professionals have been pleased to be part of that culture in which we expect patients to be responsible and “get care.” We have struggled with the problem of bringing the poor, the fringe groups, the illiterate, and all those deprived of healthcare into the arena of modern medicine in order to treat all of the above important ailments with what? Medications of course. From 2004 onward, the public will look at most drugs with a very critical eye and as never before. While fully accepting the vivid truth that medications can be life-saving and a valid means of improving the quality of life for us all, the American public must nonetheless consider that antiarthritic drugs, the antihypertensive drugs, the weight-reduction pills, and the cholesterol-lowering potions of the day are also a foreign chemical with potentially lethal side effects. While we will watch the FDA and the drug companies clean up the current mess, the damage has been done. Just as our view of music and the drug culture changed with Woodstock, and our perceptions of the presidency changed with Watergate, as did the casual acceptance of the space program when that fire ball rose over the Cape, none of us can casually accept the safety of “routine” medications for healthcare.

There is another alternative to the last fifty years of this dynamic of demanding a pill for a medical problem. Gosh, what might that be? How about behavior modification. Oh, Lordy, we have to do something ourselves. In the pre-2004 culture of healthcare, it seemed ridiculous to exercise and to reduce calories when a daily pill would do a better job and was easier. Why would anyone in their right mind eat less and drink less alcohol to reduce heartburn when a pretty purple pill covered by insurance would do the trick? Why exercise and reduce body weight to reduce the pain of osteoarthritis when Vioxx worked so well? In the post-2004 culture, the paradigm of medical care may shift in that the American public, and certainly the medical profession, will balance the reasonable concept of behavior modification for the treatment of common medical ailments against the uncertain risks of taking an “FDA approved” or “scientifically tested” drug.

Recently a very interesting study from Emory University and Intervent, USA has been completed and the findings will soon appear in the medical literature. Intervent, USA is a Savannah-based company dedicated to offering education and behavior modification (diet and exercise) in order to improve and protect cardiovascular health. In a 12-week study of several thousand patients, participants were able to reduce blood pressure and other stroke and heart attack risk factors by adhering to a quite reasonable program of diet and exercise. In many patients the results were as good as one might expect from a 2004 program of drugs. There are many other examples of behavior modification programs that can reduce symptoms of common illness. Until now, neither the public nor the medical profession had embraced them because our culture has been simply to take a pill. All that changed with the revelations of senate hearings for 2004 regarding the activities of the FDA and Merck. In 2005 it is likely that Intervent, USA will be considerably busier. 2005 is a very good time to review all your drugs with your physician and ask one question, “What do I have to do to get off some of these drugs?” If you do, you will have entered the New Year in the new and likely safer culture of medical care. For that reason and also because I will be curiously watching the Red Sox and George W., I look forward to 2005. Have a healthy and Happy New Year.

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