A recent medical article has demonstrated that doctors cave to their patients’ medication requests with regularity, even when controlled substances like Oxycodone are involved. It’s not that big a surprise really—the customer is always right, after all.

The study serves as a reminder, though, of a venerable truth: the relationship between the doctors who diagnose and the drugs they prescribe is every bit as complex as the well travelled crisscross between Gwyneth and Chris —maybe even more so. Long ago, it was all so simple: the doctor was part shaman, part priest, part pal with nothing to offer but a smile and a shrug.

Then came remedies: the powder, the salve, the wondrous elixir. The real charlatans (as opposed to flummoxed, inept, surely avaricious practitioners) all leaned in, hoping to find the next sucker born that minute. After all, no group is more ripe for the picking than the infirm, either those chronically afflicted or the once healthy who meet a sudden calamity. So much desperation means so many opportunities—how simple then, to squeeze out a fortune or two on the promise of a miraculous cure. 

But with so much money changing hands, rules were created. That veteran killjoy, the FDA, stuck its sanctimonious nose into the entire orgy and separated the action into two basic teams: the doctors and the pharmacists. Each would get a healthy slice of the healthcare pie and live mostly peacefully and plumply, with the self-satisfied sense that they didn’t quite get all they deserved.

Rather than live happily ever after, however, this Eden too was invaded—by the customer. That’s you, the potential patient (and we are all potential patients, a market 7 billion strong and growing daily). First, as mentioned, was movement that came to regard patients as human beings, not animals or children that disinterested (though informed) outsiders made decisions about. In the first major self-reflective moment of modern medicine, doctors and patients alike suddenly remembered that illness, just like car repair, involved discussions between adults, not dictation and stenography.

Growing the exact opposite direction, though, towards the heart of wealth management, was the 1997 FDA “guidance” that trampled the barrier which previously had restrained direct to consumer (DTC) advertising. Prior to that, there was a gentleman’s agreement to behave, mostly; the TV and mag ads that ran were cautious and proper since the pharmaceutical guys knew the FDA might swoop in at any moment and make them play by the rules.

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