Reflections on coloured pens and dull meetings

Sunday Blog 128 – 24th March 2024

While I usually date my advocacy career as beginning with my daughter’s birth, in truth, I have always quite enjoyed sharing my opinions. I enjoy puzzling apart systems, how they work and what the puppet strings might be that are putting on the show we live with day in and day out. And I tend to think that everyone is entitled to my opinion.

Wherever it started, there were seven years when I held a senior health advocacy leader role. I went along to hundreds of long, long meetings about health reforms and policies and so forth. Full-time. Every day. Often for twelve-hour days.

My single unifying theory of life is that everyday people need to be at every decision-making table. But the corridors of power are full of talented, well-paid or well-resourced lobbyists. This arrangement privileges the voice of the self-interested, those invested in making a profit and/or maintaining the status quo above all else. The more sensible, disinterested everyday voice is usually absent.

So, dull or not, I needed to be at those meetings, a fly in the ointment constantly asking pesky questions such as how many patients or health consumers had been part of the initial discussions? I would know the answer to be none, but I would ask, anyway, point to the policies and frameworks the status quo had created that promised such engagement would take place.

Despite being convinced of the importance of being at these meetings, and appearing very authoritative, I rather shamefacedly always brought a pencil case with coloured markers to these very important meetings. As I listened to the speakers, I would underline or just doodle with beautiful colours and patterns.

Soul-searching about whether such Sisyphean work is effective was something I regularly indulged in at the end of a long week. Since Covid, I left the leadership role and now maintain about a day a week of this same sort of dogged, not entirely welcome work of health advocacy. The rest of the time is mine to write and create.
The coloured pens have vanished.

And then this week, listening to an episode of Revisionist History entitled In Triplicate, I realized again, anew, afresh why I have given, why I continue to give, so much of this lifetime to health advocacy.

It follows the contribution of health advocate Sid Wolfe. He noticed the Triplicate Program, established in California in 1939, required a triplicate prescription of every painkiller prescribed by a doctor. This meant there was a backup copy of each prescription, which could then be randomly audited. It created “the chilling effect” of observation and this impacted physician behaviour, decreased the level of prescribing. Knowing your prescribing practices will be audited will do that.

In the 1980s, before the scourge of Purdue Pharmacy’s aggressive marketing of Oxycontin, Sid Wolfe argued for the Triplicate Program to be implemented nationally. California, Texas, New York, Illinois and Idaho all implemented the Triplicate Program, and a physician from New York commented at the time; “I wish that anyone who opposes triplicate prescription programs could walk with me into the real world, where these regulations are saving lives.”

Purdue Pharmacy undertook their focus groups before their blitz of marketing of Oxycontin; and they elected to avoid those five states where the Triplicate Program was in operation. The result? Significantly fewer deaths and resultant social harms inflicted by the now-disgraced and bankrupt Purdue Pharmacy. (If you haven’t watched the 2023 Netflix series Pain Killer or Hulu’s Dopesick, I would recommend).

So I still sit at these tables, I still hold the faith that bureaucratic solutions which are painfully slow and boring to enact, will support the safety of everyday people from the rapacity of some elements of our health system.

But now, I don’t need to take my coloured pens with me. I get to colour all the other days of the week.

If you want to listen to the episode in full, you can find it here.

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