# Pain relief at a cost: are private doctors prescribing too much medication?

An episode of [Afternoon Drive with John Maytham](https://invisiblenetwork.ai/podcast/1212305258), 22 Oct 2026, 7:51.

Audio: https://p.podderapp.com/1951050295/traffic.omny.fm/d/clips/5dcefa8e-00a9-4595-8ce1-a4ab0080f142/e2113905-04ff-472c-9fff-a6cd00b63b20/6ace12b0-750a-4750-8d48-b4eb00f0148c/audio.mp3?utm_source=Podcast&in_playlist=cab9ce5d-42b6-4239-9177-a6cd00b6d1ff

To discuss the concerns raised in this article about pain medication, prescribing practices and the differences between South Africa’s public and private healthcare systems, John Maytham is joined by Nathan Geffen, director of GroundUp News and author of this piece. Presenter John Maytham is an actor and author-turned-talk radio veteran and seasoned journalist. His show serves a round-up of local and international news coupled with the latest in business, sport, traffic and weather. The host’s eclectic interests mean the program often surprises the audience with intriguing book reviews and inspiring interviews profiling artists. A daily highlight is Rapid Fire, just after 5:30pm. CapeTalk fans call in, to stump the presenter with their general knowledge questions. Another firm favourite is the humorous Thursday crossing with award-winning journalist Rebecca Davis, called “Plan B”. Thank you for listening to a podcast from Afternoon Drive with John Maytham Listen live on Primedia+ weekdays from 15:00 and 18:00 (SA Time) to Afternoon Drive with John Maytham broadcast on CapeTalk https://buff.ly/NnFM3Nk For more from the show go to https://buff.ly/BSFy4Cn or find all the catch-up podcasts here https://buff.ly/n8nWt4x Subscribe to the CapeTalk Daily and Weekly Newsletters https://buff.ly/sbvVZD5 Follow us on social media: CapeTalk on Facebook: https://www.facebook.com/CapeTalk CapeTalk on TikTok: https://www.tiktok.com/@capetalk CapeTalk on Instagram: https://www.instagram.com/ CapeTalk on X: https://x.com/CapeTalk CapeTalk on YouTube: https://www.youtube.com/@CapeTalk567 See omnystudio.com/listener for privacy information.

## Transcript

[0:00] Speaker 1: We're joined now by Nathan Geffen, who is director at
[0:02] Speaker 1: Ground Up News, but speaking to me as a man
[0:05] Speaker 1: who's recently had an operation and walked away with too
[0:10] Speaker 1: many pills. Hello, Nathan.
[0:12] Speaker 2: Hello, John. How are you doing?
[0:13] Speaker 1: Yeah, I'm very well. It's something that I'm reading more
[0:16] Speaker 1: and more about, over prescription and the implications of that.
[0:21] Speaker 1: And I thought I'd like to speak to you because
[0:23] Speaker 1: you tell a personal story about exactly this.
[0:27] Speaker 2: Thanks, John. First of all, I just want to say
[0:29] Speaker 2: that the treatment I had throughout this process was excellent.
[0:33] Speaker 2: The doctors were great. The nurses were great. My shoulders recovered.
[0:38] Speaker 2: So I don't want to cost aspersions on any particular doctor.
[0:41] Speaker 2: This is a systematic issue that I've raised. And the
[0:46] Speaker 2: second thing I should say is that I've done the
[0:48] Speaker 2: classic arrogant journalist thing of writing a thousand words on
[0:52] Speaker 2: a topic on which I have no expertise. But in
[0:55] Speaker 2: my defense, I did speak to a lot of experts
[0:57] Speaker 2: before putting the article together, and the feedback I've had
[1:01] Speaker 2: from doctors has been largely positive.
[1:04] Speaker 1: Yeah, but I mean, I speak to experts all the time,
[1:06] Speaker 1: and there's nobody more expert than the citizen. I said
[1:10] Speaker 1: that with great confidence as if it was universally true.
[1:14] Speaker 1: But sometimes the personal story does illustrate that. the general picture,
[1:19] Speaker 1: which one can then also spend some time on. So
[1:23] Speaker 1: you left your wonderful medical experience lucky enough to have
[1:28] Speaker 1: private medical aid, and you make also the point that
[1:30] Speaker 1: people in the public health system would not have had
[1:33] Speaker 1: necessarily the experience you had, but you walked out with
[1:37] Speaker 1: too many pills, some of which you didn't need, and
[1:40] Speaker 1: some of which conflicted with another.
[1:44] Speaker 2: Well, so I received four cartons, four packages of painkillers.
[1:52] Speaker 2: And there's a photograph of that on the article in
[1:54] Speaker 2: Ground Up. And it's not unusual. Apparently, this is quite
[1:59] Speaker 2: often what happens. And the point I make is that
[2:02] Speaker 2: only one of those was appropriate. And even that one
[2:06] Speaker 2: could have been substituted with a much cheaper drug. And
[2:09] Speaker 2: two of the packages were pretty much Almost the identical drug,
[2:16] Speaker 2: just in a slightly different format, but definitely not both needed.
[2:21] Speaker 1: And one of the drugs should not be taken with
[2:23] Speaker 1: another one of the drugs that you were given.
[2:26] Speaker 2: Well, I don't know about that, but they basically duplicate
[2:29] Speaker 2: each other. And these are drugs that are potentially dependency-causing, although,
[2:38] Speaker 2: I mean... I think the odds of any one patient
[2:41] Speaker 2: becoming dependent from this particular prescription that I received is unlikely.
[2:45] Speaker 2: But if you do it over and over again for many,
[2:48] Speaker 2: many patients, some will become dependent. And the cost is unnecessary.
[2:54] Speaker 2: The risk is unnecessary. It's too much pain relief. It's
[2:58] Speaker 2: too much of a good thing, as I've written in
[3:00] Speaker 2: the article.
[3:02] Speaker 1: But the reason you were given these four different kinds
[3:05] Speaker 1: of pain relief was they were let's look on the
[3:09] Speaker 1: bright side or let's look on the positive side. They
[3:11] Speaker 1: wanted to be absolutely certain that you had something that
[3:15] Speaker 1: would reduce and control your pain.
[3:18] Speaker 2: Absolutely. And pain is highly subjective, right? So it's quite
[3:22] Speaker 2: possible that other patients who came out with exactly what
[3:27] Speaker 2: the procedure I underwent might have felt much more intense
[3:31] Speaker 2: pain and might have felt that they needed something stronger.
[3:33] Speaker 2: And so I get that it's not straightforward. But this
[3:36] Speaker 2: was a bit over the top. I spoke to a
[3:40] Speaker 2: doctor today who said, well, you know, he doesn't quite
[3:42] Speaker 2: agree with my article. He would have prescribed two instead
[3:45] Speaker 2: of four of these medicines. So, you know, one could
[3:50] Speaker 2: certainly quibble with the finer points I've made, but that
[3:54] Speaker 2: this is too much, I think is hard to quibble with.
[3:59] Speaker 2: And the other point that another doctor made to me
[4:02] Speaker 2: is that What he does is he prescribes quite a
[4:05] Speaker 2: conservative pain relief medication, quite conservatively, to patients when they
[4:10] Speaker 2: come out of an operation. But he provides them quite
[4:15] Speaker 2: conservatively with maybe paracetamol and ibuprofen. But he'll give them
[4:21] Speaker 2: a prescription for something stronger if that isn't doing the trick.
[4:24] Speaker 2: So they're not walking away from the hospital with all
[4:26] Speaker 2: of these medicines. They can exercise the prescription if they
[4:29] Speaker 2: feel they need it. And that, to me, seems like
[4:32] Speaker 2: quite a reasonable approach as well.
[4:34] Speaker 1: The conversations you had with experts, because inevitably people are
[4:38] Speaker 1: going to be suspicious and some of the suspicions might
[4:40] Speaker 1: be grounded that this is, you know, this is around
[4:44] Speaker 1: contracts with particular pharmaceutical companies. And the more you prescribe,
[4:48] Speaker 1: the more you get taken on jollies. You go to
[4:52] Speaker 1: Venice for carnival or whatever. But there does seem to
[4:58] Speaker 1: be not just in South Africa, there does seem to
[5:00] Speaker 1: be an awareness growing that too many pills that might
[5:10] Speaker 1: be but probably won't be necessary are being prescribed as
[5:14] Speaker 1: a kind of scattergun approach. And what did you experts
[5:18] Speaker 1: say about that?
[5:19] Speaker 2: Yeah, correct. I mean, one of the people I spoke
[5:22] Speaker 2: to said that, you know, that this is happening in
[5:26] Speaker 2: part because of the heavy marketing of pharmaceutical reps when
[5:30] Speaker 2: they go and see doctors. Now, I'm not suggesting that
[5:33] Speaker 2: any doctor here was involved in anything nefarious or that
[5:37] Speaker 2: there was any kind of corruption. But when you're being
[5:41] Speaker 2: visited by pharmaceutical reps day in and day out, and
[5:43] Speaker 2: they're telling you how wonderful this is and how wonderful
[5:46] Speaker 2: that is and and they're not telling you that actually
[5:48] Speaker 2: the evidence base doesn't suggest that this is really necessary
[5:52] Speaker 2: or that this more expensive medicine is actually no better
[5:56] Speaker 2: than a much, much cheaper one. You don't have the
[5:59] Speaker 2: time often to look into that as a doctor, and
[6:03] Speaker 2: these prescription habits develop, I think, across the industry without
[6:07] Speaker 2: anyone intending to do, on the doctor's side, intending to
[6:11] Speaker 2: do anything that they shouldn't do. It sort of becomes
[6:15] Speaker 2: almost traditional.
[6:18] Speaker 1: You see, the risk of prescribing too little, not prescribing enough,
[6:24] Speaker 1: is probably greater than the risk of overprescribing, I think.
[6:28] Speaker 1: So naturally, one would want to make sure that the
[6:33] Speaker 1: patient has what the patient needs to get better rather
[6:37] Speaker 1: than go, I'd better be cautious because one doesn't want
[6:40] Speaker 1: to overprescribe.
[6:42] Speaker 2: I definitely think it's a counter argument to what I've written.
[6:45] Speaker 2: And as I say, one doctor did say that to
[6:47] Speaker 2: me today. I had a chat to him and he said, look,
[6:50] Speaker 2: he thinks I've over-argued the case that he would definitely
[6:55] Speaker 2: prescribe two of the four medicines that I got. And
[7:00] Speaker 2: I hear that. I understand that this isn't easy, but
[7:03] Speaker 2: there are treatment guidelines that South Africa has. There are
[7:10] Speaker 2: pain management guidelines. that are primarily for the public health system.
[7:15] Speaker 2: And Andy Gray, pharmacologist, probably the most respected pharmacologist in
[7:20] Speaker 2: the country, told me that these are really good guidelines
[7:24] Speaker 2: and they're followed in the public health system, although often
[7:29] Speaker 2: not properly because there aren't enough resources there. And the
[7:35] Speaker 2: private health system should really adopt them. And I've linked
[7:38] Speaker 2: to those guidelines in my article.
[7:41] Speaker 1: And that's on Ground Up, where Nathan Geffen is a
[7:44] Speaker 1: director at their news division. Nathan, thanks very much for
[7:50] Speaker 1: sharing your story.

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