Monday, November 01, 2010

Their job, your life

Remember when doctors used to listen to patients & their symptoms. Symptoms are the body trying to tell a story, whether it is about an underlying condition or a reaction to medication (going on or off it).

The doctor (GP) is the lynchpin, the one who takes an overall view of the patient. He it is who must balance the advice of consultants and mediate such, often conflicting, advice in the interest of the whole patient. He it is who must explore with the patient such issues as the trade-off between treatment and quality of life. He is the one dealing with patient as person. The others are only looking after their own specialised bits.

There is a German term Fachidiot which denotes a type of person who is specialised in such a narrow range that he knows nothing. This description reminds me of consultants. It also brings to mind the old song The Gasman Cometh. I think it was a Flanders and Swan song. The gist of it was that you started off with a problem with your gas (supply for the cooker). The gasman came and fixed it but damaged the wall. You then had to get a builder to come and fix the wall, and so on, until the following week you had to get the gasman back as the previous tradesman had messed up the gas supply in his efforts to repair the damage caused by the tradesman before him.

Well, consultants are only interested in their own specialised bits. A heart man will give you a pill to cure your heart, even if it blows your head off. He is not a head man after all. That is another fella's problem.

Quite apart from that many consultants, and doctors alike, act like gullible bureaucrats. They prescribe by the book, and the book is written by Big Pharma. Moreover most of it is fiction. Big Pharma makes exaggerated claims for its products, falsifies studies to prove the claims, and markets any given product for a successively wider and wider range of complaints. Products which fail to fulfil their primary purpose are marketed for their side effects. Never mind what the the product is doing to other parts of your system. And have you ever tried coming off some of these products? Scare the wits out of you.

Ivan Illich coined the term iatrogenic illness to describe an illnesss caused by doctors. And it is a hell of a lot worse since his day. Check out any of the online victim support groups. Rafts of side effects of medications never, or barely, mentioned in the patient leaflet and frequently unreported to the regulator.

Not that reporting to the regulator would solve the problem. Regulators in this area are, more often than not, captives of the industries they purport to regulate.

The intensive marketing by Big Pharma directed at doctors is something else - high pressure salesmanship accompanied by incentives which vary from trinkets (pens etc) to computers. Their marketing aimed directly at the consumer, where this is allowed, is usually based on fear.

Equally, doctors are not statisticians, and they can fall for the most outrageous claims of Big Pharma.

I remember a pamphlet written by the Director of the Irish Economic and Social Research Institute in 1972, which he wrote in total frustration at the misuse of statistics by the newly emerging cadre of social scientists. He titled it The Social Science Percentage Nuisance. Unwarranted conclusions were being drawn from surveys due to the total ignorance of statistical techniques and the limitations of statistics on the part of the social science practitioners. This was surely a benign scenario compared with Big Pharma's willful distortion of the facts in the interest of crude marketing.

And what of the patients. Doctors/Consultants are dismissive of the complaints of patients who have followed up their own conditions on the internet. In many cases they may be right as people can unreasonably latch onto particular aspects of their case and ignore the wider context. But the emergence of patient support groups on the internet cannot be ignored. As never before, widespread, but hitherto unreported, side effects of medications abound, and this on a scale that challenges the supposedly rigorous standards applied in the testing of medications for approval by the regulator.

The doctors/consultants now have a choice. They can go by the book (written by Big Pharma) and prostitute themselves and break their Hippocratic oath, or, they can try and factor in the legitimate reactions of patients, who are the ones experiencing the side effects of the medications they have rashly prescribed, and who are the ones faced with huge suffering and life disruption while the doctors/consultants calmly tick the boxes.

And the money involved. Doctors charge enormous sums for their advice/consultation/prescription and the consultants are in the mega-sphere in this regard. These "consultations" are time limited, often interrupted by external phone calls, and undertaken without a familiarisation with the patient's up to date file - assuming of course that all relevant material has actually been recorded on the file.

And where do we stand with alternative medicine? Decried by the conventional prescribers, and without access to the vast funds of Big Pharma, the alternative sector staggers on. The genuine alternatives do not generally have the resources to distinguish the snake oil from the homeopathic from the traditional cures. While it might have one big advantage in that people have faith in it, the sector is increasingly in danger of being sidelined or even outlawed under pressure from Big Pharma and its medical acolytes.

Did the spider's web not bring us penicillin. Do dock leaves not cure nettle stings. And, chewing raw garlic might even keep the vampires at bay. Who knows?

And then there's poor Maurice Neligan. A first class heart surgeon who wouldn't go near a doctor to save his life. And a heavy smoker to boot. Sadly he died recently. But who is to say that he did not have a better quality of life from his own philosophy than if he had listened to Big Pharma and his own colleagues.

I had a thought recently to suggest that tweeters/twitterers who have suffered iatrogenic illnesses should tweet their experiences on 18 October with the hashtag #iivd (iatrogenic illness venting day). Unfortunately nobody took up the suggestion, but then I suppose very few people read my tweets in the first place. St. Luke, the physician, whose feast day is 18 October, must have been very disappointed. Maybe next year.

Does anyone in the medical profession ever ask: what are we here for? This is not necessarily a hugely abstract philosophical question. It may be more a matter of deciding where the trade-off point is between prolonging a life which has become intolerable from the side effects of doctors, or, taking a chance on a shorter life span by going it alone.


Jonathan said...

Slim picking left for any vultures, medical or otherwise, from that poor dog's life.

Anonymous said...

Great post, but a nail still needs to be driven home.
One of the few countries with really good quality and affordable healthcare is Belorussia. Why?
Because, basically it still works as a socialist coutry, meaning business hasn't got a grip on everything like it has, say, in Ireland. The only way to restore decent Public Service is to destroy capitalism. Generally speaking, but especially for a country like Ireland. You can try to put up with the nonsense the bosses and their lackeys the politicians are imposing on the people, or you can organise for a society run by the people, and that works for the people, not on their backs and to the benefit of 10% of fat cats. It all comes down to deciding: what kind of society do we want to live in?

Póló said...

Don't forget 18 October 2011 is Iatrogenic Illness Venting Day.

Follow it on Twitter at #iivd and keep that stream posted on what and where you are venting.

Póló said...

This article merits a thorough forensic and scientific analysis.

While it is always difficult to evaluate the claims of writers in the health area, both conventional and natural, I must say a lot of this resonates with me.

We, the public, have a tendency to trust the authorities and fear the consequences of not heeding their advice, all the more so in the area of health. However, the recent financial meltdown, and the delusional reaction of the authorities to it, should wake up people's individual critical faculties and provoke a thorough analysis of the system of incentives which effectively determine how we live or die.

The difficulty of carrying out, not to mention evaluating, basic research is enormous. Financial rewards favour the most interventionist and production intensive "remedies". The authorities who should be looking after the long term interests of people in general are more often than not compromised.

The lack of basic epidemiological questioning, such as is set out in the article referenced at the beginning of this comment, is frightening.

I am sceptical of spurious statistical correlations and of premature claims of cause and effect. But a good researcher leaves no avenue unexplored and only makes claims according as firm evidence is accumulated. It is frightening to think that this process is often/usually inhibited from the outset by entrenched interests.

This is the globalisation of protectionism, two terms that used to be mutually exclusive, at least in the economics I learned at a younger and more innocent age.

Having read the above article, and remembering a comment made by my dentist when he removed the last of my rotting teeth, I think he may have saved my life.

Read the article.

Póló said...

I'm a agreat fan of Pat Ingoldsby. He is a sane sane man in a mad mad world. He inherits the mantle of Spike Milligan as far as I'm concerned.

I particularly liked this poem of his from 1995, which I have just come across:


I think that doctors should only ask
"And how are we this morning?"
when they are addressing the occupants
of a double bed.

Says it all.


Póló said...

Starve Big Pharma and help your heart. Check out this article.

Póló said...

More medicalising of minors.

When will it end?

Where will it end?