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.