Tuesday 4 September 2012

What is the modern medicine focused upon? Giving the people what they don't want


Traditionally, medicine was focused upon a patient asking a doctor for help in alleviating his condition - the doctor's job was first to make the patient feel better as quickly as possible, secondly (if possible) to cure the disease.

Modern medicine has - under government influence - moved well away from this traditional basis.


The main focus of modern medicine is not to make the patient feel better, and only sometimes to cure a disease; mostly it is about (alleged) prevention.

The patient is told by the doctor that (as a result of their medical history, heredity, examinations or tests) they are at risk of some illness, or covertly have some illness that they did not realise they had - and they are given treatment alleged to improve their future risks - but that treatment will usually make the patient feel worse.


Blood pressure is an example: most patients who are treated for high blood pressure get drugs not because they went to the doctor complaining of symptoms, but as an attempt by the doctor to reduce the risk of strokes.

In fact, patients treated with blood pressure medication usually feel worse - because most drugs have side effects, and side effects make people feel worse.

(There are exception - high blood pressure may make people feel worse, for instance high BP makes me feel worse! And then the treatment can make people feel better. But this accounts for a small minority of the people taking medication for blood pressure.)


So much of modern medicine is about making patients feel worse now and for the rest of their lives, on the basis that this will lengthen their lives and prevent severe later pathology.

This may be perfectly rational and justifiable - but it is important to recognise that it represents almost a reversal of traditional medicine.

And it is important to recognise that this transformation of medicine was imposed, top-down, by governments, and especially by Leftist governments (by politicians but even more so by public administration officials).

This is the kind of medicine which government likes, and where government will channel health service resources.

By contrast, governments are not much bothered about the problem of helping patients get what they want from doctors.


(Note: this reversal is particularly bizarre in psychiatry, where making people feel better is pretty much the whole point of psychiatry outside of the context of compulsory confinement or treatment of dangerous or suicidal lunatics. In the past this kind of psychiatry was dominated by drugs which made people feel better - stimulants like amphetamine and tranquillisers like Miltown or Valium. Nowadays, the drugs used tend to make many people feel worse: the SSRIs, the 'mood stabliziers' and (especially) the 'atypical antipsychotics. Both groups of drugs are about equally likely to lead to drug dependence; but in the first instance the patient is dependent on a drugs that made them feel better, in the second on a drug that always made them feel worse but which is alleged or intended to prevent worse things in the future.)



Blablo said...

I you already haven't, read Ivan Illich's Medical Nemesis

one qoute: "Modern medicine is a negation of health. It isn't organized to serve human health, but only itself, as an institution. It makes more people sick than it heals."

"Ivan Illich was well ahead of his time in identifying and classifying the health hazards of the ‘medicalisation of society.' …He used medicine as an example of his general thesis that industrialisation and bureaucracy were appropriating areas of life previously regarded as personal. In particular, he identified how drugs and other medical technologies remove personal responsibility for suffering and create dependence on health care, which itself has a wide range of hazardous side effects."

Bruce Charlton said...

@Blablo - Yes, I've read Illich. Daignosis pretty accurate, but his ideas for treatment were futile: the National Health Service has been, for the past twenty years, run by Leftist bureaucrats who read and believed Illich as radical young students...

Samson J. said...

Good GRAVY, Bruce, you have a way of articulating my own thoughts! Having been through medical school recently (well within the past decade), I can tell you that this was one of the most disillusioning aspects of the whole slog. (And there were LOTS of disillusioning bits...) MOST of "general practice" today is "preventive" medicine, which I realized dejectedly at some point is not even really medicine, at least not in the traditional sense - and I'm glad to see that I'm not the only one who thinks this way. And it's gotten to the point where a person's doctor can be successfully held liable for failing to sufficiently perform such "preventive" medicine! Don't neglect this aspect of it... to use your example of stroke and blood pressure, many times a doctor puts the patient on medication because he knows that if the patient has a stroke, and *wasn't* put on BP medication (or at least spoken to about it), the doc is legally liable. Terribly disheartening situation, to be sure.

The Crow said...

Hah. Leftists have a knack for that sort of thing. No matter the meaning, of no matter what it is, the leftist hacks it about, to fit their existing ideology, as if it were always expressly about that.
You would be amazed at the sheer number of leftist 'taoists' prattling utter drivel on the internet, as if Lao Tzu were a neolithic Karl Marx.

FHL said...

Heh, it's like you can read my mind sometimes.

Just a couple of nights ago, I heard my mother reciting some medical phrases.

"Studying for another test?" I ask.

"No. Just reading updates. They have now decided that we are to prescribe blood-pressure medication to those over 40 years old who smoke or have family history. They changed it from where it was only if the test results showed high-blood pressure, but now it's done as a precaution."

"So they just keep changing it?" I ask.

"Well they keep doing studies and discovering more causes and conditions that could be prevented. So they advise that we give them the medication based on the studies."

"Do you take their advice?"

"I have to, if I don't and I send him to the pharmacy to pick up any other sort of medication, the pharmacy will call me and tell me that my patient meets the criteria for being at risk, and will wonder why I have not been following the new guidelines. I might get reported."

My mother, God bless her soul, always means well and truly cares for all, but she doesn't see what's going on. I've always said it, and I think it will eventually be true- one of these days, EVERYTHING will be found to cause death. And then everything and anything will be considered a risk-factor for some sort of condition that you need immediate intervention for, and for which you will be declared irresponsible for not receiving. It will also cost thousands.

I reluctantly drove my sister (who is in her early 20's, mind you) to the urgent care clinic of the local hospital when she complained of a faint head and anxiety.

The doctor popped his head in around the corner of the door and asked asked "What's up?"
The male nurse replied "Feels faint."
The doctor says "BP?"
The nurse says "Fine."
Doctor says "CAT."
-and promptly disappears, his head vanishing to wherever it came from as he left to wherever doctors go after they haphazardly order ultra-expensive tests.
Probably to Best Buy.

Man, he never even entered the room! They tried to do a CAT scan (not even telling us it was what they were planning, but from the conversation before, we figured it out and asked), but then refused to tell what it was for! When I demanded he tell us what they thought was the problem or else we leave, the male nurse on duty (who refused to let us see or speak to the doctor despite my repeated requests) kept saying "But you can't leave! The doctor thinks something might be wrong... what if there is something wrong? It'll be on y'all then, not us..."

The damn CAT scan is 800 dollars plus per round! At least tell us what the hell you are looking for, not something ambiguous and evasive like "there may be... something!"

(we left. no CAT scan. she was fine.)

My father works as a surgeon, and that seems to be going fairly standard though. It doesn't seem there can be much ambiguity in that field, so it proceeds as usual: saw down middle of chest, crank ribs open, see blockage here, shock heart to stop, pour in ice, cut here, connect here, shock again to start, bypass complete. It either gets done or it doesn't. When you're dealing with something mechanical and physically intrusive*, such as sawing into someone's chest, well, you can't really say upon his death: "Well, it wasn't necessary, but we just wanted to be on the safe side, ya' know?"

*medication can also be considered "mechanical and physically intrusive" but, in the modern view, since it doesn't go "BRRZZZZZZT" and connect to a power source through the wall outlet and there's no blood to suction nor stitches to administer, then hey, it's just a pill, and no harm, eh? Looks like candy!

Samson J. said...

"I have to, if I don't and I send him to the pharmacy to pick up any other sort of medication, the pharmacy will call me and tell me that my patient meets the criteria for being at risk, and will wonder why I have not been following the new guidelines. I might get reported."

Yes. It's not that bad here in Canada, but you're onto the idea.

I could rant on and on about this, but I don't have time today. For now here's another example of something that makes me crazy: a little statistic medical folks call "Number Needed to Treat", or NNT for short. This refers to the number of patients you need to treat with a medication in order to positively affect one patient. The layperson, poor, benighted soul that he is, might think that MOST drugs we are giving people are having some beneficial effect, but alas not so. The NNT for many common drugs is very high - 20 or even much higher (in the hundreds) is not unusual. This means that we are giving drugs to a lot of people KNOWING that most recipients are deriving no benefit from the drug. Well (thinks I), this is ridiculous. But the situation arises because, as mentioned in the OP, the government cares about "the population" in the abstract, not about individuals.