Monday 17 November 2014

Are we moving back to normal? - the Doctor's Dilemma situation - when the net effect of medical interventions is negative (and mostly brain-damaging)?


In The Doctor's Dilemma, Bernard Shaw describes the world of medicine as it was in England until (ironically) not long after the time this play was performed in 1906  - which was a world where physicians and surgeons and apothecaries did - overall - more harm than good.

Then there was a period in the mid twentieth century - say 1925-1975 - when the numerous immunisations were developed for fatal diseases, surgery and anaesthesia greatly improved, and antibiotics, steroids, hormones and a host of other medications were discovered, and ECT was introduced and made safe in psychiatry.


But it seems more and more like that 25-75 era was just a blip in the long term trend in history, of medicine doing more net-harm than good - because nowadays there are very few real breakthroughs, and these are swamped by new treatments that are worse than old treatments, and treatments that always cause side effects (as all treatments do) with extremely  little chance of benefit.

Furthermore, there is a vast apparatus is hype and invention of benefit, distortion of risk-benefit, and outright concealment of harms.

Some of the concealed harms involve such huge money spinners as cancer chemotherapy and radiotherapy killing people and causing dementia; surgery of the elderly causing dementia; antipsychotics causing demotivated Parkinsonism and being dependence-producing; antidepressants causing emotional hardening and being dependence producing (and both antipsychotics and antidepressants causing out-of-character violent self-harm and suicides); cognitive damage from statin drugs, diabetic drugs, and blood pressure drugs; plus of course the fact that hospitals are so unhygienic that they breed and infect patients with antibiotic resistant infections. I could go on.


The common factor is mostly psychiatric - that many modern medical interventions damage the mind, and the functioning and structure of the brain - this is the main problem because it is deniable and easy to hide.

If Granny has a hip replacement and walks again, that is much more noticeable than the fact that when she eventually recovers she is demented and needs to go into a home.

If Peggy Sue has a period of nervousness and takes an SSRI 'antidepressant' which dulls the anxiety, that is noticed more than the fact she gets hooked and cannot come-off the drug due to severe withdrawal effects.

If Charlie is disruptive at school, gets a diagnosis of 'bipolar disorder' and treatment with a cocktail of anti-psychotics, anti-convulsants and what not - his disruptive behaviour certainly stop! - as effectively as if he was tied up on chains - but at the cost of making him zombie-like, with flattened emotions.

If Bert kills himself while taking psychiatric drugs that he did not need, then his suicide is put down to the fact that he 'needed' to take psychiatric drugs.

And so on.


We now need to reverse the assumption we were raised-on; the assumption that any given medical intervention is probably effective unless proven otherwise; and revert to the skepticism of wise men in the pre-twentieth century era: that most medical interventions are mostly harmful most of the time (and the task is to find the few exceptions).

The difference is that now there are (still, for the timebeling) many effective and beneficial interventions 'on the books' (although not necessarily on offer); but due to the medicalisation of life and overtreatment of (non-) disease, these effective interventions are swamped - and their effect increasingly overwhelmed - by harmful interventions.

Because in medicine the rule is: when something does not good, it will do harm.



JP said...

I liked that post on leftist and rightist hypocrisy. Why did you take it down?

Bruce Charlton said...

@JP - It was just a filler.

Anonymous said...

Hey Dr. Charlton,

I think a lot of the problem is simply ignorance.
The amount of medical knowledge that is out there is overwhelming. How can one person taking care of patients understand completely every drug they are giving, every treatment, every operation and all the concomitant side effects of these? So much of it is based on trust, that the people in charge of new drugs and operations are the good guys.

-First year medical student from America

Bruce Charlton said...

@Anon - Sadly it is not ignorance. Try reading Pharmageddon by David Healy.

outsider said...

A useless second in an American hospital costs more than the recipient was able to earn in a day in the Third World.