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Health, psychology & science stories

 

Medicine is mortally ill

7 August 2001

Published in The Age


In 1883, Dr Oliver Wendell Holmes said, “I firmly believe that if the whole materia medica ...could be sunk to the bottom of the sea, it would be all the better for mankind - and all the worse for the fishes.”

A century or so later, this minority, eccentric view is gaining respectability. In the US, more patients now visit alternative practitioners than GPs.

Australia is heading in the same direction: by 1996, 50 percent of us were using some form of “complementary” therapy, according to The Lancet. Vitamin and mineral supplementation is rising steadily.

There’s a growing belief that mainstream medical therapies have reached the point of diminishing returns. The American psychiatrist Dr William Philpott, who has largely replaced standard treatments with an allergy/vitamin approach, says:

“The statistics get worse every year. Obviously symptomatic drug therapy is not getting at the heart of the nation's health problems.”

The disaffection with Medicine has many causes, and high on the list must be distrust of pharmaceutical drugs - and more particularly the relationship between doctors and drug companies. Full-page colour ads for new drugs in medical journals, revelations of hair-raising side-effects, and drug companies’ promotional budgets and “bribes” to doctors have created a vague, but unsettling impression of profits taking precedence over patients’ health.

The impression has been building for decades. In his 1976 classic, Limits to Medicine, Ivan Illich revealed that the money spent annually on promoting drugs to each American doctor would keep a student in medical school for one year.

Medical negligence is another long-festering worry for the health consumer. Illich also revealed that the frequency of reported accidents in hospitals was higher than in all industries but mines and high-rise construction. And that once old people entered medically supervised aged care, their risk of death rose significantly.

Things don’t seem to have improved a lot since then. Staggeringly, each year 18,000 Australians are killed by “preventable hospital mishaps”, according to a study published last year in The Medical Journal of Australia. That’s more than ten times the national road toll. About double that number are permanently disabled.

Another frequent complaint is that drug companies and governments fund very little research into the effects of natural - but non-patentable - medicines.

The few studies which have been done, mostly overseas, have often produced promising results. For example, a landmark 1996 study in the Journal of the American Medical Association found that selenium supplementation reduced cancer mortality dramatically. A 1999 trial published in the Archives of General Psychiatry documents extremely promising results against bi-polar disorder with omega-3 fatty acids.

Yet there seems to be an unwillingness to take this knowledge further. Oncological and psychiatric research still focus on chemotherapy, despite growing evidence that holistic approaches would knock many mainstream pharmaceuticals out of the ring in terms of cost and safety.

Whilst much of the funding from Australia’s National Health and Medical Research Council’s goes to extremely valuable biochemistry work, it’s disappointing that the only “holistic” research funding this financial year is a $60,000 study into “the influence of acupuncture stimulation on the induction of labour” - .3% of the NHMRC’s budget.

This lack of experimentation and verification leads to natural therapists making extravagant claims about therapies which have not been properly trialled - to say nothing of straight-out duds - and to doctors falling complacently back on the drug approaches their clients are becoming so apprehensive about.

Criticism of the medical establishment is nothing new: the profession has long been pilloried for its self-interest, and its almost Masonic conservatism. Alexander Fleming famously said, “Penicillin sat on the shelf for ten years while I was called a quack.”

Three hundred years before Fleming, when the major disease was smallpox, Sir Thomas Sydenham came up with a treatment which cut the death rate from 50 percent to one or two percent. He was challenged to a duel, and the English medical association tried to expel him.

Another look at medical history is, perhaps, equally sobering: Epidemics of tuberculosis in the early 1800s, of cholera, dysentery, and typhoid through the Nineteenth Century, and of scarlet fever, diphtheria, whooping cough and measles between 1860 and 1965, all peaked and dwindled before medical intervention was applied or, in most cases, even invented.

Of course Medicine’s diagnostic technology, and its surgical advances, have no parallel in the alternative modalities. For emergency treatment, no other approach can touch it. And Medicine’s recent decentralisation into community care shows that it is capable of rising to meet the community’s needs.

Medical training is also evolving. Associate Professor Susan Elliott, who oversees the development of Melbourne University’s Medicine curriculum, says the course now has a strong preventive focus.

“The study of nutrition is now integrated throughout the entire course - from year one to year six - and students study it in relation to the causes of a disease, and also its management.

“One of the first clinical problems students tackle is skin malignancy. They also learn about tobacco-related illness, and risk-taking behaviour. All of this is prevention. There’s been a seachange in thinking in the last ten years: we’re steadily going from a ‘treatment’ model to a preventive one for many diseases.”
 
It’s hard to know whether such welcome changes will be sufficient to stem the tide. Medicine is still widely perceived to be bogged down in a philosophy rooted in symptoms rather than causes; in drugs rather than rallying immune defences; in treating calamities (with lasers, “miracle surgery”, transplants and the like) rather than preventing them; and in the unsustainable cost spiral which all this brings.

These are not particularly radical views. The majority of Australia’s health consumers are saying the same thing with their feet. Out-of-pocket, Australians pay more each year for natural medicines than pharmaceuticals. In the eyes of an Internet-savvy and increasingly educated public, medicos are slowly losing the war to other healers.

Amidst the disillusionment, the wrong targets are sometimes singled out - doctors’ salaries being perhaps the most popular.

The perception of overpaid, greedy practitioners is boosted by examples like the new US protocol whereby cancer patients are given chemotherapy and irradiated - before even exploratory surgery. (It’s jokingly known in the industry as “The Oncologists' Guaranteed Employment Act.”)

However the areas of biggest expansion are not doctors' salaries, but technology and administration.

In 1766, Empress Maria Theresa had her court physician certify “fitness to undergo torture”. Today - largely because medical technology, administration and certification have been burgeoning ever since - the cost of Medicine borders on the unsustainable.

The $50 billion Australians spend annually on health care is growing at about 4 percent per year. The $3.1 billion we spent on prescriptions in 1999-2000 was a seven percent increase on the previous year. The rises are not merely due to increasing population. The Australian Bureau of Statistics reports: “As a proportion of total household expenditure on goods and services, health and medical care increased from 3.9 precent in 1984 to 4.7 percent in 1998-99.”

A clutch of committees, and a dozen inquiries, would find a hundred short-term solutions to the threat of rising health costs. A lasting solution, however, might only be found in forging a new philosophy of illness and healing - a paradigm shift.


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