Numbers in brackets correspond with page numbers in the Warner Books Edition, 1980.
[11] I do not believe in Modern Medicine. I am a medical heretic. My aim in this book is to persuade you to become a heretic, too. I haven't always been a medical heretic. I once believed in Modern Medicine. In medical school, I failed to look deeply into a study that was going on around me, of the effects of the hormone DES -- because I believed. Who could have suspected that twenty years later we would discover that DES causes vaginal cancer and genital abnormalities in children born to women receiving the drug during pregnancy?
I confess that I failed to be suspicious of oxygen therapy for premature infants, even though the best equipped and most advanced [12] premature nurseries had an incidence of partial or total blindness of around ninety percent of all low birth weight infants. A few miles away in a large, less "advanced" hospital, the incidence of this condition -- retrolental fibroplasia -- was less than ten percent. I asked my professors in medical school to explain the difference. And I believed them when they said the doctors in the poorer hospital just didn't know how to make the correct diagnosis.
A year or two later it was proved that the cause of retrolental fibroplasia was the high concentrations of oxygen administered to the premies. The affluent medical centers had higher rates of blinding simply because they could afford the very best nursery equipment: the most expensive and modern plastic incubators which guaranteed that all the oxygen pumped in reached the infant. At the poorer nurseries, however, old-fashioned incubalors were used. They looked like bathtubs with very loose metal lids. They were so leaky that it made very little difference how much oxygen was pumped in: not enough reached the infant to blind it.
I still believed when I took part in a scientific paper on the use of the antibiotic Terramycin in treating respiratory conditions in premature babies. We claimed there were no side effects. Of course there weren't. We didn't wait long enough to find out that not only didn't Terramycin -- or any other antibiotic -- do much good for these infections, but that it -- and other tetracycline antibiotics -- left [13] thousands of children with yellow-green teeth and tetracyeline deposits in their bones.
And I confess that I believed in the irradiation of tonsils, lymph nodes, and the thymus gland. I believed my professors when they said that of course radiation was dangerous, but that the doses we were using were absolutely harmless.
Years later around the time we found out that the "absolutely harmless" radiation sown a decade or two before was now reaping a harvest of thyroid tumors -- I couldn't heip wondering when some of my former patients came back with nodules on their thyroids: Why are you coming back to me? To me, who did this to you in the first place?
But I no longer believe in Modern Medicine.
I believe that despite all the super technology and elite bedside manner that's supposed to make you feel about as well cared for as an astronaut on the way to the moon, the greatest danger to your health is the doctor who practices Modern Medicine.
I believe that Modern Medicine's treatments for disease are seldom effective, and that they're often more dangerous than the diseases they're designed to treat.
I believe the dangers are compounded by the widespread use of dangerous procedures for non-diseases.
I believe that more than ninety percent of Modern Medicine could disappear from the face of the earth -- doctors, hospitals, drugs, [14] and equipment -- and the effect on our health would be immediate and beneficial.
I believe that Modern Medicine has gone too far, by using in everyday situations extreme treatments designed for critical conditions.
Every minute of every day Modern Medicine goes too far, because Modern Medicine prides itself on going too far. A recent article, "Cleveland's Marvelous Medical Factory," boasted of the Cleveland Clinic's "accomplishments last year: 2,980 open-heart operations, 1.3 million laboratory tests, 73,320 electrocardiograms, 7,770 full-body x-ray scans, 24,368 surgical procedures."
Not one of these procedures has been proved to have the least little bit to do with maintaining or restoring health. And the article, which was published in the Cleveland Clinic's magazine, fails to boast or even mention that any people were helped by any of this expensive extravagance. That's because the product of this factory is not health at all.
So when you go to the doctor, you're seen not as a person who needs help with his or her health, but as a potential market for the medical factory's products.
If you are pregnant, you go to the doctor and he treats you as if you're sick. Childbirth is a nine-month disease which must be treated, so you're sold on intravenous fluid bags, fetal monitors, a host of drugs, the totally unnecessary episiotomy, and -- the top of the line product -- the Caesarean delivery!
[15] If you make the mistake of going to the doctor with a cold or the flu he's liable to give you antibiotics, which are not only powerless against colds and flu but which leave you more likely to come down with worse problems.
If your child is a little too peppy for his teacher to handle, your doctor may go too far and turn him into a drug dependent.
If your new baby goes off his or her feed for a day and doesn't gain weight as fast as the doctor's manual says, he might barrage your breast-feeding with drugs to halt the natural process and make room in the baby's tummy for man-made formula, which is dangerous.
If your are foolish enough to make that yearly visit for the routine examination, the receptionist's petulance, the other patients' cigarette smoke, or the doctor's very presence could raise your blood pressure enough so that you won't go home empty-handed. Another life "saved" by anti-hypertensive drugs. Another sex life down the drain, since more impotence is caused by drug therapy than by psychological problems.
If you're unfortunate enough to be near a hospital when your last days on earth approach, your doctor will make sure your $500-a-day deathbed has all the latest electronic gear with a staff of strangers to hear your last words. But since those strangers are paid to keep your family away from you, you won't have anything to say. Your last sounds will be the electronic whistle on the cardiogram. Your relatives will participate: they'll pay the bill.
[16] No wonder children are afraid of doctors. They know! Their instincts for real danger are uncorrupted. Fear seldom actually disappears. Adults are afraid, too. But they don't admit it, even to themselves. What happens is we become afraid of something else. We learn to fear not the doctor but what brings us to the doctor in the first place: our body and its natural processes.
When you fear something, you avoid it. You ignore it. You shy away from it. You pretend it doesn't exist. You let someone else worry about it This is how the doctor takes over. We let him. We say: I don't want to have anything to do with this, my body and its problems, doc. You take care of it, doc. Do what you have to do.
So the doctor does.
When doctors are criticized for not telllng their patients about the side effects of the drugs they prescribe, they defend themselves on the grounds that the doctor-patient relatlonship would suffer from such honesty. That defense implies that the doctor-patient relationship is based on something other than knowledge. It's based on faith.
We don't say we know our doctors are good we say we have faith in them. We trust them.
Don't think doctors aren't aware of the difference. And don't believe for a minute that they don't play it for all it's worth. Because what's at stake is the whole ball game, the whole ninety percent or more of Modern [17] Medicine that we don't need, that, as a matter of fact is out to kill us.
Modern Medicine can't survive without our faith, because Modern Medicine is neither an art nor a science. It's a religion.
One definition of religion identifies it as any organized effort to deal with puzzling or mysterious things we see going on in and around us. The Church of Modern Medicine deals with the most puzzling phenomena: birth, death, and all the tricks our bodies play on us -- and we on them -- in between. In "The Golden Bough," religion is defined as the attempt to gain the favor of "powers superior to man which are believed io direct and control the course of nature and of human life."
If people don't spend billions of dollars on the Church of Modern Medicine in order to gain favor with the powers that direct and control human life, what do they spend it on?
Common to all religions is the claim that reality is not limited to or dependent upon what can be seen, heard, felt, tasted or smelled. You can easily test modern medical religion on this characteristic by simply asking your doctor Why? enough times. Why are you prescribing this drug? Why is this operation going to do me any good? Why do I have to do that? Why do you have to do that to me?
Just ask why? enough times and sooner or later you'll reach the Chasm of Faith. Your doctor will retreat into the fact that you have no way of knowing or understanding all the [18] wonders he has at his command. Just trust me.
You've just had your first lesson in medical heresy. Lesson Number Two is that if a doctor ever wants to do something to you that you're afraid of and you ask why? enough times until he says Just Trust Me, what you're to do is turn around and put as much distance between you and him as you can, as fast as your condition will allow.
Unfortuately, very few people do that. They submit. They allow their fear of the witch doctor's mask, the unknown spirit behind it, and the mystery of what is happening and of what will happen to change into respectful awe of the whole show.
But you don't have to let the witch doctor have his way. You can liberate yourself from Modern Medicine -- and it doesn't mean you'll have to take chances with your health. In fact, you'll be taking less of a chance with your health, because there's no more dangerous activity than walking into a doctor's office, clinic or hospital unprepared. And by prepared I don't mean having your insurance forms filled out. I mean you have to get in and out alive and accomplish your mission. For that, you need appropriate tools, skills, and cunning.
The first tool you must have is knowledge of the enemy. Once you understand Modern Medicine as a religion, you can fight it and defend yourself much more effectively than when you think you're fighting an art or a science. Of course, the Church of Modern [19] Medicine never calls itself a church. You'll never see a medical building dedicated to the religion of medicine, always the medical arts, or medical science.
Modern Medicine relies on faith to survive. All religions do. So heavily does the Church of Modern Medicine rely on faith that if everyone somehow simply forgot to believe in it for just one day the whole system would collapse. For how else could any institution get people to do the things Modern Medicine gets people to do, without inducing a profound suspension of doubt? Would people allow themselves to be artificially put to sleep and then cut to pieces in a proeess they couldn't have the slightest notion about -- if they didn't have faith? Would people swallow the thousands of tons of pills every year -- again without the slightest knowledge of what these chemicals are going to do -- if they didn't have faith?
If Modern Medicine had to validate its procedures objectively, this book wouldn't be necessary. That's why I'm going to demonstrate how Modern Medicine is not a church you want to have faith in.
Some doctors are worried about scaring their patients. While you're reading this book, you are, in a sense, my patient. I think you should be scared. You're supposed to be scared when your well-being and freedom are threatened. And you are, right now, being threatened. If you're ready to learn some of the shocking things your doctor knows but won't tell you; if [20] you're ready to find out if your doctor is dangerous; if you're ready to learn how to protect yourself from your doctor; you should keep reading because that's what this book is about.
[21] I don't advise anyone who has no symptoms to go to the doctor for a physical examination. For people with symptoms, it's not such a good idea, either. The entire diagnostic procedure -- from the moment you enter the office to the moment you leave clutching a prescription or a referral appointment -- is a seldom useful ritual.
The mere act of delivering yourself to the priestly doctor and submitting to his wishes presumably bestows the benefit. The feeling is that the more exams you have, and the more thorough the exams, the better off you'll be.
All of which is nonsense. You should approach the diagnostic procedure with suspicion rather than confidence. You should be aware of the dangers, and that even the simplest, [22] seemingly innocuous elements can be a threat to your health or well-being.
The diagnostic tools themselves are dangerous. The stethoscope, or example, is nothing but the priestly doctor's religious badge. As a tool, it does more harm than good. There's no question that there's a high degree of contagion from the use of stethoscopes from patient to patient. And there's almost no form of serious disease that cannot be suspected or diagnosed without the stethoscope. In congenital heart disease where the baby is blue, it's obvious because the baby is blue. In other forms of heart disease, the diagnosis can be made by feeling the various pulses around the body. In coarctation of the aorta, for example, there's a deficiency of the pulse rate in the femoral arteries in the groin, You don't need a stethoscope to make that diagnosis.
The only value of ihe stethoscope over the naked ear applied to the chest is in the convenience and modesty of the physician. There's nothing that he can hear with the stethoscope that he cannot hear with his ear against the person's chest. As a matter of fact, I know some doctors who now put the stethoscope around their neck and don't put the ear pieces in their ears as they apply the bell to the patient's chest! At one time I used to think that was really terrible. Not any more. The doctor probably realizes, consciously or otherwise that the patient needs the stethoscopic examination because it's part of the sacred ritual [23] rather than because it makes any sense or does any good.
And it can do harm, especially in the case of children. Suppose a mother brings her daughter in for her annual exam. The child has no symptoms of illness whatsoever. But the doctor uses the stethoscope and discovers a functional heart murmur -- a harmless heart sound found in at least one third of all children at one time or another. At that point the doctor has to make a decision whether or not to tell the mother. Now at one time doctors used to keep this information to themselves. They might put it in the chart in symbolic form so that nobody but a doctor could read it. Recently doctors have been taught to share this information with the parents either because of their belief in the patient's right to know or -- more likely -- because they're afraid another doctor will find it and tell them first.
So the doctor tells the mother. And whether or not he reassures the family that the murmur is innocent, both mother and daughter may suspect -- perhaps for the rest of their lives -- that something really is wrong! Mother may then begin a trek to pediatric cardiologists who will take repeated EKGs, chest x-rays, or even perform cardiac catheterizations to help the mother "get to the bottom of all this." Studies have shown that families of children with heart murmurs tend to do two things: they restrict their child's activity and do not allow them to play in sports, and they encourage them to eat [24] more. Naturally these are the worst things they can do! They literally make cardiac cripples out of their children.
Though it's a lot more impressive than the stethoscope, the electrocardiogram (EKG) is little more than an expensive electronic toy for the physician. More than twenty years ago a survey revealed that the reports of expert EKG interpreters varied by twenty percent among individuals and by another twenty percent when the same individuals re-read the same tracing at another time. Time of day, recent activity, and many other factors besides the condition of one's heart can affect the readings. In one test the EKG delivered a positive finding in only twenty-five percent of cases of proven myocardial infarction, an equivocal finding in half, and a totally negative finding in the rest. And in another test, more than half of the readings taken of healthy people were grossly abnormal.
Yet physicians and other medical personnel continue io increase rather than decrease their reliance on the EKG as a detector of cardlac problems. I have a recurring fantasy of a person lying in an intensive coronary care unit after suffering a heart attack. He is perfectly comfortable -- until he's approached by a nurse with a hypodermic syringe. She explains that his EKG monitor has shown an irregularity that demands immediate treatment. Of course, she is not aware of the studies that show the high degree of error in electronic monitoring equipment, or the studies that show the not [25] infrequent leakage of electricity from one monitor to another in the same ward. My fantasy patient protests and pleads with the nurse: "Please, nurse, feel my pulse. It's alsolutely regular!" The nurse's answer is that there's no point in feeling his pulse. You can't argue with the machine. So she immediately plunges the needle in his arm. You can guess at the outcome.
My fantasy is not so fantastic as you might think. There are electronic monitors in "advanced" coronary units that are equipped to electrically "correct" the heartbeat of patients who, the machine decides, need a jolt. I have heard of cases where the machine decided the person needed a jolt when, in fact, he didn't.
While the electroencephalogam (EEG) is an excellent instrument for the diagnosis of certain kinds of convulsive disorders and the diagnosis and localization of brain tumors, not many people are aware of its limitations. About twenty percent of people with clinically established convulsive disorders never have an abnormal EEG. Yet fifteen to twenty percent of perfectly normal people have abnormal EEGs! To demonstrate the questionable reliability of the EEG as a measure of brain activity, one researcher connected one in the standard manner to a mannequin's head filled with lime jello and got a reading indicating "life."
Despite the obvious possibilities for error the EEG is used as the primary diagnostic tool in determining whether or not a child truly has organic learning difficulties, minimal brain [26] damage, hyperactivity, or any of the twenty or thirty other names assigned to this ill-defined syndrome. Despite the fact that every pediatric neurologist in need of publishing a paper has reported some significance of this spike or that dip, there has been a total lack of agreement on a valid correlation between an EEG reading and a child's behavior.
Nevertheless, this lack of scientiffc validation has in no way interfered with the proliferation of EEG machines and the skyrocketing numbers of EEGs performed. I often recommend to students in search of a career the entire field of electroencephalography since it, like everything else connected with learning disabilities, is a growth industry. Today educators, physicians, and parents have consciously or otherwise joined in a conspiracy to medicalize almost all behavior problems. What happens is that a child gets sent home with a note asking for a conference. At the conference, the parents are told the child might have an organic brain problem, might be hyperactive, might be minimally brain damaged. Parents and child are hustled off to the doctor for an EEG. Then, on the basis of the EEG -- which may or may not be accurate -- the child is drugged into fitting the behavior mold that best suits tbe teacher.
By far, the most pervasive and dangerous dignostic tool in the doctor's office is the x-ray machine. Unfortunately, because of its religious significance, the x-ray machine will be the hardest for doctors to give up. They know that people are awed by the doctor's power to [27] see right through their flesh, to gaze firsthand at what is afficting them, to see where they cannot. Doctors literally got drunk on this power and started using x-rays on everything from acne to settling the mysteries of the developing fetus. Many obstetricians still insist on x-rays if they don't quite trust their skill in determining fetal position by palpation -- despite the fact that childhood lukemia has a well-documented link with prenatal radiation exposure.
Thyroid lesions, many of them cancerous, are now turning up by the thousands in people who were exposed to head, neck and upper chest radiation twenty to thirty years ago. Thyroid cancer can develop after an amount of radiation that is less than that produced bv ten bite-wing dental x-rays. Scientist testifying before Congess have emphasized the hazards of low level radiation to both the present generaton and to future generations in the form of genetic damage. They have implicated x-rays in the development of diabetes, cardiovascular disease, stroke, high blood pressure, and cataracts -- all associated with aging. Other studies have matched radiation to cancer, blood disorders, and tumors of the central nervous system. Conservative estimates peg the number of deaths each year directly attributable to medical and dental radiation at 4000.
As far as I'm concerned, these deaths are unnecessary, as is the host of other afflictions attributed to radiation. A quarter century ago I was taught in medical school that x-rays of [28] the breast were practically worthless. A recent survey showed that things haven't changed very much. Physicians supposedly trained to interpret mammograms were no more accurate than untrained physicians in spotting breast cancer on mammograms. A survey more than thirty years ago showed that as many as twenty-four percent of radiologists differed with each other interpreting the same chest film, even in cases of extensive disease. Thirty-one percent of them even disagreed with themselves when re-reading the same films! Another study in l955 showed that thirty-two percent of chest x-rays showing definite abnormalities in the lungs were misdiagnosed as negative. In 1959, thirty percent of the experts disageed with other experts on radiographic readings, and twenty percent disagreed with themselves when rereading the same films! A 1970 Harvard study showed that the going rate of disagreement among radiologists was still at least twenty percent.
Yet x-rays are still sacred in most doctors' and dentists' offices. Hundreds of thousands of women are still lining up every year for breast x-rays, despite the well published scientific evidence that the mammography itself will cause more breast cancer than it will detect! The ritual of the annual x-ray, the pre-employment x-ray, the school entrance x-ray, and the health fair x-ray continue. I hear about and get letters from people whose doctors pronounce them in perfect health, but still insist on a chest x-ray. One man told me about going to the hospital [29] for a hernia operation, where he was given six chest x-rays. From the radiologists conversations, he got the distinct impression they were experimenting with the exposure levels. This same man was given thirty x-rays at a local dental school where he went to get a crown replaced.
Many doctors defend their use of x-rays on the grounds that the patients demand or expect x-rays. To that excuse, I reply that if people are addicted to x-rays, the greatest service doctors might perform would be to rig up machines that look and sound like real x-ray machines. A tremendous amount of disease could be avoided.
Lab tests are another part of the diagnostic procedure that do more harm than good. Medical testing laboratories are scandalously inaccurate. In 1975, the Center for Disease Control (CDC) reported that its surveys of labs across the country demonstrated that ten to forty percent of their work in bacteriology testing was unsatisfactory, thlrty to fifty percent failed various simple clinical chemistry tests, twelve to eighteen percent flubbed blood grouping and typing and twenty to thirty percent botched hemoglobin and serum electrolyte tests. Over all, erroneous results were obtained in more than a quarter of all the tests. In another nationwide survey fifty percent of the "high standard" labs licensed for Medicare work failed to pass. A large scale retesting of 25,000 analyses made by 225 New Jersey labs revealed that only twenty percent of them produced [30] acceptable results more than ninety percent of the time. Only half passed the test seventy-five percent of the time.
To get some idea of what people are really getting for $12 billion worth of lab tests each year, thirty-one percent of a group of labs tested by the CDC could not identify sickle cell anemia. Another test group incorrectly identified infectious mononucleosis at least one third of the time. From ten to twenty percent of the tested groups incorrectly identified specimens as indicating leukemia. And from five to twelve percent could be counted on to find something wrong with specimens which were healthy! My favorite study is one in which 197 out of 200 people were "cured" of their abnormalities simply by repeating their lab tests!
If you think these tests are shocking keep in mind that the Center for Disease Control monitors and regulates fewer than ten percent of the country's labs. So these tests indicate the best work of the best labs. With the rest, you pay your money and you take your chances. And you will pay more and more, because doctors practicing "just in case medicine" are ordering more and more laboratory tests.
As long as these tests have such an immense possibility for inaccuracy, the only way to look at them is as sacred oracles or fortune telling rituals: they depend on the whims of the deities and the skill of the magician-priest. Even if the deities are keeping up their end of the bargain and your tests results are miraculously correct, there is still the danger that the doctor [31] will misinterpret them. One woman wrote me that at her last routine examination, a test revealed blood in her stool. Her doctor subjected her to every possible test, including barium x-rays, all of which proved negative. The doctor did not give up. Though the woman was in real pain because of the tests, he recommended further testing. Six months later, his diagnosis was announced to a much weakened woman: she had too much acid in her stomach!
Lab tests and diagnostic machines wouldn't be so dangerous if doctors weren't addicted to the quantitative information these tools provide. Since numbers and statistics are Modern Medicine's language of prayer, quantitative information is considered sacred, the word of God, indeed, the last word in a diagnosis. Whether the tools are simple, like thermometers, scales, or calibrated infant bottles, or complicated like x-ray machines, EKGs, EEGs, and lab tests, people and doctors are dazzled into crowding out of the process their own common sense and the qualitative judgment of doctors who are real diagnostic artists.
Scales cause all kinds of trouble in pediatrics and obstetrics. The pediatician weighs the baby and gets all upset if the baby doesn't gain a certain amount of weight. Again, he's substituting a quantitative evaluation for a qualitative one. The important questions are: what does the baby look like? What's his behavior? How does he look at you? What are his movements like? How's his nervous system functioning? Rather than relying on these observations, [32] the doctor goes by the numbers. Sometimes a breastfed baby won't gain as fast as the doctor mistakenly thinks it should. So he puts the baby on formula -- to the detriment of both mother and baby.
Pregnant women also should pay no attention to the scale. There is no correct amount of weight for any mother to gain. Again, the important evaluations are qualitative rather than quantitative. She should be eating the right food, not merely "correct quantities" of any food. If she's careful about what she eats, how much she eats will take care of itself. She'll rightly be able to ignore the scale.
Calibrated infant formula bottles are another menace. The pediatrician tells the mother to make sure the baby gets "x" amount at every feeding, and, by golly, she's determined to stick to that goal. So at every feeding she cajoles, threatens, and in some way gets that exact amount out of the bottle and into the baby. Most of the time the babv will throw most of it back up, anyway. The net result is a lot of bad feelings between mother and baby -- a lot of anxiety and tension where there should be love and enjoyment. Not to mention a good chance of obesity in later life.
Temperature taking is virtually useless, too. The first question a doctor asks a mother over the telephone when she calls to complain about an illness is what is the child's temperature. This question has no meaning because there are innocuous diseases that carry very high fevers. Roseola, for example, is a common disease [33] of infancy, absolutely harmless; yet it frequently carries a temperature of 104 or 105. On the other hand, there are life-threatening diseases, such as tuberculous meningitis and others, that carry no fever at all or even a subnormal temperature. The doctor should be asking for qualitative information, such as how the child is feeling and what the mother has noticed in his behavior. The reliance on numbers is simply to validate the whole process for religious purposes. Because it is merely a useless ritual, mothers should answer the physician's question about temperature by saying, "I don't know; I haven't taken it." Or, "I don't have a thermometer in the house." Of course, the doctor then thinks they're kooks or health nuts or mentally deficient, so I tell mothers instead just to pick out a fictitious number. If you really want to command the doctors attention, pick out a high number, 104 or anything within the realm of credibility. Then if the doctor comes over and finds the temperature is normal, right on the button 98.6, you can say, "Oh, it was so much higher before!" If the doctor doesn't believe you, the only thing he can accuse you of is misreading the thermometer. You can even volunteer that remark by saying, "I might have misread the thermometer!" Then, once you get by the sacred quantitative barrier of the thermometer, you and the doctor can move on to more important things.
One of the common dangers of going in for an exam is that you'll be used for purposes other than your own. Years ago, after becoming [34] director of an outpatient clinic I found out that one of the routine questions asked of mothers was "Is your child toilet trained?" Every boy who was not toilet trained by the age of four was separated out and referred for a urological workup, which included, among other things, a cystoscopy. All these four-year-old kids were being cystoscoped! I immediately eliminated the question about toilet training. It didn't take long before I got a call from the chairman of the urology department, who happened to be a friend of mine. He was very angry. First he told me I had done the wrong thing eliminating the question and, thereby, the urological workup. He said it was important to do this kind of examination in order to find the rare cases in which there might be something organically wrong. Well, of course that was nonsense, because all the rare cases can be identified by measures that are far less dangerous than a cystoscopy.
Then he told me more about what was going on. The real problem was that I was destroying his residency program because in order for a residency to be approved by the accrediting authorities, the residents have to perform a certain number of cystoscopies every year. In this case it was around 150. I was taking away his source of cystoscopies, and I got into trouble over it.
This is true for other specialties, too. In order to have a cardiology residency approved, the resident must perform a minimum-number [35] -- 150, 200, 500, whatever it is -- of catheterizations every year. There is a great tendency to take people off the street and identify them as needing a cardiac catheterization!
Because of the increased danger of being used for the doctor's own purposes, it's best to regard any doctor who does research or teaching as potentially harmful. As far as I'm concerned, a doctor treating a person should be a treating doctor. Leave the research and teaching to someone who is identified as a researcher or a teacher. When a doctor mixes roles he has to be extremely careful. And so does his patient.
Naturally, the most sinister and dangerous ulterior purpose you expose yourself to is the doctor's need to recruit patients. Without the ritual of the checkup, internists would have trouble paying the office rent. How else can the doctor ensure a steady supply of sacrificial victims for the Church's other sacraments without the examination? The Gospel said many were called and few were chosen, but the Church of Modern Medicine has gone that one better: All are called and most are chosen.
Annual physicals were once recommended for such high-risk groups as industrial workers and prostitutes. However, today many doctors recommend that everybody have at least one a year. In the last fifty years of regular checkups, however, not a shred of evidence has emerged to show that those who faithfully submit live any longer or are any healthier than those who [36] avoid doctors. Because of the definite risks involved, I'd say those that stay away are better off.
In no uncertain terms, you're at the doctor's mercy. The fact that you're there in the first place means you don't know how you are or what is going on with you and that you want the doctor to tell you. So you're ready to give up a precious liberty, that of self identification. If he says you're sick, you're sick. If he says you're well, you're well. The doctor sets the limits of what's normal and abnormal, what's good and what's bad.
If you could rely on the doctor's conception of normal and abnormal, sick and well, submitting to him would be scary enough. But you can't rely on it. Most doctors are unable to recognize wellness, simply because they're not trained in wellness but in disease. Because they have sharper eyes for signs of disease than for signs of health, and because they have no conception of the relative importance of signs of both in the same person, they're more apt to pronounce you sick than well.
As long as the doctor is in control, he can define or manipulate the limits of health and disease any way he chooses, narrowly or broadly -- depending on his intentions and interests. In this way he can manipulate the amount of disease. For example, he can define high blood pressure as anything above or within the high range of normal. And he can treat it accordingly -- often with very powerful drugs. Disease can thus be defined to encompass small or large [37] numbers of the population. If he measures 100 children's height, he can state that any child standing at either extreme -- in the lowest and highest one, two, or five percent -- is "abnormal" and requires further testing. He can set his outer limits of normal blood or urine values or electrocardiogram readings so that a certain percentage of each population is labeled possibly abnormal, requires further investigation.
If he were selling laxatives, he would tend to define constipation in such a way as to include the great majority of Americans, by saying that if a person doesn't have a good bowel movement once a day, he or she is constipated. On the other hand, if he's interested in the truth, he would say that if a person has normally formed bowel movements, it doesn't make a difference if they have them once or twice a week. That puts almost nobody in the "sick" category.
The doctor can define sickness even where no sickness exists. After all, among those 100 children measured for height, among those blood, urine, and electrocardiogram measurements, someone has to be at the extreme high and low ends of the scales. And there are very few people in whom a battery of thirty or forty tests will not reveal at least one "statistical abnormality" which can then lead to an entire series of potentially damaging and disabling medical events.
You have to consider -- and beware of -- the doctor's self interest. Doctors almost always get more reward and recognition for intervening [38] than for not intervening. They're trained to intervene and do something rather than observe, wait, and take the chance the patient will get better all by himself or go to another doctor. As a matter of fact, one of my key pieces of subversive advice to medical students is this: To pass an exam, get through medical school, and retain your sanity, always choose the most interventionist answer on a multiple choice test and you're more likely to be right. For example, suppose somebody says to you that the patient has a pimple on his nose, and asks what should you do? If the first answer is watchful expectancy, wait and see what happens for a few days, that's wrong, reject that. But if one of the answers is cut off his head and hook him up to a heart lung machine, then resew all the arteries and give him twenty different antibiotics and steroids, that answer is right. This piece of advice has carried more of my students through various crucial examinations, including national boards and speciality exams, than any other lesson.
As a patient, once you submit to a physical examination, your doctor might interpret minor abnonmalities -- real or bogus -- as pre-conditions of some serious illness, requiring, of course, serious pre-intervention. A minor fluctuation on a blood sugar test might be interpreted as pre-diabetes, and you'll get some medicine to take home. Or the doctor may find something -- maybe a stray tracing on the EKG caused by a passing jet plane -- that leads him to believe you have a pre-coronary condition. Then you'll [39] go home with a pre-coronary drug or two, which while fighting your pre-condition will mess up your life through striking alterations in behavior and mental status, including blurred vision, confusion, agitation, delirium, hallucinations, numbness, seizures, and psychosis.
Maybe you'll get a prescription for Atromid S, a cholesterol-lowering drug, which, besides possibly lowering your cholesterol, could also give you one or more of these side effects: fatigue, weakness, headache, dizziness, muscle ache, loss of hair, drowsiness, blurred vision, tremors, perspiration, impotence, decreased sex drive, anemia, peptic ulcer, rheumatoid arthritis, and lupus erythematosis. Of course your doctor is not likely to read you this list from the prescribing information that comes with the drug. And he's even less likely to tell you the contents of the paragraph that's set in a black border: "It has not been established whether drug-induced lowering of cholesterol is detrimental, beneficial, or has no effect on the morbidity or mortality due to atherosclerotic coronary heart disease. Several years will be required before scientific investigations will yield the answer to this question."
What kind of person will take that drug after reading that information?
What must be the most common pre-treatment for pre-disease is what happens when you go in and the doctor finds your blood pressure a little high. Ignoring the fact that your hypertension might be temporarily caused by your very presence in the office, you'll most likely [40] leave with some sort of anti-hypertensive drug. Though you'll receive little in the way of relief from it, you might get something else: side effects ranging from headaches, drowsiness, lethargy, and nausea to impotence. In 1970, the Coronary Drug Project Research Group found that these drugs produced an excess number of adverse effects such as non-fatal infarction and pulmonary embolism -- and that these effects were not outweighed by any trend towards reduced mortality.
Doctors started hawking the importance of the physical examination during the Depression of the 1930s -- for all the obvious reasons. For the same obvious reasons, dentists are beginning to hustle people into their offices for routine checkups. I got an announcement the other day from an establishment dental organization that every child should be examined on his third birthday by a dentist and on his seventh birthday by an orthodontist. These exams certainly will not do very many children any good, and they will definitely do most of them harm. Not only from the mercury pollution characteristic of dental offices, the sacramental x-rays, and the Holy Water flouride applications -- but from the treatments themselves. The sharp dental explorer that dentists use to examine teeth has been shown to actually inoculate various bacteria from infected teeth to healthy teeth. Orthodontia is still a mysterious and unproven art. We know that a lot of people get into gum problems later in life because of orthodontia early in life. We also know that [41] a lot of people who are recommended for orthodontia and don't get it find that their teeth straighten out all by themselves. Although the recommended exams most probably won't do you or your child any good, they certainly will be good for the dentist or orthodontist.
From my experience, doctors -- and dentists, especially -- got very defensive about the regular checkup. I've known dentists to refuse to see patients in emergencies because the person hadn't been in for a regular checkup within the past six months. Of course, this attitude gives doctors and dentists the right to play the big game in medicine, Blame the Victim. Rather than admit that their sacraments are useless, the magic nonexistent, they can always tell you that you came to them too late.
You can never go to the doctor too soon, most doctors would claim. And most people seem to believe that. You must realize, however, that the mere act of submitting to the diagnostic procedure implies that you're asking for treatment, at least as far as the doctor is concerned. In no uncertain terms, if you show up, you're asking for it. You're asking to be exposed to the whole range of sacramental treatments, from aspirin to ritual mutilation. Of course, the doctor is going to tend towards the more intense forms of sacrifice, since these increase his sacred stature. Some lean so heavily in that direction that they miss completely the lower extreme of possibilities. A young friend of mine took up the challenge of a 1OO-mile bicycle race, something he'd never done [42] before. About a third of the way into the race he'd already made up his mind that he wasn't trained for this sort of punishment -- but some passing cyclists jeered at him for his slow pace. That made him angry and he vowed to finish the race, which he did. The next day he woke up and could hardly move. His knees had taken the brunt of the punishment.He was in such discomfort that he went to a doctor. After examining him and taking x-rays, the doctor let him know that he had either gonorrhea or some kind of cancer of the knee. My friend, who had told the doctor about the 100-mile ride, asked whether that didn't have something to do with his condition. The doctor said, "Not at all," and wanted to refer him to a specialist. Of course, my friend didn't even bother to take the referral home with him. In a matter of day, his legs were as good as new.
Some doctors blame the patients for demanding treatment for conditions that will take care of themselves, they use the excuse that people show up wanting antibiotics to knock out colds, or powerful and dangerous anti-arthritics for mild joint stiffness, or hormone pills for teenagers to fight acne or stifle growth. I don't accept this excuse. Patients demand a lot of things such as more considerate care, more natural healing techniques, and discussion of alternatives -- and doctors rarely give in on these issues.
If you want to defend yourself, you've got to understand that the doctor's standards are different from yours and that his are no better. [43] Doctors aren't considerate of the fact that their very questions imply the need for treatment. I counsel doctors not to tell patients about harmless heart murmurs, large tonsils, umbilical hernias -- almost all of which will disappear by the sixth birthday. I tell doctors not to ask mothers of three-year old boys whether or not the child is toilet trained because that automatically makes the mother think there's something wrong with her child if he's not toilet trained.
There are lots of other attitudes and strategies you need to learn if you want to defend yourself against the dangers of the diagnostic procedure. Of course, if it's an emergency such as an accident, injury, or acute appendicitis, you have no choice. But these situations account for only five percent of medical situations. If you have no symptoms at all, you've got no business going to the doctor in the first place. If you do have symptoms, if you are sick, then your first defense is to become more informed about your problem than the doctor. You've got to learn about your disease, and that's not very hard. You can get the same books the doctor studied from, and chances are he's forgotten most of it. You can find books written for laymen on just about every disease you're likely to have. The idea is to find out as much about it as possible so you can discuss your problem on an equal -- or better -- informational footing with the doctor.
Whenever a lab test is prescribed, look up the test and find out what it's supposed to show. Ask the doctor what the test is supposed [44] to demonstrate. Your doctor won't tell you this, but if you do your own detective work, you'll find out that the simple tests such as the blood counts, urine analysts, tuberculin tests, and chest x-rays are so controversial and difficult to interpret that their usefulness is extremely limited.
You should also try to find a lab which maintains a high degree of accuracy. If a lab won't talk about its rate of errors, scratch it off your list. If a lab boasts perfect or near perfect accuracy be suspicious. But keep asking questions. How do they know they're so accurate? Is the accuracy certified? By whom? You might never find a lab that satisfactorily answers all your questions. If you do, insist that your doctor use that lab. You might have tough going here because a lot of doctors have a financial interest in certain testing laboratories. Insist. If your doctor does all his own testing, ask the same questions that you would ask a lab. Finally, if a serious course of treatment hinges on the results of lab tests, have them done again at another lab. Even if you have to have them done again at the same lab, have them repeated.
The most important way to subvert the diagnostic procedure for your own protection is to ask the doctor questions. In some cases, he'll answer the questions. That's the rare exception. In most cases, the doctor will get upset. Ask the questions anyway -- short of getting yourself thrown out of his office. From his attitude [45] and his responses, you can judge him as a human being and get an idea of his expertise.
Questioning can come in handy to protect yourself from x-rays. Of course, the best protection is no radiation at all. Breast x-rays for women under fifty, women with no symptoms, and women with no history of breast cancer in their family are unjustifable for the detection of breast cancer. And they're of dubious value to all other women, since the breasts are especially sensitive to x-rays. Any woman can avoid x-rays merely by telling the doctor she thinks she might be pregnant -- whether she is or not. Sometimes, as happened to the wife of one of my colleagues, claiming you're pregnant will provoke them into requiring a pregnancy test, too! My friend's wife avoided that by telling the nurse-inquisitor that she wanted her husband to perform the test since this was her first baby and they wanted to keep as much of the event to themselves as possible. She never had to get the x-ray. You can get away with a similar ploy by merely saying you want your own doctor to perform the pregnancy test. Then, rely on bureaucratic inertia to keep the question from ever coming up again. A woman who is pregnant, or who truthfully thinks she may be, should make her condition clear by speaking up loudly to anyone who tries to aim an x-ray machine in her direction. Any doctor or dentist who insists on needlessly radiating a pregnant woman should have his license pulled.
[46] Techniques for avoiding x-rays can range from playing dumb -- Do I really need all those x-rays, doc? -- to persuasion and cajolery. Sometimes these will work but you should be prepared to resort to direct challenge and confrontation. Sometimes a doctor will have you placed on a cart to be wheeled into the x-ray room. This is a typical ploy to deliberately humiliate, depersonalize and demean perfectly capable men and women and transform them to docile, cooperative, accepting, manageable patients. If this ever happens to you, jump off the cart and stand on your own two feet. Exercise responsibility for your own health. Any disability you suffer from jumping off the cart will doubtlessly prove less than the effects of the x-rays.
Once you've made known your preference for avoiding x-rays, if your doctor still wants you under the gun, here are the questions you should ask: What are you looking for? What is the likelihood that you will find it using the x-rays? Can you find what you are looking for by a safer method? Are you using the most modern and well-maintained machines with the lowest possible dose of radiation? Will you properly shield the rest of my body? In what way will the x-rays change my course of treatment? When was the last time your machine was checked for safety? Keep asking questions until the doctor explains the situation in such a way that allows you to make an informed choice. If you decide that you must have the x-rays, submit to only the specific photos [47] necessary at the time. Don't let either your doctor or the radiologist shoot extra photos "as long as you're on the table."
To fully protect yourself from your doctor, you must learn how to lie to him. This is not such a strange maneuver, really, since anyone who has learned to survive professional bureaucracies has learned to deceive professionals. You learn to lie to school teachers quite early in life, since the purpose of going to school isn't to learn but to end up with a credential at the end. Then you do all your real learning outside of school. I advise medical students to learn the arts of hypocrisy and duplicity, just as Southern blacks once learned the art of shuffling. Shuffling was the fine art of appearing to be active and obedient when in reality you were nothing of the sort. That's what you have to do with your doctor.
If you are a mother who wants to breastfeed, for example, your doctor will almost always be against it, even if he says he doesn't care one way or the other, because doctors know nothing about breastfeeding. What do you do when your doctor weighs the baby and finds it hasn't gained as much weight as his chart says it should? What do you do when he tells you to start hot dogs at two weeks of age? My favorite image is that of the obstetrician waiting, and as the baby emerges from the womb he sticks a hot dog in its mouth to get it started on solid foods and to create an early dependence. Well, when a doctor tells you to start solid food such as cereal or fruit or anything else at one month [48] of age, you can try arguing with him since you know what's best for your baby better than he does. You can simply refuse to do it, in which case he'll get huffy and probably fire you as a patient. You can try to persuade or cajole the doctor, on the assumption that he's a rational, caring human being. If you try that, good luck.
Or, you can shuffle. Don't tell the doctor anything but Yessir. If he has given you a six-pack of formula to take home and start the baby on, throw it in the trash at your earliest convenience. Simply continue to breastfeed your baby. When the next checkup comes around and the doctor puts the baby on the scale, just tell the doctor how the child's enjoying his cereal and fruit. Then the doctor will look at the scale and tell you the baby's doing just fine.
Unfortunately, in some medical situations you reach the point where you can't lie to the doctor. In obstetrics, the doctor gets a chance to see what you're doing. He can check on you with the scale and enforce his dangerous ideas of limiting the amount of weight you gain during pregnancy. My women will bring a list of what they want and don't want to the obstetrician on the first visit, They'll tell him they don't want to be shaved, no episiotomy, analgesia, induction of labor, and so on. The doctor will nod his head. Then, in the final moments of labor, she'll find out that she's getting them anyway. You can't really expect a woman in labor to say no to whatever her doctor says she needs.
[49] That's why it's crucial to subvert the process and get the jump on the doctor as much as possible before the situation gets critical. After you've asked your questions, don't take it for granted that you can trust the doctor's answers. Check out whatever he says. Again, read all the sources you can find. You have to know more about it than he does.
Doctors in general should be treated with about the same degree of trust as used car salesmen. Whatever your doctor says or recommends, you have to first consider how it will benefit him. For example, if a neonatologist tells you that high risk nurseries improve the survival rates of babies, find out if he works for a high risk nursery.
Whenever you get a second opinion that is different from the first opinion, you should go back and confront the first doctor with what the second doctor said. People don't often do this because they're afraid of the anger and hostility of the first doctor. It's very valuable to test the doctor this way. It's a good idea to elicit that anger and hostility because that might change your attitude towards the doctor, And towards doctors in general.
Whenever you have to make a decision regarding a medical procedure, you should seek out and talk to people you regard as having wisdom. At one time, if you go back far enough, doctors were wise, cultured people. They knew literature and culture and were marked by sagacity and consideration. That is not the case anymore. People who may be a [50] source of information and counsel are people who have had the same experience as you, people with the same symptoms or disease. Talk over your problem, whatever your doctor tells you it is and whatever you think it is, with friends, neighbors, and family. Find out what their doctors say. Doctors tell you not to do this, not to listen to opinions you hear in the butcher shop or the grocery store or the hairdresser's. They tell you not to listen to relatives and friends. But they are wrong. They're protecting their sacred authority. As a matter of fact, you should talk to friends and relatives, people who live around you, whom you know and trust, at the outset of your symptoms.
You may find you can do without the doctor.
[51] I can still remember how, early in my medical career, I gave intravenous penicillin every few hours to children who were suffering the agonizing symptoms of bacterial meningitis, and then watched miraculous changes occur hour by hour. Children who had been on the verge of death recovered consciousness and began to respond to stimuli within a few hours. A few days later those same children were back on their feet, almost ready to go home.
Patients with lobar pneumonia also would endure terrible agonies. They would enter a crisis of high fever, severe cough, gasping for breath, shaking, chills, and extreme chest pains. Some recovered, but many died. When penicillin came along, people with lobar pneumonia no longer went through a crisis period. Instead, [52] the fever, cough, and other symptoms resolved within days. People who would never have left the hospital alive packed their bags and walked out.
I -- and other doctors -- truly felt that we were witnessing and working miracles.
Things are different today. Meningitis and lobar pneumonia are uncommon. Even when a doctor does come up against such a life-threatening condition, the treatment is so routine that it is mainly carried out by a nurse or a medical technician. While the fascination with the miracle remains, these drugs that were once extremely valuable are now extremely dangerous.
Many doctors prescribe penicillin for conditions as harmless as the common cold. Since penicillin works almost exclusively against bacterial infections, it's useless against viral conditions such as colds and flu. Penicillin and other antibiotics do not shorten the course of the disease, do not prevent complications, and do not reduce the number of pathogenic organisms in the nose and throat. They do no good at all.
What they can do is cause reactions ranging from skin rish, vomiting, and diarrhea to fever and anaphylactic shock. If you're lucky, you'll only be one of the seven to eight percent of people who suffer a rash -- although a much higher percentage of people suffering from mononucleosis have gotten a rash when given ampicillin. For the unlucky five percent who get serious reactions to penicillin, the picture of a [53] patient in anaphylactic shock is not pretty: cardiovascular collapse with clammy skin, sweating, unconsciousness, fallen blood pressure, disturbance in heart rate and rhythm. It eerily evokes images of the very diseases which penicillin was designed to cure.
By no means is penicillin the only villain. Chloromycetin is a drug which is effective in a certain type of meningitis caused by the H. influenza bacillus, as well as in diseases caused by typhoid and similar germs. In such situations, chloromycetin is often the only antibiotic that will work. But chloromycetin also has the not uncommon fatal side effect of interfering with the bone marrow's production of blood.
When a person's life is at stake anyway, this is an acceptable risk to take. But if a child suffers nothing more than a viral sore throat, is the non-relief chloromycetin will bring worth risking depression of the child's bone marrow which will require multiple transfusions and other therapies, none of which will guarantee complete recovery? Of course it's not; yet doctors do prescribe chloromycetin for sore throats.
Tetracycline became so popular in outpatient clinics and office practices that it became known as the housecall antibiotic. It has been widely prescribed for children as well as other age groups because it is effective against a wide variety of organisms and because it's side effects are not considered dangerous. But there is a fair list of adverse reactions which the informed person might not choose over the drug's non-use in situations it wasn't designed [54] for anyway. A more formidable side effect is that the drug is deposited in the bones and teeth. While no one knows exactly what tetracycline does to the bones, hundreds of thousands -- perhaps, millions -- of parents and children know that it permanently stains the teeth yellow or yellow-green. Though you might feel that's too high a price to pay for the dubious effectiveness of the drug in relieving the symtoms of a common cold, many doctors do not. The current rationalization for the drug's use in such situations is the suspicion that a child who appears to be suffering from a cold might actually have a mycoplasma infection. The vast majority of children with a common cold have no trace of this sort of infection.
The U.S. Food and Drug Administration finally woke up to the widespread overuse of tetracyclines in 1970, when it required a warning on all packages of the drug: "The use of drugs of the tetracycline class during tooth development (last half of pregnancy, infancy and childhood to the age of eight years) may cause permanent discoloration of the teeth yellow-gray-brown. This adverse reaction is more common during long term use of the drugs, but has been observed following repeated short term courses. Malformation of tooth enamel has also been reported. Tetracycline, therefore, should not be used in this age group unless other drugs are not likely to be effective or are contraindicated."
Whether this warning has done much good is hard to tell, since doctors very seldom read [55] package inserts on drugs. Even if they do, warnings do not usually stop them from using the drugs when they feel like it. Particularly when the warning on the insert, like the one for tetracycline, doesn't really make it clear enough that these drugs carry side effects which merit their use only in critical situations.
One of those risks is even more grim than that of the side effects: superinfections. When an antibiotic fights one infection, it may encourage an even worse infection by a strain of bacteria that is resistant to the drug. Bacteria are remarkably adaptable organisms. Subsequent generations can develop resistance to a drug as their ancestors are exposed more and more. Penicillin in moderate doses once easily cured gonorrhea. Now it takes two large shots of the antibiotic to treat it, and it's sometimes necessary to use additional drugs! Two new strains of gonorrhea recently were discovered in the Philippines and in West Africa -- strains which totally destroy penicillin's effectiveness.
Of course, Modern Medicine has a stronger drug ready for the stronger gonorrhea bacteria -- spectinomycin. Spectinomycin costs six times as much and has even more side effects. Mean while, the gonorrhea bacteria have developed a strain which is resistant to spectinomycin, too! As the battle escalates, the germs grow stronger while the patients and their pocketbooks grow weaker.
All of which would not happen if doctors recognized that antibiotics have a place in the practice of medicine -- a severely limited place -- [56] and if they enforced that restriction. A person may need penicillin or some other antibiotic three or four times during his or her entire life, at times when the stakes are worth the risks.
Unfortunately, doctors have seeded the entire population with these powerful drugs. Every year, from 8 to 10 million Americans go to the doctor when they have a cold. About ninety-five percent of them come away with a prescription -- half of which are for antibiotics. Not only are these people duped into paying for something which has no effectiveness against their problem, but they're set up for the hazards of side effects and the risks of deadlier infections.
The doctor, once the agent of cure, has become the agent of disease. By going too far and diffusing the power of the extreme on the mean, Modern Medicine has weakened and corrupted even the management of extreme cases. The miracle I and other doctors were once proud to take part in has become a miracle of mayhem.
In 1890, Dr. Robert Koch derived a substance from tuberculosis bacteria which he claimed would cure the disease. When he injected it into patients, however, they got worse or died. In 1928, a drug called thorotrast was first used to aid in obtaining x-ray outlines of the liver, spleen, lymph nodes, and other organs. It took nineteen years to discover that even small doses of the drug caused cancer. In 1937, children who received a new antibacterial [57] drug died because the drug was contaminated with a toxic chemical. In 1955, more than 100 fatal and near fatal cases of polio developed among unsuspecting people receiving certain lots of the Salk vaccine which contained presumably inacivated polio viruses. In 1959, about 500 children in Germany and 1,000 elsewhere were born severely deformed because their mothers had taken thalidomide, a sleeping pill and tranquilizer during the early weeks of pregnancy. In 1962, a cholesterol-lowering drug, triparanol, was removed from the market when it was acknowledged that the drug caused numerous side effects, cataracts among them.
Most of these pharmaceutical backfires were corrected either when the drug was removed from the market or when the manufacturing error was discovered and tighter controls were established. The controls haven't been tight enough though, because drug disasters like these are going on every day. Actually, the only apparatus that has grown stronger seems to be the machinery of keeping dangerous drugs moving from the factories through the hands of doctors into the mouths and bodies of unwary patients. Reserpine, a drug used, against high blood pressure, is still prescribed, even though it was discovered in studies five years ago to triple the risk of breast cancer. Although insulin is turning up in scientific studies as one of the causes of diabetic blindness, its use is still heralded as a medical miracle.
[58] Of course, if drugs were merely products of medical science, dealing with them would be a matter of science, rationality, and common sense. But drugs aren't merely scientific -- they're sacred. Like the communion wafer which Catholics receive on the tongue, drugs are the communion wafers of Modern Medicine. When you take a drug you're communing with one of the mysteries of the Church: the fact that the doctor can alter your inward and outward state if you have the faith to take the drug. And just as an undeniable factor in the healing or the spiritual boost the communicant gets at the altar rail is psychologically determined, the placebo effect -- the power of suggestion -- plays a tremendous role in whatever good a drug may do. As a matter of fact there are some drugs and other procedures in which we know the placebo effect is the primary therapeutic agent!
The sacraments of the Catholic Church -- or any other real church -- seldom harm anyone. Doctor-prescribed sacramental drugs of Modern Medicine kill more people than illegal street drugs. A nationwide survey of medical examiners reported that street drugs cause twenty-six percent of drug abuse deaths. Valuim and barbiturates --prescription drugs -- made up another twenty-three percent of drug abuse deaths. This study did not take into account the 20,000 to 30,000 yearly deaths attributed to adverse reactions to drugs prescribed by doctors. The reason for the wide girth between the estimates is that doctors often fudge [59] in stating whether or not drugs are the actual cause of death. If a patient has a terminal illness and dies during the drug therapy, the death will be attributed to the disease, even if the patient wouldn't normally have died for some time yet. The Boston Collaborative Drug Surveillance Program monitored patients admitted to acute disease medical wards and found the risk of being killed by drug therapy was better than one in 1,000 in American hospitals. An earlier survey by the same group found that the risk among hospitalized pitients with serious chronic diseases such as cancer, heart disease and alcoholic cirrhosis was four in 1,000. Of course, many of these people were in the hospital in the first place because of the effects of drugs prescribed by their doctors. Conservative estimates say that five percent of the people in American and British hospitals are there because of adverse reactions to drugs. Another conservative estimate puts the price tag on this preventable suffering at more than $3 billion.
Another, even more powerful, group of drugs whose use for the treatment of extreme conditions has shifted to common conditions is the steroid drugs. Steroids mimic the action of the adrenal glands, the most powerful regulators of body metabolism. Practically every organ is directly or indirectly affected by the secretions of the adrenal glands -- as well as by the synthetic chemicals prescribed by the doctor. Once upon a time, steroid drugs were prescribed for severe adrenal insufficiency, for disturbances of the [60] pituitary gland and for certain life-threatening conditions such as lupus erythematosus, ulcerative colitis, leprosy, leukemia, Hodgkin's Disease, and lymphoma. Today steroids are prescribed for conditions as common as sunburn, mononucleosis, acne, and a large variety of skin rashes which are often incorrectly diagnosed.
The entire list of precautions and adverse reactions to Prednisone fills two columns of small print in the Physicians Desk Reference, the enclyclopedia or "bible" of licensed drugs in the United States. Among the adverse reactions are: hypertension, loss of muscle tone, peptic ulcer with possible perforation and hemorrhage, impaired wound healing, increased sweating, convulsions, vertigo, menstrual irregularities, suppression of growth in children, manifesiation of latent diabetes, psychic disturbances, and glaucoma. Is getting rid of some minor skin rash worth risking one of these disasters? Apparently some doctors think it is.
For example, a woman from Atlanta wrote me about her twenty-year-old daughter who had never had a menstrual period. At the age of eleven, the girl had developed a rash on her feet. The dermatologist prescribed Prednisone, and the youngster took it for three years. "Can anything be done for our daughter?" the woman asked me. "If only that dermatologist had told us that drug might do this to our daughter's reproductive system, we would have let her keep the rash!"
A young woman from Ohio wrote me that [61] she had gotten a prescription for Prednisone accompanied by shots of another steriod, Kenalog, for poison ivy. "I suffered severe headaches, muscle cramps, swelling of my breasts, and bleeding for twenty-five days." Her gynecologist told her the bleeding was caused by the medications she took for the poison ivy, so she must now undergo a D&C (scraping of the walls of the uterus).
A couple of years ago, the University of Chicago was slapped with a $77-million class-action suit filed on behalf of more than 1,000 women who unwittingly took part in a University experiment, some twenty-five years ago, with the synthetic hormone DES. This suit has special significance to me since I was then a student at the university's school of medicine and spent part of my time at Chicago Lying-In Hospital. I knew of the experiment, which tested the use of diethylstilbesterol in preventing threatened miscarriages. Being a conscientious medical student who trusted his school and believed his professors knew what they were doing I didn't even question the experiment.
Of course neither I nor the 1,000 or so women should have trusted the school, because the professors didn't know what they were doing. In 1971, Dr. Arthur L. Herbst, then of Harvard Medical School, first announced that an alarmingly high rate of daughters of women who had taken DES were developing vaginal cancer. Later on we learned that male offspring of these women had an alarmingly high rate of [62] genital malformations. And a statistically significant number of the women themselves were dying of cancer.
Of course, by then the bloom was off the rose as far as my unquestioning acceptance of medical science was concerned. I was not surprised when I heard the news. The damaging effects of hormones used in the Pill and in sex hormones used for menopause had already surfaced. If it hadn't been obvious twenty-five years ago that DES would have a damaging effect on the developing, vulnerable fetus, it was now.
Today my surprise quotient is so low that I scarcely raise an eyebrow when I see that the same Dr. Herbst who unveiled the dangers in the first place has since come out with a paper that plays down the DES cancer risk! Since the damage has already been done and doctors have been exposed as ignorant of the possible dangers of the drugs they use, all that can be done now is retreat into the sacred language and make it look like the mistake wasn't a mistake at all, the danger not a danger at all. Try to convince the mothers who found out they were guinea pigs in the DES experiment. Try to convince their children. For every one of those diseased or deformed children, the risk has been l0O percent.
Dr. Herbst's own records show 300 cases of vaginal or cervical cancer in babies whose mothers were treated with DES. Imagine what a commotion Modern Medicine would have made a couple of years ago if "only 300 cases" [63] of swlne flu had been discovered. Would doctors then talk about how really miniscule the risk was? How about when a doctor wants to use antibiotics on an infant when the chances the child really needs them are less than one in 100,000?
DES is just one of the sex hormones prescribed for women at all stages of their lives. Tens of millions of women take such hormones daily in the form of contraceptive pills or menopausal estrogens. DES is still being given as the "morning after" contraceptive pill and to dry up breast milk. In 1975, the FDA sent a warning bulletin to doctors recommending that they switch women over age forty to a contraceptive other than the Pill. In 1977, the FDA required a warning brochure emphasizing the astronomical risk of cardiovascular disease among women over forty taking the Pill. Whether these warnings will do much good remains to be seen. Women over forty are still taking the Pill, either because they are not properly informed or because they choose to accept the risks. The overwhelming majority of women on the Pill are under forty. The risks are great for these women, too, and they include not only cardiovascular disease, but liver tumors, headaches, depression and cancer. While taking the Pill over age forty multiplies the risk of dying from a heart attack by a factor of five, from age thirty to forty the PilI multiplies it by a factor of three. All women taking the Pill run a risk of high blood pressure six times greater than women not taking it. [64] Their risk of stroke is four times greater, and their risk of thromboembolism is more than five times greater.
Doctors maintain the enormous market for the Pill by telling women it's safer to take the Pill than to get pregnant. Of course, that argument defies logic as well as science. First of all, the dangers of the Pill are just beginning to surface. They are the dangers of an unnatural substance interfering with body processes. Pregnancy, however, is a natural process, which the body is prepared to deal with -- unless it is unhealthy in some way. To take the Pill is to introduce disease into the body. Comparing the risk of pregnancy to the risk of taking the Pill illogically jumbles together rich women, poor women, healthy women, sick women, women on the Pill, women off the Pill, women using other contraceptives, women using no contraceptives, married women, single women teenagers, adults, promiscuous women, and non-promiscuous women. When these women get pregnant, they already bring to the statistics risk factors which have nothing to do with pregnancy.
Of course, it's bad science to compare the Pill's dangers with pregnancy anyway. The real question is: Is the Pill safer than other forms of contraception?
Added to the 10 million women who still take the Pill are more than 5 million who take menopausal estrogens. Again, these drugs have been implicated so strongly in the causation of gall bladder disease and cancer of the utenus [65] (they multiply the risk by a factor of five to twelve) that the FDA has been forced to issue warnings to doctors and patients. Warnings which have gone largely unheeded, as far as doctors are concerned. For instead of limiting the use of these drugs to infrequent, short term relief of severe symptoms, most doctors use them routinely supposedly to prevent the mildest of menopausal discomforts. Estrogen therapy is used to preserve youth, for cosmetic purposes, to relieve depression, and for the prevention of cardiovascular disease -- all for which its effectiveness has been disproved. Estrogens also are used to prevent bone demineralization in older women. Exercise and diet can prevent demineralization and they don't cause cancer. Many women obtain estrogens from their doctor at the first sign of depression during middle age. Seldom does the doctor take the time to find out if perhaps the depression isn't caused by some other factor, something that can be treated without estrogen or -- perish the thought -- without any drug.
Actually, quite a few drugs are invented and prescribed for conditions which can be treated perfectly well with less dangerous methods. Antihypertension drugs have filled such a market void for an easy way to lower blood pressure that their popularity has soared in the few years they've been available. Now a doctor no longer has to tell a person with high blood pressure that his lifestyle is killing him. He can just write a prescription for a drug and use his powers of persuasion to get the patient to take [66] the drug. We even have television, radio, and magazine commercials urging people to take their high blood pressure medication! Somehow, somewhere, someone has convinced enough people that taking these drugs is the only way to lower blood pressure. And someone has, of course, also failed to alert a lot of people to the side effects of these drugs. Someone is aware of those side effects, though, because many of the high blood pressure drug ads in the medical journals are for drugs designed to deal with the side effects of the antihypertension drugs!
Some of those side effects include: rash, hives, sensitivity to light, dizziness, weakness, muscle cramps, inflammation of the blood vessels, tingling sensation in the skin, joint aches, confusion, difficulty concentrating, muscle spasms, nausea, and loss of sex drive and potency. That last side effect, by the way, affects both men and, women on antihypertensives. Sometimes I wonder just how much of the middle-aged population suffers from impotency -- not from any psychological cause but simply from their blood pressure medication. All the sex therapy in the world won't correct drug-induced impotence and loss of libido. If doctors aren't aware of the side effects from these drugs, they aren't doing their job, because the manufacturers list them in the Physicians Desk Reference (PDR). If they do know about them and prescribe these drugs anyway, you have to stop and wonder: would a doctor who was [67] found to have high blood pressure take these drugs himself?
Perhaps any doctor foolish enough to prescribe these drugs is also foolish enough to take them himself, since most doctors are aware of the controversy over whether these drugs do any good at all. Even if you assume that high blood pressure is dangerous, doctors are still guilty of being a bit quick with the prescription. Many people who receive high blood pressure medication are really borderline cases: their blood pressure isn't high enough to warrant a drug with the side effects of antihypertensives. Most of these people could more effectively lower their blood pressure through relaxation therapy, dietary or lifestyle changes. In one study, relaxation therapy reduced blood pressure faster and farther than drug therapy. Similar studies have shown that weight loss, reduction of salt intake, vegetarian diet, and exerclse can also lower blood pressure at least as effectively and certainly more safely than drug therapy. There's little doubt that many patients don't need to lower their blood pressure at all, since as soon as they leave the danger zone of the doctor's ofice, their blood pressure returns to normal.
One of the unwritten rules in Modern Medicine is always to write a prescription for a new drug quicky, before all its side effects have come to the surface. Nowhere is this syndrome more evident than in the unleashing of the herd of new antiarthritic drugs on the unsuspecting [68] patients. Nowhere is it more evident that the "cures" are worse than the disease. Within the last few years, a torrent of advertisements in medical journals has heralded the coming of such anti-arthritis drugs as Butazolidin alka, Motrin, Indocin, Naprosyn, Nalfon, Toletin, and others, The drug companies have spared neither time nor money in rushing their arthritis "cures" to the marketplace. Millions upon millions of prescriptions have been written. And in just these few years, this new class of drugs has a record of side effects that promises to rival antibiotics and hormones as genuine public health menaces.
Just reading the information supplied by the manufacturer of Butazolidin alka, and thinking that your doctor actually is prescribing the stuff to you is enough to make you ill: "This is a potent drug; its misuse can lead to serious results. Cases of leukemia have been reported in patients with a history of short and long term therapy. The majority of the patients were over forty." If you read further you find that your doctor is setting you up for a possible 92 adverse reactions, including headaches, vertigo, coma, hypertension, retinal hemorrhage, and hepatitis. The company goes on to admit: "Carefully instruct and observe the individual patient, especially the aging (forty and over) who have increased susceptibility to the drug. Use lowest effective dosage. Weigh initially unpredictable benefits against risk of severe, even fatal reactions. The disease condition itself is unaltered by the drug."
[69] After reading that, you have to wonder why the drug company would bother marketing the stuff. What doctor would give such poison to his patient? What person would willingly take this drug? You can stop wondering, because Butasolidin alka makes millions of dollars for its manufacturer. Doctors may or may not be aware of the drug's disastrous side effeets. They may not be offended by the admission by the company that the doctor has to weigh unpredictable benefits against the possibility of death. They just may not care.
Or they may be guided by a force that goes beyond logic and consideration -- the rhythm of a religious sacrifice.
In the case of at least one antiarthritis drug, Naprosyn, the sacrifice has graduated into a farce. Though the FDA has discovered that Syntex, the drug's manufacturer, falsified records of tumors and animal deaths during the safety tests for its drug, the government is unable to remove the drug from the market without long and tedious proceedings.
No modern medical procedure better displays the inquisitorial nature of Modern Medicine than the drugging of so called "hyperactive" children. Originally, behavior controlling drugs were used to treat only the most severe cases of mental illness. But today, drugs such as Dexedrine, Cylert, Ritalin, and Tofranil are being used on more than a million children throughout the United States -- on the basis of often flimsy diagnostic criteria of hyperactivity and minimal brain damage. Some medical [70] tests, when performed correctly, are conclusive. But there is no single diagnostic test that will identify a child as hyperactive or any of the twenty-one other names assigned to this syndrome. The list of inconclusive tests is at least as long as the list of names. All a doctor has to go on is a list of inconclusive tests and the "educated" guess of an "expert."
One school in Texas took advantage of this ambiguity and diagnosed forty percent of its students as minimally brain damaged in a year when government money was available to treat that syndrome. Two years later, this money was no longer available, but funds for treating children with language learning disabilities were floating around. Suddenly, the minimally brain damaged students disappeared and thirty-five percent of the children were diagnosed as having language learning disabilities!
If that school district and others took the government money and used it on teachers' salaries, books, playground equipment, and supplies, their larceny could be forgiven. But what happens is that the child who can't sit still in class -- instead of being given tasks that will interest and occupy him -- is diagnosed as hyperactive and "managed" by drugs. These drugs are not without serious side effects. Not only do they suppress growth and cause high blood pressure, nervousness, and insomnia, but they transform children into "brave new world" type zombies. Sure, the kids slow down -- dramatically. They're also less responsive and enthusiastic, and more humorless and apathetic. [71] And they don't perform any better when measured objectively over long periods of time.
The original authors of scientific studies on these behavior modifying drugs have tried to disassociate themselves from their present use by claiming that the problem isn't the drugs' existence but the way doctors over-diagnose, mis-diagnose, and overmedicate. While such arguments may salvage a few individual reputations, keep in mind that the original investigators and authors have made little or no attempt to properly limit the use of their discoveries. On the contrary, we still have three-page ads in the medical journals which picture a school teacher proudly proclaiming, "How wonderful! Andy's handwriting no longer looks like hen scratchings." This is the first time in history that powerful drugs have been sold to cure poor penmanship! And sold quite successfully, I might add. More then a million children are being given these drugs, a yearly habit that stuffs tens of millions of dollars into the pockets of the drug companies.
Nowhere does the Church's Inquisition emerge as clearly as it does through the drugging of children as a means of control. The medieval Inquisition went beyond defining unorthodox beliefs and behavior as a "sin" and started calling them a crime. Criminals were punished, first by the Church and then by the secular authorities. Modern Medicine sets up its Inquisition to define behavior which doesn't conform as sick. Then it proceeds to "punish" the guilty by "managing" them with drugs. [72] Since the primary purpose of schools is not to liberate the intelligence through learning but to create properly socialized and manageable citizens, the Medical Church and the State join forces to maintain public order. The Church enforces the behavior standards that suit the State and the State enforces the exclusive view of reality that allows the Church to flourish. All in the name of Health -- which, in reality, is not even a minor consideration of either party.
Witness the vigor with which the State proselytizes Modern Medicine's line of Holy Waters. Now, Holy Waters are special cases slightly removed from drugs in that the thin veil of diagnostic necessity has been removed. Everybody needs -- and gets -- the Holy Waters: routine silver nitrate in the eyes of the newborn, routine intravenous fluids to laboring mothers and other hospital patients, routine immunizations, and fluoridation of water supplies. All four of these procedures are automatically, thoughtlessly imposed on people whether they wish them or not, whether they need them or not. All four of them are at best unnecessary ninety-nine percent of the time. All four of them are of questionable safety. Yet all of them -- except the intravenous fluids so far -- are not only Church Law, but State Law as well.
I'll never forget the overwhelming compulsion of the priest making his way to the premature nursery to get some holy water on the infants and baptize them before they died. That same fierce compulsion motivates the [73] priests of Modern Medicine in slapping their Holy Waters on their patients.
One of the mottoes medical students are taught to memorize but never practice -- such as "first do no harm" -- is "when you hear the sound of hoofbeats, think of horses before zebras." In other words when symptoms present themselves, first consider the most obvious, common sense cause. As you can see, this motto doesn't survive very long in most doctors' practices. You can't use powerful and expensive drugs and procedures on horses. So what the doctor does is hear a herd of zebras every time, and treat accordingly. If a child is bored or can't sit still, he's hyperactive and needs a drug. If your joints are stiff because you don't exercise them the way you should, you need a drug. If your blood pressure is a little high, you need a drug. If you've got the sniffles, you need a drug. If your life isn't going the way it should, your need a drug. On and on ... the zebras keep coming.
One of the factors that keeps those zebras coming is the cozy and profitable relationship that exists between the drug companies and doctors. The drug companies spend an average of $6,000 per year on each and every doctor in the United States for the purpose of getting them to use their drugs. Company detail men, actually salesmen, build friendly, profitable relationships with the doctors on their route, wining and dining, doing favors, handing out samples of drugs. The sad fact is that [74] most of the information reaching doctors about the uses and abuses of drugs comes from the drug companies, through the detail men and advertising in medical journals. Since most of the clinical test reports are financed by the drug companies, information from these, too, is highly suspect.
A commission of distinguished scientists, including four Nobel Laureates, studied the drug problem and found that the culprits are the doctors and the scientists who test the drugs. They found clinical trials of new drugs were "a shambles." The FDA spot checked the work of some doctors doing such clinical trials and found twenty percent guilty of a wide range of unethical practices, including giving incorrect dosages and falsify records. In a third of the reports checked by the FDA, the trial had not been carried out at all. In another third, the experimental protocol was not followed. In only a third of the tests could the results be considered scientifically worthwhile! [Journal of the American Medical Association, November 3, 1975]
Despite the obvious corruption of the drug company-doctor marketing connection, I don't blame the drug companies, the detail men, the government agencies which are supposed to police these activities, or the patients who badger their doctors for drugs. Doctors have enough facts in their possession to know what's going on. Even where the drug is fully tested and the side effects and limitations of the drug are well known, most of the harm is done by [75] doctors indiscriminately prescribing the drug. Doctors, after all, are the ones who claim the sacred power and the ethical superiority that goes with it. The drug companies are in business to make money, and they do that by selling as much of their product as they can at as high a price as they can. And although the drug companies subvert the scientific process through which drugs are tested, certified, and made available to doctors, once the drugs are available they do let doctors know -- albeit subtly -- just what these drugs can and cannot do.
The drug companies don't have to fight against package inserts that would explain the side effects and hazards of medications to the people who take them: the American Medical Association does it for them. Doctors either play down the side effects or conceal them altogether on the grounds that the doctor-patient relationship would be endangered. "If I had to explain things to patients, I could never get through my office hours." Or, "If patients knew everything these drugs could do, they never would take them." Rather than protecting the patient, the doctor protects the sacred relationship -- which relies on ignorance to survive. Blind faith.
If doctors still obeyed the first rule of medicine -- Primum, non nocere, first do no harm -- there would be no need for them to enforce the blind faith of their patients. When it came down to weighing risks against benefits, the patient's welfare would be the first consideration. [76] But that rule has been rationalized into a grotesque mutation that allows the doctor to weigh the risks and benefits in a totally different ethical frame. Now the rule is First Do something. Now, you hurt the patients most by not giving them something, whether it's a drug or some other procedure. Whether the "something" does any good or not is irrelevant. (To question it is irreverent!) Whether it does any harm matters even less. If the treatment does happen to hurt enough to make the patient complain, the doctor merely says "Learn to live with it."
Of course, a doctor would never consider saying that to a patient until he had tried at least one drug. Doctors have completely bought the advertising slogan "Better Living Through Chemistry." You might think the reason for this is purely economic. The doctor can write a prescription in a few seconds, whereas discussing with the patient the state of his nutrition, exercise patterns, career, and psyche would certainly take up more time and allow him to see fewer patients. In a fee-for-service system, the quick chemical fix has its obvious financial reward for the doctor as well as for the pharmacist and the drug manufacturer.
I think the reasons go deeper than money. One way to look at it -- though an admittedly cynical way -- is to recognize that doctors have throughout the ages embraced the wrong ideas. Considering the drug problem in our time, the adamant disregard of sterility in the nineteenth century, leeches, bleeding, purgatives, you [77] could make a case that medicine has always been hazardous to the majority of patients.
That -- and most doctors' high regard for financial reward -- helps explain what the patient is up against. If you go deeper still, you come up against philosophical reasons that I can only describe as the Theology of Modern Medicine. Ironically, this theology is a corruption of certain aspects of Christian theology.
If you look at almost any other system of medicine besides the Western, you'll find a heavy reliance on food. The food of Modern Medicine, however, is the drug. The American doctor, aside from a very fragmentary and usually incorrect approach to certain "therapeutic diets" (gout, diabetic, low salt, gallbadder, weight reduction, low cholesterol), completely disregards nutrition. Those who are concerned with nutrition are labeled faddists, freaks, extremists, radicals, and quacks. Occasionally, they're (more correctly) referred to as heretics.
Oriental medicine, on the other hand, recognizes and utilizes the importance of nutrition in health. If you look at Oriental religion, you'll find that it, too, regards food as important to a person's spiritual welfare. But Western religion, namely Christianity, did exactly what Modern Medicine did: substituted as an obiect of reverence a sacramental, symbolic food in place of real food. "What goes into the mouth does not make a man unclean; it is what comes out of the mouth that makes him unclean."(Matthew 15:11)
[78] Perhaps in their zeal to reject the Old Testament dietary laws, some of the early Christian leaders moved too far in the opposite direction and bypassed nutrition altogether. There's no doubt that Modern Medicine took the hint and carried it to extremes. Obviously, as far as a person's health is concerned, what goes into the mouth is at least as important as what comes out. In fact, what goes in may determine what comes out. Yet, if anyone dares to claim that a person is what he or she eats, Modern Medicine regards them as a heretic or an intellectual weakling. Instead, the "food" with the sacred "power" is the drug, the man-made chemical coursing through your veins, for better or for worse.
To protect yourself from the pusher-priest you again have to make the heretic's radical leap of unfaith. Don't trust your doctor. Assume that if he prescribes a drug, it's dangerous. There is no safe drug. Eli Lilly himself once said that a drug without toxic effects is no drug at all. Every drug has to be approached with suspicion.
That goes double if you're pregnant. In fact, if you're pregnant you and your baby are better off if you stay away from all drugs completely. A drug that has minor side effects or even no side effects on you may do irreparable harm to a developing fetus. Hundreds of drugs are marketed long before their effects on the fetus are known. Unless you want to donate your baby's welfare to science and be one of [79] the first to find out a drug's effects, don't take any drug unless your life is at stake.
That includes aspirin. Though it's been around for eighty of more years doctors still don't know how aspirin works. Because it's been a "friend of the family" for so long, people don't realize that aspirin is not without side effects and dangers of its own. Besides the most common side effect, stomach bleeding, aspirin can cause a hemorrhage under the scalp of a newborn if a mother takes it within seventy-two hours of delivery. I've often wondered why doctors always say to take "two tablets" of five grains each despite the availability of a single, ten-grain aspirin tablet. Could there be some sort of religious significance in receiving ten of something in two tablets?
Before you take the first dose of any medication your doctor prescribes, you should make it your business to find out more about the drug than the doctor himself knows. Again, learning more about your situation than the doctor won't be all that difficult. Doctors get most of their information about drugs from advertisements and from detail men and their pamphlet handouts. All you have to do is spend some time with a good book or two in order to get the information you need before deciding whether to take a drug or not.
The best book to start with is the Physicians' Desk Reference, the PDR. The PDR is the beginning of knowledge about drugs. Although it's easily available now, up until about two [80] years ago the publisher refused to distribute it to other than members of the medical profession. I wasn't aware of this when I gave the PDR many plugs in my column and newsletter. Finally, I got a letter from the publisher telling me to please stop referring people to their book since they distributed it only to professionals. They felt that the public wouldn't understand the PDR and would be confused by it. Well, I published that letter in my column and I commented that it was the first time in history a publisher didn't want to sell his books. Shortly thereafter, without any kind of fanfare, the PDR not only started showing up in bookstores, but it was promoted in bookstores! Now, if you go into the bookstores, you'll see piles of PDR's. I guess the publisher finally got the idea.
Of course, you don't have to buy the book. Almost every public library now has it. You shouldn't worry about understanding it. Anybody with an eighth grade education and a dictionary can read any medical book. Even doctors will testify that patients always seem to be able to pick out and understand the parts that they must know.
The PDR is good because all the information is provided by the drug companies in an effort to protect themselves. Not only does the FDA require them to put in all the information they have, but they also want to ward off any liability claims against them. In effect, they are saying to the doctor: we are telling you everything we know about this drug. What it may be [81] useful for. What it may do to the person who takes it. The wonderful thing that seems to be happening is that the PDR is becoming more and more discreet. For example, the latest issues divide drug side effects into major categories according to how frequently they can occur. Now at least you've got horse race odds when you take your medicine.
The PDR can be considered the "bible" of the Church of Modern Medicine, especially since for a long time it was forbidden literature except to the priesthood. But there are other sources for the kind of drug information you need. The American Medical Association publishes a Drug Evaluations book which in some cases gives even more information than the PDR. For one thing, the AMA book has a list of cross-referenced symptoms in the back. You look up your symptom or your side effect and it will tell you which drugs are indicated or suspected.
Because we're living in an era of poly-pharmacy -- everybody is taking more than one drug at a time -- you've got to become aware of the dangers of combinations of drugs. One drug may have side effects harmful to one organ three or four percent of the time, two percent to another organ, six percent to another. A second drug may have dangers for one organ that occur three percent, dangers for another organ ten percent. If you're taking enough drugs, the danger can easily add up to more than 100 percent. You're virtually assured of suffering some toxic effect! Even more dangerous are the [82] potentiating effects of drug combinations. One drug might have only a five percent chance of hurting you. But in combination with another drug, the danger can be multiplied by a factor of two, three, four, five ... who knows? Not only can the risk be multiplied, but so can the strength of the toxic effect! There are books which give lists of drugs which interact with a given drug. (An excellent one which I use is Eric Martin's Hazards of Medications.) Of course, you also should let your doctor know what drugs you are taking. But don't rely on his knowledge of any dangerous cross-reactions that might occur.
You should be aware of all the drugs for which the side effects are the same as the indications. This isn't as rare as you might think. For example, if you read the list of indications for Valium, and then read the list of side effects, you'll find that the lists are more or less interchangeable! Under the indications you'll find: anxiety, fatigue, depression, acute agitation, tremors, hallucinosis, skeletal muscle spasms. And under the side effects: anxiety fatigue, depression, acute hyperexcited states, tremors, hallucinations, increased muscle spasticity! I admit I don't know how to use a drug like this: what am I supposed to do if I prescribe it and the symptoms continue? Stop the drug or double the dose? What strategy lies behind using drugs like this is a mystery to me. Perhaps doctors are playing the placebo effect for all it's worth? Or maybe they are merely trying to sanctify a patient's original symptoms [83] by giving a drug that causes them? Maybe they figure the symptoms will go away when the drug is withdrawn, in the fashion of primitive rites of purification and purging? In any case, Valium is the largest selling drug in history, with prescriptions approaching 60 million a year. Maybe it deserves to be the largest selling drug in history, since, by having identical indications and side effects, it achieves what all systems of science, art, and faith strive for: Unity!
You should not let your doctor prescribe a drug without asking him lots of questions. Ask him what will happen if you don't take the drug. Ask him what the drug is supposed to do for you and how it's going to do it. You can also ask him the same questions you will bring to the PDR, questions about side effects and situations when the drug is not advised. Don't expect too explicit an answer. Most drugs' mechanisms remain mysteries even to the people who develop them.
Once you've exposed yourself to all this information you have to sit down and decide whether or not you want to take the drug. Again, don't trust your doctor's decision. Even if you can get him to admit to the side effects, he'll most likely discount them by saying they occur only in a small percentage of cases. You also might get that impression from the PDR or any other book you consult. Don't be misled by risks that are expressed in small percentages. If you judge the danger of an iceberg by the size of the part that's above the water, you're not [84] going to stay afloat very long. Like a game of Russian Roulette, for the person who gets the loaded chamber, the risk is 100 percent. But unlike that game, for the person taking a drug no chamber is entirely empty. Every drug stresses and hurts your body in some way.
The doctor doesn't consider this because his philosophy of decision is corrupted. First Do Something. The doctor is going to find himself saying ridiculous things such as, "The Pill is safer than pregnancy." Because the doctor believes it, he's dangerous. You have to determine your risk individually. Only you, as you read up on the drug will be able to recognize certain conditions you have or have had which might make the drug even more dangerous. And only you will be able to decide whether or not you want to risk going through one or more of whatever side effects you find there in exchange for the possible benefit the drug may deliver.
Most of all, you should keep in mind that you can refuse to take the drug. It's your health that's at stake. If you read things that make you not want to take the drug, first of all confront the doctor with the information. Through cajolery, badgering, or some process of persuasion, you should convince the doctor that you really want to avoid the drug. As in all confrontations with doctors, his reaction may tell you more than you bargained for. You may once and for all recognize that his opinion is no more valid than yours.
On the other hand if you don't find anything [85] in your research to dissuade you from taking the drug, if the possible benefits appear to outweigh the risks, you're still not home free. You still have to protect yourself. First of all, make sure you carry out the instructions given by your doctor. If you find his instructions are different from the prescribing information in the PDR you should ask him why. He may have a perfectly good reason: his experience may suggest that the drug works best when taken according to his instructions. Or he may be making a mistake that could decide whether or not the drug will help you or hurt you.
Another reason why you should follow the instructions is that often these will include various tests that should be carried out while you're taking the drug, tests that are designed to reveal any serious adverse effects before they go too far. These tests are usually found with the prescribing information. Every doctor knows about or has access to this information. Yet few doctors bother to fulfill this responsibility. So it's up to you to make sure your body's reaction to the drug is tested.
You should also monitor the drugs effect subjectively. How does the drug make you feel? If you experience any side effects -- no matter how unimportant they may seem at first -- you should call your doctor and let him know. Here is where your homework can really pay off, because your doctor may not be aware of certain side effects that are a signal to stop taking the drug. On the other hand, some side effects are temporary, and if you've already [86] made up your mind to take the drug, you may not want to stop as long as the discomfort is temporary. If you're hit by a serious side effect you should immediately seek medical attention. Don't wait too long for your doctor to get in touch with you. Go to the hospital emergency room. You're not only protecting your health, but you're covering all the bases in the event any legal action ever results from the therapy.
If on the basis of your complaints of side effects, or because you refuse to take a certain drug at all, your doctor prescribes another drug make sure it's not the same substance with a different brand name. The doctor may himself be ignorant -- or he may be trying to put one over on you.
If you find yourself having to protect your child from the recommendations of school officials and doctors that he or she be "treated" for hyperactivity, your first move should be to prepare yourself to start with simple measures but be willing and able to go on to more drastic maneuvers. The simplest procedure involves a little diplomacy, a little skillful deception of professionals, and perhaps a few changes in how you manage your child. Have a conference with the classroom teacher. Let him or her know that you don't want your child receiving drugs and that you want to explore alternative ways of dealing with the problem. It helps to try to find out exactly what aspects of your child's behavior led the teacher to label him or her "hyperactive." You can ask for suggestions [87] on how to change your management of the child at home in order to better prepare for the classroom. Here is where you've got to be ready to lie a little. You should give the teacher's suggestions honest consideration. If they sound reasonable, you should consider changes. But if they don't seem like things you could do without sacrificing family habits and practices that you consider important, you should discard them. You don't have to tell the teacher that. You can lie and rave about how your child has changed so positively since you tried his or her suggestions. Chances are that will end the problem, since the teacher's expectations of the child's behavior determine the teacher's perception of it, and may even determine the child's actual behavior in accord with the self-fulfilling prophecy.
The next step is to have a conference with the teacher to explore possible ways in which the classroom management could be modified. You're going to meet resistance here, because the philosophy of most schools -- despite all the lip service to individual attention and consideration is that the student has to fit the mold cast by the school.
At this point, if you're not getting anywhere, you might want to consult with people who have wisdom and whom you trust. These can be special education experts or grandmothers.
Consider a change in your child's classroom. Before you allow a doctor to tamper with your child's chemistry, you should realize that perhaps it's the "chemistry" between child and [88] teacher, or child and classmates, that is really at fault. A move to another school could be the answer for the same reasons.
The most drastic solution is to remove your child from school altogether and have him or her tutored at home, if state law permits. If your child really does seem to have a behavior problem that goes beyond the normal range of childhood intractability, you might want to consider a solution many families have successfully tried: the Feingold diet. Dr. Ben Feingold is the chief of the Kaiser Foundation's allergy clinics. His diet eliminates food coloring and other artificial additives, and certain natural foods -- on the assumption that certain substances in these foods stimulate a child who is especially susceptible. The concept is sound -- although vigorously attacked by advocates of drug therapy.
You can't rely on your doctor to aid you in your struggle to keep a child diagnosed as hyperactive off drugs. the doctor may play along with you and say, "well, let's talk to the teacher and try to change the environment!" but in ninety-nine out of one hundred cases the doctor will return to the drugs. The same is likely to happen if you try to get your doctor to treat you without drugs in any other situation. Doctors simply don't believe in non-drug therapies. For one thing, very few of them know how to treat without drugs. So they don't believe in it. If you have high blood pressure and your doctor wants to put you on drugs but you don't want to take them, he might try by having you [89] lose weight and by exercising. But he'll make only a half-hearted attempt because in the first place he doesn't believe in it and in the second place doctors don't know enough about nutrition and lifestyle to really show a patient how to make a useful change. Maybe one doctor in fifty knows.
From the standpoint of the patient, of course, it makes perfectly good sense to want to be treated without drugs. But from the standpoint of the doctor, it's totally outrageous. Again, the ethics of the doctor and the ethics of the patient conflict. That shouldn't come as too big a surprise. Medical ethics are usually the opposite of traditional ethics. For instance, if you're in the operating room and somebody finds a sponge in the belly left from a previous operation, traditional ethics would make sure that somebody in the family found out about it. Medical ethics tells you to keep your mouth shut about it. The surgeon will say, "I don't want anybody to know about this," and if the nurse tells the family, she'll be out of a job. Medical ethics also waffles on the point of stopping at the scene of an accident. If a doctor passes the scene of an accident traditional ethics tells him to stop and try to save a life. Medical ethics tells him first to find out if the state has a Good Samaritan law.
The ethics of Modern Medicine are different from traditional religious ethics as well as from traditional social ethics. Religious systems that are in conflict generally try to dissubstantiate the ethics and beliefs of the systems they are at [90] odds with. In the Church of Modern Medicine, the doctor who treats without drugs is regarded as a heretic because he or she appears to have rejected the sacrament of medication. Nondrug healers are regarded as belonging to a different religious system and are thought of as quacks, nuts, or fadists. The religious restrictions are so stringent that doctors are discouraged from even associating with the infidels. The AMA code of ethics says that M.D.s are not supposed to associate with cultists. They're not to talk to them, not to have them in their homes! If you keep in mind that this is the type of person that's advising you to take this or that dangerous substance into your body, you should have no problem mustering the motivation to protect yourself.
[91] I believe that my generation of doctors will be remembered for two things: the miracles that turned to mayhem, such as penicillin and cortisone, and for the millions of mutilations which are ceremoniously carried out every year in operating rooms.
Conservative estimates -- such as that made by a congressional subcommittee -- say that about 2.4 million operations performed every year are unnecessary, and that these operations cost $4 billion and 12,000 lives, or five percent of the quarter million deaths following or during surgery each year. The Independant Health Research Group says the number of unnecessary operations is more than 3 million. And various studies have put the number of useless operations between eleven and thirty percent. [92] My feeling is that somewhere around ninety percent of surgery is a waste of time, energy, money, and life.
One study, for example, closely reviewed people who were recommended for surgery. Not only did they find that most of them needed no surgury, but fully half of them needed no medical treatment at all. The formation of committees to review tissue removed in operations has resulted in some telling statistics. In one case 262 appendectomies were performed the year before a tissue committee began overseeing surgery. During the first year of the committee's review, the number dropped to 178. Within a few years, the number dropped to 62. The percentage of normal appendices removed fell fifty-five percent. In another hospital the number of appendectomies was slashed by two-thirds after a tissue committee went to work.
These committees and study teams are composed of doctors who are still working within the belief system of Modern Medicine. There are dozens of common operations they would no doubt see as useful most of the time, such as cancer surgery, coronary bypass surgery, and hysterectomies. Yet as far as I'm concerned ninety percent of the most common operations, including these, are at best of little value and at worst quite harmful.
The victims of a lot of needless surgery are children. Tonsillectomy is one of the most conmmon surgical procedures in the United States. Half of all pediatric surgery is for the removal [93] of tonsils. About a million are done every year. Yet the operation has never been demonstrated to do very much good.
Back around the same time I got into trouble for cutting urological workups on children at an outpatient clinic, I got into trouble again for not discussing the size of tonsils. There are very rare cases -- less than one in 1,000 -- where someone may need a tonsillectomy. I'm not talking about when the child snores or breathes noisily. But when it really impedes the child's breathing, if he or she is really choking, the tonsils may have to come out. You don't have to ask a child or a parent about it. It's obvious! So I cut out that question on the examination. Of course, the number of tonsillectomies went way down. As you might expect, I soon got a call from the chairman of the ear, nose, and throat department: I was threatening his teaching program.
Tonsillectomies have been performed for more than 2,000 years, and their usefulness in most cases never has been proved. Doctors still can't agree on when the operation should or shouldn't be performed. The best reason doctors and parents can give for the attack on the tonsils is, as if they were some mountain range that had to be conquered, "because they're there."
Parents are lulled into believing that the operation "can't do any harm." Though physical complications are rare, they're not altogether non-existent. Mortality ranges in different surveys from one in 3,000 to one in 10,000. Emotional [94] complications abound. Getting to eat all the ice cream you want doesn't make up for the justified fear a child experiences that his parents and the doctor are ganging up on him. A lot of children show marked changes for the worse in their behavior after the operation. They're more depressed, pessimistic, afraid, and generally awkward in the family. Who can blame them? They can sense, and unfortunatety be seriously affected by, a patently absurd -- though dangerous -- situation.
Women also seem to be the victims of a lot of unnecessary surgery. Another operation steadily climbing towards the million-a-year mark is the hysterectomy. The National Center for Health Statistics estimated that 690,000 women had their uteruses removed in 1973, which results in a rate of 647.7 per 100,000 females. Besides the fact that this is a higher rate than for any other operation, if the rate continued, it would mean half of all women would lose their uterus by age 65! That's if the rate holds steady. Actually, its growing. In 1975, 808,000 hysterectomies were performed.
Very few of them were necessary. In six New York hospitals, forty-three percent of the hysterectomies reviewed were found to be unjustified. Women with abnormal bleeding from the uterus and abnormally heavy menstrual blood flow were given hysterectomies even though other treatments -- or no treatment at all -- would have most likely worked just as well.
In their lusting after the status and power of surgeons, obstetricians are rapidly turning the [95] natural process of childbirth into a surgical procedure. Layer upon layer of "treatment" buries the experience under the mantle of sickness, as each layer requires another layer to compensate for its adverse effects. Strangely enough, you can always count on doctors to take credit for the compensations, but not for the medical disasters that make the compensations necessary in the first place!
The first major intrusion into childbirth was the introduction of forceps. Two sinister sixteenth-century barber-surgeons, the Chamberlen brothers, always carried a huge wooden box into the delivery room. They sent everyone else out of the room and blindfolded the mother in labor before opening the box. It wasn't until the nineteenth centurv that the contents of the box became widely known: obstetrical forceps. Using forceps to extract the baby whether or not the birth proceeds normally was the first step towards turning labor and delivery into surgery.
The next step came as scientists became interested in the birthing process. Doctors began to compete with midwives, and as they won, the process came to be supervised by the male doctor rather than the female midwife. It wasn't long before childbirth moved from the home into the hospital, where all the trappings and stage settings for treating it as a disease could be easily arranged. Of course, when the male doctors took over childbirth, it did become a disease. The doctors did something the midwives never did: they went right from the [96] autopsy labs where they were handling corpses to the maternity wards to attend births. Maternal and infant death rates skyrocketed far beyond where they had been when midwives delivered babies. One courageous doctor, Ignaz Philipp Semmelweis, pointed out the deadly connection and was hounded out of medicine, and into an insane asylum for suggesting that doctors were the agents of disease. Once Semmelweis' suggestion that doctors wash their hands before attending a birth was adopted, maternal and infant mortality rates dropped -- an event for which the profession predictably took credit.
Once it became possible to drug the mother into a state of helpless oblivion, the obstetrician could become even more powerful. Since the mother couldn't assist in the delivery while unconscious, the forceps place in the delivery room was assured.
Sedated, feet in stirups, shaven, attached to an intravenous fluid bag and a battery of monitors the woman in labor is set up so well for surgery, an operation had to be invented so the scene wouldn't go to waste. Enter the episiotomy. So routine is this surgcal slicing of the perineum to widen the opening of the vagina that few women and even fewer doctors think twice about it. Doctors claim that the surgical incision is straighter and simpler to repair than the tear that is likely to occur when the baby's head and shoulders are born. They fail to acknowledge that if the woman is not drugged silly, and if she's properly coached by someone [97] who knows what's going on, and if she's prepared, then she will know how and when to push and not push to ease the baby out. When the birth is a conscious deliberate experience, the perineal tear can usually be avoided. After all, the vagina was made to stretch and allow a baby to pass through. Even if tearing does occur, there's no evidence that the surgical incision heals better than a tear. Quite the contrary, my experience demonstrates that tears heal better, and with less discomfort, than episiotomies. There is some feeling that the episiotomy may lead to a later lessening of sexual pleasure.
Obstetricians were not long satisfied by the minor surgery of the episiotomy. They had to have something more awesome and dangerous. After all, the delivery room setting only adds to the feeling that something terribly abnormal must be happening here. And such an abnormal process surely demands medical intervention. The more extreme the better. And since the delivery room is really an operating room disguised by the simple addition of an incubator, what really should be going on here is a full blown operation. Hence the obstetrical sacrifice graduates beyond the simple mutilation of the episiotomy to the most sinister development of modern obstetrics, the epidemic of Caesarean deliveries.
Fetal monitoring -- listening to the fetal heart either through the mother's abdomen or, most recently, through electrodes screwed into the infant's scalp during labor -- is the diagnostic [98] sowing procedure that is reaping the harvest of Caesarean section deliveries. Whether or not the fetus is really in trouble, if the monitor says something is wrong, there's a rush to slice the mother open and remove the baby. Then the obstetrician can bask in all the limelight that comes with performing a miracle. After all, he's snatched a life from the jaws of certain death or disablement. Studies of comparable deliveries show that Caesarean deliveries occur three to four times more often in births attended by electronic fetal monitoring than in those monitored with a stethoscope. That's not so hard to understand.
If the mother doesn't want the operation, all the obstetrician has to do is point to the distressed blips on the monitor screen. That's reality, what appears on the cathode ray tube, not what the woman feels and wants.
A woman has plenty of other reasons not to want her delivery electronically monitored. In order to attach the electrodes to the fetus' scalp, the bag of waters must be artificially broken. This results in an instant depression of the fetal heart rate. In one study, children whose birth was electronically monitored were sixty-five percent more likely to suffer behavioral or developmental problems later in life.
Of course, what the woman feels and wants is secondary to what the obstetrician says must be. And that includes scheduling the delivery according to the doctor's convenience. In many hospitals the induced, "nine-to-five" delivery has become the rule. Working only from his [99] calculations of when the baby is due -- which can be off by as much as six weeks! -- the doctor induces labor when he feels like it, not when the baby is naturally ready to pass through the birth canal. A labor induced by the doctor can end up a Caesarean delivery because a baby that's not ready to be born will naturally show more distress on fetal monitors, distress at being summoned prematurely.
Fetal lung disease, failure of normal growth and development, and other mental and physical disabilities associated with premature birth are dangers of induced delivery. As many as four percent of the babies admitted to new-born-intensive care nurseries come in after medically induced deliveries. Mothers, too, are more likely to end up in the intensive care ward after an induced delivery. Post operative complications occur in half of all women who deliver by Caesarean section. And the maternal death rate is 26 times higher than in women who deliver vaginally. I propose that we drop the term fetal monitoring and start calling it fatal monitoring!
Full-term, regular size babies delivered by Caesarean section are also in danger of a serious lung condition known as hyaline membrane disease or respiratory distress syndrome. This poorly understood, sometimes fatal, and usually unresponsive to treatment condition was once found almost exclusively in premature infants. If a baby delivers normally, the compressing action of the uterus squeezes the chest and lungs as the baby emerges. The fluids [100] and secretions that accumulate in the lungs are then propelled through the bronchial t