| HEALING NATIONS | the practice, the philosophy and the language of healing and alternative medicine for ourselves, for our communities, and for our nations |
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the following are extracts from Richard Dell's book Healing Nations |
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Side Effects Few drugs are administered without side effects. Sometimes side effects can be massive and painful; other times mild. Take one non-prescription drug, and let us ponder just how many side effects it has. And this is a drug that can be bought over the counter. This is a drug that for some people is as much a part of their lives as the cornflakes on their breakfast table. Sir, I have recently bought Boot's own-brand, over the counter sleeping tablets called “Sleep-Aid”. The packet assures me that I will enjoy a “restful night's sleep”. However, the leaflet inside warns me of some 25 possible side-effects, two of which are “nightmares” and “sleep disturbances”. But the side effects from some drugs are more serious. Chemotherapy in cancer treatment can produce nausea and hair loss. Some medications can kill: An adverse reaction to drugs is so common in American hospitals that it has become the nation's fourth biggest killer. Researchers who examined the results of 39 studies of adverse drug reactions in the United States calculated that they could affect as many as 2.2 million hospital patients a year, causing 106,000 deaths. This is equivalent to 4.6 per cent of all recorded deaths. To be fair on the drug companies, many of the deaths listed above may have been due to the administration of powerful drugs to already terminally ill patients. Nonetheless, it is a rare medicine indeed that has no side effect.
Letter from Miss Annabel Davis to ‘The Times', 14 th April 1998 This problem plagues us without us realising it. It twists in and out of our lives, as if weaving a spell across our senses.
Experiments show that stress can cause a decrease in the number of antibodies in our saliva. The result is a lowering of our immune defences. In fact, although they did not understand the mechanism, they knew that in the nineteenth century. The following is taken from ‘The Lancet' of 1884: ... the depression of spirits (following a bereavement and funeral) under which the chief mourners labour on these occasions peculiarly predisposes them to some of the worst effects of chill. And they know it now: The popular belief that illness is more likely to follow anxiety and depression has recently been substantiated by two studies in America . Immunologists are discovering more about the link between mind and body. For instance, we know that during stressful periods the body produces large amounts of a steroid called cortisol. This inhibits the work of macrophage cells which are a key part of our immune system--they digest the debris of dead cells in the bloodstream and they summon other defences such as T-cells when they encounter a virus, bacterium or other foreign organism. This means the body can no longer respond normally to infection. Gout can also be triggered by stress, as can ‘migraines, stomach aches, ulcers, hypertension, anxiety, panic attacks, depression, and back pain' We can present with flu one day, and stomach ache another. Two different conditions, it would seem. But there might be nothing wrong with our body . We might be suffering from problems in our life styles. And if we continue to concentrate on symptoms, we shall never get to the root of such problems. We ought to be looking upon our body as providing ‘signs'; not treating it as an entity separate from ourselves. Do the latter, and we shall be forever mesmerised by symptoms. We shall be ‘serial symptomees'. And of course, our doctors will collude in treating each symptom. They will do so because it is easier and quicker, because they can get us out of their surgery fast, and because they can retain control. Lancet 1884 quoted in ‘Pleasing the Patient', Geoff Watts. p38 ‘Sunday Times', 27 th February 1986 ‘The Paradox of Healing' by Dr Michael Greenwood and Dr Peter Nunn Lack of Humanity This is the bane of our modern lives. Too often within our medical practices there is a lack of genuine human care, whether in consultation rooms, or in medical procedures. It is not any one individual's fault. It is the system's fault. Prince Charles, president of the British Medical Association during 1982/83, told the association: By concentrating on smaller and smaller fragments of the body, modern medicine perhaps loses sight of the patient as a whole being, and by reducing health to a mechanical functioning it is no longer able to deal with the phenomenon of healing.
Quoted in ‘Pleasing the Patient', Geoff Watts, p 111 Rocketing Costs Medical costs rise every year. By 1991, medical costs in the USA had reached 13.3% of Gross Domestic Product. In Europe , in 1987, the figures were:
Britain : 6.0% Switzerland : 7.4%France : 8.4% Netherlands : 8.4%Germany : 9.5%
These are enormous sums of money. And alarm bells are being rung. Even when the above figures were compiled, everyone knew things were out of hand. This is what a British newspaper was reporting in 1988: The National Health Service is moving towards “terminal decline” characterised by exhausted , and demoralised doctors and nurses, endangered patients and “filthy” hospitals, a leading article in the British Medical Journal says today. In 1987, 3,500 hospital beds were closed because of lack of money, lack of nurses or other pressures, the article says. The result of reducing the average bed stay to save money is that patients are “in and out so fast that no-one has time to talk to them. The margins are now so narrow that patients are put in danger.” Yet it is not even as if the procedures involved, high-tech or not, are always efficacious: One standard textbook of clinical pharmacology has estimated that as many as 35 to 45 per cent of all prescriptions are for substances incapable of having any effect on the conditions for which they have been prescribed. But this would seem to have more to do with incompetence than with exploitation of the placebo effect. On the other hand, a study of treatments for the common cold found that a surprising 53 per cent of patients were prescribed antibiotics. The common cold is caused by a virus, and viruses do not respond to antibiotics.
‘The Times', 2 nd January 1988 ‘Pleasing the Patient', Geoff Watts, p120
Science has moved on from Cartesian dualism. But orthodox medicine has not. It is still locked in a mindset that debases us and disempowers us. Drs Michael Greenwood and Peter Nunn: Modern physics tells us that reality is best described as an indivisible whole, that everything is related to everything else, and yet modern medicine persists in separating mind from body, body from disease. Just as the mind and body are connected, so in fact are body and disease allied. From that perspective the idea that disease should be eradicated is absurd. Disease is fundamentally an extension of the self . It is the difference between objectivity and subjectivity. When we present to an orthodox practitioner we are externalising our problems. When we work with an alternative practitioner we internalise them. With the former we see ourselves as separate from the problem. We demand mechanical work done on our body to alleviate our symptoms. With the latter we are required to take responsibility for our condition, to share with the practitioner in discovering the root cause of our ills. When we break down the barriers we have erected between ourselves and our bodies, we no longer see our ills as structural . Instead we recognise them as part of our functioning . When we do that, we can actually welcome symptoms as signs of what is a truth about ourselves.” Knowledge is power. Teachers who double up on the games field see this. What they observe on a cold day, at the end of a hard match, is invariably what they observe in the classroom. Only the attitudes are now writ large. They are given a physical dimension; becoming more clearly defined. Capra, writing as a physicist, equates this functionalism with process: The second criterion of new-paradigm thinking in science concerns a shift from thinking in terms of structure to thinking in terms of process. In the old paradigm it was thought that there were fundamental structures, and then there were forces and mechanisms through which these interacted, which gave rise to processes. In the new paradigm, we think that process is primary, that every structure we observe is a manifestation of an underlying process. Dr Michael Greenwood and Dr Peter Nunn, ‘The Paradox of Healing', p29ff Invasive Approach Dr. Andrew Weil respects modern surgery: when it is properly conducted. But he sees problems: A common estimate is that 25 percent of operations are unnecessary. During the five weeks of a doctors' strike in Los Angeles in 1976, the weekly death rate in hospitals dropped below normal for that time of year. Analysts attributed the drop to unnecessary operations that were not performed during the strike. Emergency surgery went on unchanged, but elective surgery stopped altogether. Once the strike ended, and physicians and surgeons resumed full activity, the death rate rose and stayed above normal for several weeks. But it is not just our surgeons. The administration of drugs is invasion too. Cold steel might be obvious. But the pill, or the needle invade us no less.
The readiness of orthodox practitioners to prescribe antibiotics for the common cold is well documented. And antibiotics are not only ineffective against a virus, their liberal use endangers their future efficacy. Bacteria mutate fast. There already exist strains that are resistant to our newest drugs As stated before, we must see symptoms as signs to be welcomed, not as threats to be ‘nuked'. We learn nothing from fighting wars against our own bodies. We learn and gain everything by entering into the story, the dialogue, the life signs that our body/minds, and indeed that our body-politics, can furnish us. Problems of Diagnosis “So how would you feel,” we say, “if we told you that in the year 2000 the British National Audit Office reported that up to 40,000 patients a year died as a result of hospital accidents, and that one in fourteen patients suffered an ‘adverse event', such as diagnostic error or operation mistake?” “I wouldn't believe it,” says Mike. “Nor would I,” says Sandy . “Then read the National Audit Report of the 5 th April 2000. In fact, by 14 th June 2000, the British Chief Medical Officer was estimating that 850,000 patients a year experienced ‘harmful adverse events' in hospital, and that ‘one in ten patients admitted to hospital becomes even more ill because of medical errors and negligent care' . Mike and Sandy look glum. “Let's look at diagnosis in detail,” we say. “If you go to a doctor with a throbbing thumb and a hammer in your hand, you will get an incontrovertible diagnosis. It will be pronounced that you have hit your thumb with a hammer. But is diagnosis always that simple? “Of course it isn't,” says Sandy . “Even I could tell what's wrong if you came to me like that. So could Mike: on a good day.” “Ha. Ha,” Says Mike. “The point is,” we say, “even with modern technology it is not simple. The causes of illnesses are rarely obvious. Prognosis is uncertain, prescription has built in flaws, and response to treatment, even after correct diagnosis, is unpredictable.” “Demonstrate it,” says Mike. “Let us see what consultant physician Graham Bradley B.Sc. Ph.D. FRCP, who in the 1990s was Clinical Director of Medicine at South Kent Hospitals , had to say. He made a study of how doctors make decisions. Graham Bradley shows that diagnosis is difficult from the beginning: In the majority of cases, what the patient has to say about his illness—the history—contributes most to the diagnosis... Disagreement is not limited to clinical features found on physical examination; observer error in taking the medical history has also been shown… Any doctor will have been struck by the ability of patients to give what seems to be a completely different history to different people, and even to the same person at different times. This is usually not cussedness on the part of the patient, but is a response to the way the questions are asked. “Look,” we say. “The doctor has barely begun, and he or she is in a minefield.” “So what we tell the doctor isn't always accurate,” says Sandy . “So what?” “All we can say is: Pity the isolated doctor in his surgery. But pray for our political practitioners as they try to make sense of their newspapers, opinion polls, weekly magazines and academic digests. But the diagnosis problem does not end with the history. Once we have caught our breath, the physical examination begins.” However accurate the diagnostic process may be, when the clinical findings are inaccurate a correct diagnosis may not be made. Students desperately listening for reverse splitting of the second heart sound may be unaware that even cardiologists disagree about the findings on auscultation, and specialists in other fields show an even greater disagreement when examining the heart… Fletcher was one of the first doctors to question the accuracy of clinical findings by putting this to the test. He arranged for experienced doctors to examine the chest of patients with emphysema to assess consistency in the evaluation of physical signs. Agreement was not very good, and, with many signs, little better than chance. Why are our medical practitioners experiencing such difficulties? Why, after a century of remarkable technological advances, is diagnosis a problem? The answer comes down to philosophy. Everything centres about the flaw at the heart of the orthodox lexicon.
Our classical scientific lexicon relies upon Isaac Newton's concept of cause and effect. Event ‘A' always causes event ‘B'. And in much of our universe, that is true. Nothing arbitrary is happening when we strike a billiard ball. Hit it right, and it will travel right. Indeed, if we know exactly how the ball will be hit, the movement of every other ball can be predicted. This is because they obey Newton 's laws of physics: as do the planets, as does a rocket going to the moon. And it is not just in physics. Even our medical, economic, social and political practices can be predicted by those laws. Let dirt into an open wound and the wound turns septic. Up the price of your commodity and demand is reduced. Treat prisoners like animals and riots ensue. Punch your boss in the evening, and be sacked in the morning. But note the emphasis: “ can be determined.” Newtonian physics breaks down when describing complex systems: such as the atom, or the complex entity that is the human body and mind. Take the examples above. None of them entirely obey those physical laws. Some wounds do not fester. Some commodities sell better when more expensive (raise the price of luxury goods, and exclusivity can be achieved). Some prisoners will become so cowed they withdraw into themselves. Some bosses might be impressed by the blow; others might be dead by the morning. Complex systems? Yes. The breakdown of Newtonian physics? Possibly. Or, if we choose to be mechanistic, there are so many unknowns we can never truly predict the outcome. Thus one person will smoke sixty cigarettes a day and never contract lung cancer. Another will smoke nothing and will die of the disease before forty. Tell one patient she has cancer and you can be certain her gloom will speed her to death. Tell another who has the same dyed hair, the same bizarre dress sense and the same sort of husband, and she will fight the damn illness to go on and laugh at her doctors on their own deathbeds. And it is not just diagnosis. The complexities of prognosis, prescription, treatment, and response to treatment come into play. But the point is the same.
“Are you saying there is a flaw at the heart of modern medicine, and therefore at the heart of modern politics?” asks Mike “Yes.” “And the flaw is philosophical?” “Yes,” we say. “There is that tendency. Most doctors understand the problems. Their patients usually do not.” “And you are saying the flaw is that orthodox medicine is mechanistic, in that it assumes that event A will always cause effect B?” “Very good,” we say. “Whereas human beings are too complex for that to apply?” “Yes.” “And likewise a nation is too complex for it to apply?” “Correct. But it is not just that we are too complex. For that would imply that all we need do is gather more information. The point is that we as human beings are not machines; but we can come back to that. Let us for now consider that paradox which lies at the heart of our medical and political arenas. It is simply stated:”
But diagnosis leads to prescription. And it is the prescriptions that we triumphantly present to our local pharmacies. They are proof of our ailment. They are talismans of a better and pain free future. Much of this chapter has been informed by Graham Bradley's book. He describes the problems inherent in prescribing: Anyone who doubts the existence of wide variations in medical practice—and there can be few practising doctors to whom this could apply—need only glance at the literature to convince themselves that inconsistencies abound. This was convincingly shown in a study which looked at the advice given to school children with recurrent tonsillitis. At the time the study was published (1945), tonsillectomy was a popular approach to this problem and out of 1000 children with this problem a group of doctors decided that 611 required tonsillectomy. The 389 children for whom tonsillectomy was not advised were taken to a second group of doctors and the same question with regard to tonsillectomy was asked. It was now decided that 174 of these children required tonsillectomy after all. Undaunted by this finding the authors had a third opinion on the remaining 215 children to discover that 99 of them required surgery. The reader will not be surprised to discover that the intrepid research workers took the remaining 116 to yet another group of doctors and that they advised 51 to have surgery. Out of the original 1000 children only 65 had been consistently advised not to have tonsillectomy. At that point they ran out of doctors! “I'm not enjoying this,” says Sandy . “It makes me scared.” “You don't need to be scared,” we say. “You just need to understand the situation. Then you can question, and consider alternatives.” “Exactly,” says Kate. “We already have complementary medicine, precisely because of these sort of things.” “Look,” says Mike. “I understand that diagnosis and prescription can be difficult. Being a doctor isn't easy. But you've been looking at complicated things. Most of what doctors and politicians do is clear cut.” “You think tonsillitis is complicated?” Kate asks. “Well…” “Graham Bradley talked about simple issues,” we say: Medical students soon learn that the practice of medicine is far from straight forward: there are difficult choices to be made and risks to take. As a young medical student, steeped in anatomical, physiological and biochemical knowledge, ready and keen to apply this knowledge to my future patients, I was somewhat disappointed when the ageing—but no doubt wise—Professor of Surgery spent all his first lecture showing how the treatment of blisters had changed over the years. It seemed to be either mandatory or contra-indicated to puncture blisters depending on which decade you lived in. Apart from leading to a lifelong distrust of the words ‘mandatory' and ‘contra-indicated', this shook my confidence. If we didn't know how to treat blisters what hope was there for the treatment of more complicated conditions? ‘Disease, Diagnosis and Decisions', Graham Bradley, pp 61-65 ‘Disease, Diagnosis and Decisions', Graham Bradley, p64 ‘Disease, Diagnosis and Decisions', Graham Bradley, p111 ‘Disease, Diagnosis and Decisions', Graham Bradley, pX Enough has been said. But let us take this one simple point on board. If diagnosis presents us with difficulties, as we have seen, then should we not be more careful before adopting the invasive approach? Should we not be more circumspect with the blade, less trigger happy with whatever latest “magic-bullet” drug our pharmaceutical companies have foisted upon us? Autopsies show that a high percentage of diagnoses are wrong. And no-one should be trigger happy without being sure of the facts.
There are of course exceptions. The symptoms of meningitis, for example, can appear benign, and yet require immediate attention. No-one promised us an easy world. We Present as being Sick and in need of a Cure Why are our medical practitioners so rarely involved in preventative medicine? Bad enough in itself is that fact. Serious enough too, when we consider the soaring costs of medicine. In ancient China they only paid their doctors when they were well. Once ill, the doctors worked for free. Think how that alone might change our medical and political arenas! But there is something far worse in this pathological, even morbid, relationship between us and our doctors.
Too often the doctor works only with an enfeebled aspect of ourselves. And what does that result in? The growth of a one-sided, and damaging, power relationship. It should not be like that! We should not be ashamed of the times when we are laid low. All such moments can be blessings in terms of the lessons we might learn from them. But no-one so important as a doctor should know us only when enfeebled, only when in need. We must be in partnership.
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Healing Nations: life / society / nation-changing |