John Tyndall, Science and Man
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Let's leave the new drugs. What's old? Blood, for example, which carries with it overtones of cannibalistic rites. "In the blood is the life," says the Bible. Also death and illness. "Transfusions are still one of the most dangerous forms of medical therapy," states Dr. Aaron M. Josephson of the Michael Reese Research Foundation and Blood Center in Chicago. Transmission of hepatitis, syphilis and malaria are possible hazards of blood transfusions, but more important are sensitization to blood antigens, unpredictable sbock-like reactions, and hemolytic changes. A significant alteration occurs in whole blood stored in blood banks; there is an increase of plasma potassium, plasma ammonia, inorganic phosphates and free plasma hemoglobin, besides a heightened alkalinity of the blood. The altered blood is often deleterious to patients with heart, liver and kidney ailments, to old people and to infants. And yet how many times have families expected and have their doctors ordered blood to be given to the unfortunate The Medicine Men patient "just to make sure?" 3. What else does the doctor do to help his patients get well? He uses instruments for diagnosis and treatment, not gourds or sand paintings, but ingeniously devised tubes and mirrors. Without them he'd be at a loss. Without them he could not photograph the arterial supply of the brain or map the chambers of the heart or supply air to damaged lungs and nutrition to unconscious patients. The doctor knows the hazards of such treatment, but in his zeal to do good be brushes that knowledge aside. Tracheostomy is the making of an artificial opening in the windpipe so that oxygen maN- be more easily administered, under pressure, if need be. The operation has become almost routine in badly burned or severely injured patients. "The major fatal complication is no longer wound sepsis [infection] but pneumonia. The decline in wound infection is due to eff ectix,,e topical chemotherapy [local application. of chemicals that kill germs], and the rise in fatal pneumonia is probably due to the effects of earlier and more prolonged ventilatory assistance and oxygen therapy ... Tracheobroncliitis is the most frequent finding in the lungs of burned patien.ts. The focal ulcerative laryngeal and tracheal lesions seen are clearly related to tracbeostomy rather than to inhalation therapy . . . . ~" In other ,-,,ords, in their zeal to help the severely burned patient, the doctors have overreached themselves and bax-e ended up with harming him. Enough said. Bladder catheterizations, often done to save bed linens and wear and tear on nurses, accounted for 40% of hospital-acquired infections in the Johns Hopkins survey previously quoted. That percentage does not include infections after diagnostic cystoscopies. The routine use of intravenous infusions for support and nutrition, conveniently provided now by plastic indwelling tubes, has brought on almost an epidemic of septic phlebitis, inflammation of the vein in which the tube is lodged. The growth of bacteria in one part of the circulatory system then is frequently followed by septicemia. In burned patients especially, an eighteenmonth study by the Army Surgical Research Unit at Fort Sam Houston, Texas, disclosed that post-phlebitic septicemia caused the death of 12clc of those autopsied. A Harvard study in 1968 showed a 34.3~Ic incidence of 50 Capt. F. Daniel Foley, M.C., Col. John A. ),Ionerief, NI.C., and Dr. Arthur D. Mason, Jr., "Pathology of the Lung in Fatally Burned Patients," Annals of Surgery, 167:251-264, 1968. 49 Dr. E. Y. Kuzucku, in the Journal of the Anierican ~ifedical Association, 211:1162, 1970. Cauldron
NN-heii the medicine man approaches with his paraphernalia, maybe the cringing patient should cry out, "Don't do me any favors!" To put it bluntly, do not submit yourself to having instruments and devices pushed into natural or artificial orifices without good and sufficient reason. The doctors may call you uncooperative, So what? Names will never hurt you. The catheters may. 4. That's for treatment. It's worse when sickness follows diagnostic procedures like angiograms, cardiac catheterizations or pyelograms. They are not entirely innocuous. Arteriography, the visualization of arterial circulation, one of modern medicine's most imaginative techniques, should not be used routinely in diagnosis, warns Dr. William Likoff, Professor of Medicine and Director of the Cardiovascular Institute at Habnemann Medical College in Philadelphia. He says, "It is a sophisticated, expensive procedure fraught with danger and requiring hospitalization ... The physician can inadvertently destroy the artery or cause the formation of a clot ...... When multiple angiograms using a contrast medium are used in infants, there is a grave risk of renal medullary necrosis, a fatal disorder." Besides the dangers of infection and allergic reactions (often piously referred to as "an act of God," thereby removing the blame from the doctor and placing it on the Blameless One), the instrument that is being used may perforate the part being examined. Such accidents, although rare, happen often enough for patients to be wary of examinations "just for the record." The antics of the witch doctor may be comical to behold and may not do much good, but at least he can't be held responsible if his patient gets sicker or dies. His jumping around diddt do that. 5. "WE DID OUR BEST" A young man had an acutely inflamed throat. He went to his doctor, who gave him an injection of penicillin. The sore throat quickly got better. Three days later, the young man began to itch. The itching got worse and he developed hives all over his body. The doctor made the correct diagnosis of an allergic reaction to penicillin. He prescribed antihista mines. The hives disappeared. The young man, a machine operator, got drowsy from the antihistamines and cut his hand at work. The nurse in the dispensary gave him first aid and put on an anti-bacterial ointment containing penicillin. The hives returned and now the young man had swelling of the eyes and lips. The doctor recognized that a potentially dangerous allergic reaction was present; he ordered a course of corticosteroid treatment. Result-the itchiness, the hives and the swellings disappeared and the patient was well again. Except that now he had pain in his belly plus heartburn, and he began to show signs of blood in his stools. The correct diagnosis of a peptic ulcer (induced by the corticosteroid) was made. The young man did not do well on medical treatment; he continued to bleed from his ulcer. His doctor, therefore, bad a surgeon in consultation. The two doctors agreed that partial gastrectomy was necessary, an operation to remove the ulcer-bearing portion of the stomach. The operation was successful. But because of the previous bleeding and the unavoidable blood loss at the operation, a transfusion of 1000 milliliters (two pints) of blood was given. Hepatitis (inflammation of the liver) followed. The young man became intensely jaundiced; be vomited his food and had to be fed intravenously for a few days. His youth did him in good stead. He recovered from his hepatitis. At the right ankle, where the intravenous needle and the plastic tube bad been inserted into a vein exposed by cutting through the skin, a tender nodule appeared. It became red and inflamed, evidence of infection. Because of the bad experience the patient bad had with penicillin, the doctor prescribed tetracycline. The inflammation promptly subsided. Because of the antibiotic, diarrhea came on and the patient had severe colicky cramps. The doctor ordered a special diet and gave a new synthetic antispasmodic drug to control the cramps. Diarrhea stopped. The new drug was in the belladonna class. It relaxed smooth muscle all over the body, and by its action on the iris, it caused dilatation of the pupil. The young man's vision was impaired. He drove his car into a tree. Exitus young man. This is a true story. 51 Reported by Dr. Alan B. Gruskin, director of pediatric nephrology at St. Christopher's Hospital for Children, Philadelphia, basing Itis finding on histologic studies of 34 infants who died after diagnostic angiography to evaluate congenital heart disease. 60 The Medicine Men Advice From an Infidel "Knowledge is the principal thing; therefore get kiionvledge: and NN7itli all t]iN- ,ettiiig get understanding." Proverbs, 4:7 Is N-our flesh crawling? I hope so. I hope I have instilled some doubt into you, some doubt about the efficacy of the ceremonials of American medicine men. In doubt lies the beginning of wisdom. If x~oti can't put faith in your doctor, what can you do'-' First, forget the faith. That word shouldn't apply to doctors. Next, do some hard thinking. You want physical iiiimortality, of course. Well, that's impossible. Then do you want to prolong the years of your life? Not at all, if that means being blind, deaf, doddering, incontinent, a stinking Struldbrug, a painful burden to your children, a living inemento i7wri. You want to live in full possession of your faculties, to enjoy eatiiicy and drinking and sex, to be vigorous and alert. So how do you achieve those glorious goals? I can offer you a few guide points. Don't regard your doctor as a wizard but as a niortal man who sees in the world a microcosm of ailments. And because of his specialized vision remember that he is sliortsi(rlite(l. He xn,aiits to solve one problem and he often can, but to -,N71iat end? NN'liat's the use of treating ilietiiiiatoid artliritis NN,itli effecti\,e aiitiiiialarial drugs if blindness ii-tay occtti-? NN']iNorder iodized salt to prevent ,~oiter and end tip with severe aciie in adolescents? lIoNNvaluable is an orcyaii transplant -,N,Iieii the coijclitioii that caused the trotil)le in the original oi-glill persists ( as arteriosclerosis, in the case of Di-. Blail)ei-g) ? Don't expect more of the doctoi- than an honest and iiitelli(,eiit application of his leariiii)g. That means what lie does lie should do well and wliat lie can't do lie slioti](I let alone or (,et help in doing it. It also means that lie should not order laboratory work as a routine \N,itliotit specific need for it, and he should explain its iiecessitn- to .-oti. Don't ask him to work miracles. He cannot resurrect the dead iioi- restore power to linil)s paralyzed by severance of the spiiial cord. He cannot foretell the exact hour of birth nor prognosticate the moment when life will depart. He cannot make the blind see without eyes, nor tl-ie deaf hear without auditory nerves. He can't e\,ei) promise your backache \x-ill not i-ectir nor ,,,our litir not turn gray. Don't foi-tret there are no top secrets in medical care. Doctors like to cro\N, al)otit their sticc,esses: they hasten to I)til)lisli tlieii- good results. Once ~t pi-ocediii-e is no ~7) loii,,ei- experimental, its use becomes iii)i\-ei-sal. Once a di-ti,, est~il)lislies its iiierit, eNer\, (loctoi- will prescribe it \N,Iieii it is ii)(licated. OiilN,, charlatans pi-eteiid to have secret remedies. The (la\7 after the clti-e for cancer is (liscoN-ei-ed, \-Our doctor will know about it. Don't think ~iii\,oiie else kiio\N-s iio\N, and won't tell. Don't demand of the doctor the tenderness and love ~-oti may be iiiissiii(j- in votir life. "A kiss on your hand makes \7ott feel (,ood but a diamond bracelet lasts a long time." The doctor is not a substitute for wife or ii-iother or I)iisl)aiicl or father. His jol) is to keep you well and fit. That means a radical change in your attitude toward doctors. Don't be a gttllil)le participant in the s6aiice. Don't regard doctors as wizards, omniscient and possi1)1\- omnipotent. Renieiiil:)er the dialectic relationship: \"Iitliotit voti lie wotildii't be a doctor. Therefore-don't let N-otir I)odN- I)e poisoi-ied by paradoxically useful and tiseless drugs. Ask, ask, ask about the dangers in the prescriptions. Let the doctor think you're an overcautiotis iitit. His opinion won't hurt you as much as a liarniftil medication. Don't submit yourself to diagiiostic procedures of doubtful value and doubtless possil)ilities for, hari-i-i. Insist oi-i knowing why they are being ordered. Don't be a guinea pig for the latest medical fads just because the joneses are falling for them. And don't go to the other extreme-don't set \,our itidgmerit against your doctor's as to what is good and what is ])ad in medicine. Presumably he gets his information from better sources than you do. just make sure be knows what lie is doing ai-id why. Your own common sense must be used. If a technique or a procedure or a drug doesn't make sense to you, ask your doctor to explain. Don't be put off by medical double-talk; if he says you won't understand, rest assured he doesn't ei Advice From an Infidel ther. Making him speak straight English will make him oftener so much in a hurry that they do instead of think straight too. Don't think that by stiing the doctor when he makes a mistake that yoi-i're goina to improve the qualit-,7 of medical care. All you're doing is making his malpractice insurance rate go up and that expense is inevitably -added to ~rotir ])ill. \Ialpractice su:ts make lawyers richer, not you healthier. You're mistaken if you think a le,,al jtidgment can alter a i-iiystic ritual. Don't i~iiterfere in the doctor's practice, except to poke fun at his antics. You don't know the details of what is necessary to turn the art into a science. Wellr~ieaiiiiig reformers tried to cure alcoholism by Prohibit-loii and ended tip with Capone. Demai-idiiig medical care audits, uniformity of records, compulsory laboratory teStiDg-all lead to an increase of l~)urdensome bureaucracy and an increase in the cost of medical care, not in its quality. Likewise, don't get carried away I)x, the idea that So\-iet-style polyclinics or Britisb-style panel medicine will automatically bring about superior medical care. '\IaN,I)e you won't have to wait so long for the witch doctor to come, but when he does he'll have the same old bag of tricks. Nor is prepaid health insuran(,e the answer. What difference will it make if the witch do~,tqr,:- -oid by the state if the mummery's the same? Remember that, altho~,igh doctors make a great deal of moiie),, iiione), is seldom their sole aim when they treat you. They actually want you to get well. Don't attribute mercenary motives to tliei-i-i when they advise an operation or diagnostic tests. just be sure that the --~---feasons they give for those procedures make sense to vou. Doctors are Dot conscious charlatai-is or ignorant irauds, but they are often intellectually lazy and even think. Change doctors if the one you have is not candid with you. Change if his treatment is not giving results or if it has added complications to what you started with. Chai-ige if he promises miraculous cures. Change if he treats you like a child or an idiot. Change if he gets angry when you question him about his diagnosis or treatment. There are plenty of good doctors around. You have to look for them and from personal experience I can tell you the search will not be easy, but it is well worth the trouble. "Every country has the government it deserves" runs the adage. And every country has the doctors it deserves. If y*ott want to get away from witchcraft, start throwing out your own superstitions. Be open-minded and receptive to fresh ideas. If you hanker for the good old days when Doc tramped through the snow carrying a heavy black bag, you'll keep right on being satisfied with Doctor in a shiny office radiating sympathy. What's needed in this country is a new kind of medical practice, one that won't be dependent on your good will oi- your willingness to be amused, one whose function will be to prevent illness and to cure or alleviate those illnesses that cad't be prevented, one that will help you to reach your goal of a long, happy and healthy life. flow that will come about I don't know, but I do know that an intelligent, informed public can help to eliminate much of the ceremonial nonsense that attends present-day ryiedical practice. I didn't mean to eiid by giving advice but I did, ann,way. That's what comes of being a doctor for so long. Out of habit I clon the mask and give a solemn opinion. Do you trust your doctor? Does he really know what he's doing? To most Americans, the answer to such questions is an immediate "Of course," and to this extent our blind faith in the wisdom and powers of physicians is little different from the belief of primitive peoples in their witch doctors' incantations and spells. THE MEDICINE MEN is a well-documented and witty book which explodes the myth of quality medical care in the United States. Dr. Leonard Tushnet, a respected doctor of almost forty years' experience, here analyzes many of the recent "breakthroughs" in medical technology, diagnosis and treatment, and finds that they' have been dangerously overemphasized and not fully understood by many in the medical profession. THE MEDICINE MEN gives the layman an insider's view of both general practitioners and specialists-internists, obstetricians, psychiatrists, gynecologists and surgeons, among others-and some of their commonly used and often dangerous treatments. The author also casts serious doubt on the effectiveness of some of our most honored articles of medical faith: the annual check-up, laboratory ''tests," and medical "consultations. '' This is a book which pulls no punches. It is not an indictment of all doctors, but it does offer sound advice on how to tell a competent physician from a highly educated witch doctor. THE MEDICINE MEN is a book which could conceivably save your life, and is required reading before you keep your next appointment with your doctor! Dr. Leonard Tushnet has recently retired from his New Jersey Medical practice after almost forty years of service. He is the author of numerous medical and historical articles, and has had more than sixty short stories published in the past ten years. Two of his previous books have dealt with the history of the Warsaw Ghetto. THE MEDICINE MEN is his first full-length analysis of the profession to which he has devoted most of his life. Jacket design by John-C-,---,h CONSUMER EDUCATION RESEARCH GROUP P.O. BOX 336 SO ORANGE, N.J. 07079 Directory: 2013 2013 -> Annual InStructional unit plan 2013 -> The Ministry of Education and Science of Ukraine 2013 -> #1 a lifesafer of virginia inc 2013 -> Name(s): your name here team or Group #(if applicable): Professor’s name 2013 -> Alcott Local School Council (lcs) Meeting Minutes 2013 -> Table Of Contents introduction 2 2013 -> Supplemental demographic information 2013 -> 【Education&Working Experience】 Download 468.23 Kb. Share with your friends:
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