Tuesday, 1 April 2014

The Limits of Modern Medicine

Medical science has limits an we discover them soon enough when we, or
someone we care about, are ill or in pain. Better treatment does not mean
better health. Medical care improves, but rates of illness continue to rise.
Most suffering is beyond the reach of medicine.

There are three main ways of measuring the general health of the
population. First, whether you live at all- infant mortality. Secondly, how
you will live. This can be roughly measured by work days lost through
sickness. Thirdly, how long you live- adult mortality and average lifespan.
The effect of modern medical practice, systems of prescribing, and
hospitalisation, influence these standard indices by less than 10 per cent.
The rest are governed by factors over which doctors have little or no
control- amount of exercise, social conditions, eating habits, air quality- in
other words social and environmental conditions and individual lifestyle.

We would not wish to demean biomedical achievements. Within their
chosen area of treating disease their impact has been considerable,
increasing both longevity and quality of life. However, the greatest
advances in public health have been achieved through sewage disposal,
water purification, pasteurization of milk and better nutrition. It is these
that have led to the greatest increase in quality and length of life.

In 1900 the average American life expectancy from birth was about 48
years. In 1990 it was 79. However, most of this increase has been
because medicine has been successful at reducing infant mortality by
preventing and treating dangerous diseases of childhood. Life expectancy
has not increased very much for adults. At the moment, a 45- year old
man in good health can expect to live another 29 years. In 1900 a man of
45 could expect to live another 25 years. We are healthier today not so
much because we are receiving better treatment when we are ill, but
because we tend not to become [acutely] ill in the first place. The main
effect of many medical advances is that people are now able to live longer
with their illnesses.

Modern medicine acts as if al health problems are biological and can
ultimately be solved through research. But the diseases that threaten us
now are very different from those infectious diseases against which
medicine has proved so successful. Now, the main threats are
degenerative diseases such as heart disease, cancer, rheumatoid
arthritis, osteoporosis and diabetes, and those associated with the
breakdown of the immune system, such as AIDS. Alzheimer’s disease is
an enormous problem as the population lives longer. And regularly new
illnesses come to light- myalgic encephalomyelitis (ME), seasonal affective
disorder (SAD) and repetitive strain injury (RSI). Many environmental
factors are now seen as contributing to disease- and air pollution and
overcrowding cannot be immunised against or easily prescribed for.

Nature also keeps pace with our medical ingenuity. As fast as we develop
drugs to cure infections, the micro- organisms change and adapt. For
example pneumonocuccus is a bacterium responsible for meningitis,
pneumonia, and middle ear infections. Research at the American Centre
for Disease Control and Prevention in 1995 found that 25 per cent of
patients were infected by a strain of pneumonococcus that was resistant
to penicillin. Ten years earlier, in 1985, the frequency of penicillin
resistant pneumonococcus was less than 1/10 of 1 per cent.

A survey of half the intensive care units in Europe carried out by the
Journal of the American Medical Association found more than 20 per
cent of patients they examined had ear infections they had acquired in
the unit. These infections were resistant to antibiotics. A three week
stay in intensive care increases your risk of infection 33 times. As fast
as we find drugs, micro- organisms become resistant to them.

Medicine has less impact on our health than we think and we have more
influence than we give ourselves credit for. This is clear when doctors are
not available. In 1973, when doctors in Israel were on strike for a month,
admissions to hospital went down by 85 per cent. The death rate dropped
by 50 per cent to reach its lowest recorded level. The previous low level
was 20 years before- also during a doctor’s strike. During a doctor’s
strike in Los Angeles County in 1976 to protest against high malpractice
insurance premiums, the death rate fell by nearly 20 per cent. Sixty per
cent fewer operations were performed. At the end of the strike the
death rate quickly rose to normal levels. Such strikes bring home that
your individual longevity and individual health are your responsibility.

[Reproduced from NLP and Health by Ian McDermott & Joseph O’Conner,
1996. Since it was written, some of the things they mention such as
antibiotic resistance, and the development of new clinical syndromes have
increased so much that they are now considered an everyday fact of

By South Utsire

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