First Duties of The Physician: How Are They Doing Now in This Regard?
"One of the first duties of the physician is to educate the masses not to take medicine." Says Sir William Osler, the father of modern medicine.
"Medicine is a collection of uncertain prescriptions the results of which, taken collectively, are more fatal than useful to mankind." The French emperor Napoleon Bonaparte's sentiment about medicine justifies the appeal of the father of modern medicine.
A Marquis' Sentiment Re-Confirmed by His Own Death
Napoleon died at the receiving end of such a medical practice he described. He was only 51 when he died in 1821 on the island of St. Helena, where he was out of power and exiled from his beloved France. Prior to his death, he had been suffering from recurrent abdominal pain and unabating constipation. His last weeks were plagued by vomiting, incessant hiccups and blood clots in various parts of his body (Markel H, 2022).
The physicians who conducted Napoleon’s autopsy concluded that his death was from stomach cancer, exacerbated by bleeding gastric ulcers, after a huge dose of calomel (a compound containing mercury) was administered to him on the day before he died.
One could ague that Napoleon was not a physician, nevertheless his sentiment about medicine in 1800s could not be more scientifically accurate even today.
Medicine from 500 BC to 20th Century
2500 years ago, Hippocrates (460-370 BC), the father of Western medicine, stated, “The greatest medicine of all is teaching people how not to need it.”
In China, 100 to 200 BC, the Chinese Medicine Classic Huandi Neijing talked about the drugs and non-drug medicine: “The Yellow Emperor asked Qi Bo: I take pity on my people, ... I don't want them to have to rely on poisonous drugs [herbs and non-herb substances]...”.
In 18th century, “If the whole materia medica, as now used, could be sunk to the bottom of the sea, it would be all the better for mankind—and all the worse for the fishes”, says Oliver Wendell Holmes (1809 --1894), dean of Harvard Medical School.
In 1970s, Medical doctor Robert Mendelsohn in his book "Confession of a Medical Heretic" (1979) criticized: “Medicine's treatments for diseases are seldom effective, and that they are often more dangerous than the diseases they're designed to treat.”
Medicine Today
A drug without toxic effect was no drug at all. This is how Eli Lilly (1838-1898), founder of the drug company of that name, defines a drug. However, drug intervention is extensively used in modern medicine as the first line treatment.
Overprescribing has become a vicious cycle: One prescription often leads to another. A drug given for high blood pressure may cause ankle swelling due to fluid retention, leading to another prescription for a diuretic (water tablet), which may cause potassium depletion, leading to a prescription for potassium tablets, which may cause nausea, leading to a prescription for anti-nausea drugs, which may cause confusion, and on and on (O’Mahony S., 2019).
In 2022, a report published on the Global & Mail titled: "The unnecessary crisis in Canadian health care: We know what needs to be done, but not how to do it". (Andrew Coyne, 2022).
In US, more than 100,000 'unnecessary' operations were carried out by America's hospitals during the first year of the COVID-19 pandemic, a report at DailyMail.com finds (Luke Andrews, 2022).
Modern medicine wastes a huge amount of money. Despite its global dominance, this medical-industrial complex has given us meagre, feeble comforts at vast expense. It has been estimated that as much as 85% of medical research is useless. The spending huge amounts of money on drugs did little to improve health or prolong life (O’Mahony S., 2020).
Roughly 30% of total health spending in the US is wasted; similarly, in Canada, if health care dollars were used more efficiently, health outcomes could be improved by up to 35% (Allin S, 2019).
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Let’s face it, surgery is expensive, resource intensive and complex. In most Canadian provinces, health care has assumed >50% of the overall provincial budget and these costs show no signs of falling (Arneja JS et al, 2014).
On a cursory count, at least one dozen separate processes need to dovetail for a surgical procedure to occur, including a suitable infrastructure (preoperative, operative, recovery), appropriate equipment, adequate human resources (nursing, anesthesia, surgery and support staff) and aligned patient variables (correct indication, informed consent, fasted, etc).
Summary: How Is Modern Medicine Doing?
It relies on drugs in first line medicine.
It extensively relies on surgery (risky and money burning).
It slows down self-healing (due to the adverse effects of drugs and that from sugeries).
It handles patients like a robot works on a production line.
Deep Thinking
Is there is a way to enable the physician to do one of their first duties - stop over-prescription and unnecessary surgeries?
References
Allin S, Reducing Waste in Health Care – Are We Making Progress? July 25/2019
Arneja JS et al. Does the ideal health care system exist? Will it be accepted in Canada? Plast Surg (Oakv). 2014 Spring;22(1):7-8.
BBC News, Overprescribing of medicines must stop, says government. September 22, 2021
Bennett F. et al, Overprescribing and rational therapeutics: Barriers to change and opportunities to improve. British J Clinical Pharmacology 2020
Davis Liu, MD, Vinod Khosla: Technology Will Replace 80 Percent of Docs, Aug 31, 2012. https://thehealthcareblog.com
Hegde BM, Rapid response to: Evidence debased medicine. BMJ 2010;341:c5715
Horgan J., Is Medicine Overrated? 2019. ScienceAmerican.com
Markel H, How Napoleon’s death in exile became a controversial mystery. Aug 15, 2022 PBS News Hour
Mendelsohn R., Confession of a Medical Heretic, 1979
O’Mahony Seamus,?Can Medicine Be Cured? The Corruption Of A Profession. 2020