What does it mean for medicine to "work"?

via ranprieur.com

Anne, a blogger whose work I have enjoyed in the past, recently began a new blog. Her article there about the cultural context of medicine is not to be missed!

Using the story of two hypothetical people with heart trouble, who take different paths in health care, she illustrates how it is impossible to separate the practice of medicine from questions of values, even within the context of a supposedly uniform American culture.

She wrote these two stories to illustrate a much more general (I would say universal) point about the workings of medicine in context, which I think should be addressed any time we compare different modes of health care; particularly, she addresses herbal remedies and manufactured pharmaceuticals, both of which are topics she seems to have gained professional competence in.

http://huntgathermedicine.wordpress.com/2010/11/14/medicine-in-context-2-but-does-it-work/

What are your criteria for whether or not a health intervention "works" in your case?

P. S.: It might also be worth looking at her more-recent article on the barefoot doctors of China. It seems that experiment has a lot to say about how we might care for human health in the context of permaculture, with abundant examples of both "do"s and "don't"s. If only the Cultural Revolution had been more committed to openness and truth, there might be even more to learn from it.

Good article.  Makes you think.

I like the fact Anne did not use the article as a soapbox to preach or condemn any person's preference for their own care.  The purpose of the article, as I saw it, is to make you think and assess your health and quality of life priorities. 

exploring some of the same territory, and some more, is Ivan Illich's Medical Nemesis.  pretty short, and a very interesting read even if you don't agree with all his conclusions.

I agree Joel and Al, excellent article. As a mother who has chosen a lot of alternative health care for her kids, I've questioned my choices a lot, and have been questioned and judged a lot.

The query that points me down different health care paths is: does the "cure" cause more harm and long-term issues than it solves AND is there a "cure" or health aid that can help without harm and possible side effects? For example, if I can use herbs to cure a sinus infection, I'll definitely do that before I upset the body's flora and fauna with antibiotics.

Tel mentioned, Illich's Medical Nemesis, which, according to Wikipedia, is about the undue medicalization of what should be natural processes. I can respect that, and lived it somewhat, too, by having home births for both of my kids. I must admit, however, that I am SO thankful we have hospitals, and surgeons and modern medicine for when we need them.

I have another story to add to Anne's two about heart trouble late in life--this one about heart trouble early in life.

My friend told me of someone who'd also had a home birth - a lovely baby girl. The pregnancy had been so normal that the mother hadn't even had an ultrasound because of some reports that ultrasound waves (are they called waves?) could possibly be harmful. (For the record, I also chose NOT to have ultrasounds for both of my pregnancies.) Their daughter was born without incident and seemed to be healthy and happy...until one awful day when she choked on a bite of food while sitting in her high chair and...died.

The baby girl had been born with a heart defect. My friend's impression was that an ultrasound might have seen this defect, and then the baby would have been subjected to all kinds of tests, surgeries, etc., catapulting the entire family through intense stress for all those days and months of the pregnancy and her young life. Without knowing about the defect, the family had simply enjoyed each other and their baby daughter, without the stress and doubts.

My friend was convinced the baby girl's heart defect could not have been cured by surgeries and whatnot. She thought it was better that the family had been able to enjoy her without knowing of her heart defect, than to go through the torture and pain of useless surgeries. To this day, I wonder if that's one of those little comfort lies we might tell ourselves, or whether the surgeries really would have been fruitless. I don't know enough of the facts or parties involved to tell.

Jocelyn Campbell wrote:
Tel mentioned, Illich's Medical Nemesis, which, according to Wikipedia, is about the undue medicalization of what should be natural processes. I can respect that, and lived it somewhat, too, by having home births for both of my kids. I must admit, however, that I am SO thankful we have hospitals, and surgeons and modern medicine for when we need them.

Illich's argument is roughly that we need them much less frequently than most have been taught to believe, and that visiting hospitals too frequently has caused all manner of undue problems.  a statistic mentioned in the book that I found particularly interesting concerned the significant reduction of well-being in areas after hospitals were built to serve them.  he also decries that attitude taken toward patients, particularly at research hospitals.

Illich also pointed out that a majority of life-saving and health-restoring procedures carried out by professional specialists in hospitals could easily be carried out by lay practitioners in homes.  I don't think he would have argued for the abolition of hospitals--because they do have the potential for healing--but for a radical change in how they operate.

at 100 or so pages it's a short book, though dense, and very interesting.  if reading a computer screen is palatable, Medical Nemesis is available at Scribd.  or your local library if paper and ink are more agreeable.

A metaphor I use with patients goes like this; You place a dimmer switch in line on a row of receptacles (outlets).  You plug in 3 different computers. The first, a Dell, the second a HP, etc... After starting the computers, the dimmer switch is turned down, say 30%.  The first computer, the Dell, has a screen malfunction.  Sizes, shapes, colors vary.  The computer is still "on" but there is something obviously wrong with the screen function.  Next in this example, an expert researcher is hired to sit at the computer and make note of every variance from normal he or she can document.  Eventually, an exhaustive list of malfunctions with the screen is compiled.  The next step, is to develop a think tank of experts to make suggestions on how do get the most use out of this Dell computer.  The best solution developed is an information guide with sets of stickers to apply to the keyboard for different programs.   With a Word program, success of the “treatment” is 91%, meaning the stickers and guide will allow the computer to do 91% of the functions of a normal computer using Word.   If any other computers are discovered around the world with this particular constellation of screen abnormalities, it is called Dells Disease and the treatment is considered 91% effective.  The question being asked here is “what is the best treatment for Dells Disease?”   There is another possible question.  “Is there anything that could be done to restore the computer to its design potential?” 
From this perspective, by far the majority of medical care is aimed at asking the question about treatment for disease, NOT restoring health (design potential).  It is obvious in the above metaphor what the design potential solution is, to turn the line voltage back up to 100%.  An example of this can be illustrated with cholesterol.  If cholesterol comes down in a patient after a program of vigorous exercise,  then their high cholesterol was a correlate of inadequate  exercise.  Treating with drugs supports the body in the diseased state (“what is the best treatment for high cholesterol”) vs. the other question “what would make this patient healthier?”  A: exercise.

I'm very cynical about medicine in the US. It is money motivated and money driven.

Most of the doctors I've seen treat conditions, not people. Quite honestly, I think a lot of them would be content to look at labs/xrays, weights and vitals taken by a nurse and prescribe from there and be perfectly happy to not have to deal with a patient. There are good doctors out there as well, but few and far between. I believe that the attitudes that many of our younger doctors have is being taught them in medical schools. They aren't healers, they are prescribers. They aren't taught to treat people, they are taught to address conditions, the person with the condition is irrelevant.

wow, did I get caught up in that or what! Knew I had strong feelings, just didn't realize how strong until those words came flying out of my finger tips!

Well, Feral, seems to me that you just told it like it is. We all experience it when we go to a doctor and hope and pray that the next medical practitioner we encounter will be someone who really cares about people.