A Frugal Physician Prescribes
Common Sense and Enthusiasm

Good Medicine, Bad Medicine

Nutty Professor

Despite obvious and common shortcomings, modern medicine has indeed done some amazing things during its development over the last hundreds of years. Those advances are just a beginning. It is hard to imagine what the state of medicine will be hundreds of years from now. But, it will be built on some of the accomplishments of recent history.

Even now, medical care excels in some areas while others lag far behind those in which technology and common sense come to the rescue. We don’t want to “throw out the baby with the bath water.” Let’s first look at positive points in medicine - where medicine excels and where consumers can expect real benefits.

• First Aid. This tops them all. In case of true emergency, access to a Trauma Center puts patients in the best possible position for immediate, aggressive and effective treatment. “If doctors reduced their involvement with people by ninety percent and attended only emergencies, there’s no doubt in my mind that we’d be better off.” (Mendelsohn)

Medicine, like most disciplines, does its best work in situations where problems are clear and well-defined. That is usually the case in true emergencies. If you have one, you want to be near a tried and trusty big city ER.

In incidents like motor vehicle injury, construction mishaps, explosions, and the like, life threatening problems can be quickly identified and substantive care provided. Operating theaters and intensive care units can be mobilized to sustain life for extended periods. This is television ER at work doing its finest. If medicine ever “saves lives,” it is in such settings.

• Man-made injuries. From another angle, medicine is best in dealing with problems which human advancement and technology have helped to create. Like wounds from bullets, moving vehicles, and falling objects. If human beings created the implement of injury, they have likely prepared - to some degree - for the sinister effects of such products and structures.

Many, many modern medical innovations have come out of the effects of warfare. Every new weapon has spawned new medical advances to deal with man’s aggression. Military medics and surgeons have literally been at the front lines to deal with new kinds of injuries as well as their long term effects. Warfare has obviously damaging effects. It also has the effect of creating products and procedures which help civilians in peace time. Prosthetic limbs, skin grafting, cosmetic repair, joint replacement, etc. have evolved out of War Medicine.

There are numerous drawbacks to such advances: The tools and weapons of war have rolled over into civilian life. Wounds from AK47s don’t just occur on battlefields. Cosmetic surgery becomes a fetish with some. Joint replacement had become commonplace.

• Prosthesis. Centuries removed from barbaric amputations and equally crude prostheses (wooden legs), surgeons have become proficient at removing and replacing limbs. The former aided by anesthesia and latter with computers. Those two aspects, however, are only half the battle, so to speak. The body must adapt and adapt and adapt. Healing from such major trauma is generally a very long process.

From prosthetic advances have come joint replacements which are more and more and more common. Orthopedic surgery is a booming business. Surgeons have the aura and patients have the belief that joints are as replaceable as teeth. (Teeth are not all that replaceable.) They forget that even if joint replacement is a “success,” they are trading one problem for another.

Maybe one problem for several. Every bodily intervention has wide ranging effects. Some take months or years to show, as in the taking of medication. Some of the effects are undoubtedly in other body systems. Despite what physicians and scientists suggest, there is no metal or substance which can be implanted in the body which is totally inocuous.

“Bone on bone” (pretty simplistic) is the common refrain - along with patient complaints - which gets people into the operating theater to have their living joints sawn out and titanium ones hammered in. Watching such surgery is like viewing a carpenter in action. Only one who is in a hurry, makes a bloody mess, and expects miracles out of his quick work. Only one attempt, usually. Not much of an opportunity for fitting, etc.

Physicians and patients forget that people are not machines with interchangeable parts. Every human “part” is invested and connected with numerous layers and lines, tissues and vessels, networks and systems - visible and invisible. All much more complicated than any man-made device ever will be.

There is no surgical invasion of the body or chemical intervention (medication) which is without acute AND long term effects. Nonetheless, medics and cutters persist in spreading their trades thinking that they KNOW. How little do they know How little do we know

Robert Mendelsohn (Confessions) retold a thought-provoking story which any potential orthopedic surgery patient might wish to ponder: “My favorite example of how doctors can be less intelligent than the situation calls for is a matter of public record. As part of the hearings before the Senate Health Subcommittee, Senator Edward Kennedy recalled a skiiing injury to his shoulder, suffered when he was a young man. His father called in four specialists to examine the boy and recommend treatment. Three recommended surgery. The advice of the fourth doctor, who did not recommend surgery, was followed, however. He had just as many degrees as the others. The injury healed. Senator Kennedy’s colleagues then proceeded to question Dr. Lawrence Weed, Professor of Medicine at the University of Vermont and originator of a highly popular patient record system for hospitals. Dr. Weed’s reply was the ‘senator’s shoulder probably would have healed as satisfactorily if the operation had been performed.’”

I will leave the reader to make his/her own observations on this story. It was and still is quite a shocker to the writer.

• Poisonings. Humans have probably made more poisons in last hundred years than nature has in eons. Certainly, infinitely more people go to the hospital for artificial poisoning than ones they consume in nature, like mushrooms. Still, if chemists can make a poison, they can also make antidotes. And, usually do.

So in case of poisoning, deliberate or incidental, “Hie thee to the hospital.”

While considering incidental poisoning, it should be correct to point out how common downright deliberate poisoning occurs in the medical setting. Practically all of cancer chemotherapy is medical poisoning. If the disease won’t kill you, the chemical cure has a good chance.

Chemotherapy is meant to poison and destroy the “bad cells” more quickly than the good cells. A neat trick. It may be no more than a trick. But, it certainly is poison, toxic and very traumatic to the human system.

I can’t help remembering when my mother used to come home from her chemotherapy infusions for breast cancer. The poison was by then coursing through her bloodstream into her whole system. It was scary. I described it inadequately saying, “She was buzzing.”

• Restorative surgery. The author has been impressed by the benefits of some surgeries. The list is not long and most have obvious and outward effect. Cataract surgery, in which the lens of the eye is removed and replaced, is generally very successful and dramatically improves the quality of a person’s life.

Cosmetic repair of face and skin after injuries can have profoundly beneficial effects. Some orthopedic repairs for congenital deformities can be impressive.

On the other hand, surgical procedures in general are way out of hand. Caesarean sections are sometimes as frequent as one in four deliveries. Something is not quite kosher there.

Tonsillectomies are not as common as they used to be, but still much over done. Appendectomies should be passe in this age. Hysterectomies are far too readily recommended than needed. “Oh, you don’t need it anymore.” Bosh!

Some surgical procedures are downright hokum. Modern versions of snake oil. Tennis elbow surgery for one. The operation severs the tendon to supposedly relieve pain. Scientific rationale behind the procedure is non-existent. There is practically no rationale behind it, “But it works.” Eventually. And, so does time.

Like the cortisone shots which often precede it, the tenotomy is a very common, wasteful, inane procedure. Many rotator cuff operations fit pretty much in the same ballpark. Cutting into healthy functioning tissue to cure a temporary problem often causes more of them in the future.

We have taken a quick look at Good Medicine, with more than a few forays into Bad Medicine. Sadly, there is still much of the latter because of our medical ignorance and continued blind belief in medicine as we know it. We must become willing to explore other layers and dimensions of human life. When we do, Frugal Physicians will be part of that change and help bring in a new era of real knowledge and true health.

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