The young woman who sat before me said she was overwhelmed. Earlier that day she had visited a woman doctor for her Pap test and to discuss contraception. The young woman (whom I have known since the evening of her birth) sat and listened to the cascade of information and advice that flowed over her. She felt she was drowning; ‘My head swam. I thought I might faint or vomit. It was too much for me.’
The young woman is no dimwit. A graduate in Neuroscience and Philosophy she handles ideas that make my head swim. Her doctor is a thorough and thoroughly modern practitioner. She explained the actions of oestrogens and progestogens. She detailed the various routes of administration. She canvassed the respective durations of action of the different preparations.
Let us give the young woman a name. She can be Lucy.
Lucy explained why it was now critically important that she not conceive. For pressing medical reasons pregnancy could be disastrous. Her past use of barrier contraception would no longer do. Hormonal means were required. I asked, ‘Lucy, what is it you don’t understand about the Pill or the progesterone IUD or the progesterone implant?’
‘I understand them alright’, she said, ‘I just don’t want them. None of them. They’re all unnatural.’
I asked Lucy to elaborate. ‘Those hormones, they all do things to you. They affect your organs. I don’t want that. I’ve never liked that.’
Lucy is quite correct. They all do things to you. Whether it’s a device impregnated with progesterone that is inserted into the uterus – with or without a general anaesthetic (another unnatural chemical) – or a tablet that contains both oestrogen and progesterone, or a small progesterone-impregnated rod sewn under the skin of the upper arm, all will prevent pregnancy by violating Lucy’s natural biology. It was these assaults that alarmed Lucy. She felt she’d be a traitor to her own health if she embraced any of those measures. Her audience with the doctor struck at her ideology, her beliefs.
I sat and listened. I know how Lucy feels. Like most of my patients I am drawn to the natural remedy. Whether it is a hot lemon drink for a sore throat or a hot salty water soak for an infected finger, I have always prescribed these for my children, knowing I have no skerrick of scientific data attesting to their value. They just feel good. And right. And natural. My children have long mocked me for my atavism. And nowadays I see them treating their own children with the same nostrums.
Science has no truck with ideology. Science is an unsympathetic bastard. And profoundly unsentimental. The science of pharmacology defines a drug as any substance that alters a biological system. In other words, in our retreat from such unnatural substances as drugs, we resort to our hot lemon drinks and our hot salty soaks. And we feel better. But pharmacology’s corollary declares: any chemical which alters a biological system is a drug. If my inflamed finger feels better, if my sore throat improves, the salt or the lemon is a drug. Or a placebo.
I love placebos. Over the many years they’ve relieved lots of my symptoms. But, as I explained to a forlorn Lucy, placebos don’t prevent pregnancy. Against an incoming tide of one hundred and fifty million sperm cells, the placebo cannot prevent penetration of her waiting egg.
I tried to comfort Lucy. ‘There can be no natural contraception. Nature wants your every egg to be fertilised. Only the highly unnatural (but physiologically innocent) condom or the highly unnatural act of withdrawal or the offensive intrusion of hormones will prevent conception. Those or celibacy.’
Lucy took this in. She had no enthusiasm for celibacy. I added my opinion that withdrawal and cyclic celibacy were the two parents of most of the babies ever born.
Lucy left me, taking with her a prescription for the Pill. She will violate her biology that would otherwise have seen her conceive at fifteen and again – following two years of lactation – at eighteen, and again and again every three years or so until menopause and subsequent senescence and early death.
Of course everything I do in my work is unnatural. I intervene when hypertension or diabetes or elevated cholesterol would otherwise hasten the onset of heart disease. I order x-rays which expose the body to cancer-causing radiation. My surgical colleagues introduce stents. My psychiatrist friends alter brain chemistry with their medications, as they struggle to control the demons in our minds of schizophrenia and bipolar disorder. Sometimes they save lives. Most unnatural. All of it, most unnatural.
There are two Laws I have learned.
FIRST LAW: There is no such thing as natural medicine.
SECOND LAW: There are no cures. Medical science always fails. We all die.
This is what i am getting when i try to open your blog
I tremble before the computer
Computers own us
Computers rule us
They own our secrets
They give away Our secrets
They operate us
And they don’t co-operate with us
I no longer despair because I no longer hope
Sorry to be so cheerless
At risk of appearing too hippy-triply or ideological, my friend Howard, I beg to differ. Science IS an ideology. The belief that there is no other ideology is itself an ideology. The danger of the idea that Science is NOT an ideology is that, like all ideologies, sometimes the biases and predilections of its high priests and gurus are accepted even when they run counter to the fundamental premises (or “ideology”) of science: Observe, analyse, establish an hypothesis, test hypothesis, repeat (or variations thereof).
And there are many variants in the practices of this ideology of Science, including the unqualified (such as Malcolm Roberts declaring that anthropogenic climate change is a conspiracy-based myth) and the qualified (CSIRO’s Dr. Larry Marshall gutting Australian climate science to pursue market-driven “solutions” and “applications”).
We see many practitioners of this ideology assume they have objectivity, that the practice of western medicine is without bias, untainted by ideology, etc, etc. This runs counter to the very foundations of science and everything we know of psychology and neuroscience. I know, Howard, that you are far more open than most to new ideas and hypotheses. I love your musings about your ideology offered to us through your blog, which seems to be driven by values such as compassion, curiosity, openness, social justice, etc, etc and beliefs placed at the centre of your practice.
On the other hand we see leaders in western medical practice dismiss Chinese medicine, for example, as quackery and voodoo medicine. Despite clinical trials clearly demonstrating the effectiveness of acupuncture, for example, many Scientists declare that there are no such thing as “meridians” in the human body as their existence has not been clinically demonstrated. The hypothesis is dismissed despite evidence gained from the applied testing that they do. Further, many assert that all forms of Chinese medicine, sometimes including acupuncture, should not be considered “real” medicine. (This includes senior doctors advising government and insurers.) Yet this practice has 4,000 years of accumulated clinical practice, is taught in major teaching hospitals in China and practiced daily by doctors in conjunction with “modern” western practice. Numerous clinical trials of diagnostics, treatments and herbal concoctions have been conducted, which are generally dismissed in the west, often merely because they are not available in English. When they are available, the results are howled down because there is no critical mass of such research available. Yet the Chinese pharmacopeia is yielding impressive results in western labs in the treatment of everything from common infections to malaria and cancer. Why is there such resistance to the science of Chinese medicine?
With the social and economic power of the western pharmaceutical industry we continue to see western medicine practised with an emphasis on the provision of drugs as first recourse in treatment. So pervasive is this that you have written about patients who want the prescription of a drug, any drug, rather than wanting to hear a more complex story of how to achieve health and of some doctors who support this approach. We have a culture of “science” where alternatives can often be dismissed and where pharmaceuticals are pushed to the frontline of treating almost any and every condition. Incidentally, my father peddled Debendox – among many other drugs- to doctors in the 1960s and ’70s for the treatment of morning sickness and later associated with birth defects. It was given to me as a treatment for travel sickness. Hard science and its practice makes mistakes.
Please forgive my self indulgence in presenting my rant, Howard. I know your musings are often light-hearted and exploratory of deeper things. But I guess my point is this: there is an ideological spectrum in medical practice, which can be said to range from “natural” to “unnatural”. There is medical practice that works with the “natural” processes of the human, which includes an understanding of diet, exercise, psychology, history, social conditions, the environment, etc all having their effects, good and bad, on human lives. In common parlance “natural” usually refers to seeing patients as people first, human beings subject to and part of nature in never-ending cycle of birth, life, death, repeat (depending on your belief). My experience of your practice puts you in this camp. Do as little harm as possible, be cautious, be curious, respect the person, do not jump to conclusions or easy answers, respect the life process. Sometimes trauma means offering treatment (or not) that may cause damage or harm. A difficult choice.
There is also practice that does not respect the human, does not give value to patient’s experience, knowledge of their body, etc. There is a dominant (moot?) practice of prescribing western pharmaceuticals first and asking questions later in the next 15-minute consultation a week later. This well-documented practice is disease focussed and knows little of health, except as the “absence” of disease. This “unnatural” practice is characterised by a focus on the disease or condition, of which the “patient” is merely the subject. Treat the disease, not the person.
This spectrum lies at the heart of current debate and power struggles within medicine and in policy regarding human health. It has enormous implications also for all policy that focuses on the human species as somehow separate from “nature”, implicitly subject to different rules, with or without the possibility of divine intervention to protect us from ourselves.
I feel that you do yourself and your practice a gross injustice when you describe your work as “unnatural”. For me, you inspire through your practice of those “natural” (god-given”?) values, strengths and passion for humanity. You seem to quest to bring your ideology and practice together. A word for that is “Integrity” 🙂
Your response deserves thought
I will ponder then reply
But for now I simply thank you for the time and effort and care that you invest in my flimsy edifice of ideas
It is highly likely, when all is said and all considered, we will find ourselves in the FIERCEST agreement
Don’t go overboard, migolo