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.