Paleo Retiree writes:
It’s been a long time since I’ve wanted to link to an article at The Atlantic. For decades a great magazine that was reliably substantial and well-written, it’s now an SJW-infested clusterfuck that too often reads like it’s being written and edited by ambitious Cultural Studies undergrads.
Forgive a short detour: In the last ten years, many media outlets, in their struggle to cut costs in the digital age, have sent their older employees packing. The impact of this trend on our public discussion hasn’t received nearly enough recognition, IMHO. Whatever the faults of the older crowd — and I say this as one of them (I was retired-with-a-bonus from a MSM magazine in 2008) — they’d seen a lot and they’d dealt with a lot. They had thick hides as well as a healthy cynicism towards both their subjects and their bosses. By contrast, today’s youthful MSM staffers, while having the virtues of energy and tech-savviness, often seem completely unworldly as well as over-eager to please the powers-that-be. When I scroll or leaf through today’s news-oriented magazines and newspapers, I invariably come away with a general impression of callowness and wet-behind-the-ear-ness. It’s as though the writers and editors are dealing with their subjects for the very first time. Wide-eyed freshness can be a virtue in lyric poetry; in journalism maybe not so much.
Takeaway: if our public discussion has come to feel like it’s being conducted by 13 year olds, it isn’t just because you yourself are growing older and more cranky. It’s also because a lot of the people supplying us with reporting and opinions these days really are near-children.
But back to the point of this posting, which is to link to an article by David Epstein. It’s about unnecessary and unhelpful medical treatments that nonetheless continue getting prescribed, and it’s a well-reported, provocative beauty. Why, Epstein asks, even in cases when the best studies show that some treatments are useless or worse, do patients continue demanding them? And why do doctors continue providing them?
For all the truly wondrous developments of modern medicine—imaging technologies that enable precision surgery, routine organ transplants, care that transforms premature infants into perfectly healthy kids, and remarkable chemotherapy treatments, to name a few—it is distressingly ordinary for patients to get treatments that research has shown are ineffective or even dangerous. Sometimes doctors simply haven’t kept up with the science. Other times doctors know the state of play perfectly well but continue to deliver these treatments because it’s profitable—or even because they’re popular and patients demand them. Some procedures are implemented based on studies that did not prove whether they really worked in the first place. Others were initially supported by evidence but then were contradicted by better evidence, and yet these procedures have remained the standards of care for years, or decades.
Even if a drug you take was studied in thousands of people and shown truly to save lives, chances are it won’t do that for you. The good news is, it probably won’t harm you, either. Some of the most widely prescribed medications do little of anything meaningful, good or bad, for most people who take them.
Epstein’s piece is full of eye-opening examples. One of my favorites is treatments that will make your body hit the sought-after numbers — pills, for example, that bring some blood marker into the desired range, or that lower your blood pressure to “normal” — yet that won’t prolong your life or help you avoid catastrophes. What’s the point of them? Does it matter if your numbers look good if you get sick and die anyway?
Epstein got me thinking over a number of things. I’ve been accompanying an in-law to the hospital for chemo treatments, for example, and so have had a lot of time to observe the scene there. Good lord but there are a lot of fat people and smokers among the patients. People who have just had dumb accidents and homeless people too. One ambulance guy I gabbed with recently told me that 70-80% of the ambulance runs he and his team make are for homeless people. “A lot of them are drunks and addicts. Sometimes they really need treatment but often they just want attention,” he said to me. “You run out of compassion for them pretty quickly.” And a surgeon I knew once said to me that American hospitals would be half as crowded as they are — and America’s perpetual health-care crisis would be much alleviated — if Americans did four things: 1) Avoided getting obese. (“Overweight isn’t a problem,” he said. “Obese is.”) 2) Avoided getting addicted to drugs or booze. 3) Didn’t smoke. 4) Took more care to avoid preventable accidents — falls from ladders, that kind of thing.
These musings led me to two (very amateurish, but hey, I been around) reflections:
- It’s probably a mistake to think of our bodies as mechanical things — or, to be more up to date, as cyborgs. That view tends to lead people to think of their bodies as a device detached from them that needs the occasional visit to the garage, or maybe the occasional attentions of Apple Geniuses. If you’ve got a pain or a gripe, drop your body off at the hospital and get it worked on. Problem solved. In my experience it all too often doesn’t work out quite so simply. For all the things that modern medicine is good for, I can’t tell you the number of times friends have had back operations or knee replacements or heart stents that haven’t finally done them much good. And, even when these treatments do work out well, the pain, horror and shock of the experience is something people are rarely ready for. Bodies aren’t machines; they’re sacks of wet, gloppy biological materials. They really don’t like being knocked out and cut into. Another big surprise: trauma to the body (and surgery is extreme trauma to the body) tends to have big, unpredictable mental and emotional consequences. You aren’t just dropping your jalopy off at the shop; you’re putting your very being on the line. It isn’t at all rare for people having surgery to come out of the experience feeling quite changed (and often not in a good way) by it.
- We’re mistaken when we look to Western medicine to make us feel good. Western medicine is brilliant at fixing bone-breaks, at sewing up bullet holes, at curing some cancers and helping with diabetes. But can it really make you feel good in the “I’m experiencing ease and purpose” sort of way? Is it even meant to? Yet that’s exactly what many people look to it for. I can’t tell you the number of friends I have who are, in their quest to feel a little better, taking a half a dozen pills a day. People get hooked on a medication then need more medications to take care of the side effects of it. “There’s no such thing as a medicine that doesn’t have side effects,” a Harvard Med School doc once told me. “Even aspirin has side effects.” My friends swirl around and around, getting groggier and groggier, trying to extinguish symptoms that they themselves have created, and never ever achieving the desired state of feeling pretty good.
Epstein is, btw, very good on the “why?” part of his topic: Why do doctors prescribe these treatments? Why do patients demand them? I think it’s beyond-understandable that people today should look to medicine for miracles. These days, where else are they going to look? It’s too bad, though, if doctors and medicine hold out promises they can’t really deliver on, and it can backfire when people project their larger hopes onto medicine. A little less confusion, heartbreak and pain would be nice.
Fwiw, my working theory about how to proceed is: use Western medicine for what it’s good for, but generally avoid it. For everyday health — and especially for that elusive “feeling good” thang — rely first on eating well, on moderate exercise, on living a modest and low-stress life, and on being conscientious with your mental/emotional hygiene. Qigong, yoga, meditation, massage, swimming, etc, can all do a soul a world of good. Incentive: it never hurts to remember that doctor and hospital goofs may be the third leading cause of death in the U.S. If you’re hit by a car or need a tumor removed, by all means get yourself to a doctor, and do it pronto. Otherwise, why expose yourself to more medical treatments than you probably really need?
- At my old blog I wrote about receiving a diagnosis of cancer and going through surgery for it. An epilog to that story: I’ve begun to wonder if the surgery was necessary. As thinking about prostate surgery has progressed in the years since my operation, many doctors have come to suspect that there may be several different kinds of my kind of cancer, some of which will kill you no matter whether you’re treated or not, and some of which won’t kill you no matter the treatment. That would certainly jibe with my experience. A good friend of mine was diagnosed with the same cancer I had. His markers and my markers were almost identical — in other words, as far as medicine was concerned and could tell, we were virtually identical cases. And we received identical treatments. Yet he was dead from his cancer within five years while I’m still around and in good shape. So: given that I may have had a brand of cancer that I’d have survived in any case, why did I go through the gruesome, life-changing procedure I did?