Newsmen Practice
Medicine*
S.Q. Lapius threw the newspaper to the floor and
snorted. Then he developed a fit of coughing. I have warned him
time and again, but to no avail, that a snort is usually followed by a deep
inspiration, which is dangerous when smoking a cigar. I brought him a
glass of water and slapped his back briskly. He tried to drink.
Water sloshed on the cigar. Ashes fell on the rug.
When he had recovered
sufficiently he remonstrated. “Harry, I am perfectly capable of clearing
my own throat without you calling out the rescue squad. Look at the mess
you made. My cigar is a shambles.”
So much for being a good
Samaritan, I thought. “The news generally is bad,” I said. “But it
has been bad ever since I can remember. You should be inured to it by
now.”
“Harry, I can tolerate
bad news, but still react when misinformation is published in the
newspapers. You know I honestly believe there is a cabal afoot to
discredit the medical profession.”
“How so, Simon?” I asked
while I was scraping up the ashes and drying the water spray from the
furniture. “Well, one piece of misinformation can be forgiven; two may be
an oversight; but when it occurs repeatedly one must wonder whether there are
dark forces catering to some conspiratorial bias that does not serve the best
interests of the public.”
“You are not still
referring to the small pox business I hope. I mean it is a dead horse--.”
“It is not a dead horse,
Harry. But that is only part of it. The fact that small pox
vaccination is no longer mandatory puts the public at great risk – not
necessarily this generation, but those that come along in the future. **
But in addition, to that, irresponsible statements about the now infamous ADR’s
which as you know, translates to mean the adverse drug reactions. The
figures have mounted like Rockefeller’s bankroll. First doctors have been
supposed to have killed 30,000 patients yearly, and now it is up to something
like 144,000 by medications alone. This is a spurious figure and a baseless
canard. Certainly someone with terminal leukemia may die from the
remedial drugs given, but it is the leukemia that kills not the drug.”
“Of course someone with
severe heart failure my end up in digitalis toxicity, but again, this is not
carelessness on the part of the physician, but simply the nature of the
illness, which in the last resort, requires near toxic doses of
medications. It is the heart disease that put the patient in that
bind. And included in those figures are patients who themselves took
overdoses of barbiturates in successful suicide attempts. Certainly they
cannot be blamed on the physician – there are other examples.”
I brought Lapius another
cigar, “Don’t light it till you’ve finished with this painful subject,” I
advised.
“Now there is the attack
on oral anti-diabetic agents. The infamous University Group Diabetes
Program study, otherwise known as UGDP. The attack on these agents as you
know is based on the fact that statistically patients receiving these have a
statistically higher incidence of heart disease and heart attacks than
diabetics controlled in other ways.”
“Of course this would be
true, since patients on these agents will not be encouraged to lose weight
since their sugar is under control. But on the other hand, have you ever
tried to convince a 70 year-old diabetic weighing 250 pounds that they must
suddenly change their way of life. They don’t want to unless they are
feeling desperately ill. The obesity itself is a cardiac risk.”
“But while all this is
going on, exhortations to weight reduction, and advice on penalty of
malpractice to use these agents only when the use of insulin is
contraindicated, no one mentions the risk of insulin and even the risk of rapid
weight reduction.”
“If weight is taken off
too rapidly the amount of fats in the blood increases and probably the
coagulability of the blood increases commensurately. That in itself is
conducive to coronary thrombosis. Or the patient who lives alone, with
poor eyesight, trying to measure daily the exact amount of insulin in a syringe
with markings small enough to strain the eyes of an eagle.”
“Suppose that patient
takes the morning dose of insulin and falls ill that afternoon with vomiting –
and can’t eat. Sure as shooting he will be in the emergency room in
insulin shock before the night is over. Those attacks can be fatal
also. You simply can’t isolate one modality of therapy for attack without
discussing the entire problem – and that is what is being done. Then to
cap the climax there are the recent statistics, which I must admit I can’t
understand, that claim those patients on reserpine products have an increased
incidence of breast cancer. But these increased risks are small – are
they smaller than the risk of hypertension itself? The answers are not
forthcoming in the newspapers. But the public is surely alarmed.”
“It certainly is
alarmed. I have had a number of patients ask me to transfer them to other
medications. But then apresoline causes increased cardiac output, and
this may cause a strain in certain people. Aldomet has not been on the
market long enough to be evaluated with regard to breast cancer.”
“Precisely. But
now there is an attack on circumcision. I thought it had been well
documented that circumcision prevents cancer of the penis; however now there
are people who would deny this, and feel that the psychic trauma of
circumcision is the greater risk. Anyone is entitled to an opinion, but
the way these matters are presented to the public spreads alarm, and causes a
stampede by the patient to be consulted in their own therapeutic
regimens. Certainly the patient cannot be as well informed as the doctor
– and certainly the doctors are being bullied to fall in line with the new
thinking. If a physician gives an oral anti-diabetic agent, or reserpine
today, and the patient suffers one of the advertised ill-effects, the doctor
becomes disadvantaged with respect to malpractice attacks.”
What do you propose to
do about it, Lapius?” I asked. “Stop reading the papers?”
“Not in the least.
As a matter of fact, I might consider journalism as a second career.
Journalists seem able to treat more patients with less effort than can the
doctors.”
“And they don’t have to
fill out insurance forms either,” I added hopefully.
*Today pharmaceutical companies treat patients on TV
**The government is currently worried that small pox might be included in
bio-terrorism.