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.