Newsmen Practice
Medicine
Daily Observer
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 that would 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.
They seem to be treating more patients with less effort than are the
doctors.”
“And
they don’t have to fill out insurance forms either,” I added hopefully.