The arts that promise to keep our body in health and our soul in health promise us much: but at the same time those who profess these arts among us show the results of them less than any other men. The most you can say for them is that they sell medicinal drugs; but that they are doctors you cannot say.
Montaigne is frequently pretty harsh about doctors and the practice of medicine in his “Essais”. The last sentence in that passage above did really strike me however. “The most you can say for them is that they sell medicinal drugs; but that they are doctors you cannot say.”
A number of thoughts sprang up from there.
First up was Professor Peter C Gøtzsche, a researcher who published “Deadly Medicines and Organised Crime”. Read this from the introduction to that book –
The main reason we take so many drugs is that drug companies don’t sell drugs, they sell lies about drugs. This is what makes drugs so different from anything else in life … Virtually everything we know about drugs is what the companies have chosen to tell us and our doctors … the reason patients trust their medicine is that they extrapolate the trust they have in their doctors into the medicines they prescribe. The patients don’t realise that, although their doctors may know a lot about diseases and human physiology and psychology, they know very, very little about drugs that hasn’t been carefully concocted and dressed up by the drug industry … If you don’t think the system is out of control, then please email me and explain why drugs are the third leading cause of death … If such a hugely lethal epidemic had been caused by a new bacterium or a virus, or even one hundredth of it, we would have done everything we could to get it under control.
This is an “evidence based” book from an “evidence based” expert. It’s not a conspiracy theory – and that, actually, makes it all the more shocking. Montaigne might have said that doctors only sell drugs, but Gøtzsche says pharmaceutical companies sell “lies about drugs”.
Then I thought about a doctor friend of mine who was told by their Clinical Director to spend less time talking to patients because that wasn’t a doctor’s job. A doctor’s job, according to this senior doctor, was “to write prescriptions”. (The astonishing thinking behind this was that only doctors have the legal right to write the full range of prescriptions so that was what they should focus on)
And finally this week I read in the Huffington Post, a piece by John Weeks about Integrative Medicine and CAM in the USA.
Regular medicine’s dominant influence when “CAM” integration by medical delivery organizations began in the mid-1990s was the industrial value of service production. Mayo Clinic’s director of innovation captures this concisely when he recently spoke of medicine’s historic focus on “producing” services rather than on “creating health.”
What he is writing about is a report from the RAND corporation about Complementary and Alternative Medicine which focuses on the issue of practitioners being reduced to providers of “products” – e.g. a chiropractor does a manipulation, an acupuncturist puts in needles. In fact, although this is not where that article goes, doctors are being reduced to prescribers.
So, full circle, back to Montaigne again – what does he mean when he says “The most you can say for them is that they sell medicinal drugs; but that they are doctors you cannot say”? Personally, I think he is saying if you reduce a doctor to someone who just supplies you with medications, then you don’t have a doctor any more. I agree. A doctor undergoes an immense, broad, arduous training. I think a doctor should always keep the focus on the whole patient, seeking to understand them in their uniqueness. The doctor should be an expert in diagnosis, able to figure out what’s happening by great listening skills, great observational skills and the knowledge and experience of dealing with patients with a wide range of diseases. When it comes to doing something therapeutic (apart from understanding and supporting their patients, which is therapeutic in itself) then, surely, we want to be able to offer more than just a prescription for a drug?
A few days back I wrote a post about biomimetics. Wouldn’t it be great if doctors became experts in health? In how a human being stays healthy? And in how a human being recovers from injuries and illnesses (we used to call that “healing”). I reckon there’s mileage in the biomimetics idea. We could be learning how living organisms stay healthy, repair and recover when injured or ill, then developing techniques which support, or mimic, those strategies and processes.