The Medical Soviet - Part 1

Today’s comments do not have so much to do with medicine as they have to do with the various twisted ideas that come out of those witches Sabbaths of stupidity and hypocrisy known as “tea parties.” That tea parties are anything more than a collection of disaffected white racists who bemoan their perceived loss of privilege is a difficult position to defend. However, through the vulgar taunts and the vicious looks comes a number of complaints that have a pedigree pre-dating the Obama presidency and which have held together the right wing consensus through a number of presidential administrations. Some of those complaints emerge from a theory of society and economics. That theory maintains that government action, or any collective action for that matter, which stymies the free working of “the market” is illegitimate and guaranteed not only to fail as economics but also to undermine the sacred values of a democratic state.

Unfortunately, there is no easy way to distinguish between one set of regulations and another. To bring medicine back into the conversation, if the principle of open competition were to operate freely in the medical sphere, as I, for one, believe it should at least to a greater degree than it does, state regulation of physicians would be an unacceptable encroachment on freedom of choice. If I want to consult a physician who treats on the basis of the latest nutritional and herbal knowledge, why should I be denied the freedom of doing so? Considering the vast uncertainties upon which medicine is based, it is curious that there are not more disagreements among medical professionals. But medicine as conducted in this country is a series of closely monitored practices based on what is considered to be the best science. Even so, science, if it is science and not dogma, must be an open-ended practice ever laboring toward new paradigms. However, the track record of American medicine has not been one of toleration for alternative views or practices. All one needs to do is consult the history of chiropractic or the oppression suffered by lay midwives. The only way that medicine is able to exert any power is through the monopoly granted it by the state. But if competition effectively sorts between those who succeed and those who fail, why not allow the market to decide who stays in business practicing medicine and who does not?

Of course, to a degree I am playing the devil’s advocate. I suppose even hounds of the tea party breed would bark loudly and lustily if it was suggested that the state cease licensing and regulating the practice of medicine. But why? Well, I suppose it might be argued that some things are so well settled that it only stands to reason that the state has an obvious basis for intervening. The fact that this last insight should be applied to medicine and should not be applied to the provision of medicine would seem to me to be a failure of imagination. Reasonable people can come together and through their consensus determine that some things will not be subject to the whim of fate. “The market” in reality is only another way of saying “fate” or “chance.” At the risk of offending some religious believers, an analogy could be made between this fear of regulation and the refusal of some individuals to accept medical treatment on the basis that it upsets “God’s plan.” Medical treatment may not work and some social regulation may be misconceived and fail to produce its purpose. Neither of those two possibilities should mean that we avoid taking the most advantageous action when the opportunity arises. If the tea parties were operating out of a sense of wisdom and not vitriol, their medicine would be a lot easier to swallow.

Good to the Last Drop!

Hooray! As per a new study out in the last few days, not only has coffee been rehabilitated heart-wise, it is now touted as being heart protective. The new study (funded by the Robert Wood Johnson Foundation and Kaiser Permanente) suggests that dangerous heart arrhythmias are found to occur less often in people who are the heavier coffee drinkers. Of course, media reports of the study do not tell you which kind of coffee to drink, what time of the day to drink it or whether or not it operates the same way if you are taking it with Beta Blockers or whipped cream. Long ago my cynicism reached its now epic proportions concerning medical pronouncements when it became obvious from the conflicting studies that appeared on a regular basis in the media that all one needed to do was wait. You like to indulge in fried pig’s livers but were told that this is a death sentence for your circulatory system? Wait a few days and a new study may appear that will not only clear those livers of all harm but will exalt them to such a height they will be given their own float in the Rose Parade.

Don’t get me wrong. I love coffee, especially the kind that comes mit schlag in the wonderful cafes scattered so conveniently about the city of Vienna. When it was partially vilified by earlier studies, I continued to drink it. Now that coffee has been fussed over yet again by the medical establishment, my love for it has not increased. I drank it before, drink it now and will continue to drink it. Why? Because it tastes good (to me), has not caused any fatal complications as of yet and has a sophisticated complex of flavors and sensations that are appealing. That appeal is ancient and when coffee finally made its way into European salons it took off like a shot. There seems to be little or no evidence that its allure is fading anytime soon. Of course, everything needs to be approached sensibly, but that seems beyond the ken of our modern sawbones. Now that this study has given a green light to coffee drinking, I expect that Americans will put the pedal to the metal and start guzzling coffee like Ponce de Leon at the Fountain of Youth.

But isn’t this exactly the problem with the way that medicine is practiced? Physicians prescribe literally billions of drugs per year to Americans (see Greg Critser) but can only tell in the most general fashion who will suffer serious or even fatal side effects. Everything is a matter of percentage risk. Of course, herbs, teas, natural foods are off limits for most physicians to discuss with their patients because they cannot find “studies” which provide the probabilities of risk. Now that coffee has been the subject of a study and the numbers are in, their confidence swells like Tarzan’s pecs. What about the old studies? What all this is about is a professional narrative that medicine, especially American medicine, would like to have believed. That narrative is simple – we knew nothing before modern medicine came on the scene and we all owe our lives (and most of our fortunes) to the good doctors for the great benefits they have brought us. They have brought us great benefits indeed, but those need to be kept in perspective. Drugs which are enthusiastically marketed at one moment, become a deadly menace the next. Medical errors cost tens of thousands of lives a year. One cannot fault the medical profession entirely. It is really the American public that needs a good hiding for forgetting the simple lessons of their great-grandparents. With medicine, less is more.