By Mike Newland.
Western medicine has contrived many miracles since WWII, but could its success now be leading to a frightening upsurge in the conditions needed to foster chronic ill-health?
It is undoubtedly true that medicine since the 1930s has made vast strides in tackling many serious conditions. Younger people today have little awareness of the horrors their grandparents lived through. The ghastly septic wards before antibiotics, and the horrors of tuberculosis which often tortured people slowly to death over many years, are quite outside awareness.
People imagine that such things are of distant history like blood letting. The reality is that we’ve enjoyed since WWII a charmed time about which our ancestors would be incredulous if they knew. Until WWII, a quarter of those having appendix operations died. No one now expects their routine surgery to end in their deaths.
Antibiotics were discovered by chance in the Paddington Hospital. Some think the marvellous mould which would kill germs came from beer in the pub opposite. A pub familiar to many nationalists.
When antibiotics came into major use from the 1940s onwards the effect was miraculous. The seriously ill and dying walked out cured in vast numbers. Wards and sanitoria closed all over the world.
During the following decades, miracle after miracle made it seem as though everything could soon be cured. By the 1970s, belief that doctors could cure anything began to outstrip the reality. This was particularly true of chronic degenerative illness.
An elderly man spoke to the writer not long ago in glowing terms about how the NHS had dealt with his angina. Straight away the pain was gone. He appeared utterly unaware that the treatment had not cured his heart problem at all. It had merely relieved the symptoms.
Now symptom relief is nothing to sneeze at when you are in pain. But there is a vital implication in this happy patient’s attitude to his health which tells us how we may be on slippery slope to a level of ill-health it’s impossible to treat with costs which cannot be met – and especially in a free at the point of sale system like the NHS.
This article is not about the side effects of treatment. It’s certainly true that blind faith in medical procedure has often shut out the reality of the side effects which commonly arise from continued treatment of chronic conditions. A drug to treat the bad effects of the first drug is the parable.
The risk we now run is belief that the doctor has a cure for everything leading to a blithe disregard for doing what will likely help you to avoid getting ill in the first place. The newspapers are filled with ‘breakthrough’ stories many of which are spun to high heaven and pay little heed to cost.
One of the staples is about the person who is morbidly obese and who looks to the doctor for a stomach operation to reduce their weight when what they should be doing is simply cutting down on the Snickers. Responsibility for oneself is slung on to the poor doc.
At this point, a bright spark will always appear to insist that his Uncle John did everything right – healthy diet, exercise, did not smoke. But poor virtuous Uncle John nevertheless dropped dead suddenly at 38. Thus proving that it’s useless trying to help yourself. Better to visit the doctor and chemist.
The flaw in this lazy argument is that trying to help oneself is not a guarantee of survival. There aren’t any guarantees. What it does is to improve your chances. People have no difficulty with that concept in many other areas of life yet cognitive dissonance creeps in all too often where health is concerned.
Another angle on avoidance of the issues is to suggest that people mostly died young a century or two ago and that medicine has halted the Grim Reaper in his tracks. The Royal College of Surgeons found, in fact, male life expectancy during the 19th century to have been around 75 among those who survived childhood. Not bad!
The reality is that public hygiene measures like sewers, clean air and factory rules plus economic growth allowing better food (in principle if not always in practice) have done far more than doctors. There is a very good case for a statue of Sir Joseph Bazalgette in Trafalgar Square. Over 90% of the fall in tuberculosis preceded antibiotics.
The Boer War uncovered just how bad public health was at the time because of a lack of the basics when a large proportion of potential recruits to the armed forces were found to be partially crippled in one way or another because of poverty.
The monumental issue in public health arising from the ‘rely on the doctor’ cognitive scotoma has been publicised recently in connection with statins.
Statins are designed to control the bad effects of cholesterol – strokes, heart attacks and angina.
The British Medical Journal recently estimated that, if statins were routinely prescribed to all over 50s, as has been suggested, it would reduce annual deaths from vascular disease by over 9,000. Unfortunately, among many other problems, there would be 10,000 more cases of diabetes.
Much the same could be achieved without the problems by eating an apple a day.
More medicine as a substitute for self-help can actually make your lot in life worse. Yet that is the likely effect of over-selling medicine as a solution to chronic disease. You then require more medical services to deal with the unfortunate additional disease you’ve created or maybe has replaced those you‘ve controlled.
Heart trouble – or would you prefer a nice diabetes sir!
A visit to the doctor and his reassurance about your prospects if you keep taking the medicine may even make things worse. Caution about one’s health thrown to the winds on a warm upbreeze of ‘there is a cure for everything’ and even worse dietary and lifestyle outcomes.
Doctors complain about the prevalence of visits from the ‘worried well’. But there are two sides to consulting your doctor. One the one hand, reassurance that your nagging little pain is not portent of a nightmare is hugely helpful to well-being. But on the other it signals an over-confidence that the medic can fix anything so you don‘t need to bother. But bodies are not cars amenable to the attentions of a garage no matter what broke.
Two-thirds of British adults are now overweight it’s said. Now you can argue about the methodology of the standard Body Mass Index measure a bit but simply looking round the streets tells its own story.
According to a recent survey, only a third believe heart disease is avoidable by suitable lifestyle. 20% are found to have high blood pressure in their forties.
It’s story of extraordinary complacency undoubtedly generated by belief in modern medicine. Self-congratulation about the certainty of increasing life expectancy may be premature however.
With some of the gushing prose in newspapers, who make it their business to generate readers with ‘breakthrough’ stories, you wonder why undertakers are still in business!