This year I have written a book for patients and doctors who have lost faith in the quick fix approach to modern healthcare, and often are in despair about it. Over the past years of writing articles about the politics of medicine, the question my readers have asked me most frequently has been: “How does one know what information to trust?”
The House of Medicine is undergoing a renovation that could more properly be seen as a revolution. Doctors and patients are moving about in an enormous building site and would be well advised to wear hard hats and steel-toed boots. Unfinished buildings are potentially dangerous. Improperly supported theories of disease and treatment are as deadly as unsafe scaffolding. The difference between a real building site and the present House of Medicine is that the former has signs posted everywhere reading “Keep Out! Danger!” while the latter, without fail, demands at some point in our lives an inescapable visit from each one of us without any protection at all. An encounter with medicine is as certain as life and death. One may go through life and never enter a church, fly in an airplane, or travel to distant parts of the planet, but everybody is going to get sick at some point, be in the hands of a doctor, and enter a hospital.
Since I have an unshakable faith in science, having never been disappointed by good science, I hope that this book will be of some use as a guide through this enormous and perilous renovation site.
This is a self-help book only in the sense that it hopefully will empower the reader to trust his and her own instincts — always. Hippocrates taught 2,500 years ago: “A wise man ought to realize that health is his most valuable possession and learn how to treat his illnesses by his own judgment.” That’s where I am heading.
Chapter 1 will engage you in a discussion about the nature of a Golden Age, why I believe medicine has entered such an era, and what in my view one needs to watch out for in such heady times, which invariably produce terrible disasters as well as the grandest of triumphs. I will also tell you the story of The Wizard of Oz as a metaphor for modern medicine and the patient-doctor relationship. Finally, you will also be introduced to the Great Doctor, Hippocrates, the ancient Greek who is also the father of environmental, nutritional and occupational medicine.
Chapter 2 provides a trip through the Devil’s Kitchen of modern drugs and the crimes of their makers. Chapter 3 attempts to explain the nature of modern diseases and why they demand a new kind of medicine, but that there is reason for optimism. Chapter 4 is devoted to doctors as they see themselves and as patients see them, and outlines what is happening at the frontiers of doctoring — and especially what you can do to educate your doctor. Chapter 5 analyzes what it is to be a patient and suggests how to cease being patient appropriately and effectively. Chapter 6 is an interview with Sir William Osler (born 1849) who, by unanimous consent among medical historians, is considered one of the greatest physicians in the history of medicine. The fact that he died in 1919 did not deter this great Canadian from graciously granting me a long and thoughtful interview. Hopefully, the extensive resource section and the bibliography will prove useful as well as helpful.
This book is intended to entertain and liberate. The future of medicine is in the hands of patients — and doctors know it. Indeed, if patients don’t rise to this challenge, medicine as we know it will not only be bankrupt (which it already is), but continue to cause even more harm than it already does.
No — this book is not an amalgam of my published articles, but has most of the information I could not possibly have managed to squeeze into the 2,500-word format of my monthly publications and contains observations too irreverent to expect any editor to print. What follows is an excerpt from chapter 1. You can read the whole chapter and place an advance order for the book, due out in June, by visiting my website www.kospublishing.com.
CHAPTER ONE
A Golden Age is a gilded cage whose owner struggles to maintain its perfection. Since perfection is an illusion as is control, the dynamic force of reality produces change when the current order has become unsustainable. Historically, we then observe that characteristic clustering of irreversible events which initiate a new era. Using a biological concept, one might say that a Golden Age is like a speciation event observed in the fossil record: the old order worked well for a while, but disappeared as circumstances changed; those creatures capable of adapting did so, and those who couldn’t died and are known to us only as fossils. A Golden Age, like Evolution, supports many life forms but is never eternally in love with any one of them. Evolution in biology as well as in history always travels one way with the arrow of time: we do not return to a former stage of evolution, just as we never return to the kindergarten of Uranos or Kronos. A Golden Age, ultimately, is always an illusion – but a creative one.
To illustrate the drama of a Golden Age’s evolution in medicine, I will give just one example. This discussion will go into greater depths in chapters 3 and 4.
DOCTOR DISCOVERS THAT HANDWASHING PREVENTS THE SPREAD OF INFECTIOUS DISEASE
Dr. Ignac Semmelweis was a gynecologist working in Vienna in the 1840s before the “theory” of bacteriology was accepted; Louis Pasteur was his contemporary and at the time highly controversial, but both doctors were destined to emasculate the big daddies of their time, just as Zeus had done with Kronos. Pasteur was fortunate in being celebrated for his discoveries as an old man. Semmelweis died in an insane asylum after being beaten to death by the attendants. Dr. Semmelweis wondered why the women giving birth in the Vienna General Hospital (a fairly new development at the time) died in such great numbers from childbed fever not even comparable to those who gave birth literally in alleyways of the city slums. He also observed that there was a similar discrepancy between the two wards: poor women attended by midwives in one ward had a better survival rate than the rich women attended by doctors in the other ward; the physician-attended death rate was tenfold higher. He noticed that injury to the cervix or uterus during complicated births almost certainly brought on this lethal disease, and finally he observed that whenever the physicians’ ward was closed and cleaned, the rate of death in the new admissions was low and increased only after some time. This set of observations strikes us today as a simple and elegant example of epidemiological reasoning. In the 1840s this was the work of a master detective whose trains of thought the ordinary mind would not, at first, understand at all. Dr. Semmelweis did not know that at this time on the other side of the Atlantic Ocean Dr. Oliver Wendell Holmes, a fellow Golden Ager, was making identical observations.
Dr. Semmelweis suddenly understood the disease when a fellow physician, Dr. Koletschka, died of it. Not only was the doctor a male, but he became sick after accidentally cutting his finger while conducting an autopsy on a patient who had died of puerperal fever — not while delivering a baby. Dr. Semmelweis later wrote, “If septic changes arose from the inoculation of cadaver particles, then puerperal fever must originate from the same source. The fact of the matter was that the transmitting source of the cadaver particles was to be found in the hands of the students and attending physicians” — who did not even dream of washing their hands when coming from the morgue to the delivery room. The importance of this deduction is better understood when comparing it to the insight Newton had when he saw the famous apple fall from a tree. What Newton understood was not merely that a force, now called gravity, could be inferred from this apple — everybody knew that — but that the apple’s attraction to the ground suggested how the whole solar system moved and how the planets maintained their various orbits in relation to one another.
Dr. Semmelweis had understood the underlying universal dynamic of infectious disease and, thereby, he initiated a new way of doing medicine: doctors needed to wash their hands because the doctor is placed into an invisible dynamic unity with the patient — like the apple and the gravitational force of the earth, and the earth in the solar system’s gravitational field. The discovery of bacteria, toxic agents in pus and putrid material from cadavers placed doctor and patient into a common arena and made them comrades in arms.
In 1848 Dr. Semmelweis had risen sufficiently in the medical hierarchy to be able to conduct an experiment: he made everybody in his part of the ward wash their hands. Within one month the death rate went down from 18.3% to 1.3%. Medical historian Nulan observes: “No longer could the deliberately myopic obstetricians remain inattentive to the difference in mortality rates between the two divisions…an explanation had been found, but it brought with it an excruciating accusation and a demand that the old methods give way to new. For many a conscience-stricken obstetrician, already tormented by years of helplessness in the face of puerperal mortality, it would be an appeal to self condemnation that was too heartbreaking to bear.”
DENTIST REALIZES IMPLICATIONS OF THE LINK BETWEEN DENTAL MERCURY AND DISEASE
In the Spring of 2000, when attending a medical conference in Toronto, I had lunch with a group of doctors and dentists. We had all just attended a presentation on the connection between dental silver (mercury) amalgam fillings and their primary role in triggering chronic neurological diseases, Alzheimer’s and more. A dentist sitting opposite me volunteered in a flat, calm voice while staring at his plate, “I spent some thirty years of my life placing those fillings into the mouths of thousands of patients. Today I know that I caused countless deaths and incalculable misery.” Nobody knew what to say. It was true. Finally, I asked, “What do you do now?” He replied, “I am no longer a dentist. I developed neurological disorders myself from all the mercury I handled. I now run an institute that teaches dentists how to fix teeth properly and without mercury.”
Dr. Semmelweis, in the words of Nulan, became “a hellfire-spewing evangelist” telling his fellow physicians they were murderers. He lost his job, and as soon as he did, the mortality rate went back to “normal” at the hospital. He had difficulty in publishing his observations in the medical journals, and finally descended into a deep depression which, today, we would identify as the result of post-traumatic stress. He was admitted to an insane asylum. Nulan took the trouble to study the records on Dr. Semmelweis’ two-week stay there and also had access to the X-rays taken of his remains made a century later by the Austrian government; it was clear from the combined evidence that Dr. Semmelweis had died from blows to the head, which was quite standard then in restraining agitated patients.
It took another couple of decades before obstetricians washed their hands routinely. Puerperal fever virtually disappeared. Dr. Semmelweis won the war but died on the battlefield. Often the pessimistic observation of the originator of quantum physics, Max Planck, holds true. He wrote in his autobiography with respect to the difficulties he and Einstein’s experienced in having their ideas accepted, that new ideas are often only accepted when the old geezers who espoused the old notions finally retire; this neatly sums up the hazards of taking on the paradox of a Golden Age.
In the following chapters we will explore the battles of many doctors and patients who, like Dr. Semmelweis, could not help but be true to the spirit of Hippocrates. Those universal truths give medicine its very life, wherever it is practised. The lasting achievements of the struggle in a Golden Age bring the peace that comes from war, but unlike the George Bushes of the world, they do not expect sacrifices of current rights and freedoms for uncertain pies of unknown flavours later; universal truths point to the Here and Now; Socrates, Galileo, Jefferson, and many other dissenting voices from Golden Ages are wake-up callers, not demagogues. A Golden Age is an era of wake-up calls of such force and clarity, that humanity cannot remain asleep.
Currently, medicine is at the end of such a Golden Age; the true and lasting discoveries of the last 150 years are not enough anymore. Hippocrates observed about medicine, “Science and opinion are two different things; science is the father of knowledge, but opinion breeds ignorance” (The Canon). Indeed, the conflict between opinion and science is the central conflict of every Golden Age and the source of its arising and its fall. Hippocrates has joined us in our journey through the Land of Oz, the land of Modern Medicine, where the roads are golden in more ways than one. His wake-up call is changing everything.
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