walkitout (walkitout) wrote,

a paragraph from _Prescribing by Numbers_

I don't know if it's possible to over-recommend this Johns Hopkins published work by Jeremy A. Greene. Sure, it violates one of my cover metrics (all quotes are from journals/magazines, with no one person's name on the line). And okay, yeah, you could argue that it's a little wonky. Maybe a lot wonky.

After a few chapters describing the rise of diuretics to treat hypertension and how that changed the definition of hypertension as a disease category, Greene moves on to the first of the oral anti-hyperglycemics (diabetes drugs for Type II folk who may or may not also be taking insulin): Orinase. After describing the massive throwdown when a couple studies showed increased mortality associated with long-term usage of a drug that was supposed to decrease risk of vascular disease (yeah, _that's_ an all too familiar story these decades), Greene produces this sentence which, I swear, is the kind of thing I live for.

"As they complained about malpractice implications of changed labeling, physicians were not only thinking about lawsuits based on their future actions but also grappling with the theoretically far broader culpability for their past decade of participation within a therapeutic system now being considered potentially harmful."

As if that gem were not enough, he adds in the next paragraph:

"The pharmaceutical mobilization and expansion of a disease category -- whether hypertension or asymptomatic diabetes -- is a complex process involving the coordination of many stakeholders...But as labor-intensive and plodding as the expansion of a disease category from symptomatic to asymptomatic might be, the process of _restricting_ a disease entity once it has successfully been expanded is an effort on an entirely different order of magnitude....Once those actors have been mobilized, once physicians have formed their practice around such labels and once pharmaceutical consumers have formed corresponding disease identities, any process of disease contraction must be contested by the embodied inertia of these newly diagnosed populations. After a decade of pharmaceutical therapy, it is difficult to tell a patient that he never really had a treatable disease without calling into question the entire edifice of medical knowledge and previous trust in the doctor-patient relationship."

I am not being sarcastic. That's basically the thesis statement for the book ("This observation is central to the argument of this book."). He's describing exactly my problem with the medical industry. Yeah, there are access problems. Yeah, doctors miss real, symptomatic diseases. People don't wash their hands. Hospitals and doctors spread serious and at times incurable diseases. The wrong limbs get amputated, risk is amplified everywhere, blah, blah, bleeping blah. None of it matters if everyone is taking pills because they believe in a disease that isn't real, and the pills are killing them, or at least making them sicker, than they would otherwise be. If a big chunk of our country's GDP is tied up in doing that, it almost doesn't matter what else we are or are not doing.

I would say it is far from clear what to do to reverse it, but it's actually quite clear. Keep pointing out the naked emperor and hope people start listening. Some day.
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