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posted by martyb on Monday February 18 2019, @05:23AM   Printer-friendly
from the getting-sick-is-hazardous-to-your-health dept.

https://blogs.bmj.com/bmj/2019/02/13/richard-smith-most-devastating-critique-medicine-since-medical-nemesis-ivan-illich/

Seamus O'Mahony, a gastroenterologist from Cork, has written the most devastating critique of modern medicine since Ivan Illich in Medical Nemesis in 1975. O'Mahony cites Illich and argues that many of his warnings of the medicalisation of life and death; runaway costs; ever declining value; patients reduced to consumers; growing empires of doctors, other health workers, and researchers; and the industrialisation of healthcare have come true.

[...] Unlike Illich, who believed that modern medicine counterproductively created sickness, O'Mahony does see what he calls a golden age of medicine that began after the Second World War with the appearance of antibiotics, vaccines, a swathe of effective drugs, surgical innovations, better anaesthetics, and universal health coverage for most of those in rich countries. It ended in the late 1970s, meaning that O'Mahony, who graduated in 1983 and is still practising, enjoyed little of the golden age. We are now "in the age of unmet and unrealistic expectations, the age of disappointment."

[...] O'Mahony begins his dissection with medical research, "the intellectual motor of the medico-industrial complex." Governments see life sciences as a saviour of economies, and charities urge us to give more to cure every disease. Big Science, which appeared after the golden age, has provided jobs and status but "benefits to patients have been modest and unspectacular." A study of 101 basic science discoveries published in major journals and claiming a clinical application found that 20 years later only one had produced clinical benefit. Big Science is corrupted by "perverse incentives, careerism, and commercialisation."

[...] No disease is better marketed than cancer, and after Richard Nixon's War on Cancer, Barack Obama launched his Cancer Moonshot, which is now renamed Cancer Breakthroughs under Donald Trump. As O'Mahony writes, the language around cancer "is infected with a sort of hubristic oedema." For Big Science cancer is a blessing, leading to huge investments in molecular biology and genetics, but, as cancer researcher David Pye put it: "How can we know so much about the causes and progression of disease, yet do so little to prevent death and incapacity."

[...] "The medical profession," he writes, "has become the front-of-house sales team for the [drug] industry." He argues that "doctors' professional culture obliges them to do something—anything," but he is too easy on doctors, who could push back. Society, he says, displays "childishness" in going along with these expensive treatments: "we must have higher, and better, priorities than feeble, incremental and attritional extension of survival in patients with incurable cancer."

[...] The first thing that I ever had published in a medical journal was a letter to the Lancet in 1974 asking why there had been no response to an article in the journal by Ivan Illich describing in detail how modern medicine was a threat to health. (It would cost me $35.95 today to access the letter, about 50 cents a word from memory.) As a medical student I expected that the leaders of medicine would carefully dissect Illich's argument and with evidence show him to be wrong. But such a response never came. I was naive: I know now that it's easier simply to ignore cogent criticisms. I hope that O'Mahony's book, a Medical Nemesis for 2019, will not be ignored. It deserves to be taken very seriously.


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  • (Score: 2) by Runaway1956 on Monday February 18 2019, @10:55AM (3 children)

    by Runaway1956 (2926) Subscriber Badge on Monday February 18 2019, @10:55AM (#802899) Journal

    I can agree that law enforcement are often a bunch of heavy-handed thugs. But, no laws? Not even laws or regulations administered by the medical profession? With no laws and regulations, it would be a free for all, with rogue doctors intentionally over prescribing stuff that the patient doesn't even need. The same doctor can create an addict, intentionally, then "cure" that addict, all the while making money.

    I'm all for making dangerous drugs difficult to get, unless some need is demonstrated. Once that need is demonstrated, then they should be readily available. A lot of that has to be the doctor's judgement - he might be wrong sometimes. But, that seems more a matter for professional organizations to deal with, than for general law enforcement.

    But, IMO, Patient Sixpack should not be able to wander into a doctor's office, and demand a script for whatever drug is fashionable this week/month/year. There have to be some kind of guidelines, don't there?

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  • (Score: 2) by sjames on Monday February 18 2019, @06:19PM (2 children)

    by sjames (2882) on Monday February 18 2019, @06:19PM (#803082) Journal

    We would still have the usual professional standards, ethics, and liability. Also the same body of laws that in general would punish a doctor for deliberately making the patient sick(er) in order to cure them or otherwise through a procedure or prescription. There's no need to single out "fun" drugs there.

    Patients go into doctor's offices or online demanding a prescription for Viagra all the time. The doctor is obligated to meet at least minimal professional standards and make sure the patient doesn't have any likely conditions that would make viagra a bad idea and to do followups to make sure the patient isn't being harmed by side effects. Failure to meet those minimum standards could cause a doctor to lose his license to practice medicine as well as significant civil liabilities. If the patient dies or is seriously injured from a reasonably forseeable exacerbation of an existing medical condition the doctor could face criminal penalties as well.

    The same would apply for opoids. Doctors would have to weigh risk vs. benefit like any other drug.

    • (Score: 2) by urza9814 on Tuesday February 19 2019, @07:58PM (1 child)

      by urza9814 (3954) on Tuesday February 19 2019, @07:58PM (#803637) Journal

      In order to even have the doctors be involved, you still need laws regulating what drugs can be prescribed for what conditions and under what circumstances. You still need the Controlled Substances Act, which is written by non-doctors and is not written from the perspective of patient care but instead focuses almost exclusively on criminal justice and maintenance of existing power dynamics. But without that, everything is just over-the-counter and some people will take what their doctor recommends while others will start popping every pill that gets mentioned on Oprah. Which wouldn't necessarily be worse than the current system, but it's not likely to fix this particular problem.

      You can't just revoke a couple laws and assume that standard negligence/malpractice will cover it. You've gotta build a whole new system, built on a foundation that is actually based on medical science rather than politics and profit. That's an interesting challenge....

      • (Score: 2) by sjames on Wednesday February 20 2019, @03:15AM

        by sjames (2882) on Wednesday February 20 2019, @03:15AM (#803840) Journal

        There are no laws saying what condition a doctor can prescribe what drug for or under what conditions other than the general professional standards. Drugs cannot legally be advertised off-label but they can be prescribed off-label.

        But my point was that we don't need special laws and handling of opoids.