September 24, 1999 (Ira Pilgrim)


The wierdest ills are put to route

By having teeth and tonsils out,

But if, with teeth and tonsils banished,

The ills referred to haven't vanished,

It is generally understood,

The operation did no good.

Samuel Hoffenstein, 1923

Very much more is known about diseases, their prevention and cure, than was known 100 years ago. Even though it is considerable, it is still very very small when compared with what remains to be discovered. I could write a long list of once fatal diseases, that are now curable. I could write a longer list of diseases that aren't curable. That list would include all viral diseases, including the very common cold, and diseases related to ageing.

When some people find out that doctors aren't gods, they sometimes turn to people who know a good deal less. The results are predictable, and "going to the doctor" becomes the equivalent of going to church, or Lourdes; with the same results.

A number of years ago, I had a virus infection that ended in a cough that persisted for over a month. I finally went to the doctor. He did something that delighted me. He suggested three remedies, provided some samples and three prescriptions. He told me to try one for about a week. If it didn't work, to try the next one. What delighted me was that this approach is in stark contrast to the usual approach to dealing with such a problem. Usually, a patient is given a single prescription. After a week or so, the patient comes back and is given a different prescription. This practice is bread and butter for many doctors, particularly people who treat chronic diseases.

What happened with the cough? The first two remedies didn't work at all. The third seemed to help, but the drug was too powerful to use for a long period of time for something as trivial as a cough. Eventually the cough went away by itself.

What did do me a lot of good was that my physician had ruled out several things that are much more serious than just a cough. That's worth a lot to me; but then, I don't expect miracles. I know what doctors know and when they are guessing.

Competent physicians spend a lot of their effort treating the mistakes of their less competent colleagues. There are a number of iatrogenic diseases. Those are diseases that are caused by physicians. Perhaps the most deadly of these are X-ray caused cancers, particularly breast cancer. These were caused by the excessive use of X-rays; much more radiation than was really needed to take a picture and diagnose diseases. This has to be equated against many people who have had their lives significantly prolonged by procedures where X-ray was an essential part. The correction of congenital heart anomalies, that used to mean certain death, had to involved diagnostic X-rays. There is no question that the increase in risk of breast or other cancers 40 to 80 years down the road is insignificant compared to an immediately fatal heart problem.

Nowadays, the amount of X-ray exposure that an infant is exposed to is a small fraction of what it used to be. As a new generation of physicians becomes aware of the risk of radiation, we can hope that exposure of patients will decrease in the future. All that is necessary is for every physician, chiropractor, or dentist to ask himself "Is this X-ray really necessary?" Much of the time, the answer will be "No."

The use of ultrasound as a diagnostic tool has made a good deal of x-ray unnecessary. Ultrasound has no known undesirable side effects. It has the added advantage of being able to take pictures of organs like the heart in motion. Hopefully much of x-ray use, including cat-scans, will be replaced by MRI(Magnetic Resonance Imagery). At the present time, MRI is frightfully expensive and cannot be used on some people.

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