Triggerband Web Journal

As physicians we practice modern medicine. However, we must not become confused about what this means. True, we may be more medically knowledgeable than our predecessors of a generation or two ago; but let this not suggest that our knowledge is reality and theirs was not. Reality is massive and intricate, paradoxical and overwhelming. As humans, we simply do not have the perspective to gauge it accurately.

Medical knowledge is limited to our own personal experiences, the perspectives of others who have told us what they think reality is, as well as hard data that has been recorded over lengths of time. Consider this unsettling hypothetical: What if all forms of medical knowledge suddenly disappeared? What would we do to rebuild our knowledge banks?

We would probably do what medicine has always done. Break our understanding of the world into pieces, form conclusions, and test them. We would, in essence, make models of the world; small insights of predictability that represent a working knowledge. And this is exactly what we do today. We work with medical models – not reality.

Some of today’s models seem to sensibly represent the world. They appear efficacious for the most part. Other models, however, make little sense. They survive because the political clout which birthed them continues to fight for their existence today.

We must be careful about what we believe. The history of science is filled with preposterous “truths” that stood lifetimes – even centuries – to be finally discarded as rubbish. Certainly, some of today’s most cherished medical beliefs will meet a similar fate. “Why?” you might ask. For the same reason those others were discarded: they are not tenable. Once the political and financial matrix that holds them in place disintegrates, they will lose support. Other models with more efficacy will nibble at their edges, then devour them. Old models will be replaced by new models; which will, hopefully, be more workable mechanisms of thought. However, if stronger political or financial incentives arise that support less workable models, they may replace their predecessors instead. When this happens, medicine, in a sense, steps backward.

Medicine is constantly marching. It may take two steps forward, one step back, then a step to the side. This is not a march to reality, but rather from one vague point in the past to another vague point in the future. Surely, some aspects of medicine will improve, while others will actually become more harmful. Many models and treatments will change neither for better nor for worse. Technology continues to improve, yet breast cancer is increasing. Bubonic plague may no longer be a threat, but AIDS is a pandemic. Tuberculosis was well-controlled twenty years ago, but more and more resistant strains are developing around the world. Although immunizations have saved millions of lives, only one disease has been completely eradicated.

Many of our twentieth century victories may be hollow. They may not even be victories at all. Instead, they may be no more than a natural or technological reprieve from the onslaught of future ills.

. . . .

Stephen Typaldos, D.O.
July 1994

At the center of the healthcare industry lies a corrupted system that is the source of innumerable troubles. That core is the medical profession.

Medicine underwent a period of growth, reform, and cohesion in the latter part of the nineteenth century that formed the medical profession of today. Newly transformed, during the first half of the twentieth century medicine used advances in technology and industry to cure infections and injuries that had been previously untreatable.

Unfortunately, the medical profession failed to adapt itself to a new wave of epidemics surfacing during the second half of the twentieth century. It had served the profession well to use drugs as weapons against a deadly array of pathogenic infections. However, medicine did not change its tactics to meet recent challenges of lifestyle- and pollutant-related illnesses.

One might wonder why a profession that prides itself on being modern has stubbornly resisted change. The answer is that there is no good reason why physicians abandoned rational thought and adaptability, but there are reasons:

1. Self-preservation. Physicians fear that fundamental changes in the practice of medicine could limit their viability, jeopardize their livelihood, and require further educational pursuits.

2. Self-esteem. Too many physicians have sacrificed their families, friends, and identities for the sake of their practices. Having failed in every other area of life, emotionally it is unthinkable they have also failed in the practice of medicine.

3. Indoctrination. Strange though this sounds to the outsider, a cult-like mentality prevails within the medical profession. Members are expected to believe the tenets of medical philosophy and not think for themselves. Most American physicians are competitive, ambitious professionals who long for approbation and acceptance. Only a rigid framework of universally-held “doctrine” provides them with a concrete measurement of their achievement.

4. Unholy alliance. Why do physicians willingly cater to the business interests of pharmaceutical corporations by prescribing expensive and unnecessary medications? Drug companies ensure physicians keep their niche as gatekeepers of the medicine cabinet (see reason 1, above); drug representatives are readily available as buddies to physicians on a personal level (see reason 2, above); and drug companies determine the “standard” in medical care (see reason 3, above).

What is notable is that all these reasons have to do with the physician and none have to do with the patient. Physicians have subordinated patient results to their own interests, including their desire to feel like they are helping patients.

The profession has become so corrupt and ineffective that there is a trend toward marginalizing physicians – replacing them with nurse practitioners, physician assistants, physical therapists, nurse anesthetists, and online pharmacies. Healthcare’s rotten core must be either repaired or replaced. In other words, to reform healthcare we must also reform medicine.

Alexander Typaldos, JD

Whenever progress meets convention there is conflict. We see it manifested in many ways; for example, the construction of a new highway through an established neighborhood. Resistance swells and rational thought retreats. Appeals to the advantages of progress are met with entrenched attitudes and adherence to tradition. Over long periods of time progress can occur. However, it is at a very high cost to those involved in the endeavor. In the field of medicine the results of this type of conflict have been painful and personal.

During the 1840s, an Austrian doctor named Ignaz Semmelweiss noticed that women who delivered their babies in a clinic with midwives had a low incidence (1-3%) of childbirth fever. Whereas women who delivered with assistance from interns, who performed autopsies concurrently with the delivery, caught fever up to 18% of the time.

In 1843, Dr. Oliver Wendell Holmes, writing on childbirth fever and noting similar results, stated he would rather have his family members delivered “unaided, in the stable, by the manger side” rather than be exposed to the “vapors of this pitiless disease.” Both men advocated that doctors wash their hands between patients, as a simple and effective means of preventing disease.

Dr. Semmelweiss developed a chlorinated lime solution interns used at the obstetrical clinic in Vienna. As a result, incidents of childbirth fever decreased drastically, to only 1-2%. Nevertheless, both doctors faced ridicule from their contemporaries. You see, the germ theory was years away and doctors simply would not believe that they could be the source of transmission of a fatal disease.

Dr. Semmelweiss urgently sought support from obstetricians in the European community. But all he found was skepticism. He showed them his results, and invited them to duplicate the same results in their own practices. When they refused his request, without reason, he called them “irresponsible murderers.”

He became so obsessed about the matter that fellow physicians, and even his own wife, concluded he was mentally imbalanced. Eventually they relieved him of his position at the Vienna General Hospital and admitted him to an insane asylum in Hungary, where he died 14 days later, at the age of 47.

As tragic as this story is for Dr. Semmelweiss personally, it was much more tragic for the millions of women who needlessly died after childbirth. The prevailing ignorance stemmed from a universal, decided rejection of clear evidence. Ignorance ran so deep that hand washing did not become accepted medical protocol until 50 years later.

A Recurring Theme

The situation above might seem extreme, but it is not. Today, as in the 1800s, attitudes exist that are comfortable for the possessor but incompatible with rational and reasonable thinking. What about hypothyroidism, which is grossly under-diagnosed and untreated in the traditional medical field? Then there is chronic Lyme disease, where doctors who prolong treatment are harassed by regulatory boards who sincerely believe they are serving the public good. Meanwhile, patients continue to suffer.

During the 1970s and 80s, many women experienced puzzling symptoms of sudden onset fatigue and muscle and joint pain. Nothing was known about this new perplexing disability. Scores of women were told it was “all in your head,” stress, or any number of burden-shifting explanations. Now we know that Chronic Fatigue Syndrome and Fibromyalgia are bona fide ailments – physical manifestations of myriad factors robbing women (and sometimes men) of their health and wellbeing.

Cherilyn Typaldos