Too much medicine?

Almost certainly

by Ray Moynihan

Gazette’s Introductory Note:.  This short article, pregnant with ideas that relate to our modern medical dilemma, is reprinted here without footnotes.  If you want to pursue the issue, please go to the fully footnoted original that is linked at the bottom of this page.–-Hardly Waite, Gazette Senior Editor.

 

Most doctors believe medicine to be a force for good. Why else would they have become doctors? Yet while all know medicine’s power to harm individual patients and whole populations, presumably few would agree with Ivan Illich that “The medical establishment has become a major threat to health.”¹ Many might, however,accept the concept of the health economist Alain Enthoven that increasing medical inputs will at some point become counterproductive and produce more harm than good. So where is that point, and might we have reached it already?

Readers of the BMJ voted in a poll for us to explore these questions in a theme issue of the BMJ, and this is that issue. Unsurprisingly, we reach no clear answers, but the questions deserve far more intense debate in a world where many countries are steadily increasing their investment in health care. Presumably no one wants to keep cutting back on education, the arts, scientific research, good food, travel, and much else as we spend more and more of our resources on an unwinnable battle against death, pain, and sicknessparticularly if Illich is right that in doing so we destroy our humanity. And do we in the rich world want to keep developing increasingly expensive treatments that achieve marginal benefits when most in the developing world do not have the undoubted benefits that come with simple measures like sanitation, clean water, and immunisation?

Any consideration of the limits of medicine has to begin a quarter of a century ago with Illich, who has so far produced the most radical critique of modernor industrialisedmedicine.¹ His argument is in some ways simple. Death, pain, and sickness are part of being human. All cultures have developed means to help people cope with all three. Indeed, health can even be defined as being successful in coping with these realities. Modern medicine has unfortunately destroyed these cultural and individual capacities, launching instead an inhuman attempt to defeat death, pain, and sickness. It has sapped the will of the people to suffer reality. “People are conditioned to get things rather than to do them . . . They want to be taught, moved, treated, or guided rather than to learn, to heal, and to find their own way.” The analysis is supported by Amartya Sen’s data showing that the more a society spends on health care the more likely are its inhabitants to regard themselves as sick.²

Illich’s critique may seem laughable, even offensive, to the doctor standing at the end of the bed of a seriously ill person. Should the patient be thrown out and told to cope? It is of course much easier to offer a critique of cultures than to create new onesand Illich (like doctors, ironically) is much stronger on diagnosis than cure. But he does write about recovering the ability for mutual self care and then learning to combine this with the use of modern technology. Though his polemic was published long before the internet, this most contemporary of technologiescombined with the move to patient partnershipis shifting power from doctors back to people. People may increasingly take charge, more consciously weighing the costs and benefits of the “medicalisation” of their lives. Armed with better information about the natural course of common conditions, they may more judiciously assess the real value of medicine’s never ending regimen of tests and treatments.

Although some forcesthe internet and patients’ empowermentmight offer opportunities for “de-medicalisation,” many others encourage greater medicalisation. Patients and their professional advocacy groups can gain moral and financial benefit from having their condition defined as a disease.³ Doctors, particularly some specialists, may welcome the boost to status, influence, and income that comes when new territory is defined as medical. Advances in genetics open up the possibility of defining almost all of us as sick, by diagnosing the “deficient” genes that predispose us to disease.⁴ Global pharmaceutical companies have a clear interest in medicalising life’s problems, ^5 6 and there is now an ill for every pill.⁷ Likewise companies manufacturing mammography equipment or tests for prostate specific antigen can grow rich on the medicalisation of risk.⁸ Many journalists and editors still delight in mindless medical formulas, where fear mongering about the latest killer disease is accompanied by news of the latest wonder drug.⁹ Governments may even welcome some of society’s problemswithin, for example, criminal justicebeing redefined as medical, with the possibility of new solutions.

As the BMJ ‘s debate over “non-diseases” has shown, the concept of what is and what is not a disease is extremely slippery. ^10 11 It is easy to create new diseases and new treatments, and many of life’s normal processesbirth,¹² ageing,¹³ sexuality,¹⁴ unhappiness,¹⁵ and death¹⁶can be medicalised. Two sets of authors in the issue argue convincingly, however, that there is much undertreatment, suggesting a need for more medicalisation. ^13 17 The challenge is to get the balance right.

It is those who pay for health care who might be expected to resist medicalisation, and governments, insurers, and employers have tried to restrain the rapid and unceasing growth in healthcare budgets. They have had little or no success, and Britain’s government now plans to raise taxes to pay for more health care. Labour, the party in power, will have calculated that the risk of trying to bottle up demand is greater than thesubstantialrisk of raising taxes. But while increased resources will be widely welcomed, the cost of trying to defeat death, pain, and sickness is unlimited, and beyond a certain point every penny spent may make the problemworse, eroding still further the human capacity to cope with reality.

Ivan Illich did not want the wholesale dismantling of medicine. He favoured “sanitation, inoculation, and vector control, well-distributed health education, healthy architecture, and safe machinery, general competence in first aid, equally distributed access to dental and primary medical care, as well as judiciously selected complex services.”¹ These should be embedded within “a truly modern culture that fostered self-care and autonomy.” This is a package that many doctors would find acceptable, particularly if available to everybody everywhere.

Doctors and their organisations understandably argue for increased spendingbecause they are otherwise left paying a personal price, trying to cope with increasing demand with inadequate resources. Indeed this is one of the sources of worldwide unhappiness among doctors.^18-20 Although seen by many as the perpetrators of medicalisation, doctors may actually be some of its most prominent victims.³ This is perhaps why BMJ readers wanted this theme issue.

Perhaps some doctors will now become the pioneers of de-medicalisation. They can hand back power to patients, encourage self care and autonomy, call for better worldwide distribution of simple effective health care, resist the categorisation of life’s problem as medical, promote the de-professionalisation of primary care, and help decide which complex services should be available. This is no longer a radical agenda.

Ray Moynihan, journalist.

Reprinted from the British Medical Journal.

Gazette Fair Use Policy.

 

Footnotes not included in our reprint.  Please go to British Medical Journal original linked above for footnoted version.

 

And When You Get Your Factory Built, Would You Like to Rape My Sister?

 By Hardly Waite, Gazette Senior Editor

Not long ago, our fair city, as Click and Clack would say, was embroiled in a big controversy about a zoning permit granted by the city fathers to a wealthy Mexican company with more than a few shady deals in its past.  The corporation, which planned to build a copper smelter (although they never, ever called it that),  had wined and dined the city council who, save for a single councilman who was able to keep his wits about him, were so in love they were ready to skip all the usual formalities and get right on with the wedding..  Never mind that the proposed plant was to be a lead-belching smelter and its smokestacks had a straight and close downwind shot at a  large elementary school.  (more…)

What Are the Odds of Dying?The table below was prepared in response to frequent inquiries, especially from the media, asking questions such as, “What are the odds of being killed by lightning?” or “What are the chances of dying in a plane crash?”

The table has four columns. The first column gives the manner of injury such as motor-vehicle crash, fall, fire, etc. The second column gives the total number of deaths nationwide due to the manner of injury in 1999 (the latest year for which data are available). The third column gives the odds of dying in one year due to the manner of injury. The fourth column gives the lifetime odds of dying from the manner of injury. Statements about the odds or chances of dying from a given cause of death may be made as follows:

 

• The odds of dying from (manner of injury) in 1999 were 1 in (value given in the one-year odds column).
• The life-time odds of dying from (manner of injury) for a person born in 1999 were 1 in (value given in the lifetime odds column).

For example, referring to the first line of the table below:

• The odds of dying from an injury in 1999 were 1 in 1,805.
• The lifetime odds of dying from an injury for a person born in 1999 were 1 in 24.

The odds given below are statistical averages over the whole U.S. population and do not necessarily reflect the chances of death for a particular person from a particular external cause. Any individual’s odds of dying from various external causes are affected by the activities in which they participate, where they live and drive, what kind of work they do, and other factors.

Source: National Safety Council estimates based on data from National Center for Health Statistics and U.S. Census Bureau. Deaths are classified on the basis of the Tenth Revision of the World Health Organization’s “The International Classification of Diseases” (ICD). Numbers following titles refer to External Cause of Morbidity and Mortality classifications in ICD-10. One year odds are approximated by dividing the 1999 population (272,820,000) by the number of deaths. Lifetime odds are approximated by dividing the one-year odds by the life expectancy of a person born in 1999 (76.7 years).

 

Odds of Death Due to Injury, United States, 1999 Here is a sample of the list.  The entire list is massive.  Go here to see it all.

TYPE OF ACCIDENT OR MANNER OF INJURY	DEATHS, 1999	ONE YEAR ODDS	LIFETIME ODDS
All External Causes of Mortality, V01-Y98	151,109	1,805	24
Deaths Due to Unintentional (Accidental) Injuries, V01-X59, Y85-Y86	97,860	2,788	36
Transport Accidents, V01-V99, Y85	46,423	5,877	77
Pedestrian, V01-V09	6,047	45,117	588
Pedalcyclist, V10-V19	800	341,025	4,446
Motorcycle rider, V20-V29	2,316	117,798	1,536
Occupant of three-wheeled motor vehicle, V30-V39	33	8,267,273	107,787
Car occupant, V40-V49	14,549	18,752	244
Occupant of pick-up truck or van, V50-V59	3,133	87,079	1,135

The Number of Nights Before Christmas that’Twas: 1

by B. Bee Sharper

Editor’s Note:  Pure Water Gazette numerical wizard Bea Sharper writes only in the Harper’ s Index number format.  This makes fiction difficult, but you’ll see that she carries it off well in the piece below.  — Hardly Waite.

Number of nights before Christmas that ’twas: 1

Number of creatures, including mice, that were stirring: 0.

Stockings that were hung by the chimney with care: 16

Approximate number of visions of sugar plums dancing in Timmy’s head: 43.

Time when Timmy settled down for his long winter’s nap: 10:30.

Hardness level of the glass of water that Timmy drank before settling down for his long winter’s nap: 196 mg/L (11.5 grains per gallon).

Number of clatters that arose on the lawn: 1.

Total number of miniature sleighs seen by Timmy when he tore open the shutters and threw up the sash: 1.

Number of tiny reindeer that were pulling the sleigh: 8.

Exact number of little old lively and quick sleigh drivers seen by Timmy: 1

Number of little round bellies the lively and quick sleigh driver with a nose like a cherry had: 1.

Total number of toys he had in his bundle when he came down Timmy’s chimney: 176.

Number of stairs Timmy quietly crept down in order to watch Jolly Old St. Nick go about his work: 14.

Number of times you’ll have to click on this link to find out what happened next: 1.

 

 

Why I Don’t Celebrate Christmas

by Shirley Wilkes Johnson

The article below was originally printed in the paper Pure Water Gazette in 1990.  Shirley Wilkes Johnson lives in West Columbia, TX, near Houston. She is a renowned vegetarian cook with a special passion for vegetarian chili. She is also a sincere and sensitive human being who has been a long-time friend to non-human animals.

The year was 1972. People were dying in a senseless war in Vietnam. There didn’t seem to be much to celebrate. On Christmas Day, out of sympathy for those people, we ate beans and rice and spent a quiet day at home. In a search for a more meaningful lifestyle we decided to give up celebrating Christmas for many reasons. The world seemed more concerned about all forms of pollution, wastefulness and the energy problem then. The tons of wrapping paper, boxes and bows, the cutting of millions of trees, not to mention the enormous amount of electricity used nation-wide at this time of year, seemed wasteful to me. Then there are the countless gifts, given and received, that are unwanted and go unused. It seemed that all that money and effort could be put to so much better use. We have so many unsolved problems.

The increasing commercialism of Christmas bothered me, as it does many people. I read a newspaper article that said that there are many more depressed people, drunks, automobile accidents, family feuds and suicides at this time of year. The “good will toward men” that is supposed to prevail is not very apparent.

To lie to children about a fat man in a red suit may seem harmless to some people, but I question whether there is ever a reason to lie to our children.

As for gift giving, I prefer to choose to whom and when I give gifts. I don’t like the feeling of being expected to buy gifts for my hairdresser, mailman, etc.

December 25 is not Jesus’ birthday. In fact, during Biblical times only pagans celebrated birthdays. The date of December 25 was selected by the Christians as a way to bring pagans into Christianity: it was a concession to the pagan celebration of winter solstice.

I have read that 10% of the people do the thinking for the other 90% We all think we think for ourselves, don’t we? Someone once said, “A life unexamined is a life not worth living.” As I pondered these two ideas, I began to examine everything I did and asked myself, “Why do I do this? Is it because I want to, because I believe in it, or is it because I have been taught to do it?”

As my husband and I decided to quit celebrating Christmas, we decided it was important to celebrate LIFE–365 days a year. I wrote these thoughts in a letter to the Houston Post. They printed it on Christmas Day of that year. I braced myself, expecting to get letters calling me “Scrooge” and worse. But instead my mailbox was filled with letters from people thanking me for writing the letter.

I write this letter now, not to convince anyone to give up the celebration of Christmas, but to ask you to make a decision for yourself, whatever it might be. It is difficult to go against what everyone else is doing, as those of us who are vegetarians know. I hear a lot of people say they are tired of participating in the Christmas ritual. My purpose is to give them the moral support to give it up if they so choose.

 

Is Your Bathtub a Toxic Dump?

George Glasser and Andreas Schuld

The municipal water that your child drinks, bathes and plays in is a complex chemical mixture of dissolved minerals, contaminants and chemical additives. Chemicals are added to clarify the water, remove solid particulates and disinfect. And, when fluoride compounds are added to water supplies, polymers are added to inhibit corrosion of the water pipes.

The skin is the largest organ of the body. The EPA has concluded that the average person can absorb more contaminants from bathing and showering than from drinking polluted water.

Children are most at risk. Children’s bath times may range from 45 minutes to two hours. As the EPA acknowledged in a June 30, 1998 report, “Children have a greater surface-area-to-body-weight ratio than adults, which may lead to increased dermal absorption.”

Children’s tissues, organs and biological systems are still developing, with several stages of rapid growth and development occurring from infancy to adolescence. This rapid development, combined with the immaturity of body organs and systems, predisposes children to potentially more severe consequences within certain age ranges and windows of vulnerability.

Circulatory flow rates are generally higher in children, which may increase a child’s susceptibility to toxic effects. Despite these elevated risks, most toxicological data is based on occupational exposures for adults.

The Children’s Environmental Health Network (CEHN) reports that the U.S. has seen “a worrisome increase” in childhood diseases that may be linked to chemicals in the environment. According to the CEHN, “The incidence of two types of childhood cancers has risen significantly over the past 15 years.” Acute lymphocytic leukemia is up 10 percent and brain tumors are up more than 30 percent. Learning disabilities and attention-deficit disorders also appear to be increasing.

Toxins in the Bathwater

Depending on whether a child has eaten, or if there is residual food in the stomach, about 20-50 percent of chemical contaminants are metabolized when foods or beverages are consumed. With dermal exposure and inhalation, however, virtually 100 percent of the contaminants are absorbed directly into the bloodstream.

As one EPA scientist put it, “a shower cubicle can be considered an ‘exposure chamber.’ Exposure to volatile contaminants absorbed via the lung would be about double the same amount from drinking water. In the bath, underarms [axilla], scrotal and vaginal areas as well as the groin absorb far greater amounts than in the normal unwashed forearm test.”

The percentages for absorption of parathion are as follows: scalp (32 percent), ear canal (46 percent), forehead (36 percent), plant of foot (13 percent), forearm (9 percent), palm (12 percent), and scrotum (100 percent).

A study by Julian Andelman, Professor of Water Chemistry at the University of Pittsburgh’s Graduate School of Public Health (published in the May 1984 American Journal of Public Health), found less chemical exposure from drinking contaminated water than from using it to wash clothes or take a shower .

Studies done by Brown, Bishop and Rowan in the early 1980s showed that an average of 64 percent of the total dose of waterborne contaminants is absorbed through the skin.

A study by British researchers at the Health and Safety Laboratory in Sheffield published in the February 19, 2000 issue of Human Experimental Toxicology suggests that toxicants such as fluorides can be stored in the skin and released over a period of time.

A review of nearly 40,000 research papers listed on National Institutes of Health and other U.S. government Internet sites has failed to discover a single study addressing water fluoridation and dermal absorption.

All dosage recommendations developed by EPA are based on ingestion alone. The EPA and Centers for Disease Control have never commissioned studies on the dermal absorption of fluoridated water and refuse to do so.

 

Brushing Teeth with Toxic Sludge

The most popular fluoridation agent is fluorosilicic acid, a toxic by-product of phosphate fertilizer production.

On May 10, 1999, U.S. Rep. Ken Calvert, who serves on the House Subcommittee on Energy and the Environment, asked the EPA to answer a simple question: “What chronic toxicity test data are there on sodium fluorosilicate? On hydrofluorosilicic acid?”

On June 23, 1999, EPA Assistant Administrator J. Charles Fox replied that the “EPA was not able to identify chronic studies for these chemicals.”

On September 5, 2000, in response to an inquiry from the U.S. House Committee on Science, EPA Assistant Administrator Charles Fox admitted “there are no water quality criteria for fluoride either for the protection of aquatic life or for the protection of human health.”

The EPA earlier confirmed that water fluoridation puts “at risk” 52 million older Americans with calcium, magnesium and vitamin C deficiencies. People with cardiovascular and kidney disorders also may experience severe “dental fluorosis and skeletal fluorosis” from excessive exposure to fluorides.

The health threat from using fluorosilicates to fluoridate drinking water goes beyond bathing and drinking the treated water. The substances in the fluorosilicates do not magically vanish. All the pollution released from washing clothes and household items, evaporation from clothes dryers and dishwashers remains in the home. Water fluoridated with phosphate scrubber liquor becomes a vehicle to carry hazardous air pollutants directly into your home.

While this secondary contamination of children from fluoridated water is significant, it has never been investigated by the EPA or the U.S. Public Health Service — although both agencies are aware that pollution scrubber liquor is being used to fluoridate municipal water supplies.

Because children spend their days close to floors, carpets, lawns, and soils, and frequently pick up objects and put them in their mouths, they may be exposed to higher levels of chemicals in and around the home.

Physicians for Social Responsibility has warned: “Small amounts of air or water pollution that may have little or no impact on a healthy adult, can make children, especially newborns, seriously ill.” PSR notes that children’s longer lives also make them “more vulnerable to slow-acting hazards, like pesticides and dioxins.”

The EPA admits that “there are no federal safety standards which are applicable to additives, including those for use in fluoridating drinking water.” Although the reality of children’s vulnerability to environmental toxicants has been acknowledged, little is being done to address the threat. Children don’t vote and parents are uninformed. Only a few voices have expressed concern, but those voices are quickly smothered by the sound of money changing hands.

Printed Originally in the  Earth Island Journal
June 5, 2001

Fair Use Statement

Rethinking Chlorinated Tap Water by  Dr. Zoltan P. Rona MD MSc Most people never give it a thought. After all, our elected public officials keep assuring us that chlorinated city tap water is completely safe for human consumption. Numerous scientific studies, however, report that chlorinated tap water is a skin irritant and can be associated with rashes like eczema. Chlorinated water can destroy polyunsaturated fatty acids and vitamin E in the body while generating toxins capable of free radical damage (oxidation). This might explain why supplementation of the diet with essential fatty acids like flax seed oil, evening primrose oil, borage oil and antioxidants like vitamin E, selenium and others helps so many cases of eczema and dry skin. Chlorinated water destroys much of the intestinal flora, the friendly bacteria that help in the digestion of food and which protect the body from harmful pathogens. These bacteria are also responsible for the manufacture of several important vitamins like vitamin B12 and vitamin K. It is not uncommon for chronic digestive disorders as well as chronic skin conditions like acne, psoriasis, seborrhea and eczema to clear up or be significantly improved by switching to unchlorinated drinking water and supplementing the diet with lactobacillus acidophilus and bifidus. The World’s Greatest $77 Water Filter. Chlorinated water contains chemical compounds called trihalomethanes which are carcinogens resulting from the combination of chlorine with organic compounds in water. These chemicals, also known as organochlorides, do not degrade very well and are generally stored in the fatty tissues of the body (breast, other fatty areas, mothers’ milk, blood and semen). Organochlorides can cause mutations by altering DNA, suppress immune system function and interfere with the natural controls of cell growth. Chlorine has been documented to aggravate asthma, especially in those children who make frequent use of chlorinated swimming pools. Several studies also link chlorine and chlorinated by-products to a greater incidence of bladder, breast and bowel cancer as well as malignant melanoma. One study even links the use of chlorinated tap water to congenital cardiac anomalies. Anything you can do to filter tap and shower water that eliminates or even minimizes chlorine would certainly be helpful and possibly curative for some immune system problems. The use of at source water filtration devices is increasingly popular and affordable. Discuss their use with your health care practitioner. REFERENCES Fackelmann, K.A., Hints of a chlorine-cancer connection. Science News, July 11, 1992;142:23. Flaten, Trond Peter. Chlorination of drinking water and cancer incidence in Norway. International Journal of Epidemiology, 1992;21(1):6-15. Messina, Virginia. Chlorine and cancer. Good Medicine, Winter 1994;8-9. Morris, Robert D. Chlorination, Chlorination by-products and cancer. American Journal of Public Health, July 1992;82(7):955-963. Rothery, S.P., et al. Hazards of chlorine to asthmatic patients. British Journal of General Practice, Jan, 1991;39. Shaw, Gary M., et al. Chlorinated water exposures and congenital cardiac anomalies. Epidemiology, November 1991;2(6):459-460.

Fair Use Statement

Lesson from An Old Woman

by Hardly Waite

 

In the days just after the 9/11 events, when the President avowed that he had not a clue about “why they hate us,” I heard an old British woman, now a U.S. citizen, address the issue on an NPR call-in show.

She had a simple explanation.   “What Americans don’t understand,” she said, ” is how it sounds to the rest of the world when they brag constantly.  That’s the main thing that other nations notice about Americans. That they brag all the time.  What Americans need to do is stop bragging so much.”

After hearing her, I started to listen. I urge you to listen, too.  Try to imagine what it must sound like to our friends and foes alike to hear our current stable of arrogant politicians spewing constantly about how wonderful and superior America is and how terribly inadequate, weak,  and “evil” is the rest of the world by comparison.

And what’s really sad is that what most often passes for “patriotism” is nothing more than tasteless and unfounded boasting.

 

Water–Are You Drinking Enough?

by Hardly Waite, Gazette Senior Editor

Here are some facts from a brief article in The Compleat Mother, one of our favorite magazines (#64, Winter, 2001).

• In 37% of Americans, the thirst mechanism is so weak that it is often mistaken for hunger.
• 75% of Americans are chronically dehydrated.  (It is likely that this applies as well to half the world’s population.)
• Even mild dehydration slows down one’s metabolism as much as 3%.
  

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• In a University of Washington study, a single glass of water shut down midnight hunger pangs for almost 100% of the dieters.
• The #1 trigger of daytime fatigue is lack of water.
• Research indicates that eight to ten glasses of water per day could significantly ease back and joint pain for up to 80% of sufferers.
• A mere 2% drop in body water can trigger fuzzy short-term memory, trouble with basic math, and difficulty focusing on the computer screen or on a printed page.
• Drinking five glasses of water per day decreases the risk of colon cancer by 45%,  the risk of breast cancer by 75%, and the risk of bladder cancer by 50%.

Another authority says: “Water is also the best medicine, both inside and outside the body. The finest prevention for malaise (after an evening of excess consumption!) is a pint of water before bed.”

So, drink up!