Miracle Cure

Don't get me wrong. I get down on the drug companies (that's drug in black and white) and many of their products here a lot, but I don't mind taking a few. As a matter of fact, I'm alive to yell and scream at Merck and Pfizer because of antibiotics that they manufacture. Long-time readers know that I underwent major surgery about 15 years ago, of a kind that could not be done successfully without antibiotics. While the doctors made a mistake, and did a far more radical operation than I actually needed, I did have a condition that would have been 100% guaranteed to kill me before the antibiotic era.

If you've noticed that I've been off my game a bit that last couple of days, it's because I've been under the weather. Without going into unnecessary detail, right now I'm taking a late generation antibiotic, ciprofloxacin, and I'm very glad for it -- I should be back to full strength very quickly.

Most people assume that medicine became "scientific" and just started to get better and better after the Enlightenment, along with physics and chemistry and biology. But it isn't so. As a matter of fact, doctors didn't really begin to do more good than harm until the development of antibiotics, which didn't seriously happen until World War II. The improvements in life expectancy and health status that happened between the late 19th Century and the mid 20th resulted from public health measures -- which mostly means sanitary sewers and provision of clean drinking water, along with pasteurization, refrigeration and generally cleaner food handling -- plus improved nutritional status and better housing as the worst conditions of the Industrial Revolution began to recede.

Doctors could cut off mangled limbs and seal the stump with a red hot iron; and they could administer heavy metal toxins to syphillitics, which were bad for you but even worse for the spirochete so no doubt worth it on balance. They could give opiates for pain relief, and they gave smallpox vaccinations, but you didn't actually need a doctor for that. They could do various sorts of surgery to remove tumors and abscesses but it was as likely to kill you as cure you. Other than that, what they did was generally useless or harmful. As late as the 1970s, it was perfectly respectable to argue, as Ivan Illich did in Medical Nemesis, that medicine was, on balance, harmful to the health and well being of individuals and to the beneficial order of society.

Doctors still manage to kill 100,000 people or so every year in hospitals, which are still very dangerous places full of virulent, drug resistant pathogens among other horrors. No doubt doctors kill as many more outside of hospitals, due to adverse effects of prescription drugs. However, a bit more than 30 years after Medical Nemesis, it is no longer defensible to say that medicine does not make a substantial contribution to population health and longevity. The movement for evidence-based medicine (sad that it required a movement, but it happened), continuing advances in understanding disease etiology and the development of effective prophylaxis and treatment for heart disease, and better and better surgical techniques, have definitely tipped the balance.

Before WW II, lack of access to medical services no doubt made poor people feel disadvantaged, but they may actually have been lucky. That's not true any more. We should definitely still do our best to eat right and exercise and not smoke and all that good stuff, and try to stay out of the clutches of doctors. They have a bias toward intervention, they can still do more harm than good in many situations, and we should probably strive to be more conservative than our doctors when it comes to treatment decisions. But we are better off with them than without them. (Or, as Tom Lehrer suggested, it's no fun to be a Christian Scientist with appendicitis.)

And that is why it is now absolutely the case that universal access to comprehensive health care has now become an urgent matter of justice and a basic right on a planet that can afford to provide it. That wasn't true until recently; effective medical intervention was a hit or miss affair, and it made sense to say that feeding people and giving them clean water to drink and other basic conditions of life was so much more urgent that sending doctors was little more than a distraction and a way of denying the unconscionable reality of injustice.

In extreme situations, such as wars and mass famines, there still is a lot to be said for that position and medical relief agencies such as Doctors without Borders struggle with this dilemma. However, as a general proposition, the basic, effective medical services have now taken their place alongside other basic needs as essential components of a just world order. I have been asked to say more about universal access and the situation of the uninsured in the U.S. -- topics I've certainly addressed in the past but need to get back to, as the political lanscape is changing.

So I will. That's two thumbsuckers in a row, and as usual, you won't hear from me again until Sunday, when I owe y'all something on the origin of life. Then I'll get after it.