prevention

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A pox upon those who do not learn the history of science and medicine

Well, I’m back to writing on the smartphone today, with mixed feelings.  One of these feelings is the residual soreness in my thumbs, of course, but the day-long break did seem to help a little bit.  Mind you, some of that is probably in my head, for I don’t write on my smartphone on Sundays, and I also don’t write on non-working Saturdays.  So, if resting is enough, I should feel least sore on Mondays following one of my two-day weekends.  If that is the case‒if I am least sore in those instances‒I certainly haven’t noticed.

Actually, if it isn’t the case, I haven’t noticed either, but at least there it would make sense, since there is nothing to notice.  It can be much harder to notice things that are not so than to notice things that are so.  That’s part of why people don’t give credit to vaccination, for instance:  they can’t see the sickness and death that are prevented.  There’s no It’s A Wonderful Life revelation about all the lives that have been saved and‒perhaps more important*‒all the suffering that has been prevented.

There’s a similar, lesser-known preventative effect of proton pump inhibitors (e.g., omeprazole).  These medicines (and their somewhat weaker predecessors, the H2 blockers**) have prevented untold suffering and death related to gastritis and peptic ulcer disease and esophageal cancers, all of which used to be major contributors to premature death, especially in young men (if memory serves).  So, using these medicines is not necessarily an overindulgence in avoiding transient discomfort.  They are very real and powerful preventative interventions‒though, as with all such things, they do have some long term side-effects, and these must always be weighed against the benefits of taking them.

This is one of the reasons that educating people about history is so important.  If one is not aware of just how horrifying and heartbreaking the effects of smallpox were (for instance), one might think that the smallpox vaccine***** was just a sort of convenience, not a response to a low-flying, slow-moving, global catastrophe.

I suppose it was easier for Ben Franklin to recognize that “an ounce of prevention is worth a pound of cure” because there were far fewer preventable ailments and fewer avoidable disasters back in his day.  Still, he was a very smart person; he might have recognized the nature of such things even if he had lived in our more comfortable times.

It is useful, and it may be more than just useful, for people to learn how things were before the arrival of so many powerful technologies and knowledge and social and biological insights.  For 300,000 years, humans existed without (for instance) the internet, and then, starting around 30 years ago, it was here (and widely available).

But that’s a full generation of people who have never known a world without the internet, despite the fact that by default the world has no internet.  It can be immensely useful for those people to learn about what things were like pre-internet, not only so they can truly appreciate this remarkable phenomenon, but also so they can recognize some of its detriments.

Likewise for planes and cars and televisions and even books and agriculture.  What was life like before these things?  What would life be like if they disappeared?  Are their benefits worth their costs?  How can those costs be mitigated, even if they are bearable (for why not make things as net-beneficial as possible?)?

I encourage everyone, myself included, to take these notions seriously, to think about the contrafactual cases, not to accept that things simply are the way they are, because for the most part, historically, they were not that way.  Even humanity itself is a latecomer.

I don’t know how I got onto those subjects, but I guess I’m thinking of health (and particularly of gastric health) more than typically in recent days.  I still don’t feel too well, but that’s nothing unusual for me.  It’s just annoying because it’s a new, or at least atypical, discomfort.

Oh, well.  This brings us back to my point that decreasing/preventing suffering is more important than “saving lives”, since all such saved lives are merely saved for later, if you will.  Death (it seems) cannot be forever avoided, but suffering, in principle, can be eased and even sometimes prevented.  Though, sometimes, the only practical way to stop certain kinds of suffering is to hasten the inevitable other phenomenon.

In any case, I’ll draw at least one instance of your suffering to an end now, by finishing this blog post.  I hope you have a very good day, by any reasonable measure of goodness that you might choose.

*Because death is, as far as anyone can tell, completely inevitable‒it’s a matter of when, not if‒whereas suffering is variable, and boy can it vary, from person to person, from moment to moment, from culture to culture, and so on.

**No, they don’t block molecular hydrogen***, though if one thought that, one could certainly be excused.  Rather, they block the so-called type 2 histamine receptor, the one that responds to stimulus (histamine) by making the stomach secrete more acid.

***Interestingly enough, the proton pump inhibitors do block hydrogen, but it’s not molecular hydrogen, it atomic hydrogen‒or well actually, it’s ionic (cationic, specifically) hydrogen, which is a naked proton, since a hydrogen nucleus is just a proton****, and is the key effective part of essentially all acids, at least regarding their acidity.

****Sorry about all the footnotes within footnotes, but it just occurred to me to wonder what it would be like to make a sample of an acid but with all the ordinary hydrogen atoms replaced with deuterium, so-called heavy hydrogen, which has a neutron in its nucleus as well as a proton.  How would this affect the properties of such an acid?  Of course those properties are almost entirely related to the valence electron or the lack thereof, but when a positive ion of a substance is just a naked nucleus, one cannot completely dismiss the impact of that nucleus’s structure.  So, I would love to see an entirely deuteric acid being put through its paces.  An acid made entirely with tritium (one proton, two neutrons) would be interesting as well, but even in my imagination, that’s asking for a lot of the very tiny amount of tritium in the world.

*****This is the original source of the word “vaccination” since being exposed to Vaccinia (related to cowpox) provided resistance to Variola (smallpox).

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The Treatment Trap

In America today, we rely far too much on pills and on procedures–on would-be “cures” for our problems–than we really should.

It may seem strange for a medical doctor like me to be saying this, but I have insight into the issue from multiple perspectives.  I’ve been one of the doctors who falls into the trap of trying to “treat” every issue rather than prevent or solve it, and I’ve been a patient who approaches things the same way.

The irony is that a great many of the health problems we face in the modern world–especially the most rampant and devastating ones, such as diabetes, high blood pressure, heart disease and their related problems and consequences–are governable simply by modifying our lifestyles.  Indeed, for many of us, these health concerns’ very existence AS problems is only CAUSED by our modern lifestyles.  I’ve already discussed in some earlier entries the mechanisms and effects of type 2 diabetes, a disorder which is becoming more and more endemic in our nation, and at younger and younger ages.  It’s absolutely clear why this is happening:  We are more sedentary and more overweight and we eat more rapidly absorbed carbohydrates than humans have ever done before in our existence.  What’s more, thanks to public health interventions and control of infectious diseases, we live long enough for these habits to matter more than they could have in the past.  We also know, quite well, many of the things that we can do to counter diabetes and its close relatives, hypertension and heart disease. Yet, instead, we allow our health to deteriorate and then rush to modern medicine to seek “cures” or at least treatments for the outcomes of our bad habits.

I suspect that this trap of habits was set for us, to some degree, by the brilliant innovation and success of antibiotics.  These are the quintessential medical cures:  When used against an infection caused by a sensitive bacteria, antibiotics actually CURE the problem (with the help of our own immune system).  To some degree anti-virals do the same, though they are more recent, and anti-parasitic agents are also analogous.

Unfortunately, most other kinds of medicines–unless you count the occasional Tylenol or Motrin to treat a tension headache or muscle soreness–don’t actually cure anything.  They simply “treat” it, governing the symptoms and consequences to some degree or other, but not addressing whatever underlying processes might be contributing to the issues.  In addition, they give the patient the illusion that the problem is now under real control.

There are, of course, times, when health problems are not soluble or easily controllable, and managing the symptoms and consequences is the very best we can do, at least for now.  So PLEASE do not think that I am advocating the elimination of Western medicine or that those being treated for chronic health conditions should just give up their pills and let nature take its course.  Yet with so many health problems, even if we have to resort to medication, we can also make lifestyle and behavioral changes that will mitigate our problems and decrease, though not always eliminate, the need for medications (and surgery, when applicable).

We all know, or should know, that taking medicine can be a double-edged sword.  Medications sometimes create new issues of their own.  The human body is an incredibly complex system–arguably the most complicated thing in the known universe, especially when you count the human brain–and when you manipulate such a  system in one way or location, unexpected consequences almost never fail to arise.  This leads to the horrible spectacle of patients receiving medication for one problem, but developing side-effects, which then need to be treated by other medications, and which cause toxicities and interactions that later have to be addressed.  The whole affair can become a vicious cycle of increasing biological chaos, like a metabolic Rube Goldberg machine.  In the elderly especially, it can sometimes be all but impossible to be certain whether new health problems are intrinsic or are caused by earlier treatments.

We try, of course, to mitigate and avoid this conundrum by studying medications as carefully as possible and learning what their possible side-effects are…but every human body is different, and that’s going to continue to be the case, since the number of possible genetically unique humans is vastly greater than the number of human beings who have ever lived.  So we can be guaranteed that the one expectation we can reliably entertain is the UNEXPECTED.

It is better by far to avoid developing problems whenever possible rather than trying to treat them.  This is true because it is simpler and more predictable, and also because it makes life better.  Rather than being a person who identifies themselves by their litany of ailments, for which they build their house-of-cards treatment regimens, we can work to maintain lifestyles that are GOOD for our health, that work with our natures, and that help us to think of ourselves as–and to feel like–healthy, vital and thriving human beings.

Medicines are indeed wonderful products of modern science and technology, and I strongly suspect that they have saved and improved many more lives than they have harmed, even despite what I’ve said above.  If I didn’t think that, I wouldn’t have gone into medicine.  Yet, it would be even better if we could avoid having the need for medications as often as possible in the first place.

I’m going to discussing more of this in future entries.  I’ll go into some fairly obvious lifestyle issues such as exercise and diet, but I’m also going to explore philosophical and psychological aspects of health that can make a great difference in not only how long you live, but also in how much you enjoy the time you have.

A life of a hundred years can be a tragedy and a life of a single day can be a triumph.  It all depends on what kind of life it is.