Orthopaediciq

STOP! Wrong Way!

Posted on October 9, 2008 by driverjowitt | Edit

Many treatment policies in “conventional medicine” have, over the years, been inappropriate. Not only were some ineffective, but their effects were diametrically adverse, worsening the condition, often fatally.

These treatments were well intentioned and, in the world of mystery through which medicine is still searching its ways, were bound to happen.

Critics regularly point to the failures of “conventional medicine” in their self-justification, and as a promotion of whatever brand of purported therapy they happen to advocate. However this merely tells more about the critic than about the issue. It demonstrates that critic’s failure to understand that therapy will always be a percentage game.

What is important is that the best therapy is effective more often, to a greater extent, with less detriment, for most people. The distinguishing quality between “conventional” and “alternate” therapies is simply that a greater attempt is made in conventional medicine to ensure that the percentages of success are demonstrably measured to be greater than alternative therapies. If an “alternate” or “natural” form of treatment can be shown to be safely effective it will be adopted forthwith into conventional medicine.

Therefore to critically analyse the failures of “conventional medicine” is not to belittle it, but rather see this as strength and the part this plays as a continuous reminder by their peers to those in “conventional medicine”, of the need to reappraise constantly.

Another lesson is that medicine cannot and should not be practiced in an inflexible “cook-book” way. The practice of medicine is an intellectual pursuit, which requires not only extra-ordinary factual knowledge, but it also requires skills of communication, perception, interpretations, flexibility, recognition of context and critical self analysis.

Incomplete training and the exercising of rigid rules, as in “barefoot doctoring” or “rule-of-thumb” practice, will fail. Not every time, of course, but unacceptably more often.

Some past errors of management:

Diverticulosis: This common and debilitating condition of the large – occasionally small – bowel (which can be fatal) was “treated” for many years with low-residue diets. Only later was it concluded that low residue diets were contributory to the cause of diverticulosis[1], and the management switched promptly to high residue diets[2],[3]. It is likely that both the morbidity and mortality were significantly increased by this form of management.

Peptic ulcers (a not infrequently fatal condition) managed by the administration of milk. This is a classic example of pseudo-logic. It was recognised that increased stomach acidity was associated with peptic ulceration. It was (incorrectly) assumed that there was a direct cause and effect relationship (the “post hoc fallacy”).

Then came the compounding pseudo-logic: If increased acidity caused peptic ulcers, then the stomach contents should be alkalised. What alkali was available? Milk was an alkali, so, presto, milk was given, often as a continuous drip into the stomach by a nasal tube. I remember patients in hospital for weeks at a time, receiving “milk drips”. Then another twist: Alcohol was known to be a stimulant of gastric acid, and those who wanted to drink alcohol – often whisky – were advised to drink their whisky with milk. So two became associated and the perception arose that the treatment for peptic ulcers was “whisky and milk”.

However the naive idea that milk was beneficial was countered when milk, as the “designer food” which it is, was found to contain a powerful stimulant to stomach acid secretion. It should have been expected that a substance acting as a very specific food should stimulate its own digestion, but this was masked by superficial thinking. It is likely that tens of thousands died of perforated peptic ulcers during this period of management by two powerful stimulants to stomach acidity.

Kwashiorkor. This is considered to be one of the protein energy deficiency syndromes, although the precise cause is obscure, as is the mechanism distinguishing it from marasmus. One of the described features was gross enlargement of the liver. Since it was believed that energy deprivation in the form of deficient carbohydrate diet was responsible, the management of the condition in Africa was based on increasing consumption of maize and other grains. However it later became apparent that the cause of the liver disease was aflatoxin, produced by a fungus which grew in the stored grain in warm and moist conditions. Thus the children were being fed the very grain which was damaging their livers with a potent carcinogen[4]

Shaving Skin. It was said, at one time, that “it was obvious” that shaving the skin made it cleaner and that, ipso facto, would reduce post operative infections. Therefore,  for generations, patients were shaved pre-operatively. For reasons of nursing convenience this was often done the night before surgery.

The reality is that shaving the skin, and the micro-trauma which it causes, substantially increases post operative infection, and the longer the lag between shaving and surgery the greater the incidence of infections.

Forefoot Surgery. There is little doubt in my mind that a radical revision of forefoot surgery is now due. It is hoped that the surgeons correcting the forefoot in the future will recognise the irrationality, in most instances, of cutting bone and destroying joints with the associated risks and long periods of convalescence.

Multiple Sclerosis.

The association of MS with Vit. D deficiency could explain the geographical distribution on MS, so well known in the past that it “was a disease of Europe and didn’t occur in the tropics”. Much the same for TB, where a “dry climate” was prescribed. For “dry” read “cloudless” read “sunny” read “vit D conducive”. Another of the mis-logics of medicine. 

http://www.naturalnews.com/032244_multiple_sclerosis_vitamin_D_deficiency.html

These inappropriate treatments should show us in retrospect how things went wrong and the need for critical reassessment of any treatment, repeatedly on every patient: This has often been because there were:

1. Assumptions which were not verifiable
2. Quasi-logic and logical fallacies
3. Tenuous and rigid persistence without reflection
4. Practitioner self-assuredness- often by duping themselves by a belief in their own self-importance
5. A belief that the “body” of medical thinking must be correct.

 

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[1] Diverticulitis at Merck Manual of Diagnosis and TherapyHome Edition

[2] Manousos O, Day NE, Tzonou A, et al (1985). “Diet and other factors in the aetiology of diverticulosis: an epidemiological study in Greece“. Gut 26 (6): 544-9. PMID 3924745. PMC:1432747.

[3] Aldoori WH, Giovannucci EL, Rimm EB, Wing AL, Trichopoulos DV, Willett WC (1994). “A prospective study of diet and the risk of symptomatic diverticular disease in men“. Am. J. Clin. Nutr. 60 (5): 757-64. PMID 7942584.

[4] Trans R Soc Trop Med Hyg. 1984;78(4):427-35. Links

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