Keep in mind…….body, this blog has something to do with doctoring. Which when all is said and done means symptoms. Setting aside the formal definition of physician, doctors diagnose and treat symptoms rather than illnesses. Illness and disease are concepts, abstractions if you will, in comparison to the felt experience of symptoms. At the same time, I am expanding the scope of doctoring to include mindbody experiences (MBEs) of vibrancy, energy, engagement, connection, novelty, exploration, in-sight, feel, deep pleasure……….
Top Prescribed Drugs
Before exploring newer medical perspectives, more on the traditional practice of medicine. Surgeons remove “diseased” parts. Epidemiologic and infectious disease practices forever eradicated lethal outside intruders and when the occasion arises continue to help fight off various, “trouble-making” and “attacking” organisms. More commonly, doctors manage symptoms. Typically through medication, medical treatment blocks, suppresses, and seemingly eliminates the manifestations of symptoms. In the case of a deficit, medication is used as replacement, an example being Insulin for diabetes. To provide a better look at the scenario described, consider the most prescribed drugs in the US in 2019. https://clincalc.com/DrugStats/Top300Drugs.aspx
Topping the list is Atorvastatin, brand name Lipitor, commonly known as a statin. The drug is used to lower and keep in check the level of cholesterol in our system. To provide some scope, in 2019, 112,000,000 precriptions for 25,000,000 people were written in the US. Doing some calculations, the numbers show 15% of the population over the age of 40 are on this particular statin and other statins exist. The rationale for the use is the following: Cholesterol is the culprit in the formation of atherosclerosis, otherwise known as plaques in arteries which when large enough will narrow arterial vessels. The narrowing blocks the flow of oxygen-carrying blood leading to heart attack and stroke. The absence of oxygen spells damage and death, be it tissues, muscles, organs or our whole self. Unlike most symptoms, the first symptom, meaning information from our senses, of plaque formation could be sudden death. Fortunately, the more common symptom, or informing experience, of arterial blockage is angina – chest pain due to decrease blood flow to heart muscle. So, use the medication to prevent the possibility of a possible, future serious cardiovascular (heart) or cerebrovascular (brain) event.
Thyroxine is medication given as replacement for thyroid hormone, an essential chemical for living. The medication is most frequently given for Hashimoto’s Thyroiditis. To note, “itis” in a medical term means inflammation; bronchitis – lungs; myocarditis – heart muscle; pharyngitis – throat. The inflammation eventually impairs the functioning of the thyroid. The hormone can’t be secreted. Thyroxine is also used when the cancerous thryroid is removed. The third most common usage is for low levels of circulating hormone due to unknown factors. This third usage could be in response to complaints of fatigue with borderline or just low-ish hormonal level.
Three medications for lowering blood pressure are among the top ten most prescribed drugs. Lisinopril, brand names Prinivil and Zestril; Metropolol brand names Lopressor and Topril; Amlodipine brand name Norvasc. The drugs through different physiological mechanisms help blood vessels to dilate and/or block constriction of vessels. Constriction of blood vessels will cause more pressure – higher pressure in the vessels, like putting your finger over the opening of a water hose to get a more powerful spray. The medications can also reduce the symptom of angina – heart related chest pain. 47% of American adults – 116 million – have hypertension. This number comes from The American College of Cardiology (ACC) and American Heart Association (AHA) 2017 revision of blood pressure guidelines. The revision added 30-35 million people to the estimate of hypertensive people. The lead author of the revision explained the change: “We want to be straight with people – if you already have a doubling of risk, you need to know about it. It doesn’t mean you need medication, but it’s a yellow light that you need to be lowering your blood pressure, mainly with non-drug approaches.” https://www.acc.org/latest-in-cardiology/articles/2017/11/08/11/47/mon-5pm-bp-guideline-aha-2017
Gerd & Indigestion
Omeprazole, brand name Prilosec is used for the symptoms of GERD – Gastro-Esophageal-Reflux-Disease, aka, Chronic Acid Reflux. Non-prescription drugs used are Tagamet and Zantac. The medications reduce the amount of stomach acid in the system. Untreated or poorly treated GERD can lead to damage to the esophagus including precancerous cell changes called, Barrett’s Esophagus. These changes are “associated” with an increased risk of esophageal cancer.
A final medication for now is Metformin used for Type 2 Diabetes. 90-95% of diabetics have this type of diabetes which manifests because cells fail to respond to the blood sugar regulating, pancreatic hormone Insulin. This mindbody process is also called insulin resistance. Although the mechanism of physiological action is unclear, the effect of Metformin is to regulate blood sugar. In contrast, Type 1 Diabetes, most commonly seen in children and young adults and historically called Juvenile Diabetes requires daily, external insulin intake because the pancreas is unable to produce insulin. Like the inflammatory process in Hashimoto’s Thyroiditis, the insulin producing cells of the pancreas are rendered non-functional. Approximately 34,000,000 people or 10% of the US population have diabetes.
Better Living Through Chemistry?
Just these seven medications account for a total of 600 million prescriptions written in 2019. Of the mindbody experiences (MBEs) described, most can be altered through attention to what we eat and drink, how we move, weight, sleep and so-called, stress. Imagine reducing the number of those prescriptions 85% to 90 million prescriptions? At the same time, consider how many other prescriptions are filled in the US. Is this a problem or are we in a time of “better living (only to get better) through chemistry?” https://en.wikipedia.org/wiki/Better_Living_Through_Chemistry
By the way, that slogan originated in 1935 as part of the Dupont corporation’s advertising campaign. And did you know Dupont, established in 1802 was originally a manufacturer of gunpowder and later other explosives until the Twentieth Century when it expanded to make other important chemicals and products for everyday life. And what of the effect of industrialization on the environment? https://en.wikipedia.org/wiki/DuPont
Progress & Convenience
So now we are smack dab into side effects of generally speaking, progress. Do these medical drugs indicate progress? Certainly so in the case of those who can’t make insulin and thyroid hormone. In related replacement treatments, we have the life-saving transplants and the so common, implanting of pain relieving artificial joints.
Progress in our world is often about convenience – time saving and making life easier. We can now turn on a stove rather than build a fire every time we want to eat. A related element is less wear and tear, e.g., strain and dis-comfort. As a result, we may be less inclined to tolerate……standing in line for one minute more. To ask us to alter a lifestyle for health reasons may be an unreasonable expectation for many, too dis-comforting. Medication can allow us to continue as is, at least for a time. As a result we can ignore internal information signaling something is amiss.
Pursuit of Comfort
GERD and simple indigestion illustrate this idea. Most of us are sensitive to certain foods and more so with age. However, we may like these foods. We might be able to continue eating the foods if the effect is suppressed through medication. Does then the food cease to cause any injury to us? Another analogy can be made to the ubiquitous cortisone shot and most dramatically in sports. The athlete is injured with immediate pain. Shot relieves the pain – go back in the game. Does the continued activity cease to cause injury because the pain is gone? Perhaps an important person is objectively abusive – “toxic” – injurious. We have symptoms – sleeplessness – fatigue – back pain – private crying spells. For whatever reason, we wish to continue “taking in” the person. Corresponding to the symptoms, take a sleeping pill or a psychostimulant or a pain medication or an anti-depressant. Some relief of symptom(s) occurs. And now like the food, the person is somehow tolerable. What price do we pay for comfort? Is this real comfort?
In this scenario or prescription medication model I am describing, side-effects are inevitable, and all too often, the underlying condition remains. Before addressing the implications of the model, something about the actual side-effects of some of these medications. Lipitor and other statins can cause muscle pain. Blood pressure medications can cause fatigue, dizziness, headache, erectile dysfunction and gastro-intestinal symptoms. Some evidence indicates long-term use of Prilosec can cause loss of bone density, aka, osteoporosis. That being said, many people take these medications without noticeable side effects.
We have to weigh the pros and cons in many of these medical scenarios. Some are quite comfortable with medication, while others are reluctant to take medications. For many, to do other than the medication route is too much effort, perhaps a form of inconvenience. A striking and well-known to physicians’ fact is the number of people who are, “non-compliant” with medical treatment, in this case, medication recommendations. The subject is obviously important and gets into other related areas inescapable when addressing the complexities of living, which as a reminder is the intention of this blog.
Prevention & Risk
Looking at these most described medications leads back to prevention. Statins are being given to prevent a possible serious mindbody experience – MBE. This conventional practice assumes cholesterol and particularly, low-density lipoprotein (LDL) at a certain level in the blood is the essential-sole cause of arthosclerosis. Another question to ask is the actual risk of heart attack or stroke when LDL is high. Is it 1 out of 10 – 100 -1,000 – 10,000. And, at what level of circulating LDL? Does the risk go up proportionally with every increase in the LDL level? These same questions can be asked in regards to hypertensive drugs, which again are given to prevent heart attack and stroke. At what level of blood pressure is there risk and what is the likelihood of the serious MBE. And untreated GERD “can” lead to esophageal damage which “can” lead to “precancerous cells” called Barretts Esophagus which is, “associated” with “increased risk” of esophageal cancer.
Might it be important to have a better idea of the actual risk for all these possible and surely alarming MBE’s? After all, we are committing ourselves to the use of powerful drugs in the pursuit of “health,” or is it the prevention of “dis-ease?” I have done some looking into this question of risk and the answer is elusive. Perhaps a more thorough study would reveal more. I am inclined to doubt clearer answers would be forthcoming. Can we get comfortable with the idea that medical science and more specifically, the practice of medicine rests on less certain ground than we would like. Or, more correctly, our knowledge capacity is limited if we are confined to the results of the accepted rules of scientific research. Or, logic and rationality has its’ limits in the pursuit of knowledge concerning the workings of our mindbody.
Too add to all of this, various treatments are given for the earliest signs of – abnormal or pre-cancerous or is it early stage breast cancer; cancers that would perhaps never advance. This same situation of pre-screening and – I’m getting dramatic – scorched earth approach to the “enemy” is also seen in what had been the conventional approach to prostate cancer. For the prostate, the screening element is a blood test called, PSA – prostate specific antigen. Due to some association with prostate cancer, a certain level automatically meant a biopsy – procedure even more invasive and perhaps dicier to tissue than breast biopsy. The pathologist examining the biopsy uses a scoring system to determine whether cancer is present.
A shift has occurred in Urology. Rather than remove the prostate in the face of any hint of cancerous cells, the recommendation is to watch it over time as many prostatic cancers will never advance to the point of danger. One problem with this from the eyes of the “cancered” person is the label of cancer. If we know we have cancer in us, we are more likely to want it out. Regarding prostate cancer treatment, doing so brings the possibility of significant functional side effects, temporary or more long-lasting, such as urinary incontinence and erectile dysfunction. What also occurs in the standard removal of the prostate and seminal vesicles is orgasm without ejaculate, e,g, fluid. Last but not necessarily least is the experience of oneself in the removal of something central to sexuality. For all these reasons, an astute physician wrote a piece on changing the language we use. He suggests something like, “the biopsy shows, abnormal cells. So, I recommend keeping an eye on it. Come back in a year.” Or, something to that effect. https://case.edu/cancer/sites/case.edu.cancer/files/2019-09/nejmp1811521.pdf
A word on certainty and precision. Somehow we make a distinction between abnormal and cancerous cells. We have to imagine the difference is subtle at the beginning interface of “no and yes.” Might there exist some arbitrariness in these established protocols? And do abnormal cells inevitably become cancer cells? And do, “yes I think these are cancerous cells” become more obviously cancerous and than lethal? All this reminds me of appearing as an expert witness in my capacity as a psychiatrist. The operative phrase as stated in the attorney’s question, “Based on a reasonable degree of medical certainty, is it your opinion this individual suffered a line of duty injury?” Even in the courtroom, this degree is ambiguous. No standard exists. Is it 51% or 75% or 90% probability the injury was in the line of duty.
A significant aspect of preventive health care is the concept of RISK. How we deal with risk is unique. Covid has provided a measure of the range of behaviors based on perception of risk. “Each to his own” as is said. At this point, I am providing no answers to the questions I am raising. I am pointing out the belief systems and standards of medical practice piqueing my interest. An existing, independent organization takes a close look at this question of risk and prevention. https://www.uspreventiveservicestaskforce.org/uspstf/
A final point to be made from this drug data concerns Hashimoto’s Thyroiditis, conceptualized as an Autoimmune Dis-ease. The accepted “cause” of all autoimmune dis-ease is the mindbody production of antibodies directed towards our own tissues. Antibodies are blood proteins produced to counteract a specific antigen. Antibodies combine chemically with substances which the body recognizes as alien, such as bacteria, viruses, and foreign substances in the blood. Antigens are substances that causes your immune system to produce antibodies against it. This means your immune system does not recognize the substance, and is trying to fight it off. An antigen may be a substance from the environment, such as chemicals, bacteria, viruses, or pollen. An antigen may also form inside the body.
In other words, for some reason our own antibodies “attack” ourselves. In the case of Hashimoto’s, the thyroid is attacked and effectively destroyed. Other dis-eases considered to be autoimmune include: Type 1 Diabetes, Multiple Sclerosis, Crohn’s Disease, Psoriasis/Psoriasis Arthritis, Systematic Lupus Erythematosis (SLE) and Rhematoid Arthritis. A reasonable question to ask is why would we attack our own body. A Nobel Prize winning, German physician Paul Ehrlich https://en.wikipedia.org/wiki/Paul_Ehrlich studied autoimmunity and labeled the possibility of self-attack as, “horror autotoxicus.” Essentially, he disbelieved we could do something so antithetical to survival.
Attack & Destruction – Self & Others
What is the ultimate cause of these auto-immune dis-eases, which are rising globally? We do not know. The common explanations: Genetics, diet, a triggering irritant in the environment. Looking at human motivation, could we inadvertently be doing something destructive to ourselves? Do we act destructively? Yes of course, history certainly shows great acts of destruction of others. Do we act self-destructively? Consider these phrases: What are you doing to yourself? What are you trying to do, kill yourself? I hate myself. He seems hell bent on destroying himself. I’m kicking myself. How about that little knock on the head with the words, “I’m such an idiot.” Think about all the forms of masochism.
In keeping with my interest in the language we use, might some light shine on the subject through looking more closely at words. Let’s break down the word mortified as in, “I’m so mortified.” The definition of mortify: 1) Cause (someone) to feel embarrassed, ashamed, or humiliated.‘he was suitably mortified by his own idiocy’ 2) Subdue (the body or its needs and desires) by self-denial or discipline.‘they wish to return to heaven by mortifying the flesh’ Looking at the roots of the word: Late Middle English (in the senses ‘put to death’, ‘deaden’, and ‘subdue by self-denial’): from Old French mortifier, from ecclesiastical Latin mortificare ‘kill, subdue’, from mors, mort- ‘death’. And, we do actually kill ourselves in the face of overwhelming humiliation and/or shame. Self-cutters mortify the flesh. Such behaviors certainly appear to be contrary to our hardwired drive toward survival.
What about the language we use to describe autoimmune dis-ease? An attack on our tissues. Or, the antibody-antigen language with emphasis on Anti: antibody recognizes something as “alien,” as a “foreign substance.” The antibody “counteracts” the antigen. The process is all about a fight with the dangerous, “other.” We talk about big initiatives as the, “War” on drugs, cancer, terrorism, poverty……..Some believe major developments and approaches in modern medicine come from battlefield experiences which are emergency situations like firefighting. Certainly in actual war, “enemies” abound. The person who is surviving trying medical circumstances is “fighting hard” or “a real fighter.”
Locating the Unseen
Medical “success” is more likely when we can surgically remove, eradicate germs, clamp down on the bleeding, debride the wound, fix the bone, or block this or that. A battle, get rid of, kill or less warlike, replace, refit. What about when no clear, touchable, manipulative-able, viewable, measureable through tests “something” is creating dis-ease? How can we fight or counteract something seemingly intangible and for the moment, even ineffable? Perhaps, an entirely new way of looking is required.
What might that other way of looking be? To remind you, this blog post was intended as a continuation of my effort to tell you something of what informs my perspective. I have expressed my view of the conventional practice of medicine, noting the value of such practices, (what a relief I just experienced having excess cerumen – ear wax – removed), the unintended side effects of treatments and/or convenience seeking, and the limitations of the standard medical perspective in both understanding and impacting a whole range of mind-body experiences. In the next post I will describe ways of understanding gleaned from my, strictly speaking, non-medical education/experience. I believe these personal perspectives provide a more effective way in to a host of mind-body experiences which currently seem to fall outside the reach of established medical thinking and practice.