September 2015


Too many pills

By Karen Hitchcock
Too many pills

© iStock

On lifestyle diseases and quick fixes

At a literary festival, during a discussion of how medicine reflects the values of the society in which it is practised, an interviewer asked me if I thought there would ever be a time when mainstream and alternative medicine would become “truly integrated”. We’d been talking about attitudes towards the elderly in hospital, and his question took me by surprise. “Truly integrated?” I asked. He nodded enthusiastically. “By which you mean the integration of Western medicine and alternative therapies?” He kept nodding and smiled at me, as if I was surely one of his gang. “No,” I said. “I don’t think they can be.”

It’s an interesting concept, “alternative medicine”. Alternative to what, exactly? Is it like the right versus the left in politics? If something is defined in contradistinction to something else, how can the practices be “integrated”? It has been said many times: There is no alternative medicine. There is only medicine that works and medicine that does not work. If an intervention is proven by empirical science to work, it is no longer considered “alternative”. It becomes medicine.

When I was in medical school one of my classmates was a naturopath. He planned to become a GP and practise integrative (or “complementary”) medicine. He would set up shop and use vitamins, herbs and homeopathy in conjunction with pharmaceuticals. He’d take your blood pressure, and diagnose your organ dysfunction by examining your irises. He walked like a monarch, somehow managing to look down at you even if you were taller. He never lost his cool, not even when professors stood at the front of the lecture theatre taking an atom bomb to everything he held true.

We mixed in the same social circle: the misfits and miscreants. I liked him but his arrogance drove me nuts. We argued, about homeopathy in particular. Homeopathy adheres to three main principles: a disease can be cured by giving a patient an infinitesimally small dose of the same disease, treatment should be individualised, and one should use the minimal possible dose of any treatment. The last two principles are perfectly sound and in theory should be followed by all doctors. However, in homeopathy, the minimal possible dose involves dilution of a medication to the extent that not a single molecule of the active substance remains in the final pill.

I’d ask him, how can the concept that water has the capacity to hold “memories” of substances it has encountered be “integrated” into medicine? Medicine is an empirical science that believes molecules are either present or absent, and if they are absent they can have no effect. The theoretical basis of homeopathy – I would say – is fundamentally incommensurate with everything we know about chemistry, biology, physiology and disease. It hadn’t once proven effective in multiple large, double-blind randomised controlled trials. It was preposterous.

He’d tilt his head ever so slightly sideways and look sad: for my ignorance, for my future patients and for me.

Disillusionment with Western medicine is not uncommon in Australia. When, back in the ’90s, I told a dancer friend of mine I was applying to medical school, her eyes widened, her mouth opened and no words came out. Another friend placed her hand gently on my forearm, leaned in and said she was seriously worried about me: what had gone so very wrong that I would consider that?

Mainstream medicine is charged with being reductionist, inhumane, non-holistic. It denies there is Lyme disease in the Melbourne CBD; fails to take chronic fatigue syndrome seriously; scorns patients who are convinced they have undetectable autoimmune or allergic conditions; and suppresses the fact that food, vitamins or ozone enemas might cure cancer and that immunisation causes autism. Doctors are arrogant, authoritarian and non-communicative. They cut, drug and dismiss. Western medicine keeps us sick for the financial gain of doctors and drug companies. Almost everyone could tell you a story of how medicine has failed them. Alternative medicine seems to offer an alternative. Integrative and complementary practices seek to improve mainstream medicine’s poor report card.

Australians are keen users of all kinds of alternative health products and practices. A survey conducted by the guidance body NPS MedicineWise in 2008 showed that 65% of Australians had used one or more “complementary” medicines in the previous 12 months. If we include self-prescribed vitamin supplements bought from the supermarket or chemist, then it is not a stretch to say that most Australians use some form of alternative treatment in their quest for health.

I have spent a lot of time of late wondering exactly what medicine, the discipline, has become. I work on the acute medical wards of a large city hospital, looking after patients who have been tipped out of ambulances into the emergency departments and are sick enough to earn a bed upstairs. On the wards, medicine can be powerful and life-saving. If someone has a clot or an infection or an arrhythmic heart, we have drugs that fix their problem. The surgeons can cut out or repair diseased tissues, allow people to walk once again by replacing disintegrated joints, sew in brand new lungs and hearts. Cancer is obliterated or retarded. A heart is made to beat again. This is the television fantasy of medicine – where heroic doctors save patients with their bare hands, a few pieces of machinery and the medicine cabinet. And it happens, all the time. But on these wards we spend at least as much time patching up social catastrophes (drug overdoses, homelessness, violence) and the devastating effects of life-long body abuse or neglect (poor diet, physical inactivity, smoking and alcohol) as we spend treating broken body parts or immediately life-threatening illnesses. Around a third of the elderly people on any ward are lying in their hospital bed because of a side effect of a medication they have been prescribed in good faith by a doctor. A medication that has been overdosed or prescribed unnecessarily or had an unexpected side effect and has thus made the patient sick.

Australia is a rich country: we have access to immunisation and clean water. Our mosquitoes are not deadly. Most of us are not starving. Our ills reflect this. We have entered the age of the so-called non-communicable diseases: diabetes, cardiovascular diseases, cancer and emphysema, many of them attributed to our “lifestyle”.

I sat through a lecture recently where an endocrinologist showed a map of Melbourne that plotted the incidence of type 2 diabetes by suburb. The lower the average socio-economic standing of the residents, the higher the incidence of the diabetes. The correlation was picture perfect. The action the speaker proposed upon pointing this out was to collect more data, to employ more endocrinologists, to ensure those hospitalised with diabetes in these suburbs received better monitoring and treatment. I sat there quietly, face attentive, hands in my lap, wishing I could strangle someone: him, my colleagues, the government, myself. On the wards and in our clinics we are charged with treating the consequences of politics and policy mixed with bad luck and individual choices: the consequences of social problems such as poverty, alongside the consequences of excess.

The solution to diseases of lack and excess can’t possibly be supplied by medicine, and yet many doctors, researchers, politicians and funding bodies, and much of the population, seem to believe it can. It wasn’t the endocrinologist’s fault he didn’t raise his fist and call us to arms. He’s a doctor, focused on a pancreas that can’t keep up with the insulin needed to metabolise far too much sugar to supply far too much fat. He does what he’s trained to do: treat cells. Medicine wants to be of assistance.

Alongside the non-communicable diseases there is another kind of epidemic in the West: feeling unwell inside a body that medicine deems pristine. Studies show that around 30% of patients who present to specialty outpatient clinics are suffering non-organic symptoms that impair function but are not caused by a dysfunctioning body. In some neurology clinics, the proportion of patients who suffer non-organic symptoms reaches 50%. More than half of the patients in any kind of medical clinic will list fatigue as one of their most troubling symptoms. GP practices are inundated with patients suffering vague symptoms such as aching bones, sleeplessness, irritability, lack of concentration and persistent dog-tiredness that are not attributable to any disease. Why do so many “medically well” people feel so sick?As doctors, we do what we can. We can construct narratives of cellular causation that elide the social, interpersonal and the political. I have sat through lectures by experts who beam PowerPoint slides with impressive diagrams of neurotransmitter pathways they say lead to the feeling of what would once have been called simply “despair”. A doctor tells me authoritatively that falling in love is merely dopamine fucking with the brain. The mysteries of human consciousness and our intricate connection to our world and those around us – the subject of centuries of philosophical thought – are reduced to a handful of chemicals acting on a cell in an individual. We’ve become adept at inventing new “diseases” – chronic fatigue syndrome, female hypoactive sexual desire disorder, attention deficit hyperactivity disorder, irritable bowel syndrome, social shyness disorder, fibromyalgia – to account for bad feelings housed by well bodies. And we prescribe truckloads of drugs to fix them. This is our field, after all. So charged with fixing everything, this is what we treat: cells. And we are ably assisted in our task by one of the most profitable industries in human history: the pharmaceutical industry. As Ray Moynihan, Iona Heath and David Henry have written in the British Medical Journal, “There’s a lot of money to be made from telling healthy people they’re sick … Pharmaceutical companies are actively involved in sponsoring the definition of diseases and promoting them to both prescribers and consumers.”

Walk through the vitamin aisle of any pharmacy or supermarket and you are offered plastic bottles filled with the promise of better sleep, greater sexual potency, increased energy, and relief from pain, depression, fluid retention, PMS, hunger and joint degeneration.

The supplement industry is worth more than $1.5 billion a year in Australia. The CEO of the Australian vitamin and supplements company Swisse, Radek Sali, is quoted in the Guardian as saying, “If it’s not harming anyone and it is making people feel healthier and happier, why wouldn’t we have more of that?”

We buy mountains of vitamins that the majority of us do not need, that do not work, and that – despite Sali’s cheery claims – have the potential to cause harm. Many supplements contain more than the recommended daily dose of a vitamin or mineral that we are not usually lacking in the first place. Vitamin E supplementation has been linked to an increase in all-cause mortality. Taking only a few times the recommended daily dose of Vitamin A can cause nervous system, liver, bone and skin disorders, and birth defects when taken in pregnancy. Vitamin C in large doses causes diarrhoea and kidney stones. Zinc excess causes iron and copper malabsorption. Too much vitamin D causes hypercalcaemia. Beta-carotene increases the risk of lung cancer. Iron, severe toxicity. B6, nerve damage. Potassium overdose causes cardiac arrest. What are we seeking to treat with our hypervitaminosis? Do most of us really feel sick?

I saw Marie, a middle-aged, educated woman, in one of my specialist public clinics. The clinic is for patients who suffer debilitating fatigue or other symptoms – pain, paralysis, collapse – that have remained inexplicable despite multiple specialist reviews and much investigation. Marie was suffering extreme fatigue, gastrointestinal disturbances, constant aches in a constellation of ever-changing body parts, and sleeplessness. She’d seen a rheumatologist, a cardiologist, a naturopath and an acupuncturist and found no relief. I asked about her marriage, work and family. She felt revulsion towards her body and her husband, was deadly bored with her part-time work, and binged on large amounts of junk food multiple times a day. Her physical examination and blood tests were all completely normal. She was desperate to feel well. She told me she only ever felt well at a health retreat she visited three times each year: “I feel completely transformed after just one night. I can think, I can sleep, I have no pain.” She asked me if she might be suffering from chronic fatigue syndrome, perhaps that was her problem? I said I didn’t think so. She looked at me. “Then I think I need an antidepressant.”

How tempting, to pull out the script pad and pretend the drug should just about cover it. How difficult to say no: to her requests for the diagnosis and the drug. I asked her if she thought that she could attempt to bring some aspects of the health retreat into her life instead of taking medication. I suggested a psychologist, massage, perhaps a course in meditation. I knew she could pay for such treatments. She sighed and said, “Can’t you just give me the script?”

It is almost impossible to criticise our dependence on medication to treat non-communicable chronic diseases without seeming moralistic. Diagnosing the problem comes out sounding like a terrible lecture, a finger wag, a huge downer: you bad, greedy, lazy, selfish population. But the problem is not the result of the choices of a sinning bunch of individuals, it is the result of structural, societal and political design.

Many of the diseases we suffer in Australia, the diseases causing hospitals and clinics to overflow, could – theoretically – be prevented. Most of the pharmaceuticals we swallow could – theoretically – be dumped. But we don’t have time to sleep or exercise or attend to our emotional needs. We want to drive, feast, drink and smoke. We don’t want to meddle with the food industry to curb advertising, or to manipulate pricing of the fresh and the junk. We don’t want to pay more taxes or direct funds towards decent welfare, social supports for the vulnerable, movement-promoting infrastructure or better education.

I love medicine – the science, the practice, the hospital, my colleagues and patients – but I have come to hate most of our pills and the impossible expectations borne by them. In certain circumstances, medications save lives. Antibiotics cure severe infections that would have been universally fatal before their advent. People with heart failure can be kept alive for years with diuretics and beta-blockers. Adrenaline stops death from anaphylaxis. Thank god we have anti-convulsants. But many dispensed drugs will not save the life of the individual who swallows them. Statins, or cholesterol-lowering medications, are among the most common pills in our pharmacopoeia. And yet, 104 people who have high cholesterol but no known heart disease need to swallow a statin every day for five years in order to prevent one of those 104 people having a heart attack, a heart attack that would not have killed them. Eighty-three people with known heart disease need to take the pills for five years to prevent one of them from having a fatal heart attack. Each individual’s statistical benefit varies according to their age and medical history, but we prescribe these pills like crazy – presenting them to our patients without the statistics – and all of us swallow them in the belief that they will definitely have a direct beneficial effect on every individual.

Most of the blockbuster pills tweak, they curb, they do nothing or they harm. Taken by a lot of people for a long time they do save lives. But the broadly applied pharmaceuticals that address “risk factors” like high blood pressure, thin bones and high blood-sugar levels, and the drugs that are treating mild depression, anxiety and dementia, are mostly treating health problems that could be addressed in other ways: diet modification, weight-bearing exercise, weight loss, along with the social and structural changes that support these measures. All those shiny, fancy packets with zippy names that promise life, health and happiness. They promise exoneration from responsibility and consequence – both personal and political – like a priest in a confession box, telling us we’re all off the hook. Tiny white spitballs aimed at impossible targets, both large and small: gigantic sociopolitical problems as well as personal, middle-class dissatisfaction with life. We let the pharmaceutical industry dictate the pathways to health and we underfund access to physiotherapy, psychotherapy, social workers and rehabilitation.

In 1848, the German pathologist Rudolf Virchow wrote, “Medicine is a social science … Politics is nothing other than medicine on a large scale.” Medicine has been charged with the job of curing all our modern ills: organic and non-organic. No wonder it is failing.

A number of integrative-medicine GPs around Australia specialise in the treatment of chronic fatigue syndrome and related “diseases”. The patients present to these GPs with extremely common, vague physical symptoms for which they seek explanation, diagnosis and treatment. Many of these GPs will offer hard diagnoses, clear or convoluted explanations, and the hope of cure. For a few thousand dollars these doctors will diagnose you, compile the results of the countless non-Medicare-funded tests of your stool, urine, blood, breath and skin into a bound book, and start shovelling treatments upon you: expensive supplements and probiotics, multiple antibiotics taken for months or years, anti-convulsants, sun deprivation, steroids and bed rest. Their patients feel ill, their symptoms are real, but the cause of them is not a lack of vitamins, an undetectable infection or the sun. They do not have “systemic candidiasis”, which does exist but is only seen in the gravely ill, those with end-stage AIDS or organ transplant immunosuppression, and is not cured by avoiding sugar and mushrooms. They do not have “chronic Lyme disease”, “multiple-chemical sensitivity” or “myalgic encephalomyelitis”.

What is uniquely problematic about these alternative diagnoses and often-expensive treatment regimens for diseases that a patient doesn’t have is that while they may work as a placebo, they usually do not address the root of the patient’s problems and may cause harm. Psychological work and exercise treatment, for example – the only two therapies that have ever been proven effective in the treatment of people with long-standing fatigue – are usually not suggested. Patients may be treated for chronic fatigue syndrome, chronic Lyme disease or a leaky gut when the symptoms are actually caused by severe sleep apnoea or other sleep disorders, florid autoimmune disorders, extreme physical deconditioning or malnutrition.

Mr D, a 78-year-old man, came to me accompanied by his concerned wife. He had been suffering fatigue and cognitive difficulties for a number of years, and his symptoms were getting worse. He had just spent two years being treated for what an integrative-medicine GP had diagnosed as chronic fatigue syndrome. Mr D was not aware that the tests and treatments he had paid thousands of dollars for were “alternative”. He thought he’d been seeing a specialist for treatment of a disease that existed and that he had. Despite diligently swallowing every pill and following every dietary restriction prescribed, he was getting worse. He made furniture as a hobby but could no longer measure and cut the wood correctly. He got the measurements wrong, couldn’t piece the individual components together or control his tools. He struggled on, trying to work past the difficulties and create the way he had for decades. He was also losing vocabulary. He had developed convoluted ways of remembering where he left his glasses and keys, of remembering people’s names. These systems of remembering took up many hours of his day. It was no surprise that this extraordinary effort, frustration and fear sapped him of energy. He sat before me, pausing every three or four words, screwing his face in concentration as he grasped for words. It was obvious, and would have been to most doctors, that Mr D most likely had dementia. I told him and his wife what I suspected. And in the face of this devastating diagnosis, their bodies visibly relaxed and their faces filled with relief. “Of course,” Mrs D said, taking her husband’s hand. Mr D looked at his wife. “Of course.”

These alternative practitioners (the naturopaths, homeopaths, the integrated GPs) follow the mainstream medical model to a tee. The only things “alternative” about their practice are the diagnoses offered and the treatments prescribed. They spend as much time as we do prescribing industrial substances, just not ones on the Pharmaceutical Benefits Scheme. They invent diseases faster than Big Pharma and are now industries that globally turn over many, many billions of dollars each year. And they are certainly not an alternative to a simple, cellular understanding of a human being; nor to the illusion that to be drenched in wellness one must be showered with pills.

Until I hit the wards I didn’t really care about naturopathy and integrated medicine beyond it being a topic of argument with my infuriating friend. I thought of it as a benign, if mostly ill-informed, form of support for the not-really-ill. A bit of random dietary exclusion. A few vitamin tinctures or sugar pills. A nice chat, a few bucks and off you go, back to your unimmunised kids and airy house in the suburbs. Having an iridologist gaze into your eyes and tell you all they see can be a very powerful, intimate and enriching experience, even if the story you hear is a fairytale and you leave her office with $300 worth of vials containing empty promises. Many alternative treatments, however, have severe side effects and can damage the body. The greatest potential for harm is when the patient has a serious organic disease, which is misdiagnosed or for which effective treatment is shunned.

In the hospital we often see harmful results of the seemingly harmless. A 43-year-old man was sent to my ward with a fist-sized pocket of pus in his lung. He’d been intermittently feverish for weeks, drenching his sheets each night and coughing up large volumes of purulent sputum. He’d consulted a reiki therapist who treated him with three sessions a week, hovering her hands a few centimetres above his chest for 30 minutes. When his skin turned the colour of cement his girlfriend finally convinced him to see his GP, who (suspecting severe pneumonia) ordered a chest X-ray, saw the fluid-filled abscess and sent him straight to hospital. Of the reiki, the man told me, “It was really helpful. It eased my cough.” Unfortunately the cough was his body’s attempt to get rid of the accumulating pus. One of our treatments was to encourage his cough.

Perhaps this is one argument for the integration of mainstream and alternative medicine: safety. If the reiki therapist had studied medicine, she might have recognised the signs of a serious chest infection and had something to offer in the absence of organic disease.

The British journalist John Diamond, who died of throat cancer in 2001, wrote in his book Snake Oil and Other Preoccupations:

it’s no coincidence that alternative medicine grew as Margaret Thatcher’s Weltanschauung took hold. In many ways it was where the fading hippiedom of the early Seventies was able to meet the new materialism of the Thatcherites head-on. Alternative medicine, like Thatcherism, tells us that our personal well-being is entirely in our own hands, that we can all have anything we want – perfect health, freedom from anxiety – if we want it enough and are willing to take the steps to make it happen … alternativism masqueraded as another form of consumer liberation. No longer would we be tied to a single provider of health – the medical orthodoxy – but we would be free to choose. If we liked the reflexologist’s eccentric view of the body as a series of energy lines which terminate in the feet, then we’d choose that.

Most medical schools send their students to the bush for a term. In third year I spent three months in a small town in northern New South Wales known for its relentless sun and population of alternative-lifestylers. The old-school surgeon I was placed with told me I was lucky. “You’ll see great pathology here.” I asked him why. He had his hands in his pockets, his short, sturdy legs standing wide. “It’s the hippies … They treat their bowel cancer with chamomile tea.” He looked at the ground, shook his head, looked up again. “Until they start vomiting shit. Then they come to us.” He jabbed his thumb to his chest and grinned. “Huge surgery. Great surgery.”

There have been a number of high-profile cases where people have rejected mainstream therapies outright and embraced alternatives to cure themselves. In Australia, Belle Gibson (who fabricated her diagnosis of a brain tumour) and Jessica Ainscough aka the Wellness Warrior (who had developed epithelioid sarcoma, a rare soft-tissue cancer) both publicly rejected mainstream cancer treatments. They claimed healthy lifestyles and alternative therapies, such as Gerson therapy, had alone cured (Gibson) or were curing (Ainscough) them. Ainscough died earlier this year.

The clean-living aspects to their regimens – eating mostly vegetables, exercising, attending to mental wellbeing – were admirable, and are probably the key ways a human can give themselves the best shot at longevity and health. But these are preventive actions that need to be practised over a lifetime – to prevent cardiovascular diseases, dementia and diabetes. They do not have the power to cure cancer.

The belief that that the mainstream medical diagnosis of impending, unavoidable death is wrong and that some other version of the body offers hope must be incredibly seductive. Most cancer patients in Australia use some form of alternative therapy throughout their mainstream treatment. These therapies are often touted as being holistic, acting on parts of the human animal ignored by Western medicine: chakras, energy lines, biofields, channels, spirit, auras. Most oncologists will advise against fringe practices that may be dangerous, will advise when the practices are non-beneficial, and then understand when their patient does everything they can – even the futile – to get better. Desperate people, desperate measures. Undertaking what are often arduous alternative treatments (extreme dietary restriction, repeated noxious enemas, hours of meditation) can seem like “taking action” at a time when one has lost all control: one’s body is wildly growing disordered cells in places they should not grow; doctors are prescribing extreme medications, radiation and surgery; the whole thing is happening to you, at you, on you, in you. An alternative hope offers the illusion of wresting control, of saying “no” or “not enough” or “fuck you” to the authorities: your doctors.

In January 1997, the Guardian published ‘The Gift of Disease’, an article by the writer Kathy Acker about her breast cancer. She was initially treated with a double mastectomy, but when her lymph nodes were found to contain cancerous cells her doctor recommended a course of chemotherapy. Acker refused the treatment. She wrote:

As I walked out of his office, I realised that if I remained in the hands of conventional medicine, I would soon be dead, rather than diseased, meat. For conventional medicine was reducing me, quickly, to a body that was only material, to a body without hope and so, without will, to a puppet who, separated by fear from her imagination and vision, would do whatever she was told.

Acker was subsequently treated by multiple alternative therapists from a wide variety of disciplines, including acupuncture, shamanism, Gerson therapy and herbalism. She carried a suitcase full of herbal supplements with her wherever she travelled. She died of widespread metastatic breast cancer in December 1997, in Mexico, at an alternative health clinic.

Whether or not her life would have been saved by early chemotherapy is unknowable. As is the impact – positive or negative – of her adherence to alternative health regimens. Regardless, I think she accurately diagnoses our problem: at base, personally, socially and politically, we have come to think of our ill selves as meat. Individual chunks of meat lacking only some kind of medicine.

The runaway bestsellers The Brain That Changes Itself and The Brain’s Way of Healing by Norman Doidge have been widely criticised – particularly by doctors – for “blaming the patient for their disease”. The Canadian psychiatrist’s two books rage against the institution of medicine that is structured to reinforce what he calls a patient’s “passive resignation” in the face of disease. He argues that we have been trapped by the myth that treatment comes only in the form of a pill. He believes that medicine must change.

His interest is in brain plasticity. He shows the multiple ways there are to ameliorate or slow the progression of many neurodegenerative diseases through doctors “prescribing”, medical systems supporting, and patients engaging in active therapies. These therapies are mostly arduous and involve a great deal of mental and physical effort. One of his case studies tells of John Pepper, a man with Parkinson’s disease who had almost lost the ability to walk. Pepper teaches himself to make the brain stem (unconsciously performed) movements of walking cortical (consciously controlled). Each movement is directed by a conscious thought – bend hip, lift knee, kick foot out, straighten knee – so that to take a step requires all of Pepper’s concentration. You’d have to train like an athlete to attain this ability to make the unconscious conscious: it would be exhausting, you’d have to want to walk more than anything else. You’d need to be taught how to do it. Other forms of physical therapy improve the symptoms of Parkinson’s or slow the decline, but they too can seem much like boot camp. Doctors see patients with Parkinson’s, diagnose them and usually only prescribe medication, as if the patient is a generic, inert body. Conventional treatment has become something one receives from an encounter with a doctor and his or her script pad. It is this passivity of the patient – reinforced by medicine – that Doidge challenges. He asserts that the brain and the body are “use it or lose it” structures. He writes, “Exercise decreases the risk of dementia by 60%. If a medication did that it would be the most popular, talked about treatment in medicine.” Unfortunately, you can’t just buy it. You have to do it.

I sat next to Doidge at a literary festival. As we signed books, I looked at the lines of waiting people – his line snaking far across the room – and I wondered if anything would come of his words, or if we were all buying these books in the millions the way we buy diet books in the millions and never lose weight. We buy them in hope, hold them in our hands, flick through the pages, read stories of transformation, but when we don’t discover a miracle or quick fix we slip them onto our bookshelves. We buy them as talismans. We buy them as if they are pills.

Blame the patients? Blame the doctors? According to an article in the British Medical Journal in June this year, multiple studies have found that, when asked, patients overwhelmingly wanted more studies of non-drug interventions for common ailments – treatments such as physiotherapy, psychotherapy, education and coping strategies. Despite this, according to the World Health Organization International Clinical Trials Registry Platform, 86% of treatments studied in commercial trials between 2007 and 2014 were drugs. Better to blame the sociopolitical structures the patients and doctors move within, and the industries supporting these structures.

Rudolf Virchow said that medicine is a social science and politics is medicine, but he went further. “Medicine, as a social science, as the science of human beings, has the obligation to point out problems and to attempt their theoretical solution: the politician, the practical anthropologist, must find the means for their actual solution.”

We feel sick even if we are physically well. We are organically diseased by lack or excess. Most of our healers – mainstream and alternative – now act and are treated like shopkeepers, and have become entrepreneurs (or the pawns of entrepreneurs). If they don’t give us the goods – the diagnosis and pill – we’ll shop elsewhere. We seek passive means of attaining health and longevity, which is what medicine (both conventional and alternative) promotes. We want diagnoses. We want solutions we can browse, buy and swallow, be they pharmaceuticals, tinctures or vitamins. It’s convenient for politicians, suits industry very nicely. Pills are our tiny white black holes: absorbing all our hope, agency and energy. They divert attention from prevention, population health and inequity; they promote consumption.

The individual body and its individual cells exist, of course, and can be altered and treated by drugs. Mainstream medicine is magnificent in many situations: in treating frank organ dysfunction, trauma and infection; in ablating clots and tumours and abscesses. It is sometimes adequate in others: regular bursts of personal support for the desperate or lonely, prescribing drugs to protect organ function, prescribing drugs that must be taken for a long time by many people to extend the life of some. But prevention and amelioration of most of our grumbling Western ills demand something more than medicine. An alternative, a complement; yes, an “integration”. Real “integrated medicine”, however, is not Pfizer plus herbs plus acupuncture; it is not recognising a bunch of new diseases and their treatments; it is not energy lines plus cells. It is recognising that a large portion of our ill health is a combined mental, physical, environmental, interpersonal, social and political phenomenon.

A cause for many of our Western ills, organic and non-organic alike, might be found in a catchphrase that has become a cliché: that our society has degenerated into an economy. Read the papers – our main purpose and duty is to acquire and consume. At the expense of others in need, of our planet. Inequity increases. Education standards decline. We suffer existential ills that manifest in our bodies. We drive, work and eat, become sedentary, fat, diabetic and depressed. Hospital wards fill with social catastrophes and the outcome of styles-of-life and social policy. Mainstream medicine alone cannot fix this. Real integrated treatment of our disease requires vast social action. It requires personal action: use it or lose it.

Instead, we seek cures that are acts of consumption, quietly swallowing the disease itself. Browsing the numerous alternatives, we buy instead of do. And neoliberal to the core, we regard our population’s health as a problem that lies with discrete, always self-determining individuals. And at the very times when the modern, mainstream, despised and idealised discipline of medicine might actually help, or when it finally says “no, it’s not your body that is sick, I cannot help you”, it is only then we start to run. Seeking an alternative that will not fail us, that offers us hope, that promises a cure, but which turns out to be more of the same.

Karen Hitchcock

Karen Hitchcock is a doctor and writer. She is the author of a collection of short fiction, Little White Slips, and the Quarterly Essay Dear Life: On Caring for the Elderly.

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Pablo Picasso, Figures by the sea (Figures au bord de la mer), January 12, 1931, oil on canvas, 130.0 × 195.0 cm, Musée national Picasso-Paris. © Succession Picasso/Copyright Agency, 2022. Photo: © RMN - Grand Palais - Mathieu Rabeau

‘The Picasso Century’ at the NGV

The NGV’s exhibition offers a fascinating history of the avant-garde across the Spanish artist’s lifetime