Miraculous Mayhem

 I can still remember how, early in my medical career, I gave intravenous penicillin every few hours to children who were suffering the agonizing symptoms of bacterial meningitis, and then watched miraculous changes occur hour by hour. Children who had been on the verge of death recovered consciousness and began to respond to stimuli within a few hours. A few days later those same children were back on their feet, almost ready to go home. 

 Patients with lobar pneumonia also would endure terrible agonies. They would enter a crisis of high fever, severe cough, gasping for breath, shaking, chills, and extreme chest pains. Some recovered, but many died. When penicillin came along, people with lobar pneumonia no longer went through a crisis period. Instead, [52] the fever, cough, and other symptoms resolved within days. People who would never have left the hospital alive packed their bags and walked out. 

 I -- and other doctors -- truly felt that we were witnessing and working miracles. 

 Things are different today. Meningitis and lobar pneumonia are uncommon. Even when a doctor does come up against such a life-threatening condition, the treatment is so routine that it is mainly carried out by a nurse or a medical technician. While the fascination with the miracle remains, these drugs that were once extremely valuable are now extremely dangerous. 

 Many doctors prescribe penicillin for conditions as harmless as the common cold. Since penicillin works almost exclusively against bacterial infections, it's useless against viral conditions such as colds and flu. Penicillin and other antibiotics do not shorten the course of the disease, do not prevent complications, and do not reduce the number of pathogenic organisms in the nose and throat. They do no good at all. 

 What they can do is cause reactions ranging from skin rish, vomiting, and diarrhea to fever and anaphylactic shock. If you're lucky, you'll only be one of the seven to eight percent of people who suffer a rash -- although a much higher percentage of people suffering from mononucleosis have gotten a rash when given ampicillin. For the unlucky five percent who get serious reactions to penicillin, the picture of a [53] patient in anaphylactic shock is not pretty: cardiovascular collapse with clammy skin, sweating, unconsciousness, fallen blood pressure, disturbance in heart rate and rhythm. It eerily evokes images of the very diseases which penicillin was designed to cure. 

 By no means is penicillin the only villain. Chloromycetin is a drug which is effective in a certain type of meningitis caused by the H. influenza bacillus, as well as in diseases caused by typhoid and similar germs. In such situations, chloromycetin is often the only antibiotic that will work. But chloromycetin also has the not uncommon fatal side effect of interfering with the bone marrow's production of blood. 

 When a person's life is at stake anyway, this is an acceptable risk to take. But if a child suffers nothing more than a viral sore throat, is the non-relief chloromycetin will bring worth risking depression of the child's bone marrow which will require multiple transfusions and other therapies, none of which will guarantee complete recovery? Of course it's not; yet doctors do prescribe chloromycetin for sore throats. 

 Tetracycline became so popular in outpatient clinics and office practices that it became known as the housecall antibiotic. It has been widely prescribed for children as well as other age groups because it is effective against a wide variety of organisms and because it's side effects are not considered dangerous. But there is a fair list of adverse reactions which the informed person might not choose over the drug's non-use in situations it wasn't designed [54] for anyway. A more formidable side effect is that the drug is deposited in the bones and teeth. While no one knows exactly what tetracycline does to the bones, hundreds of thousands -- perhaps, millions -- of parents and children know that it permanently stains the teeth yellow or yellow-green. Though you might feel that's too high a price to pay for the dubious effectiveness of the drug in relieving the symtoms of a common cold, many doctors do not. The current rationalization for the drug's use in such situations is the suspicion that a child who appears to be suffering from a cold might actually have a mycoplasma infection. The vast majority of children with a common cold have no trace of this sort of infection. 

 The U.S. Food and Drug Administration finally woke up to the widespread overuse of tetracyclines in 1970, when it required a warning on all packages of the drug: "The use of drugs of the tetracycline class during tooth development (last half of pregnancy, infancy and childhood to the age of eight years) may cause permanent discoloration of the teeth yellow-gray-brown. This adverse reaction is more common during long term use of the drugs, but has been observed following repeated short term courses. Malformation of tooth enamel has also been reported. 

Tetracycline, therefore, should not be used in this age group unless other drugs are not likely to be effective or are contraindicated."  Whether this warning has done much good is hard to tell, since doctors very seldom read [55] package inserts on drugs. Even if they do, warnings do not usually stop them from using the drugs when they feel like it. Particularly when the warning on the insert, like the one for tetracycline, doesn't really make it clear enough that these drugs carry side effects which merit their use only in critical situations. 

 One of those risks is even more grim than that of the side effects: superinfections. When an antibiotic fights one infection, it may encourage an even worse infection by a strain of bacteria that is resistant to the drug. Bacteria are remarkably adaptable organisms. Subsequent generations can develop resistance to a drug as their ancestors are exposed more and more. 

Penicillin in moderate doses once easily cured gonorrhea. Now it takes two large shots of the antibiotic to treat it, and it's sometimes necessary to use additional drugs! Two new strains of gonorrhea recently were discovered in the Philippines and in West Africa -- strains which totally destroy penicillin's effectiveness. 

 Of course, Modern Medicine has a stronger drug ready for the stronger gonorrhea bacteria -- spectinomycin. Spectinomycin costs six times as much and has even more side effects. Mean while, the gonorrhea bacteria have developed a strain which is resistant to spectinomycin, too! As the battle escalates, the germs grow stronger while the patients and their pocketbooks grow weaker. 

 All of which would not happen if doctors recognized that antibiotics have a place in the practice of medicine -- a severely limited place -- [56] and if they enforced that restriction. A person may need penicillin or some other antibiotic three or four times during his or her entire life, at times when the stakes are worth the risks. 

 Unfortunately, doctors have seeded the entire population with these powerful drugs. Every year, from 8 to 10 million Americans go to the doctor when they have a cold. About ninety-five percent of them come away with a prescription -- half of which are for antibiotics. Not only are these people duped into paying for something which has no effectiveness against their problem, but they're set up for the hazards of side effects and the risks of deadlier infections. 

 The doctor, once the agent of cure, has become the agent of disease. By going too far and diffusing the power of the extreme on the mean, Modern Medicine has weakened and corrupted even the management of extreme cases. The miracle I and other doctors were once proud to take part in has become a miracle of mayhem. 

 In 1890, Dr. Robert Koch derived a substance from tuberculosis bacteria which he claimed would cure the disease. When he injected it into patients, however, they got worse or died. In 1928, a drug called thorotrast was first used to aid in obtaining x-ray outlines of the liver, spleen, lymph nodes, and other organs. It took nineteen years to discover that even small doses of the drug caused cancer. In 1937, children who received a new antibacterial [57] drug died because the drug was contaminated with a toxic chemical. In 1955, more than 100 fatal and near fatal cases of polio developed among unsuspecting people receiving certain lots of the Salk vaccine which contained presumably inacivated polio viruses. In 1959, about 500 children in Germany and 1,000 elsewhere were born severely deformed because their mothers had taken thalidomide, a sleeping pill and tranquilizer during the early weeks of pregnancy. In 1962, a cholesterol-lowering drug, triparanol, was removed from the market when it was acknowledged that the drug caused numerous side effects, cataracts among them. 

 Most of these pharmaceutical backfires were corrected either when the drug was removed from the market or when the manufacturing error was discovered and tighter controls were established. The controls haven't been tight enough though, because drug disasters like these are going on every day. Actually, the only apparatus that has grown stronger seems to be the machinery of keeping dangerous drugs moving from the factories through the hands of doctors into the mouths and bodies of unwary patients. Reserpine, a drug used, against high blood pressure, is still prescribed, even though it was discovered in studies five years ago to triple the risk of breast cancer. Although insulin is turning up in scientific studies as one of the causes of diabetic blindness, its use is still heralded as a medical miracle. 

 [58] Of course, if drugs were merely products of medical science, dealing with them would be a matter of science, rationality, and common sense. But drugs aren't merely scientific -- they're sacred. Like the communion wafer which Catholics receive on the tongue, drugs are the communion wafers of Modern Medicine. When you take a drug you're communing with one of the mysteries of the Church: the fact that the doctor can alter your inward and outward state if you have the faith to take the drug. And just as an undeniable factor in the healing or the spiritual boost the communicant gets at the altar rail is psychologically determined, the placebo effect -- the power of suggestion -- plays a tremendous role in whatever good a drug may do. As a matter of fact there are some drugs and other procedures in which we know the placebo effect is the primary therapeutic agent! 

 The sacraments of the Catholic Church -- or any other real church -- seldom harm anyone. Doctor-prescribed sacramental drugs of Modern Medicine kill more people than illegal street drugs. A nationwide survey of medical examiners reported that street drugs cause twenty-six percent of drug abuse deaths. Valuim and barbiturates --prescription drugs -- made up another twenty-three percent of drug abuse deaths. This study did not take into account the 20,000 to 30,000 yearly deaths attributed to adverse reactions to drugs prescribed by doctors. The reason for the wide girth between the estimates is that doctors often fudge [59] in stating whether or not drugs are the actual cause of death. If a patient has a terminal illness and dies during the drug therapy, the death will be attributed to the disease, even if the patient wouldn't normally have died for some time yet. The Boston Collaborative Drug Surveillance Program monitored patients admitted to acute disease medical wards and found the risk of being killed by drug therapy was better than one in 1,000 in American hospitals. An earlier survey by the same group found that the risk among hospitalized pitients with serious chronic diseases such as cancer, heart disease and alcoholic cirrhosis was four in 1,000. Of course, many of these people were in the hospital in the first place because of the effects of drugs prescribed by their doctors. Conservative estimates say that five percent of the people in American and British hospitals are there because of adverse reactions to drugs. Another conservative estimate puts the price tag on this preventable suffering at more than $3 billion.

From: Confessions of a Medical Heretic Robert S. Mendelsohn, M.D., 1979