I had the most unpleasant experience of having a ringside seat in the Wreckers’ Ball, the new wave of smashers which is hitting medicine full-on. Our culture has embraced a staunchly anti-human, pro-bureaucratic approach to most things. I saw the Spirit of the Wreckers in full view.
The History of Ressentiment
One of the grumblings and resentments against the thug club ISIS is the evil thrashing they undertook in Palmyra – an ancient cultural site unknown to most of us. That action is on the list of deepest resentments against ISIS, and depends our resolve that Something Must Be Done, beyond which we do not know but we trust our politicians to do.
Destruction of Cultural Heritage is, well, cultural heritage, at least for our species. We have a thuggish habit of joyfully wrecking things that are far beyond our capacity to construct. The resentment against time past is as new as Modernism (which, paradoxically, is not at all new.)
The Spirit of the Revolution, “creative destruction” of medicine is an offshoot of the Creative Destruction proposed in economics, originating in Marxist thought but quickly re-shifted into an orthodox thought in business restructuring and Wall Street capital movement.
Any idea that came from Marx and is embraced by modern conservative Wall Street Values has to be appalling. ISIS/ISIL showed us so.
Ressentiment in Medicine
The pretense is that medicine is not efficient because it is encumbered by entrenched Old Ways of Doing Things. Once those ways are blown apart, new Ways will arise spontaneously from the will of the people. ISIS says so. Besides, it’s fun to blow things up.
I am skirting the details – I have a duty to protect the guilty.
The horror I saw recently was a committee tasked to (what else?) analyze and report on the mistakes in using a certain medicine in Medical Practice. The medicine is cheap, well known, with limited side-effects and physiologically salubrious – it affects the reconstruction of healthy tissue from sick tissue. It belongs in the top ten list of Best Medicines Ever, where aspirin reigns.
The Thug Club approached it thus. It is cited in a specialty’s consensus statement as an important medicine in treating a certain condition, one of several which are labeled for its use by the FDA. It is perhaps most commonly seen in treatment this one condition.
A very good publication in the field, from which the consensus statement drew its foundations in part of this area, was a classical case-control study of the use of this medication for patients with certain parameters of illness.
The Thug Club showed absolutely no comprehension of what a scientific paper is. I find that this publication affirms the vast body of literature detailing the utility of this medicine under certain conditions. Physicians once needed a wide array of understanding of the utility and perils of a medication for its expert use. By definition, that is no longer so. All that is needed are rules – no experience needed.
When one publishes a medical paper, one defines the parameters of an inclusion set, to which a patient must belong to consider the effect of the treatment upon a certain disease. Otherwise, one compares apples to oranges, and the conclusions are muddied by vagaries.
This is all boring news and unnecessary trivia to the Thug Club. They took the inclusion criteria as the boundaries of the known universe. If a patient was excluded from this particular study for one incidental and another, they surmised that treatment of a disease which fell outside the treatment set was “wrong.” If, for instance, a research set excludes diabetics in a study, the Thug Club deduced that treatment of diabetics with this medicine is “a medical error.”
In compiling the data on this drug, the Thugs determined that 50% of the time the medicine was being used “improperly,” based on any certain patient falling outside the parameters of the research study. If a study happens to be done on men, for instance, than using the medicine on women would be a “medication error.” The FDA does not see it so; some of the “medication errors” compiled by the Thug Club were instances of the drug being used properly ACCORDING TO FDA labeling, the strictest of approval standards.
Pause for a moment to be appalled by that idea. The committee criticizes treatment that the FDA endorsed.
The study offered a set of testing parameters to be used upon subjects, including weekly blood draws for the first three months. It goes without saying that the parameters were set heavily in the direction of caution and prudence – one does not wish ‘oopsies’ in one’s study.
The brainstorming Thug Club therefore used all the testing parameters of the publication to be guidelines for safe and prudent use of the drug. If one does not take a patient’s blood weekly for the first three months, one is using the drug carelessly. A protocol for weekly testing should be maintained – because it was in the research publication.
Now, this medicine has been on the market for over fifty years. Its wholesale cost in the US varies between 60¢ a month, and $3.50 per month. It is on the World Health Organization’s List of Essential Medicines, the most important medication needed in a basic health system. Like in Uganda and Botswana. But we, in our dreadful wisdom, recoil from the safety of its use.
None of the wreckers bothered to look for studies on the bad outcomes linked to the drug – surely they would know that such things would be studied? In fact, one of the “mandates” that they wish to include for use of the drug, is actually a risk factor for bad outcomes. The goal of the thug club seems to wish to have increased control over the use of all drugs of every sort, make their prescribing dependent upon authorization by authority, like the “choosing wisely” radiology approval which proposes that all imaging studies (including chest x-rays) undergo online approval when ordered by all physicians.