Philosophy Now Forum

Simon Kolstoe says that all is not well with medicine.

https://philosophynow.org/issues/119/Ca ... al_Science

Granted, I only scanned the article, but on superficial look, it doesn't seem to be about medical science, but rather products of the pharmaceutical industry. A whole, huge, profit-driven enterprise, independent of, and uncontrolled by, the medical profession as a body.

As to whether doctors are correctly and fully informed about the medications they prescribe - that's a different problem. It's partly a result of too much to learn in too short a time. It's partly a result of advertising-driven patient demand and doctor bias. It's partly a result of a naive faith in government regulation and safeguards. It's partly a result of social pressure to 'fix' or at least manage every illness: our modern denial of vulnerability and mortality.
Humans can cope with only so much complexity before tripping or getting confused or being caught up in contradiction.

Of course we can't trust medical science.
But.... consider the alternatives:
let God decide; turn to magic cures; learn it all yourself; give up and die

Yes - after a quick look through - I agree the author appears to focus on pharmaceutical industry ethics - sounding off his personal anger. And noting a philosophical interest in other people's outrage at bad pharma and reporting bias.

He compares this with our ethical concerns re other consumables which might harm us.
Wonders why we feel medical science should be held to a higher account. He calls it an instinct. He's not sure of the philosophical justification.

I am not sure how he gets from this personal and professional outrage about reporting bias in Big Pharma to a generalised question about medical science and ethics ? Perhaps another read...

There is trust and blind trust. There is knowledge and ignorance.
We can trust medical science up to a point.

But we owe it to ourselves not to blindly accept diagnoses and treatments.
There will always be some risk of harm, known or unknown, whenever we consume anything.
That is why medical science and research is important.
And any reporting bias brought to light.

As for individuals - education is key for better decision-making re life activities and outcomes.
This article is an interesting stepping off point for issues of personal responsibility and accountability.
Prevention is better than cure.

I don't see the ethics of pharmacological production improving, or exerting less pressure on the research facilities, unless it actually came under the auspices of medical science, rather than Dow Jones index. I don't see the ethics of therapeutic practice improving, unless it comes under the auspices of medical science, rather than the insurance industry. If those areas of endeavour can't be separated, ethical concerns are moot.
Money has no moral compass.

I wouldn't trust psychiatric medicine. I stay away from doctors whose methods are trial and error.

osgart wrote:I wouldn't trust psychiatric medicine. I stay away from doctors whose methods are trial and error.

Right up until tho only alternatives you can see are suicidal depression, grave risk of doing irreparable harm to your child, prison....
It all depends on the severity of the illness, whether you decide to put your fate in someone else's hands and hope they have a better solution.

Who can we trust?

The BBC has a series, 'Trust Me I'm A Doctor' presented by Dr. Michael Mosley and a host of other 'TV friendly' doctors, which seems like 'prole fodder', but is actually a rather informative series.

The series makers invite the public to submit questions for study, to their website. Usually these questions involve the validity of products making health claims, or questions about the validity of claims made about various illnesses. Having picked a topic for study, they will approach a university to create a study, or adapt one that it is already doing, to scientifically evaluate the claims and invite members of the public to volunteer for the studies being conducted by universities in their regional area. They then bosh together a relatively compact study, and televise the results. I now take turmeric and kefir very seriously as part of my daily diet having watched the series.

One thing bugs me: they sometimes evaluate a range of makers of a particular product, for example, omega three supplements, and, whilst showing the variance in the range of results, are not allowed to share the brand names. I understand the reason but I still feel they are denying me the public service of exposing the thieving b*stards who charge a lot for a substandard product.

ForCruxSake wrote: One thing bugs me: they sometimes evaluate a range of makers of a particular product, for example, omega three supplements, and, whilst showing the variance in the range of results, are not allowed to share the brand names. I understand the reason but I still feel they are denying me the public service of exposing the thieving b*stards who charge a lot for a substandard product.

That sounds like a very intelligent way to educate the public. Good ol' BBC - not just castles and ruins!
As for the brands: when I buy a new vitamin, supplement or remedy, I read the ingredients and quantities on the recommended brand (Doctors are usually careful to name two or three) and then compare to the 'house' brand, or generic. If it's the same - and it usually is - I buy the cheap one. It's generally made by the same company, identically, and the only difference is the package. Sometimes it even comes in the same container, with a different label, at a 20-30% reduction in price. I should imagine they do something similar in the UK, no?

Skip wrote:

ForCruxSake wrote: One thing bugs me: they sometimes evaluate a range of makers of a particular product, for example, omega three supplements, and, whilst showing the variance in the range of results, are not allowed to share the brand names. I understand the reason but I still feel they are denying me the public service of exposing the thieving b*stards who charge a lot for a substandard product.

That sounds like a very intelligent way to educate the public. Good ol' BBC - not just castles and ruins!
As for the brands: when I buy a new vitamin, supplement or remedy, I read the ingredients and quantities on the recommended brand (Doctors are usually careful to name two or three) and then compare to the 'house' brand, or generic. If it's the same - and it usually is - I buy the cheap one. It's generally made by the same company, identically, and the only difference is the package. Sometimes it even comes in the same container, with a different label, at a 20-30% reduction in price. I should imagine they do something similar in the UK, no?

Maybe... Boots, the middle market chemists, if ever you stray our way, certainly has packaging that is similar to Superdrug, which is at the cheap end of the market, but you can't be certain until you open the packaging. I think their respective effervescent vitamin C is different in quality, but not always.

What was interesting, in the programme, was that when they examined the Omega 3 supplements, some of the oil being sold was rancid, even in the more expensive brands. Maybe it had been on the shelves too long, maybe in the manufacturing process old oil was being used? The supplement examined that came out best was the one of the cheapest brands. They had them ranked in order of price, I think, or some such, and a graph was on display, so you had to pretty much work it out on your own. They didn't give it away by actually stating the price, or I'd have tried to work it out. Made me rethink purchasing from Holland and Barratt, a health food chain store, aimed at the middle class purchaser. Being one for a bargain, I was knocking myself out trying to work out if it was the Superdrug brand. That's what I'm buying from now on!

Here's another interesting fact: at some point a few years ago, I went to buy my usual brand of multivitamins, an A-Z concoction, store brand. I noticed the amount of nutrients present, by recommended daily amount, had fallen below the usual 100% plus, in some cases down to as much as 60-odd-%, but the price had not been similarly adjusted to reflect this. I was paying the same amount. I complained to the pharmacist, who said: 'It's European directive. They think the Brits have poor eating habits and rely on supplements. It's to encourage better eating habits and not have people rely on pills.' I was taken aback. It was pure commercialism dressed up as considerate thinking. Some git lobbying for the pharmaceutical companies had somehow got someone in the European Parliament to push this through so that those companies could make more money, I thought. Since then, we have returned to the hundred percent products, but incidents like this gave me a healthy respect for Brexiters other Remainers never had.

(Looking at all that, I must sound like a vitamin junkie, but truth be known. I never remember to take them. They're just there to make me think I'm taking care of myself!)

Oh well. I'm sure the 'vitamin' companies are thanking allah every day for idiots, not to mention undertakers.

ForCruxSake -- I complained to the pharmacist, who said: 'It's European directive....Some git lobbying for the pharmaceutical companies had somehow got someone in the European Parliament to push this through so that those companies could make more money,

Did you check whether this was true? I heard that EU was blamed for a whole lot of irregular practices that was, in reality, nothing to do with regulation, but down to the companies.
I never buy the fish oil supplement. Flax is cheaper, safer and better smelling, as well as vegetarian. Of course, I could just incorporate the right amount of flax seed in our diets, but that's too much trouble - and I wouldn't dare anyway: our GP is very strict about his prescriptions. Oh well, he's retiring soon; then we can stop taking the vitamins. We trust him in the big things - I mean that sincerely! He's very conscientious and has weight to throw around in behalf of his patients and we'll sorely miss him - but he does reach for the pad a little too fast. Then again, maybe just for the senior patients, who have diet issues and get their drugs subsidized.

I would guess the generic version of anything over-the-counter would always be fresher, through sheer volume of sale, while the most expensive must have the longest shelf wait. I would never, for instance, buy any high-end snack with nuts in it, but get them at the bulk store, where I can sniff the bins. (Yeah, one of those.But if you love walnuts, you know how disheartening it is to bite into a rancid one. I don't even want to think about the after-affects of swallowing a rancid fish oil capsule.)

Skip wrote:

ForCruxSake -- I complained to the pharmacist, who said: 'It's European directive....Some git lobbying for the pharmaceutical companies had somehow got someone in the European Parliament to push this through so that those companies could make more money,

Did you check whether this was true? I heard that EU was blamed for a whole lot of irregular practices that was, in reality, nothing to do with regulation, but down to the companies.

It was some time ago, and I didn't check, but I wrote to the store company to complain, as it was an own brand multivitamin, and received a very unspecific apology , with not even a consolatory voucher to exchange for goods purchased in future. I just remember feeling a bit hard done by but nothing more specific.

But there have been loony tunes that have whistled their way out of the EU... Let's call it LEUnacy... The ones I've picked might appeal to your sense of vegetarianism...

- They banned 'abnormally' curved bananas and cucumbers, that were perfectly fit to be eaten, but countries voted to repeal the laws, in 2008
- A scientific EU report emerged claiming that there was no evidence to suggest drinking water prevented dehydration with the result that manufacturers are not allowed to let water bottles carry that claim.
- Similarly, prunes were not allowed to be advertised by manufacturers with the claim they assist bowel movements
- The oddest one is that turnips and swedes were determined to be different and should be labelled as such. They could not be confused in products that contained either, except in Cornish pasties, where any swedes being used could be termed turnips, because in Cornwall, swedes are referred to as turnips.

Beats me how they come up with this stuff??!

Skip wrote: I never buy the fish oil supplement. Flax is cheaper, safer and better smelling, as well as vegetarian.

I have flax seed here, which I mill, but only when I drop into low carb dieting. You can make the best low carb muffins in a minute, in the microwave, by mixing sugar/sweetener, with the flax meal, baking powder, an egg and a little butter.

I grew up in an era when we had free school milk, and they added cod liver oil to it, for a while. So my fish oil fixation comes out of giving it to my growing son, in a likewise fashion. I don't tend to have it, that often. It's for him. He's eating a lot more fish these days, and eggs, so there are fish oil free days.

Skip wrote: Of course, I could just incorporate the right amount of flax seed in our diets, but that's too much trouble - and I wouldn't dare anyway: our GP is very strict about his prescriptions.

What is the right amount of flaxseed? It's pretty rich in good fat, but it's fat nonetheless, so what's a good amount? And your GP prescribes it?!! I couldn't imagine my GP prescribing flax seed without it being accompanied by something from the British Pharmacopoeia.

Skip wrote:Oh well, he's retiring soon; then we can stop taking the vitamins. We trust him in the big things - I mean that sincerely! He's very conscientious and has weight to throw around in behalf of his patients and we'll sorely miss him - but he does reach for the pad a little too fast. Then again, maybe just for the senior patients, who have diet issues and get their drugs subsidized.

They subsidise meds given to seniors in the U.S... (-You're in the U.S., right?)...? That's great. I thought you had no social welfare over there, whatsoever.

Over here, they introduced 'The Patients Charter', which effectively allows you to request follow up investigation if you aren't happy with your doctor's diagnosis. If you want to be seen by a specialist in a hospital, they should comply. The downside is that you may have to wait months.

When I was a child, you just couldn't question your doctor. They could be terribly abusive, and malpractising, and there was little comeback unless a patient died unnaturally under their care, and even then you might only get the hint of an apology in your bucket of 'how grateful you should be to have free healthcare'.

I ended in hospital, for a month, when I was misdiagnosed, and given the wrong meds, by a GP and my older brother, who was studying pharmaceutical chemistry, home on summer break, questioned a treatment they were giving me and rushed me to hospital. He questioned the validity of the diagnosis and meds in the GP's surgery but was frogmarched out. Now it's very different. It all has to be explained, and whilst they have to get you in and out within ten minutes, four if it's a phone consultation, they must do that with due care and respect.

Skip wrote:I would guess the generic version of anything over-the-counter would always be fresher, through sheer volume of sale, while the most expensive must have the longest shelf wait.

I have a feeling the same was said on the BBC's 'Trust Me I'm a Doctor'.

Skip wrote:I would never, for instance, buy any high-end snack with nuts in it, but get them at the bulk store, where I can sniff the bins. (Yeah, one of those.But if you love walnuts, you know how disheartening it is to bite into a rancid one. I don't even want to think about the after-affects of swallowing a rancid fish oil capsule.)

You don't realise until after you burp up its contents!

We don't have many whole food stores in the city, with open bins. The ones that do are very over priced. I get my walnuts from the local Iranian store, where they are open, so I shall put your sniff tip to good use, in future, but all the other seeds and nuts I get are usually from Holland and Barratt. Very packaged.

We are, most definitely here in London, living in different times, to those that I grew up in. I don't remember seeing munchible seeds as a child. Nuts, yes, but not seeds. Now my fourteen year old insists on a daily mixed tub of sunflower and pumpkin seeds, with almonds, walnuts and Brazil nuts added to the mix. I'd have thrown in flax but it's one of those things that isn't as quite as chewable as the others, so I'd expect complaints of it getting stuck between his teeth. Maybe I will after this discussion, and once I know what the right amount is.

These days it's extremely easy to get all the vitamins and minerals you need from food, and extremely difficult to become genuinely vitamin deficient (you will know all about it if you are) unless you are a screaming alcoholic who has difficulty absorbing nutrients, in which case vitamin supplements would be hard to absorb as well. Heck, you can get practically everything you need by having wholegrain oats for breakfast with a tablespoon of ground flaxseed mixed in, and baked beans for lunch and dinner, with a couple of pieces of fruit along the way. The body will discard vitamins it doesn't need, so the best thing you can do with with vitamin supplements (especially 'multi' ones) is flush them down the toilet and save them the bother of travelling through your system. Either way they are going to end up in the sewer. To those who claim to be 'far too busy, busy, busy' to eat properly, instead popping a few multi-vitamins daily thinking it's making them 'healthy', you are wasting your money and you could save a sizable chunk of your precious time by not scanning a sea of little jars that promise to do what a banana and a can of baked beans can do infinitely more efficiently.

ForCruxSake wrote: Beats me how they come up with this stuff??!

Or who...
(Afterthought on oddly shaped fruit and veg. Might be related to nuclear accidents? I understand Japan grew some weird stuff post-Fukushima. )

What is the right amount of flaxseed? It's pretty rich in good fat, but it's fat nonetheless, so what's a good amount? And your GP prescribes it?!!

No, no, no! He prescribes Omega supplement. They are either salmon or flax oil. I have a couple of problems with salmon, so i choose the flax. I don't know what the right quantity is, because I've never actually squeezed the oil out of a flax seed. (Or an olive, or a peanut, for that matter. So many roads left untravelled!)
Actually, flax also aids digestion - polite for BM; important to people predisposed to bowel cancer - so I make up a concoction recommended by the internist - 1 part apple:1part bran:1 part prune juice:1/2 part ground flax seed - lately, because of a BBC programme, I add cinnamon - and, just for fun, nutmeg and clove. Known in our house as "muck", it's easy to prepare in a food processor, easy to take, and 100% effective.

They subsidise meds given to seniors in the U.S...

No idea. Probably not after Trump-care kicks in... I think they want the expensive old and sick people to die off, but without upsetting the churches by legalizing assisted suicide.

(-You're in the U.S., right?)...?

Hell, no! If I had been there last year, I'd be in Canada by now. Luckily, I already was.
On the whole, I have very few complaints about our health care. Some waiting for surgeries, and not very easy to find a second opinion on anything if you live in a smaller community, as we do, but our local hospital is excellent, has the calmest, kindest ER I've ever seen (coming from Toronto, where they're usually hectic) and if we need special treatments or diagnostic tools, we're referred to a regional center that has up-to-date everything.

When I was a child, you just couldn't question your doctor. They could be terribly abusive,

That's the caste system at work. We shed it a couple of generations sooner - maybe under the influence of big bully cousin to the south, (Their ideas are not all bad.), or maybe because we grew up a bit wild.
An English friend of mine was subjected to unsuccessful surgery in childhood, that resulted in life-long problems, and he always blamed his parents for allowing it. I strongly suspect they would not have dared to protest, even if they'd had a clue. It's funny, how being transplanted to a more liberal country changes your perspective and attitudes --- at least, your attitudes about situations where you get more respect, not the ones where you're expected to give more respect.
The idea of "the whole patient" (with rights) was starting to take hold in the mid-70's, when I worked at a big city hospital. New medical students were being taught to consider patients' backgrounds, expectations, circumstances, cultures, etc. for the first time. I think we started turning out much better GP's then. (Nothing curbs the ago of cardiac or neuro surgeons.)

We don't have many whole food stores in the city, with open bins.

Pity. I do enjoy the bulk food store. The one in our small city happens to be particularly well maintained by polite and knowledgeable staff. (It doesn't hurt that they're lively young women, two of them with attractive tattoos.)

Now my fourteen year old insists on a daily mixed tub of sunflower and pumpkin seeds, with almonds, walnuts and Brazil nuts added to the mix. I'd have thrown in flax but it's one of those things that isn't as quite as chewable as the others, so I'd expect complaints of it getting stuck between his teeth.

Flax is better ground or cooked. Best evening snack: rice crisp cereal, oat circle cereal, boondi (salty Indian chick pea flour ball thingies) walnut pieces, pumpkin seed, sunflower seed... and miniature dark chocolate coins.
with Polish beer
and Poirot
and a fire in the woodstove
and a warm cat

Legal, schmeegal - I may decide never to check out.

Skip wrote:(Afterthought on oddly shaped fruit and veg. Might be related to nuclear accidents? I understand Japan grew some weird stuff post-Fukushima. )

Well, it's my belief that nature has a way of warping stuff to our benefit, usually. Nuclear disasters don't count, even if nature had a hand in nudging the reactor to fail.

Skip wrote:

ForCruxSake wrote:What is the right amount of flaxseed? It's pretty rich in good fat, but it's fat nonetheless, so what's a good amount? And your GP prescribes it?!!

No, no, no! He prescribes Omega supplement. They are either salmon or flax oil. I have a couple of problems with salmon, so i choose the flax. I don't know what the right quantity is, because I've never actually squeezed the oil out of a flax seed. (Or an olive, or a peanut, for that matter. So many roads left untravelled!)

So many foods left untrammelled!

Skip wrote:Actually, flax also aids digestion - polite for BM; important to people predisposed to bowel cancer - so I make up a concoction recommended by the internist - 1 part apple:1part bran:1 part prune juice:1/2 part ground flax seed - lately, because of a BBC programme, I add cinnamon - and, just for fun, nutmeg and clove. Known in our house as "muck", it's easy to prepare in a food processor, easy to take, and 100% effective.

It's now banked in my health recipes. I tend to rely on the probiotic goodness of kefir for my bowel health. So far no-one in the family has had a cold this year, not even my son, who usually imports the illnesses that affect us, from his school. Not sure how gut bacteria prevents respiratory disorders but apparently there's a supposed immune response link between the rest of the body and what is known as the 'second brain' of the gut.

Skip wrote:

ForCruxSake wrote: You're in the U.S., right?

Hell, no! If I had been there last year, I'd be in Canada by now. Luckily, I already was.

You're Canadian! (Or an 'acceptable American' as we like to tease my brother's in-laws with!) You are so lucky to be Canada. You have so much space to live, up there, and decent social welfare practises.

Canada was the best thing to happen to my brother... and it was all because of snow! We used to have dreadful winters, with occasional blizzards of snow, around February, and then climate changes reduced snow days to virtually nil at one point. My brother made friends with someone in Canada, whom he would visit, simply to experience snow. His law career here ground to a halt and he worked in the toy department at Harrods, giving free legal advice, at a local advice centre for those on welfare. At some point in the 1990s, he decided he'd had enough here, took the law conversion exams and worked for the DA's office in Toronto. He's now a superior court judge! He says the factors he thought might have helped him advance were his height (he's 6'5"... and shrinking now!) and his English accent... or his relatively well spoken London accent, as I have to remind him. There is no English accent, only the variant strains of regionalIty. (People barely refer to themselves as English these days).

Skip wrote:The idea of "the whole patient" (with rights) was starting to take hold in the mid-70's, when I worked at a big city hospital. New medical students were being taught to consider patients' backgrounds, expectations, circumstances, cultures, etc. for the first time. I think we started turning out much better GP's then. (Nothing curbs the ago of cardiac or neuro surgeons.)

I remember reading Alvin Toffler's 'Future Shock' back in the early 80's (over a decade after it had been written) and thinking, even then, how far behind, with regard to certain aspects of our culture, we were when compared to the U.S. Advances in technology have closed that gap, not necessarily for the better.

Skip wrote:I do enjoy the bulk food store. The one in our small city happens to be particularly well maintained by polite and knowledgeable staff. (It doesn't hurt that they're lively young women, two of them with attractive tattoos.)

So you like your girls printed.... No, I didn't mean that!

Skip wrote:Legal, schmeegal - I may decide never to check out.

Good to know, as I think I can continue to learn from the way you live and think.