The Best Australian Essays 2015 (19 page)

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 socio-political 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 thirty 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
:

*

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:

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.