Posts Tagged ‘Illness and belief’

THE RIGHT TOOL. Modern medicine and belief. By the not-so-reverend bob

Sunday, February 14th, 2010

I’d have to say that I am not impressed by the efficacy of the “12-hour” cough suppressant I took last night.  I have this vague sense that it might “be doing something”, but those are thoughts that occur in the interregnum between jags of coughing that are clearly part and parcel of whatever bug it is that I’ve been carrying in my body these past weeks.

We get “sick”.  It’s is as much a part of living as anything else.  To a virus or bacteria, my body is a welcoming neighborhood blinking with neon signs advertising a variety of restaurants, bars and all-you-can-eat buffets.  The “bugs” that infect us have been evolving right along with us for billions of years.  The fact that the little buggers reproduce so rapidly means that we can never out-adapt them.  Fortunately, we have an immune response that (in most cases) tracks down the invader and beats the crap out of it (sometimes breaking a few glasses and turning over a few chairs in the process), then posts a picture of the invader to let him know he’s not welcome to return unless he wants “more of the same”.

It’s interesting to note that the average five year old knows more about the true causes of disease than a royal surgeon of a few hundred years ago.  We didn’t even know virus existed until about a hundred years ago — and we’d never seen one until the invention of electron microscopy in 1931.  As modern humans, we now know that illness is not caused by bad “bodily humors” or the alignment of planets or “miasmas” rising from damp swamps at night: illness is caused by other living organisms just following their own irresistible impulse toward survival.

That is about the only “why” there is regarding getting sick: the mechanics of it.  And yet we can’t help but attach a moral narrative to it as well.  I sensed this as I perused the shelves of my local health-food store looking for a throat lozenge that wasn’t mostly sugar and that might have some direct topical effect on the tickle in my throat:  What I saw before me (and felt from the worker in the “herbal” section) was a testament to belief — a new age version of the attitude that illness represents the evidence of an ethical or spiritual failing of some sort.  In short, I was sick because I had violated some rule of health.

I’m familiar with this idea, as it was part and parcel of the miracle-believing Christian Evangelicalism in which I spent 15 years.  In the case of Evangelicalism, disease was a result of original sin — mankind’s fall from grace in the garden — and was therefore part of the evil in the creation that required Jesus’ sacrificial atonement.  What my visit to the health-food store showed me is that this attitude is not limited to Evangelicalism but is more universal in us humans, resting just below the surface of our scientifically-informed reasoning minds.

Consider (what we might regard as) the extreme and obvious examples of AIDS and the “lesser” sexually-transmitted diseases that are so heavily loaded with the baggage of morality and divine justice that they require aggressive government information campaigns to establish some minimum of rationality in the actual discussion of how to fight the diseases themselves.  We in the “enlightened” West may look down on the ignorance of tribal people or despots who blame evil spirits for disease, but we are only a half-step away from our own irrational fears of the unknown.

We have come so far in understanding the human body and its systems and the causes and treatments of disease and injury.  Compare what we know now to a hundred years ago — even fifty — and one can’t help but feel grateful for scientific knowledge.  But as E. O. Wilson (in “The Creation”) points to the incredible percentage of the planet’s biodiversity that awaits discovery, I likewise can’ t help but think about how much more we will know about human health and disease in the next fifty years.  For it’s become almost impossible to pick up a magazine without reading of a new discovery: you can almost feel the pace of human learning as it continues to accelerate.  Technology is no different.  Look at the cell phone in your hand and you will see a design that was unknown two years ago (six months ago?) and that most of us now expect to abandon for a newer device in a relatively short time.

It is an exciting time to be alive, frankly.  Discovery builds upon discovery.

But I can’t walk into the store and find a pill that will go straight to this damn cough in my chest and quiet it down.  I mean really, truly, effectively make it stop.

My brother is an M.D. who is also an impressive thinker (and a bit of a philosopher), and so I have grown up with an understanding of both the wonders and the limits of modern medicine.  Repairing our bodies is sort of like repairing our cars — some problems are clear and have an easy fix.  Other problems are trickier and hard to track down.  This is where medicine is still part “art” and part “science”.  The fact of medicine is that we tend to fight off most “bugs” on our own, with many modern medications being useful for treating uncomfortable symptoms (generally).  But then there are the times when the antibiotic or the emergency surgery quite simply keep us from dying.  But mostly we live in the middle, murky ground where “cough suppressants” may help, or the herbal remedy or special diet “seem to do something”.  This is the realm of “belief” where our ancient superstitions rule our reason.

When I get sick, I generally call my brother on the phone to find out how sick I am and what I should do about it.  I’ve learned that what I’m really after is facts.  For the experience of illness can be a very opaque process — as if we are hosts to a show we can’t see with our own eyes — so I crave an understanding of what is happening inside this body of mine.  Almost always I will feel better about things (and my anxiety levels will drop) if I can picture or imagine what process is going on among my cells and antibodies.  My brother is very good at this kind of information.  But even his information has limits, as there is no way to keep up with every bug or bacteria that is swilling about a city or community at any given time (though most present variations on a general theme).  When something novel comes up (say the threatened outbreak of a new influenza strain) things get serious and the DNA of the new bug is sequenced and vaccines made ready.

The fact that medical science doesn’t have the resources or the knowledge yet to immediately sequence the particular bug I caught last week and in a day develop the perfect anti-viral pill to knock it out is not surprising, really.  But of course that is just what I would like to have happen.  This conflicts with my rational mind that is able to be content with the general knowledge that I’ve been invaded by an opportunistic virus that has evolved to trigger my lungs to coughing fits solely to facilitate the perpetuation of the virus itself (clever little bastard).  I’m not being punished or attacked by any force or entity other than another living organism that has a need to reproduce.  Hell, half of the cells in my body are bacteria — with over 700 kinds living in my mouth at any given time (many having co-evolved with humans and sharing an often symbiotic relationship).

I like to be efficient.  I don’t like to waste time or energy.  And I don’t like being stupid.  So I want to know what’s going on in my body and what (if anything) I can be doing about it.  It is this need to feel like we’re doing something that clears the shelves of most health-food and drug stores.  Nine times out of ten, I’d guess, it is the placebo effect of our own belief that is the major “active” ingredient in most “treatments”.  But as I stood there in the aisle of the health food store I felt very clearly that such an effect wasn’t going to cut it with me.  I didn’t need something to believe in, I needed information and something that would work — would be worth the money and the time.  And if there simply isn’t anything, fine.  At least I’d know that.

Vitamin C, herbs, tinctures, homeopathic formulas and the like with little or no science to back them up are, in essence, belief cures, useful more for calming the need to take action than for their actual results.

I think back on undeniable medical successes: the Vicodin that got me through the first days of a huge kidney stone stuck somewhere near my hip — there was no imagination needed to feel that narcotic knock excruciating pain on its heels: the anti-viral pills that transform the occasional herpetic outbreak from suffering worthy of its moniker to a few days of mild annoyance; the ibuprofen that calmed the pain of the separated rib; the root canal that removed a painful and stubborn infection from my molar.  These are like the times that I put new spark plugs in my truck and the truck ran noticeably better right away (compared to the many repairs of slight or questionable result).  They are the exception.  These are the times when modern medicine is a wonder.

I think we have to both recognize the limitations of what we know even as we press ahead to learn more.  What I see, however, is an entrenchment in belief and superstition in the face of scientific progress, as if science’ lack of complete knowledge justifies a continued irrational reliance on a fuzzy sort of metaphysical folk medicine with moral undertones.  I don’t want to believe, I want to know.  And to the extent that belief gets in the way of knowing, belief simply needs to yield.  Belief in unsubstantiated causes of illness (and the treatments of the same) holds us back as it wraps us in a comfortable (and familiar) blanket of fear and ignorance.

I’d be great if I could take a pill that knocked this cough out (like a narcotic can) without having all the side-effects (and addictive danger) of an actual narcotic.  But instead it seems the best I can do is this damn disappointing pill.

There is so much to know that it is unfair to blame science for not knowing it…yet.  The workers are few.  Instead of using the limitations of our knowledge as a justification for our own ignorance, let’s help things along.  Donate to research.  Help cure a disease.  If I can’t do anything about the bug in my chest  right now (besides wait it out), I can at least do something tangible, rational and practical and feel better that way.

t.n.s.r. bob