Drug Misuse in American Medicine Leads to Possible Catastrophe


I idolized the American medical establishment. When I was a mere Blue Cross number-collecting lackey working at the front desk of the Emergency Room of Massachusetts General Hospital, I sometimes saw, slipping into the doctors’ lounge, notable people — doctors whose surname in footnotes graced the basic core medical textbooks I was using as parallel reading in France, to prepare myself for my American examinations in medicine. I never wanted to penetrate more than the lowest echelons of the American medical establishment when I returned from France.  I mean I doubted the Harvard-types would open their world to me easily, no matter how clever I was. I proved to be right.  At a Harvard-associated residency program, I was actually asked at the interview if anyone in my family was a Harvard University trained physician. I still remember the program chairman’s barely muffled laughter when I told him my father held a graduate degree from the Harvard University School of music.

My first realization that the American medical establishment had made some serious systemic errors came from my clinician-instructors in France. I vividly remember having luncheon at the home of my preceptor in geriatics.  His wife had prepared and served an elaborate traditional dinner.  By the time we came to coffee and liqueur-laden sweets, she retired with the children, and left us to “talk medicine.” He told me gently, as he lit his cigar, that one of the reasons practicing medicine was difficult, was the way that Americans had pretty much ruined things since about World War II.  I reassured him that I would become neither angry nor defensive, but that I really wanted to hear what he had to say. He said that the two great useful medicine of the era, steroids and antibiotics, had become totally useless, as American physicians had overused them. Now, I not only believe his logic was correct, but I believe American use of medicines has indeed rendered those two groups of medicine less useful, if not soon to become useless. I believe American medicine has contributed to other disasters, the most egregious of which is the epidemic of opioid addiction. Antibiotics had been originally discovered by the Scottish biologist, Sir Alexander Fleming, n 1928, when he found a sthylococcus culture had been “contaminated” by the common mold Peniccium notatum which had killed the bacteria.  There had been ancient traditions of using molds to treat infection in the traditional medicine of many cultures, such as the orientals and the ancient Greeks. Yes — this was penicillin. Fleming, who went on to win a Nobel prize, said, “One sometimes finds what one is not looking for.”

In World War II, my French dinner host told me, American military physicians treated the GIs suffering from pneumonia with antibiotics.  Their effect seemed to be that of a “miracle cure,” which was available to few fortunate Frenchmen, who did miraculously well. Of course, all patients were soon clamoring for the “American Miracle drug.” Fast forward to my beloved medical school bacteriology “professeur,” Jeanne Orfila, who looked like she was fighting tears when she told a medical amphitheater full of students,  “Little bacteria are not stupid.  They manage, presumably by natural selection, to become resistant to antibiotics.

So every time you prescribe an antiobic, you are not just treating your patient.  You are treating the entire globe.  And you are creating resistances.  Soon antibiotics will be no help against bacteria.” I am sure my French host had heard something like that from Professeur Orfila, for he had graduated from the Faculty of Medecine of Amiens only a few years ahead of me.”I need to maintain practice, in order to feed my family,”  He told me, without eye contact, as if he were a bit ashamed.  “I take care of older folks, mostly.  They are pleased when I prescribe an antibiotic, and they send their friends. I don’t doubt for a moment that American doctors, equally eager to feed their families, have provided antibiotics in a similar manner, even though many of the complaints that send someone to a general practice physician are most likely caused by viruses, and thus, are not sensitive to antibiotics. Antibiotics are only useful against bacterial infections.

In a recent statement, a Chinese woman physician who is head of the World Health Organization, said that within two years antibiotics would be so ineffective that a patient could die from a scraped knee. As for steroids, there is no doubt in my mind that the history of steroids, as well as the whole of endocrinology, started with that marvelously sexist practice which, on one level or another, definitely qualifies as “male enhancement. Men — you gotta love them because you can’t live without them.

The ancient Greeks and the early Olympics did something or other with testosterone. Yes, it does seem as if the first organized sports were associated with the first “doping.” As for male enhancement for male sexual prowess, one example that hit particularly close to home (when I studied at the University of Kansas) was the all time shame of Kansas medicine, the “goat gland doctor,” John R. Brinkley. If you haven’t read about him before, it is possible you won’t believe what he did to people (and they begged him to do). Even though I got decent and useful instruction in psychiatry and pharmacology in that state, people were still talking about this charlatan from the first part of the 20th century in Kansas, who actually grafted goat testicles onto humans. They finally managed to chase him out of Kansas.  I even remember hearing that he was so popular he ran for governor of the state.  Eventually, justice caught up with him and he “retired” (fled) to Texas, where he lived out his life as a radio-station owner and broadcaster of quack medical advice. Any attempt to make any kind of a serious search about steroids leads to an overwhelming wealth of information about anabolic steroids and how to get them. Even reviews of their history have an overwhelming amount of pop-up advertisements. But the steroids I know and have actually prescribed appropriately, to the best of both my knowledge and my belief system were steroids more in the general family of prednisone.  These are powerful immunosuppressant drugs.  I actually recall receiving seasonal (annual) injections of prednisone for a few years of my young life, when I had barely started school, and when my hay fever made breathing a fairly laborious endeavor.

A list of the illnesses that can be treated with prednisone includes pretty much anything that can be traced to an excessively active immune system; including what is otherwise known at the autoimmune diseases. The side effects of this kind of medicine also are enough to fill medical textbooks.  The old-fashioned hard copy textbooks, the lifting of which was the closest I ever came to pumping iron.  The books that, in a small French apartment, held up my kitchen table when I wasn’t reading (and memorizing) them. They are chemically fairly close to the natural secretions of the adrenal gland.  The adrenal secretes this kind of substance during stress.The classical work of Hans Selye called it “Fight or flight” or “general adaptation” syndrome. The body is in a delicate balance.  Although alternative healers use more “gentle” treatments, there is no doubt in my mind that medicines like prednisone have saved and prolonged many fragile human lives. The side effects of prednisone and drugs like it include raising blood sugar (essentially producing or worsening diabetes or other problems characterized by high blood sugar). They include becoming more likely to catch infections, of all sorts.

When consulting in general hospitals, something I have spent plenty of years doing, I was called often to medical and surgical wards for the psychiatric side-effects of these drugs.  Mania, depression, psychosis, or anxiety, or even dementia; it is difficult to think of a psychiatric symptom that could NOT be produced by steroid drugs. Visual problems (glaucoma and cataracts) osteoporosis and weight gain; the list seems endless. The negative effects of these drugs can be mitigated by rapid withdrawal — within seven days.

The body maintains its equilibrium with systems we usually call “feedback loops.”  Basically, too much of a steroid, administered for too long, tells the brain to stop stimulating the adrenal glands to produce their own, natural steroids.  This lands the body in a state of adrenal insufficiency. This can mean muscle weakness, profound fatigue, low blood pressure — basically, the symptoms are historically those of Addison’s disease. You can tell, it is a mixed blessing.  Many lives have been saved by the use of these miracle drugs — antibiotics and steroids.  Many people have been relieved of suffering. But misuse of these drugs is rendering them ineffective of the good they can do. Doctors should know better, but we live in an age when people can learn “just enough to be dangerous” through medical-advice web sites and consumers are able to bypass legal medical safeguards to get the drugs they want from the internet.

Such a complicated world.  I can only hope sounding this alarm is my contribution to keeping people healthy, and waking up doctors who don’t take a firm stand when faced by consumer demand.

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