- © 2008 Canadian Medical Association
While summer reading traditionally brings to mind the latest pulp-fiction fare, this year's Summer Reading section in The Left Atrium aims to provide something for every palate, from a Dr. Seuss-esque take on disease mongering to the history of Canadian hospital architecture, from poetical musings to physician wellness. Enjoy.
The ABCs of Disease Mongering: An Epidemic in 26 Letters Alan Cassels; Emdash Book Publishing; 2007; 116 pp $9.95 ISBN 978-0-9780182-3-8
The Greek philosopher Zeno once convincingly proved that motion is impossible. Where, he inquired, does it occur? Does it occur where it is? Obviously not, because there would not then have been any manner of motion. Does it, then, occur where it is not? Well, what could possibly occur where it is not?
Ergo, motion is impossible.
It's difficult not to be reminded of Zeno's dialectic arguments while reading medical skeptic Alan Cassels' new book, The ABCs of Disease Mongering: An Epidemic in 26 Letters, if only because it all but induces a state of paralysis.
The University of Victoria pharmaceutical policy researcher uses clever tools — children's verse, one for each letter of the alphabet — to illustrate a central proposition: that the only legitimate response to many aspects of, and practices within, modern pharmaceutical-based medicine is a generous dollop of skepticism.
Many interventions, Cassels argues, are fuelled strictly by corporate greed, while many of the flogged pharmaceuticals have little health benefit. Some may actually be hazardous. Of the latter, a number have been widely publicized, like the perils of taking estrogen for menopause. Furthermore, treatments for osteoporosis, prehypertension, pre-diabetes, social anxiety disorder, andropause and nail fungus are among those identified as little more than a sham, if not downright dangerous.
The medical profession, driven by the dictates of the pharmaceutical industry, contributes to a self-perpetuating cycle of affairs that Cassels calls “disease mongering,” in which all involved profit from deluding people into believing there is a pharmaceutical solution to whatever may ail them.
In short, all pharmaceutical therapies invariably evolve into another staple of the monthly fee-for-service invoice and another few zeros at the end of the drug industry's annual profit charts. As for the poor beleaguered patient, well, caveat emptor, particularly with respect to the long-term effects of consuming a specific pharmaceutical, which are unknown because, of course, the drug had to be rushed to market and there was no strict requirement for follow-up studies. Moreover, if someone is sickened by an intervention, well, that ultimately adds up to another patient, requiring another pharmaceutical intervention, ad infinitum, ad nausem.
Indeed, there are times when these downright ditties are downright depressing. Behind their charm lie harsh truths about the hard evidence, or lack thereof, presented in the form of endnotes called “The Fine Print,” mini-essays on each of specific conditions, interventions or medical practices identified in the 26 poems.
It's tough not to conclude that this is bathroom reading, for manic depressives.
Yet, beneath the cynicism lies a vital message, the importance of inculcating a measure of healthy skepticism when advised by the medical and pharmaceutical industries to consume a drug.
There is, of course, a careful balance, as Cassels acknowledges in saying that many doctors are altogether well-intentioned and many pharmaceutical products are altogether efficacious, which is fortunate given most patient's implicit faith that medical treatment is a benefit.
The rub, though, is at the margins, in which the desire for solutions for diseases for which there are no easy solutions intersects with padding the profit margins.
These particularly, Cassels advises — much as readers of this book would be best advised — should be taken in small doses, if only to avoid the inevitable urge to seek a pharmacological (or alcoholical) solution to the ensuing depression or paralysis.