The patient vanishes
May 30th 2008, 15:29
One fundamental difference between alternative and conventional medicine is the way each treats the patient. To the alternative practitioner, every patient is different, and presents a unique array of symptoms; to the conventional doctor, the patient's case is one of many other similar ones.
To an extent, conventional medicine defines disease by its similarities, and so seeks to treat these, while alternative medicine looks more for the unique features of an illness, as this may provide the key to the problem.
These differences became stark at the beginning of the last century with the rise of the pharmaceutical industry, and its mass production of chemical agents. An industrial production line needs a mass market, which, in turn, requires common features.
To facilitate this, medicine adopted the raiments of science, and the double-blind, placebo study. To catch everyone within its net, the double-blind study succeeded merely in catching nobody in particular, and created a generalised hodge-podge of the typical - but non-existent - 'patient'.
It's little wonder that a senior GlaxoSmithKline executive has estimated that his company's drugs work in just 30 per cent of cases (and, in reality, probably even less).
Similarly, the double-blind uses the measurement of ratios and percentages. This is another trick in which the patient vanishes. Just one per cent of people died while taking the drug, the study might conclude, but that one per cent is, in fact, perhaps hundreds of people who died fully and completely. One hundred per cent, in fact.
These thoughts came to me this week after reading the latest Lancet journal, which quotes an extract from Tolstoy's The Death of Ivan Ilych. It reads: "To Ivan Ilych only one question was important: was his case serious or not? But the doctor ignored that inappropriate question. From his point of view, it was not a question of Ivan Ilych's life or death, but one between a floating kidney and appendicitis."
Ivan - and his unique and individual concerns - had vanished.