Some years ago I had the opportunity to assist the efforts of other health-care providers serving the needs of the people of the poorest country in the Western Hemisphere. One morning, I was working with the dentist.
His operatory was simple, consisting of a case of dental instruments, a syringe of lidocaine and a folding chair. This Caribbean nation did not have a modern dental suite with an X-ray machine. Villagers would line up and, one by one, point to the painful tooth which would promptly be removed.
What was remarkable was the number of healthy teeth that succumbed to the dentist’s instrument. When I inquired, he explained his idea that many sacrificed a healthy tooth for the prospect of a “magic” bag of pills consisting of a ziplock with about 20 ibuprofen given to each tooth-extraction patient.
From this I learned the powerful lesson that the human expectation for benefit from medication often vastly exceeds it’s true advantage.
The idea of medication as a “magic bullet” seems to date to late 19th century Germany when scientists began testing chemical dyes developed for textiles as drugs to target microbes causing human illness. While there were successes, there were as many or more failures. It became understood that chemicals used to treat illness also could cause harm.
A 19th century French physician, Armand Trousseau, recognized that the excitement about a new medicine often preceded a true understanding of it’s effect and side effects. His maxim, “use new drugs quickly, while they still work,” has become a principle for today’s wise physicians.
As a student and practitioner of allopathic medicine practicing in the antibiotic era, medications comprise a substantial part of my treatment armamentarium. Yet, I have learned to treat these chemicals with due respect.
The legal profession has a well-known symbol of lady justice as a blindfolded woman holding a sword and a scale, intended to represent judicial impartiality and objectivity. I have often thought that the medical profession should be similarly represented as a physician holding a caduceus (the staff of the healing arts) and a scale with eyes wide open, depicting the need to be vigilant to the risks and benefits of all treatments.
Modern medicine has indeed discovered and produced many “magic bullets,” collectively reducing the rates of death and disability across a wide spectrum of human illness in the past century. One needs only to measure the declines in the rate of death from cardiovascular disease and many common malignant and infectious illnesses to realize the impact of this revolution in medicine.
Yet as the range of medication options becomes more complex and as direct-to-consumer marketing of new “blockbuster” drugs changes, for better or worse, the physician-patient relationship, a measure of caution is in order. Remembering the purveyors of snake oil in the century past, I would share a pearl of wisdom: Be cautious of anyone who promises health and vitality from a bottle, without any risk of harm.
Dr. Matthew A. Clark is a board-certified physician in internal medicine and pediatrics practicing at the Ute Mountain Health Center in Towaoc.
