Saturday, February 04, 2006

Medicine and Religion- What happens when the masses get specialized information?

Michel Foucault - Wikipedia, the free encyclopedia

An interesting link...Foucault is post modern it is said, which means he argues against the need of the dominant establishment having all knowledge and power.

In this case I would argue that this is what is upsetting the medical world- specialists and generalists -because with the advent of the internet being used for medical research by laypeople, there is a shift in power from the doctor to the patient.

This is not unlike Martin Luther and the 95 Theses being posted. When Luther gave the world his manifesto for a new order in the Catholic Church, he set off a chain of events that allowed specialized knowledge to be scrutinized by the unwashed masses. This was aided by the Gutenburg press translating the Bible into the common language. These events birthed a movement that became Protestantism which both diseminated and further fragmented knowledge.

The reaction of the Catholic Church was to further tighten its hold on the territories it held , and cast out, with the help of the ruling powers of the day, those who did not believe. These cast offs from the Old World began a journey into the New World, and a different take on what religion meant took hold. It became individualized, personalized, freed from cultural and state restraints. It allowed the slaves to be freed, women to be emancipated, work to be valued, and knowledge to be pursued.

The unfortunate thing is that it also became a tool of those in power, once it was established in its New World. One only has to look at the Pilgrims or the conservative Religious Right to see that it has been co-opted by those in power to be a force that drives what is politically feasible. It has also woven its web around the powers that be. This symbiotic relationship has allowed for a coziness reminiscent of the Church in the Middle Ages, with its fears and superstitions and falsehoods being the impetus for great evils and deliberate blindness to scientific truths.

What does this have to do with medicine or technical knowledge being spread with the help of an instant technology. One, there will be a struggle, both personal and establishment based, against the use of this information. Personally, doctors will struggle when they look at a patient who has accurate information, as they realize that they may not have all the information that a patient does. Developments in research may not make it to the doctor in a timely manner, and who can blame them? They work with 40-60 patients a day, with as many problems. There is no way that they can keep abreast of all the research in a particular field. Even keeping up generally can be difficult as they have LIVES.

The patient, on the other hand, if they are discerning and able to research effectively, can often come up with options that may be effective in their particular case, or explanations as to WHY something has happened. Living with their illness, they have a personal interest in this, and can be quite able to learn terms, find links and evaluate the kinds of studies being done - are they double blind placebo? Is there a small group or large group? In a meta-analysis, what are the parameters of the study and are the studies being studied at all similar in nature.

A patient also has the lived experience of dealing with side effects of certain therapies, and intuiting their effectiveness. If Drug A has a myriad of negative side effects, as does Drug B, are they really effective? They can look up their symptoms and compare if others are having the same experience. They can find the drug fact sheet on line, which can tell them if what they are experiencing is recognized as a side effect. They can contact other doctors on line with their questions, and take that information with them to their next appointment. Though not equal in all knowledge, they put their doctor at a disadvantage, if the doctor so chooses to perceive it as so, of being on a more equal footing in understanding what is happening to them.

Some doctors do not see this as a challenge, but as a way of patients taking control of their health. For a few years now the notion of personal responsibility for one's health has been a theme and has been encourage by the profession to a point.

This is a good thing until it comes to bite a patient in the butt as in -If you had/ had not done this this would not be happening. There are certain situations in which this is completely true. Smoking creates many problems in a smoker's life. This can be an added burden for some situations. The soft sciences of psychiatry and psychology have often given other medical professionals permission to label patients who do not respond to current treatments "correctly" in negative ways. There has been a marked increase of multi-disciplinary clinics who claim to treat the whole patient but focus purely on the psychosocial aspects of disease to the detriment of physiological cause and cure. For every experiment measuring chemical responses to disease in the body there are seemingly 10 more that say that the patient is choosing to stay ill because it removes them from life's burdens. When a patient brings in data from current studies that are being published they are often dismissed as being too experimental or "just" animal studies. This further removes the trust between the informed patient and the medical community.

Patients can be deceived by the information they are getting, which leads to doctors understandably being frustrated with this useless and sometimes knowledge. In todays climate of "mind body medicine" there are charlatans who self publish important sounding things that have no basis in any scientific facts. Alternative clinics, nutrition experts, and treatments imported from other parts of the globe may look enticing and effective. The patient must be scientifically aware of how real studies are done, where they are published and how to read results. This is not a skill taought to North American children or adults even in science classes. Americans specifically score very low in the sciences on a world wide measure. It is important to research scientific methodology and see how scientists come to conclusions. This will help when evaluating whether a potential treatment that looks promising on the internet is in fact valid. There may be times even experts are fooled. Neurontin/Gabapentin comes to mind, as many doctors were told of studies that said this drug was effective for chronic pain syndromes. In factr there were two specific syndromes that it was properly tested for only. Many doctors were taken in by snakeoil salesmen themselves as they chased after something that would relieve their patients pain without narcotics.

There are many ways that technology can help and hinder a patients experience with the medical establishment. Not unlike what the Protestants experienced many years ago, patients are dealing with the knowledge that their health is a personal lived experience that can be unique to them. This can set them up against the establishment if they choose to take some ownership of the knowledge that is available to them. It can also be a positive. This shift of power however small could have a ripple effect that can change medicine and how it is practiced for the better. If patient self advocacy becomes the norm, it may also have negative effects leading to further lawsuits, pressure on insurance companies and governments to cover treatments that are cutting edge but in the language of the day "experimental" and may lead to a militancy that divides rather than empowers the patient.

Like a religion that has split, there will be mainstream protests and heretical protests, and those in between. Some will use their influence for politically and power motivated aims. I believe that most will use it for their well being and personal advantage.


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