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Miracles of Modern Medicine

In one moment, I am on the web watching a video about a brain surgery that saved Gabby Gifford’s life (an incredible decompression surgery where the simple barbaric nature of the surgery is lost considering the potential life saving impact); and a moment later I am seeing a facebook message that says this:

Day 7 of extreme body, muscle, joint pains from antibiotic Levequin. Only relief is synthetic morphine dilauded. I can barely walk and almost 100% bed ridden. Anyone, please help. Any information you have is appreciated. I want to know long term affects and if I will walk Or run again. Help please!

And after spending some time on both of them, it made me question the brain surgery.

For those who might not have caught this in the news when it happened, but in early January, Representative Gabrielle Gifford was shot in the head in Tucson AZ, in a sooting rampage that took six people’s lives.  Rep. Gifford was shot at very close range.  The surgery that was done was first designed to reduce pressure on the brain from the swelling that ensued, and secondly to remove dead tissue from the trauma.  According to media, she is improving and on the long road to partial recovery following the trauma.

So what would I ever question about such a valid intervention?  The drugs used to make it happen.

It isn’t that I question that surgery at all, in fact, it is simplistic and genius all at once (at least for our current understanding of the body).  The problem is that it takes a bunch of drugs to perform this surgery, drugs which likely each have more than a dozen options to choose from.  So at every point when a drug is administered, do you think that the very best clinical judgement is used?  That the doctors involved are considering patient factors such as gender, age, weight and morbidity (disease history and risk), while trying desperately to save a life?

Of course not, which is why the solution at every junction is provided by preference.  And preference comes from a bunch of different possible places.  One of the most likely being the relationship with the drug representative who supplies it.  Which is why we see a drug class like the fluoroquinolones with pretty significant side effects, being used in routine places where other lower risk antibiotics would be a safer choice.

This weekend I watched a movie, “Love and other drugs” (which I must warn you is not appropriate for most viewers), but I was interested in the story line as it followed an up and coming drug representative.  Though they sensationalized the relationship between doctor and rep, they still did a decent job at times of showing the battle of doctor’s loyalty that can rage between different drug companies, as well as the view of a potential “blockbuster” drug that goes on.

So though there are some awesome interventions in this country, we are still following the rules of a system that has been built on cash flow.  We need a reform in the way that medications are promoted to doctors, as well as the public.  I think drugs are WAY overused in lifestyle management, but we need to use some in trauma and emergency care, and there is no reason for higher risk meds to be an option in these situations, unless the patient history requires it.

Be well,

Dr. Eric

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