Looking for Salvation in Medicine

Several months ago, Atul Gawande wrote an interesting article in the New Yorker on why people seek unnecessary treatment.  He questions why patients will willingly undergo unnecessary treatments that are objectively more dangerous than undergoing no treatment at all.  He discusses why this is the case and posits, among other ideas, that part of the problem is that people generally don't know what statistics in medicine mean.  Having thought about the piece myself, I question whether it is so much that we don’t know as it is that we want to know about certain things in certain ways.  Alan Levinovitz, author of The Gluten Lie:  And Other Myths About What You Eat, remarked about a similar issue involving diets:

And I thought to myself, you know, it’s funny, people are trying to debunk these fad diets with scientific evidence, but what they’re not realizing is that really these beliefs aren’t scientific at all. They’re wrapped in scientific rhetoric, but ultimately they’re quasi-religious beliefs that are based on superstition and myth.

In his piece, Gawande notes that a patient from whom he surgically removed a benign thyroid cancer that was only discovered due to an unnecessary test “thanked me profusely for relieving her anxiety.”  She was not concerned about her actual physical health condition.  If she were, she would have recognized that the procedure to remove the benign tumor carried with it higher risks of death and physical harm than leaving the microcarcinoma alone and monitoring it.  The need for treatment was not medical.  Her understanding of the condition was conditioned on a belief system about cancer (and medicine) that is mythic.  Dr. Gawande was fulfilling a function perhaps closer to shaman than surgeon.  The problem, if it is a problem, is with modes of understanding and typologies of knowledge.

It is too easy to blame greed.  Certainly greed in medicine exists.  So does false hope and unrealistic expectations.  Charlatans take advantage in medicine as they do in the revival tent (or on the revival screen, as the case may be). 

The idea of medicine in America is, or has become, salvic.  Christ on the Cross is no longer intercessor or savior or redeemer.  Now it is the busy doctor dispensing antibiotics for viral upper respiratory infections or the cardiothoracic surgeon putting in a stent or the plastic surgeon cheating time with a Botox injection who intercedes, saves, or redeems.  The Rosary replaced by the Rx b.i.d.  The actual state of health is unimportant compared to the reassurance of an explanation, the ritual that allows us to feel as though everything is okay, that everything is in order, that we are being taken care of.  The soul has become the body.  Our quest for health is, as Levine notes with diet, quasi-religious.

And pain.  Pain is more than nociception.  Pain is a modality for expressing discomfort, physical or otherwise.  Complaints of pain alone seems not to establish physical pathology.  However, we have learned that when something hurts we go to the doctor.  Unhappy marriages hurt.  Financial distress hurts.  Is it any wonder that we somaticize?  Seeking understanding and counsel in medicine is normal behavior for persons acculturated as we are; that is acculturated to believe every problem is medical and every medical problem has a solution.

One of Foucault’s profound insights in The Clinic is that the patient went from being a person in the pre-clinical era of medicine to a specimen when medicine became “scientific” or clinical.  As a specimen, the patient became an object of inquiry rather than a person in the world.  The goal of treatment became a disease-free state rather than well-being.  Thus, questions about the patient’s overall well-being that were not directly related to the disease state were subverted and minimized.  “Treatment” would only be proffered in the presence of objectively verifiable disease, regardless of the patient’s degree of actual suffering.  Consciously or not, patients came to understand that if they wanted relief from pain they would have to characterize it as a disease-state.

Members of all societies suffer, some more than others, but suffering is a constant.  No society is Edenic.  Nevertheless, contemporary American society seems to predispose its members, at least those members not living in abject poverty, to a certain anomie.  For whatever reason, traditional American cultural institutions seem unable to ameliorate this state.  Instead, this cultural disaffection seems often to be medicalized in forms such as low back pain, arthritis pain, or depression.  

Unfortunately, medicine treats the manifestations of anomie as disease states, with predictably poor results.  Despite the predictably poor results, medicine treats manifestations of anomie with the same confidence and professional brio with which it treats broken bones.  Hence, a perversity of expected outcomes is created for both doctors and patients.  Doctors offer something approximating science while patients seek salvation for existential discomfort out of the firmament of superstition and myth.  Unfortunately, never the twain shall meet.