Rita Redberg: an unwavering campaigner against the harms of too much medicineBMJ 2016; 354 doi: https://doi.org/10.1136/bmj.i4390 (Published 09 August 2016) Cite this as: BMJ 2016;354:i4390
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Dr. Rita Redberg's stance on less of imaging and unnecessary tests is quite laudable. Western medicine, under the mantra of innovation, has lost its way and succumbed to a system of approaching diseases through potentially harmful technology alone, treating symptoms and prescribing the strongest of medications. Excessive CT scans and other nuclear imaging machines have become the hallmark of diagnosis. Abdominal pain triggers a knee-jerk response of ordering CT scans, or HIDA scans. Chest pains do the same for nuclear cardiac stress tests. Clinical approach to disease has taken a backseat to machines- parallel to that surgical procedures such as cholecystectomies, percutaneous coronary interventions are on the rise.
The same goes for prescription drugs and overuse of biologics without getting to the roots of the problems. The curricula of medical schools address mostly treating symptoms, seeing a patient through the lenses of multiple subspecialties. Most internists are not trained to look at the human body as one biological machine. Most patients present with systemic symptoms that are looked at by multiple subspecialists who are not communicating with each other.
Looking for root causes of systemic symptoms, looking for a common theme to explain all the symptoms and going directly to rectify the root problem, is the right path to any diagnostic process.
I am not against compelling indications for imaging or prescription medications as long as they are needed for integrating the human body's systems as one machine and looking at the root causes. We should go back and look at the order of things to fix the disorder. We should reject imaging as a routine or as a defense against potential litigation. We should prescribe only medications that are time-honored, i.e., only if they treat causes rather than symptoms. We could of course treat symptoms temporarily until we have refined our diagnostic path and found the cause.
By applying these principles, one can treat many disorders that are classified as idiopathic. Examples of that include chronic fatigue syndrome. By applying the principles of “human biology as one machine”, in my experience, over 95% of patients with chronic fatigue syndrome could be treated. Instead of obsessing about changing the name of the syndrome to ME/ SEID, one can truly look into the biology of this syndrome one patient at a time. The same applies of syndromes like IBS: what irritated the bowel? Look for the irritant, find it and eliminate it. Restless leg syndrome: find out what made your legs restless and treat the cause. Fibromyalgia: what caused the pain? Most of the guidelines come up with a vague name, mostly under the headline of idiopathic and we ask our patients to live with their misery plus the horrible toxic effects of NSAIDS and anti-depressants for life. Overuse of imaging and drugs can be reduced only when we teach our new generation a new paradigm of looking at the human biology as one machine. How to link all the systems together. Let me give an example of chronic diarrhea: you get dehydrated, you lose electrolytes such as potassium and magnesium, you lose (or malabsorb) nutrients such as zinc, iron, vitamin A, vitamin D, B12, etc. The patient could present with syncope and dizziness, and palpitations (cardiology). hair loss and dry skin (dermatology), anemia (hematology), low memory and neuropathy (neurology), anxiety, depression from lack of serotonin and B12 (psychiatry), low night vision, glare and blurry vision (ophthalmology), muscle, joint and bone pains (rheumatology and orthopedics), diarrhea itself and abdominal discomfort (gastroenterology). Chronic malnutrition, inflammation and cytokines can disturb the hormones (endocrinology). You see? In conventional medicine, If we miss addressing chronic diarrhea and evaluating it in depth as the root cause, the patient could end up with visits to all or combination of these sub-specialists; each having own cookbook of arrays of tests and imaging to tell the patient what she does not have but no one might tell her what she does have. This is just one example. Only by training a new generation of doctors how to look, how to analyze, how to think, how to learn to be adept interviewers, communicators, and skillful clinical examiners; and how to practice smart medicine, we can save the medical system from depleting all our resources, including depleting our sanity- both patients and doctors. Leaders such as Dr. Rita Redberg give us hope that this goal could be accomplished someday.
Competing interests: No competing interests
Healthcare is hell. The more we get, the worse we feel. There are 24 medical specialties and 88 sub-specialties. How can we choose, afford, or survive so much healthcare?
There are three kinds of healthcare: traditional medicine, alternative medicine, and complementary medicine. Complementary medicine (integrative medicine) combines traditional medicine with alternative medicine. All three kinds of healthcare use drugs.
Traditional medicine uses prescription drugs, such as antibiotics, tranquilizers, vaccines, and chemotherapy. Alternative medicine uses over-the-counter drugs, such as vitamins, minerals, herbs, and enzymes. Complementary medicine uses both prescription and over-the-counter drugs. So all healthcare uses drugs, and patients have no real alternatives.
Drugs are a mixed blessing. They prolong life, but they also shorten it. This is because drugs are toxins and addictions that fool and block our body's biochemistry. This is why drugs have so many serious side effects and adverse reactions. In contrast, nutritious food, which is free of toxins and addictions, fuels and builds our body’s biochemistry. This is why food is live medicine, but medicine is dead food. So healthcare needs selfcare.
Competing interests: No competing interests