Snowball in a Blizzard
A Physician's Notes on Uncertainty in Medicine
Steven Hatch, M. D.
(Basic Books)
  • Some of our most important medicines come from ancient remedies. Foxglove for atrial fibrillation, senna for constipation, opiates for pain, and aspirin - - - salicylic acid - - - as a general pain reliever.
  • 250 years ago, religious folk stated that vaccinations "defied God's will, for if one was meant to get smallpox and die, that was fate and fate should not be circumvented."
  • People that the author titles "antivaxxers" organize "'measles parties' so that their children can be exposed to the virus.
  • The Centers for Disease Control and Prevention estimates the immunizations in the US between 1994 and 2013 prevented 322,000,000 illnesses, saving over 700,000 lives.
  • The New England Journal of Medicine states that "as many as 13 million new people are in the statin pool" despite the fact that there is a risk "of suffering a moderate or serious side effect from that medication, such as liver toxicity or diabetes . . . "
  • Almost fifty years ago, eight people went to professionals and confessed to hearing voices that spoke the words "empty," "hollow," and "thud." All eight were diagnosed with "paranoid schizophrenia" and admitted to psychiatric facilities. The problem was that the whole schmeer was fabricated by psychologist David Rosenhan, a Stanford University professor. When he explained that it was an experiment - - - indeed, a farce - - - it still took these eight healthy, non-manics between a week and a month and a half to get sprung from the booby hatch.
  • James Lind is credited with finding the cure for scurvy, a vile sickness that causes a swelling of gums, loss of teeth, ease of bruising, skeletal aches and liver-failure. Lind gave limes to sailors in the British navy, which caused an almost immediate disappearance of the symptoms. But at the same time, he also gave sailors a quart of cider a day, others glasses of vinegar, others nutmeg, and the final pair daily doses of salt water. This is considered one of the first drug trials, although the only ones to benefit were the "limeys."
  • "Of all the pathogens that cause infectious disease in humans, the closest bacteria that resembles Lyme disease in terms of its structure and clinical behavior is syphilis."
And one of the problems with syphilis - - - like Lyme disease - - - is that it mimics so many other diseases. This was noted by Sir William Osler, who said that "The physician who knows syphilis knows medicine." Syphilis can be confused with HIV infection, thyroid disease, vitamin B12 deficiency, multiple sclerosis Meniere's Disease, Dementia, Rocky Mountain spotted fever, ulcers in the mucous membranes, scabies, pityriasis rosea, hemorrhoids, lupus, Alzheimer's disease, German measles, and impetigo.

§   §   §

Dr. Hatch has come up with an interesting book, centered on that fact that most of us in this country are being overdiagnosed: too many machines, too many tests, too much fear by too many medicos of being sued by too many personal injury attorneys. These items were well presented in an earlier work reviewed on these pages, Overdiagnosed: Making People Sick in the Pursuit of Health. Gilbert Welch revealed that your physician may find "polyps that might have remained hidden for the rest of your life if it weren't for the new high resolution capacity of scans." This may mean

    encountering cancers that are not large, and - - - even more importantly - - - are not even growing; ones that may turn out to be, paradoxically, neither benign nor harmful for you.

Hatch comes to many of the same conclusions, including a suggestion that as we read his book, imagine these words at the top of each page, slightly jazzed up by me:

Exercise every day

Stop eating so much already


Don't you even for a moment think of smoking anything, ever!

Unlike Welch, Hatch gets caught up in words (he has trouble in stopping the writing of them). He is especially wrought by the part-time loonies that appear on the scene in opposition to vaccines (some of whom do seem to be a bit out-of-it) and equally, the "alternatives" with their opposition to common medical practices for Lyme Disease. It is fair and helpful for the reader to tell us about these, but Chapter 5 ("Lyme's False Prophets") could have used an editor's fine touch.

Where Hatch is at his best is in asides, such as telling us of the vital studies of Dr. Arthur Herbst in his work on "clear cell adenocarcinoma" which led to a study of medications taken by the mothers of those stricken by this disease. He compares Herbst favorably with Dr. Frances Oldham Kelsey [see Fig. 2 below] who singlehandedly - - - despite considerable pressure - - - made it impossible for thalidomide to be sold in this country because "she found the safety studies on thalidomide wanting, and she insisted on further studies proving its safety in order for it to be approved." Hatch's sly footnote:

    Although she is a bit more well known than Arthur Herbst, she is significantly more obscure than physicians such as Deepak Chopra and Andrew Weil, whose contributions to the profession, even if viewed only through the lens of public education and outreach, can be described as harmless but mostly useless, at absolute best.

And most revealing of them all is Hatch's story of his own father who, despite a clear DNR ("do not resuscitate") preference in his medical file, was, after a heart attack, "revived, intubated, and taken to the nearest hospital."

Since Hatch was the doctor, it was thought that he would be able to lead other family members in steps to prevent his father from the usual indignities of one who merely wanted to die peacefully. What we learn is that even the good doctor was confused by some new strictures that were not on the table when he was in medical school, ones which stated that "patients who survived events like these through hypothermia protocol were assessed in terms of their ability, for example, to hold a toothbrush six months after the event." Hunh?

He admits to hesitating to call for - - - could we call it "disintubation?" - - - because of this "fancy new technology." Fortunately, his relatives came to their senses to complete the procedure, but "other families who find themselves in a similar bind may not be so lucky."

--- Janet Weaver, M. D.
Send us e-mail


Go Home

Go to the most recent RALPH