The Shipwreck of the Singular
Healthcare’s Castaways
By Dr. David Healy
Publisher: Samizdat Health Writer’s Co-operatrive Inc.
Publish Date: Forthcoming in 2021
Crusoe,
We say was ‘Rescued’.
So we have chosen.
Obsessed, bewildered
By the shipwreck
Of the singular
We have chosen the meaning
Of being numerous.
George Oppen, Of Being Numerous
Introduction
Before Covid struck, life expectancy in the United States had been falling consistently since 2014. In 2019, Britain’s Office of National Statistics estimated babies born there today will live 3 years less than had been expected 5 years before. In France and Germany, countries that along with America and Britain made modern medicine, and other European countries, life expectancy has stalled.
Some will dismiss increased US death rates as stemming from America’s opioid crisis and lack of access to healthcare – “deaths of despair”, but Britain, France and Germany have no opioid problem or lack of healthcare access. Poverty kills, but a greater intensity of health services also kills and disables regardless of social class. Questions as to why more health services might harm us emerged in 1990s America but were shot down as ‘rationing’. In 2008, efforts by US reformers to re-open the issue faced claims the government was creating ‘death panels’.
The response to a fall in life expectancy has been silence. There may be lessons here from mental illness, often the canary in the medical mine. In 2000, the first reports of falling life expectancy in schizophrenia appeared. By 2006 there was agreement that people with schizophrenia lose up to 20 years of life compared to the rest of us. Death in the first 5 years of schizophrenia are much more common now than a century ago. But these data, so at odds with medicine’s vision of itself, have met silence.
In 1962, faced with horrific birth defects caused by a sleeping pill, thalidomide, the US Food and Drugs Administration (FDA) adopted a set of regulations that today are the greatest influence on healthcare in every country on earth. These regulations are key to the fall in life expectancy. They have led to an increase in Drug Wrecks – treatment-related adverse effects – the problem the regulations were supposed to solve.
Treatment related deaths are now the third leading cause of hospital deaths, even though the contribution of drugs is written out of the script in, for instance, cancer or cardiovascular deaths, when it’s often the treatment that kills. Our medicines must be an even commoner cause of death and disability in our homes and workplaces where the conditions treated are less severe but the treatments just as toxic – but this has not been looked at.
In 1980, comparatively few of us were taking more than 1 drug per day and then only in short courses. As of 2020, over 50% of us of all ages are on at least one drug every day of the year, 40% over 45 are on at least 3 drugs, and 40% over 65 are on 5 drugs or more. The best evidence that our treatments may be shortening lives is – the silence – despite the publication in 2010 of evidence showing that reducing drug burdens to 5 or less drugs per day increased life expectancy, reduced hospitalizations and improved quality of life.
Tobacco’s role in contributing to cancers and heart attacks led to a wobble in (male) life expectancies in 1962, adding to the point, especially if we add in alcohol and opioids, that the substances we consume can cause problems. Medicines are on prescription because they are thought to be more dangerous than alcohol and tobacco but an ever-increasing number of us now blithely take 5 or more every single day.
The media who happily highlight the growing risk we face from the food we eat are silent about the thing most likely to kill us – our medicines. Is a doctor who makes a living out of these medicines more likely to recognize the risks than a farmer who makes a living from beef or bacon?
There are fates worse than death. In the case of the antidepressants, 15% of us take them, 80% of whom take them indefinitely, primarily because we can’t stop. Every drug has a hundred effects. For antidepressants, sexual dysfunction is just one of the 99 other things every drug does that pharmaceutical companies and regulators don’t want us to know about. These drugs compromise the sex life of everyone who takes them, and thousands remain permanently sexually dysfunctional for decades after stopping.
All other best-selling treatments – statins for cholesterol, drugs for osteoporosis, reflux, asthma, or Type II diabetes – can also cripple us. These treatments rarely offer a clear enough benefit to warrant being included in the 5 or less drugs whose disabling effects we might have to put up with as part of a life-saving trade-off. But our health systems now force these drugs on us.
We have forgotten the lesson of thalidomide – that modern medicines are dangerous miracles. As a result of thalidomide, pregnant women avoid soft cheeses, uncooked meats, hot showers, tobacco, and alcohol. But because of thalidomide, with every drug we take we swallow an invisible set of techniques that all but force 15% of pregnant women to take antidepressants, despite evidence these drugs double birth defects, miscarriages, and Autistic Spectrum Disorder rates – about which there is silence.
Every time a solider with PTSD, obeying orders, swallows an antidepressant, unaware it won’t help, he increases the pressure on women to take antidepressants and other medicines, while pregnant. This book grapples with this extraordinary situation and the silence in which it is shrouded.
Shipwreck looks at medical techniques through the window of our falling life expectancies and increasing disabilities and beyond that at the role of technique in driving history, and in particular how one set of techniques, as invisible as carbon dioxide, have brought about a change in the climate of medicine that is a real and present danger to each of us.
Techniques include technologies like guns and the behavioral techniques built into social media platforms aimed at nudging us one way or the other. All techniques are one-dimensional but our lives are not. Whether the use of technique enhances or diminishes us depends on our willingness to take responsibility for using them. There is no better place to see this than with the combination of physical and behavioral techniques that is a medicine. When we control medical techniques, we have healthcare; when they control us, health becomes a service industry.
The Shipwreck of the Singular
Healthcare’s Castaways
By Dr. David Healy
Publisher: Samizdat Health Writer’s Co-operatrive Inc.
Publish Date: Forthcoming in 2021