When doctors strike, fewer people die

Taking responsibility is the key to health

Jurriaan Kamp
Ode magazine

In 1973 doctors in Israel staged a month-long strike and during that month, mortality fell by 50 percent. A couple of years later, a two-month work stoppage by doctors in the Columbian capital of Bogotá led to a 35-percent decline in deaths. And during a ‘work slowdown’ by doctors in Los Angeles protesting against the sharp increase in premiums for liability insurance, the number of deaths fell by 18 percent. Once doctors were back at work full time, mortality immediately jumped back to the previous level.

Every year, 1.2 million Britons are hospitalized as a result of improper medical care. In the United States - where 40,000 people are shot to death each year - the chance of getting "killed" by a doctor is three times greater than being killed by a gun. And every year significantly more people die from an infection sustained while in the hospital than as a result of traffic accidents. Over 20 years ago the American culture critic Ivan Illich wrote that health care has become a threat to our health. But this is still not the prevailing image. Modern healthcare is considered one of the triumphs of the twentieth century. Most people are convinced that a close family member or friend without a pill or a doctor's input wouldn't be alive today. But as lauded as today's doctors are, they are no more effective - when it comes to medicine - than the priests of yesteryear.

Today we live twice as long, on average, compared to a century ago, but this progress is not due to modern medicine. Cholera, typhoid, tuberculosis and dysentery were already on the decline when antibiotics and vaccines were introduced. The reason? Hygiene and better nutrition. And while doctors first discovered and proclaimed the importance of these two factors, it doesn't mean that soap and boiled water are medical remedies. It is typical that the man who conducted the first heart transplant in the world, the South African physician Christian Barnard, points to Thomas Crapper as one of humanity's greatest benefactors. Crapper was a British plumber who invented the flush toilet. The greatest advance in modern medicine in the twentieth century was the advent of ‘emergency care’. If you develop an acute, life-threatening infection, suffer a heart attack, a serious care accident or an operable tumor, the best place you can be is in a western hospital. The same applies to a new hip or a cataract operation. But such ‘crisis moments’ are the exception. The vast majority of most conditions concern chronic illnesses, cancer and cardiovascular disease. And western healthcare has sadly little to offer in this regard.

Old plagues have been supplanted by new ones. The post-war belief that illness would be eradicated has come to naught. Eighty percent of the most common treatments and medicines have not even been thoroughly tested (New Scientist, 17 September 1994), don't contribute to our health, or even threaten it. For example, excessive use of antibiotics not only leads to resistance, but can also damage the body's natural, friendly bacterial balance. Recent research also shows that mammograms more often lead to cancer than detect it. And that it is often safer not to operate on prostate cancer. And that low-cholesterol diets increase the chance of dying. And so forth.

The problem lies with our vision of modern healthcare: health is the normal state of being for humans and illness is something that comes from the outside, an enemy to be fought. Often, healthcare resembles a military operation. Even the terminology is similar: the war on cancer. Doctors see the body as a machine whose dysfunctional parts are replaceable. This machine can be controlled externally by medicine and medical technology. The use of chemotherapy against cancer is a striking illustration of this way of thinking. The body is poisoned to beat the cancer. The worst part is that the results are dreadful: in over 90 percent of cases, chemotherapy has nothing to offer. When 118 oncologists at a major cancer institute in the United States were asked whether they would opt for chemotherapy if they were cancer patients, three-quarters said they would turn down the treatment. Why? "Ineffective and unacceptably poisonous."

And yet, a great many people subject themselves to this poisonous therapy. This is due to another concerning aspect of modern healthcare: the conflict of interest between doctors and the pharmaceutical industry. One example from 1995 in the United States, the country with the highest number of cancer cases in the world: an honorary chairman of the Memorial Sloan-Kettering Cancer Center in New York, the largest private cancer center in the world. James D. Robinson is also a director of Bristol-Meyers Squibb, the company responsible for nearly half of global turnover in the area of chemotherapeutic medicine. Samuel Broder, currently Chief Medical Officer at Celera Genomics, which develops therapies for cancer, was a Senior Vice President at Ivax, another major manufacturer of chemotherapeutic medicine, while also serving as chairman of the American National Cancer Institute.

In the Netherlands, such conflicts of interest are less shocking, but the Dutch healthcare system has also been touched by a worldwide trend whereby most medical research is financed by pharmaceutical companies with a significant interest in the sale of their products. This explains why new drugs continue to flood the market. According to the World Health Organisation (WHO), 270 chemical substances are sufficient to meet our medical needs while there are 100,000 different medicines available. In this tombola of commercial interests, driven by the lame analogy that more money + more medicines = better health, and in which health insurers are also wrapped up, the patient has become a powerless victim. Patients can only think that they are buying what they think they need. Patients have become objects in a system in which technology is the master and the doctor is God. They lie in hospital beds while doctors consider their "status". They are so closely identified with a sick body part that they lose themselves completely. They have become an illness instead of human beings. The defenceless patient is the inevitable result of the fact that healthcare has degenerated into an industrial system in which - and this is inherent to such a system - procedures are more important than people. In this system, taking responsibility and independence have gotten lost. "The pre-eminence of technology leads to inner debilitation," genetic expert Hans Galjaard once told Ode. And this lays the foundation for illness.

There may be another way.

Or, better yet: there is another way. Healing appears to be a complex process in which - contrary to the accepted western view - not only medicine and tangible cells play a role, but also intangible aspects such as hope, belief, trust and will. Take prayer, for example. Doctors know from experience that patients who ask "why" when blood work is ordered and don't simply undress for the doctor, usually fare well. And how can it be when a mother produces antibodies in her breast milk when her baby is suffering from an infection? All doctors take the Hippocratic oath, but do these doctors - who continually intervene in the body's natural processes - realize that this ancient Greek master once said "the healing power of nature" is the most important of all? This is why Chinese, Indian, Native American and other "primitive" medicine practices are geared towards supporting the body's self-healing processes. These traditions assume that nature is perfect and that the body wants to be healthy.

We continually hear stories about people who inexplicably heal from incurable illnesses. People, for example, whose doctors give up on them because their tumors are no longer treatable. They walk out of the hospital - and the healthcare system - choose their own path and "miraculously" heal. Years later, scans pick up no trace of the tumor. Modern medicine passes such cases off as "anecdotal" because there is no concrete explanation. But perhaps these anecdotes prove the self-healing power of the human body. Perhaps treatments and medicines mainly serve to stimulate the body's spontaneous healing process.

A phenomenon that is just as ancient as healthcare itself, points in this direction. It is known that people get better when they take pills that have no demonstrable physical effect: the placebo, which comes from the Latin for "I shall please". It's easy to accept that the medicinal effect of the brews and potions of the doctors of the past can be explained by the placebo effect. Those potions had no provable medicinal effect. But the same is true for the majority of modern medicines: only 20 percent have been proven to have a scientific effect. This means that doctors prescribe pills and treatments that are essentially inert. But that doesn't mean they don't work: their healing power comes from the placebo effect. For many disorders - from pain and high blood pressure to asthma and arthritis - placebos appear to offer substantial relief to 70 percent of patients. Placebos are even effective in cases of psychiatric disturbances, e.g. depression. Or in any case no less effective than "real" medicines.

The simple fact that a doctor prescribes a pill is apparently sufficient to boost healing. Expectations and trust play a crucial role here. And trust grows with the attention given by the doctor. Various placebo studies have shown that doctors themselves are the best medicine. A doctor who listens mobilizes a patients' ability to heal themselves. Moreover, the placebo effect indicates that all types of "healthcare" are effective once the patient believes. This also explains the increasing success of alternative therapies.

Aside from the fact that the alternative treatment methods - such as homeopathy and acupuncture - have numerous proven healing effects, alternative therapies generally show more respect for patients. They take an integral approach instead of merely addressing the symptoms. And the alternative doctor generally spends more time and attention on his patients. He listens to their whole story, including their feelings of sadness and despair. This attention restores "patients' faith in their own healing."

Attention and care are therefore crucial. But these are qualities seldom found in the modern healthcare system. Doctors who want to give their patients attention are hounded by hospital administrators and insurance companies clamoring for "efficiency". It is telling that The Economist recently argued that healthcare could learn a whole lot from McDonald's in the area of efficiency.

But the importance of care and attention doesn't start with the doctor or in the hospital. Human relations are vitally important to healthcare. The so-called "first line" in healthcare is not the GP, but the family. It has been established that most people who die of a heart attack, actually die of loneliness. Research has also shown that women with breast cancer who participate in a weekly chat group with fellow patients live an average of two years longer than women who do not. Western society has organized and institutionalized care. And increasing loneliness is the result.

Good neighbors save more lives than an ambulance. More to the point: an ambulance siren destroys a vital social structure, sending the message that it's not my problem but the system's problem.

Social support is important, but the key to health is taking responsibility. The primary reason for the spiraling cost of healthcare is the fact that people don't believe they can get a handle on their illness - or their own strength - without a doctor. Taking responsibility is different from political plans to get patients to "co-pay" for their healthcare. A co-pay of $2.50 U.S. for a pill won't change my way of thinking if the system doesn't change. Isn't it odd that I have to go to the doctor to get a prescription for a tube of eczema cream but I can buy a chain saw - which is much more dangerous - at the store? Taking responsibility means more people learn a lot more about medicinal science on their own. Taking responsibility literally means the ability to respond. The story of Norman Cousins is a good illustration of this point. That increasing numbers of people seek out alterative healers is an example of taking responsibility. These people step out of the victim role they are forced into by the healthcare system and take their fate into their own hands, actively working on their own healing.

New technology, medicines or procedures will not lead to a better and cheaper healthcare system. What will is the willingness and ability of individuals to take care of themselves. Only when patients take that step will modern medicine fall from its pedestal.

Taking responsibility is more than sticking to a low-cholesterol diet. It means asking questions. What can I do myself? How can I live my life differently? What lifestyle would suit me better? It means no longer seeing the doctor as an all-knowing master but as a partner who can help find the best method of healing based on the conviction that everyone can find his or her own answer to an illness. It means: seeking the best therapies both in the conventional and alternative circuits.

The American doctor Andrew Weil targets seven characteristics of successful patients. They won't take "no" for an answer; they actively seek alternative treatment methods; they seek advice from people who have recovered from the same illness; they constructively cooperate with doctors and other healers; they are not afraid of a radical change in their lives; they see their illness as an opportunity for growth; and they accept themselves as they are.

That last characteristic is essential because dying is not failing. Dying is a natural process that no one can avoid. Modern medicine digs its heels in against death, but in so doing robs people of the meaning of life. Ultimately, healing is not always physical recovery. It is possible to find meaning and acceptance in death. In that respect, an illness - even one that is terminal - offers an opportunity to "heal". Ultimately, a dignified death counts. There is a story about this, in which an old man in the hospital witnesses how doctors try, in vain, to bring a fellow patient back to life using tubes and machines. After this experience, the man begs his doctor to spare him a similar end. "Listen doctor," he says, "I don't want to die with my body stuffed with tubes. I don't want my children to remember their father like that. I have always tried to live with my head held high. I am not complaining that I'm dying. But I want to die like a human being, not like a plant that someone comes to water every day - I don't want to die like him."

But the man's wish goes unheeded. The hospital system is simply programmed to extend people's lives as much as possible. Ultimately, the man is able to free himself from the tubes and machines. He leaves a note for his doctor: "Death is not the enemy, doctor; inhumanity is the enemy."

The following sources were consulted for this article: Ivan Illich: Medical Nemesis, Random House 1976; Lynne McTaggart: What Doctors Don't Tell You, Thorsons 1996; Andrew Weil: Spontaneous Healing, Alfred A. Knopf 1995; John Robbins, Reclaiming Our Health, H.J. Kramer 1996 and the article The Best Medicine, by Walter A. Brown in Psychology Today September/October 1997.

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