How come up to 250,000 people a year die of medical errors and is the third leading cause of death in the USA (Makary & Daniel, 2016)?
Why are some drugs recalled after years of use because they did more harm than good?
How come arthroscopic surgery continues to be done for osteoarthritis of the knee even though it is no more beneficial than mock surgery (Moseley et al, 2002)?
How come women have more negative side effects from Ambien and other sleep aids than men?
Is it really true that the average new cancer drug costs about $100,000 for treatment and usually only extends the life of the selected study participants by about two months (Szabo, 2017; Fojo, Mailankody, & Lo, 2014)?
“It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of the New England Journal of Medicine”—Dr. Marcia Angell, longtime Editor in Chief of the New England Medical Journal (Angell, 2009).
Medical discoveries have made remarkable improvements in our health. The discovery of insulin in 1921 by Canadian physician Frederick Banting and medical student Charles H. Best allowed people with Type 1 Diabetes to live healthy productive lives (Rosenfeld, 2002). Cataract lens replacement surgery is performed more than three million times per year and allows millions of people to see better even though a few patients have serious side negative side effects. And, there appears to be new hope for cancer. The FDA on August 30, 2017, approved a new individualized cancer treatment that uses genetically engineered cells from a patient’s immune system to produce remissions in 83 percent of the children and young adults who have relapsed after undergoing standard treatment for B cell acute lymphoblastic leukemia. (FDA August 30, 2017). The one-time treatment for this breakthrough cancer drug for patients who respond costs $475,000 according to the manufacturer Novartis. Yet, it will be years before we know if there are long term negative side effects.
The cost of this treatment is much more than the average cost of $100,000 for newly developed and approved cancer drugs which at best extend the life of highly selected patients on the average by two months; however, when they used with more typical Medicare patients, these drugs often offer little or no increased benefits (Szabo, 2017; Freakonomics Radio episode Bad Medicine, Part 2: (Drug) Trials and Tribulations).
As the health care industry is promising new screening, diagnostic and treatment approaches especially through direct-to-consumer advertising, they may not always be beneficial and, in some cases, may cause harm. The only way to know if a diagnostic or treatment procedure is beneficial is to do long term follow-up; namely, did the treated patients live longer, have fewer complications and better quality of life than the non-treatment randomized control patients. Just because a surrogate illness markers such as glucose level for type 2 Diabetes or blood pressure for essential hypertension decrease in response to treatment, it does not always mean that the patients will have fewer complications or live longer.
To have a better understanding of the complexity and harm that can occur from medical care, listen to the following three Freakonomics Radio episodes titled Bad Medicine.
Freakonomics Radio episode Bad Medicine, Part 1: The story of 98.6. We tend to think of medicine as a science, but for most of human history it has been scientific-ish at best. In the first episode of a three-part series, we look at the grotesque mistakes produced by centuries of trial-and-error, and ask whether the new era of evidence-based medicine is the solution. http://freakonomics.com/podcast/bad-medicine-part-1-story-98-6/
Freakonomics Radio episode Bad Medicine, Part 2: (Drug) Trials and Tribulations. How do so many ineffective and even dangerous drugs make it to market? One reason is that clinical trials are often run on “dream patients” who aren’t representative of a larger population. On the other hand, sometimes the only thing worse than being excluded from a drug trial is being included. http://freakonomics.com/podcast/bad-medicine-part-2-drug-trials-and-tribulations/
Freakonomics Radio episode, Bad Medicine, Part 3: Death by Diagnosis. By some estimates, medical error is the third-leading cause of death in the U.S. How can that be? And what’s to be done? Our third and final episode in this series offers some encouraging answers. http://freakonomics.com/podcast/bad-medicine-part-3-death-diagnosis/
Angell M. Drug companies and doctors: A story of corruption. January 15, 2009. The New York Review of Books 56. Available: http://www.nybooks.com/articles/archives/2009/jan/15/drug-companies-doctorsa-story-of-corruption/. Accessed 24, November, 2016.
Fojo, T., Mailankody, S., & Lo, A. (2014). Unintended consequences of expensive cancer therapeutics—the pursuit of marginal indications and a me-too mentality that stifles innovation and creativity: the John Conley Lecture. JAMA Otolaryngology–Head & Neck Surgery, 140(12), 1225-1236.
Makary, M. A., & Daniel, M. (2016). Medical error-the third leading cause of death in the US. BMJ: British Medical Journal (Online), 353. Listen to his BMJ medical talk: https://soundcloud.com/bmjpodcasts/medical-errorthe-third-leading-cause-of-death-in-the-us
Szabo, L. (201, February 9). Dozens of new cancer drugs do little to improve survival. Kaiser Health News. Downloaded September 3, 2017. https://www.usatoday.com/story/news/nation/2017/02/09/new-cancer-drugs-do-little-improve-survival/97712858/
“Healing is best accomplished when art and science are conjoined, when body and spirit are probed together. Only when doctors can brood for the fate of a fellow human afflicted with fear and pain do they engage the unique individuality of a particular human being…a doctor thereby gains courage to deal with the pervasive uncertainties for which technical skill alone is inadequate. Patient and doctor then enter into a partnership as equals.
I return to my central thesis. Our health care system is breaking down because the medical profession has been shifting its focus away from healing, which begins with listening to the patient. The reasons for this shift include a romance with mindless technology.” Bernard Lown, MD, The Lost Art of Healing: Practicing Compassion in Medicine (1999)
I wanted to study with the healer and she instructed me to sit and observe, nothing more. She did not explain what she was doing, and provided no further instructions. Just observe. I did not understand. Yet, I continued to observe because she knew something, she did something that seemed to be associated with improvement and healing of many patients. A few showed remarkable improvement – at times it seemed miraculous. I felt drawn to understand. It was an unique opportunity and I was prepared to follow her guidance.
Three remarkable healers: Dora Kunz, Mitsumasa Kawakami and Norihiro Muramatsu.
The healer was remarkable. When she put her hands on the patient, I could see the patient’s defenses melt. At that moment, the patient seemed to feel safe, cared for, and totally nurtured. The patient felt accepted for just who she was and all the shame about the disease and past actions appeared to melt away. The healer continued to move her hands here and there and, every so often, she spoke to the client. Tears and slight sobbing erupted from the client. Then, the client became very peaceful and quiet. Eventually, the session was finished and the client expressed gratitude to the healer and reported that her lower back pain and the constriction around her heart had been released, as if a weight had been taken from her body.
How was this possible? I had so many questions to ask the healer: “What were you doing? What did you feel in your hands? What did you think? What did you say so softly to the client?” Yet, she did not help me understand how I could do this. The only instruction the healer kept giving me was to observe. Yes, she did teach me to be aware of the energy fields around the person and taught me how I could practice therapeutic touch (Kreiger, 1979; Kunz & Peper, 1995; Kunz & Krieger, 2004; Denison,2004; van Gelder & Chesley, F, 2015). But she was doing much more.
Sitting at the foot of the healer, observing for months, I often felt frustrated as she continued to insist that I just observe. How could I ever learn from this healer if she did not explain what I should do! Does the learning occur by activating my mirror neurons? Similar instructions are common in spiritual healing and martial arts traditions – the guru or mentor usually tells an apprentice to observe and be there. But how can one gain healing skills or spiritual healing abilities if you are only allowed to observe the process? Shouldn’t the healer be demonstrating actual practices and teaching skills?
After many sessions, I finally realized that the healer’s instruction to observe the healing was an indirect instruction. I began to learn how to be present without judging, to be present with compassion, to be present with total awareness in all senses, and to be present without frustration. The many hours at the foot of this master were not just wasted time. It eventually became clear that those hours of observation were important training and screening strategies used to insure that only those students who were motivated enough to master the discipline of non-judgmental observation, the discipline to be present and open to any experience, would continue to participate in the training process. It was training in compassionate mindfulness. Once apprentices achieved this state, they were ready to begin the work with clients and master the technical aspects of the specific healing art or spiritual practice.
A major component of the healing skill that relies on subtle energies is the ability to be totally present with the client without judgment (Peper, Gibney & Wilson, 2005; Peper, 2015). To be peaceful, caring, and present seems to create an energetic ambiance that sets stage, creates the space, for more subtle aspects of the healing interaction. This energetic ambiance is similar to feeling the love of a grandparent: feeling total acceptance from someone who just knows you are a remarkable human being. In the presence of a healer with such a compassionate presence, you feel safe, accepted, and engaged in a timeless state of mind, a state that promotes healing and regeneration as it dissolves long held defensiveness and fear-based habits of holding others at bay. This state of mind provides an opportunity for worries and unsettled emotions to dissipate. Feeling safe, accepted, and experiencing compassionate love supports the biological processes that nurture regeneration and growth.
How different this is from the more common experience with medical practitioners who sometimes have too little time to listen and to be with a patient. We might experience a medical provider as someone who may see us only as an illness (the cancer patient, the asthma patient) instead of recognizing us as a human being who happens to have an illness (a person with cancer or asthma). At times we can feel as though we are seen only as a series of numbers in a medical chart – yet we know we are more than that. People long to be seen. Often the medical provider interrupts with within the first 90 seconds with questions instead of listening. It becomes clear that the computerized medical record is more important than the human being seated there. Sometimes the patients can feel more fragmented and less safe, when they are not heard, not understood. In this rushed state, based upon “scientific data,” the health care provider may give a diagnosis without being aware of the emotional impact of the diagnosis.
As one 23 year old woman reported after being diagnosed with vulvodynia,”I cried immediately upon leaving the physician’s office. Even though he is an expert on the subject, I felt like I had no psychological support. I was on Gabapentin, and it made me very depressed. I thought to myself: Is my life, as I know it, over?” (Peper, Martinez Aranda, P., & Moss, 2015; Martinez Aranda, P. & Peper, E., 2015)
What was missing for this young woman was compassion and caring. Sometimes, the healthcare providers are unaware of the effect of their rushed behavior and lack of presence. They can issue a diagnosis based on the scientific data without recognizing the emotional impact on the person receiving it.
Sitting at the foot of the master healer is not wasted time when the apprentice learns how to genuinely attend to another with non-judgmental, compassionate presence. However, this requires substantial personal work. Possibly all allied healthcare providers should be required, or at least invited, to learn how to attain the state of mind that can enhance healing. Perhaps the practice of medicine could change if, as Bernard Lown wrote, the focus were once again on healing, “…which begins with listening to the patient.”
Denison, B. (2004). Touch the pain away: New research on therapeutic touch and persons with fibromyalgia syndrome. Holistic nursing practice, 18(3), 142-150.
Krieger, D. (1979). The therapeutic touch: How to use your hands to help or to heal. Vol. 15. Englewood Cliffs, NJ: Prentice-Hall.
Kunz, D. & Krieger, K. (2004). The spiritual dimension of therapeutic touch. Rochester, VT: Inner Traditions/Bear & Co.
Kunz, D., & Peper, E. (1995). Fields and their clinical implications. in Kunz, D.,(ed). Spiritual Aspects of the Healing Arts. Wheaton, ILL: Theosophical Pub House, 213-222.
Lown, B. (1999). The lost art of healing: Practicing compassion in medicine. New York, NY: Ballantine Books.
Martinez Aranda, P. & Peper, E. (2015). The healing of vulvodynia from the client’s perspective.
Peper, E. (2015). Towards the end of suffering: The contributions of integrating mind, body and spirit by Mr. Kawakami. In: Kawakami, M., Peper, E., & Kakigi, R. (2015). Cerebral investigation of a Yoga Master during Meditation-Findings from Collaborative Research. Fukuoka, Japan: Showado Publisher, 7-13.
Peper, E., Gibney, K. H. & Wilson, V. E. (2005). Enhancing Therapeutic Success–Some Observations from Mr. Kawakami: Yogi, Teacher, Mentor and Healer. Somatics. XIV (4), 18-21
Peper, E., Martinez Aranda, P., & Moss, E. (2015). Vulvodynia treated successfully with breathing biofeedback and integrated stress reduction: A case report. Biofeedback, 43(2), 103-109.
Van Gelder, K & Chesley, F. (2015). A Most Unusual Life. Wheaton Ill: Theosophical Publishing House.
- I thank Peter Parks for his superb editorial support and encouraging me to publish it.
- This blog was adapted the following two published articles, Peper, E. (2015). Compassionate Presence: Covert Training Invites Subtle Energies Insights. Subtle Energies Magazine, 26(2), 22-25; Peper, E. Sitting at the foot of the master-Covert training in compassionate presence. Somatics, 18(3), 46-47.
Should I get a body scan?
How aggressively should I lower my blood sugar level as I have type 2 diabetes?
I have no symptoms, should I get a routine mammogram?
I feel great, should I follow my doctor’s advice and have my annual physical?
These and hundreds of other questions often imply that the more medical care the better and healthier you will be. We assume that more care, more testing, the newer the drug, the more screening, etc. will prevent illness and promote health. In numerous cases this is not true! Although medical care can be superb for the treatment of acutely ill and injured, excessive use sometimes leads to harm.
In a superb book, Less Medicine, More Health, by Dr. H. Gilbert Welch, professor at Dartmouth Medical School and recognized expert on the effects of medical testing, the following seven basic assumptions underlying too much medical care are described in a readable and personable style.
- All risks can be lowered
- It’s always better to fix the problem
- Sooner is always better
- It never hurts to get more information
- Action is always better than inaction
- Newer is always better
- It’s all about avoiding death
Welch’s book explains the assumptions and the limitations of the assumption. Before assuming that the recommended medical procedures will improve your health—in some cases it will make you sicker—read his book, Less Medicine More Health.
Welch, H.G. (2015). Less Medicine, More Health. Boston: Beacon Press. ISBM 978-0-8070-7164-9