Let us start off with a little clarification of terms used in the context of this article.
Pharmacy and pharmacists refer to the point of final assembly and delivery of pharmaceutical products in the modern era. These products – beyond the sun glasses, nappies and cosmetics often on display – are usually, though not always, produced elsewhere and simply distributed in pharmacies either in response to public demand (cough medicine, simple analgesics etc.) or medical practitioner direction (a script). These products I will refer to as drugs; although when we refer to the illegal variety these will be distinguished at the time. The industry that produces drugs is exactly that, an industry, and will be called the pharmaceutical industry, or PI in brief.
The PI is increasingly having trouble with its public image, as is the fact that it is at one with all the corporate ethics that associated with industry in general. But the problem here as that these ethics appear fundamentally irreconcilable with those of the health industry, although it may be argued that with medicine also becoming an “industry” that such differences are less at a practical level than an academic one.
There are other additional problematic issues, which will be briefly named. Medicine is increasingly relying on the PI as its frontline approach in health management, this is an increasing and even accelerating factor. This trend has given enormous financial success and power to the PI, such that their political and social influences are significant beyond the boundaries of being simply merchants of drugs to the medical trade. These issues are further compromised when the PI is significantly and even predominantly involved in the ongoing education of doctors, which is now a required fact.
More peripheral issues include the influence over the source of drugs, such as natural products and the control of their production (particularly in poor nations) and the associated issues around manufacture, patenting and research. The patenting issue is directly related to competition between PIs, often under the guise of an “improved product”, but really for pecuniary motives. This competitive issue also leads to brand naming and the attendant confusion this brings to the consumer. A final disturbing issue, to which we will return, is that these combined factors lead directly to using alien chemical agents (henceforth called poisons) in the body, leading to problems of a varying nature that are often diametrically opposed to their purported intent, which can sometimes perpetuate the original problem and lead to the ongoing demand of the drug involved – or addiction. Added to this is the fact that dosages are often controlling bodily functions and not supporting impaired physiological function to recover, a point to which we will return.
Each of the above issues could readily be expanded; enough to fill a book I would think and which many have done. Also there are various drugs and classes of drugs that satisfy some, if not all, of the concerns highlighted above. Yet even with these concerns patients seem to remain hostage to drugs and the PI, with health issues and concerns that are often driven by fear and obviously not minimised by the PI (advertising is a further ethical issue that could be raised here). But the pattern seems too strong for most to be comfortable to walk away from. And those that do, what do they find but an “alternative medicine” industry that uses vitamins and supplements with all the hyperbole of the PI and dictated by the same pattern.
So it would seem that it is the pattern itself that is wrong; there is a pressing need for a new paradigm as the pharmaceutical and medical industries are losing the faith of their consumers. Many, including myself (Medicine at the Crossroads, Ganieda Press) have explored the issues within the medical profession and the role of the PI within this and beyond. But we are left with a consumer population losing trust, worried and dissatisfied; disillusioned doctors; spiralling health costs, and an alternative industry that seems to be adopting the Emperor’s clothes: How did it get to this and what alternatives are there?
We will start by taking the first part of the question first: How did we get to this? Whilst pharmaceutical medicine has been at the forefront of medical management, along with surgery, it has a relatively recent history. Most readers would be well aware of the major medical advances of the last century, most notable of which would be the discovery and use of antibiotics, although there are many others. These include drugs for anaesthesia (making surgery both routinely possible and extending its range considerably), drugs for the heart, diabetes, arthritis… the list goes on. What may not be readily known is that most of these modern drugs have a history in nature and the plant kingdom, such as the digitalis plant for the heart, as well as the drugs for pain, inflammation control, and diabetes.
If antibiotics are used as an example, the history is interesting on many counts. Penicillin was discovered by Fleming by accident in a way that would never occur in the modern laboratory (he left a window open and some fungal spores landed on his bacterial plates, preventing their growth). A factor of further interest here is obviously the association with the plant world, as indicated above, as the source of the miracle drug penicillin. It may also be of no surprise that many indigenous and traditional cultures had prior knowledge of this; something the PI has not lost note of in its relentless pursuit of newer and better drugs. There are many examples of this kind, so it is hoped the above will serve as sufficient illustration of a general principle.
Along with technology, medicine then progressed in leaps and bounds, such that when I arrived at the clinical phase of my medical studies well over a generation ago the pillars of technology, surgery and pharmaceutical medicine were both well established and dominant. Other medical approaches based on differing philosophies and paradigms were relegated to history (herbal medicine, the original source of drugs) or treated derisively (homeopathy, alt. homoeopathy), points to which we will return. My situation was relatively normal, but I now see it as somewhat unusual and limited with respect to the broader health and medical landscape.
I was working and training exclusively in a hospital in central London. By definition, to have bed there a patient would have to have a diagnosed disease, even an unusual, complicated, or serious one. We students did not have to determine whether the patient actually had a disease (this came as a rude shock when confronted with this initial dilemma in general practice, a problem that has still not been fully negotiated), but what disease they actually had. It was detective work and after discovery – Sherlock Holmes like – came management, which invariably consisted of drugs and usually in doses that took over bodily functions, as these patients needed this level of support. My discovery that routine medication usage in the wider community required smaller and supplemental doses came as something of an ongoing shock, and its integration (not supported by the profession) of this principle into practice has been difficult and slow.
But at this stage their power amazed me, reinforced by my first roles when qualified, which were mainly in acute, traumatic, and emergency medicine. This was frontline stuff, often with a life depending on management, which inevitably used drugs in a controlling and powerful way. As said, it was only a move to general practice a short time after that started the awareness of seeing this use relatively. Let there be no doubt though, drugs are powerful and potentially life-saving: I may have died some twenty years ago without the use of one. Their use is not to be decried, but it is very, very important to see both their place and also the way they are used.
There are some deeper issues to how we got to this point that extend well beyond the twentieth century, but which the advances of that era have drawn a relative barrier to. The medicine of antiquity is as long as human history, but most notably the physicians of Roman times used a system that was based on the elements (earth, water, wind and fire), as well as supporting “acts”, such as astrology and alchemy, in their actual practice. This has unbroken connections with pre-history and traditional medicine. It continued uninterrupted into the Middle Ages with Nicholas Culpeper the last of his kind; at least symbolically, as he became marginalised by the profession. This trend has continued on, however, and continues to inform many natural medical approaches today in the alternative health professions. This is presently a minor stream there though, as many practitioners in this very loose and nebulous coalition do not have the depth of training that the approaches of Culpeper demand. They also tend to use a mixture of approaches (Eastern included), but in a manner very similar to the paradigm they seek to replace, indicating their ultimate failure. Although, once stripped of these modern elements, the traditional medical approaches are likely to play in a significant role in the changes to come.
But we get ahead of ourselves. A century before Culpeper a sixteenth century medical misfit called Paracelsus (actually his real name was Philip Theophrastus Bombast von Hohenheim – we’ll keep to Paracelsus!) really got into the noses of the authorities for many reasons, but it was his revolutionary approach to medical treatment for which is mainly remembered. This has caused him to be given the posthumous title as the “founder of pharmaceutical medicine”; one with which he would not be proud – he would actually turn in his grave – as this is almost a complete inversion of what his method was about: which was what?
Paracelsus had experience in mining and the use of metals, which extended to chemistry in general. He used these disciplines in his art with the kind of success that would upset any institutional body, such as the medical profession of the time. In this era doctors didn’t get too close to patients, preferring to examine products like urine, consult charts, and work closely with an apothecary (the forerunner of the pharmacist) in any therapeutic regimen. The success of Paracelsus’ system made them uncomfortable, although the irony is that it was the adoption of many of his methods that led to the establishment discomfort with Culpeper a generation later. At this point it would have been valuable to have an integration of the two, but this was not to be. Although Paracelsus system was adopted and promoted in many ways with which he would not agree, it was the one that became successful, and provided the platform to the enormous advances of the twentieth century.
In a rather lengthy way this leads to the second part of the original question: What alternatives are there? I have indicated one immediately above: That we need to reconnect with the traditions and wisdoms that we have lost in the historical sweep outlined. But this is not a regressive act of “going backwards”, it is one to be engaged in the present. It is a question of the established profession being available and the alternative and traditional professions both disciplining and organising themselves, so that dialogue is not simply conducted at the practice level where “rogue” doctors are anticipating and actively practising such a changing view. There is much work to be done here, otherwise integration will not occur and the pendulum simply swing back and forth in a pathetic power struggle. For this a unifying pattern may need to be found, so that such a dualistic power struggle becomes creative rather than destructive; one that can be inclusive of both positions.
My appreciation of all the above as an example, a symbol even, of the sort of difficulties that medicine, in the generic sense, is facing; to look at facets of what this unifying position can look like, so that the paradigm shift (which it would be) can be as seamless as possible. From a philosophical perspective I am of little doubt that the position must be governed by true holistic principles, and not the rather truncated variety that exists within many of the alternative positions – and even in the medical one – at present. This is, in and of itself, a huge topic and the main background to Medicine at the Crossroads, but here I want to introduce a facet of the position, not identified in the above book, that is an extension of the discussion about the PI.
The intuition for the ensuing argument came from a seemingly casual piece of information: Certain vitamins are what is called fat-soluble rather than the more common water-soluble ones, amongst them are vitamins A and E. The interesting fact is that we are in danger of having an overdose of these vitamins (because they are stored in fat) when taken in supplemental form, but this does not occur when the equivalent amount is taken in foods. This should alert us to the fact that if taken in a whole and organic form then we do not have the same difficulty.
But is the argument for this simply that it is more natural, or are there factors in here we have not yet identified (cooperative function with other elements in the source material) or something deeper? My intuition is that the first should not be discounted and will prove to be the case, but that it doesn’t entirely answer the question, so what may these deeper factors be?
One factor is the profound and intimate connection we have with the organic world and particularly the flora. As fauna we breath in oxygen and breath out carbon dioxide: plants do the opposite, they “breath in” (photosynthesise) carbon dioxide and breath out oxygen. Each of these great kingdoms is dependent on the other in a fundamental manner and this dependency extends to feeding, if looked at closely. The extension of this is that there is something literally vital about the process and eating live (that is, fresh) material. This principle of vitality extends well beyond the rational and scientific; it has hounded philosophers and mystics through the ages. But it is relatively easy to see it is a principle, even if exactly what it is and how it operates is at present – or forever – beyond our understanding.
This vital principle extends beyond simple foods to herbs, recognised by their medicinal nature and exploited by the PI. It – may – even extend to animals; but the vegetarian or carnivore argument is too vast to enter into here. There is an interesting branch of medicine – homoeopathy – that takes this principle to the extreme in an attempt to isolate the vital component in plant material for medicinal purposes. Homoeopathy was founded by a doctor (Samuel Hahnemann) and has a profoundly holistic philosophy, which works deep beneath the apparent superficial sources identified by western medicine to core issues and problems in the organism. However, I question whether the isolation of the vital principle and having no supportive physical component in the remedies is not a swing of the pendulum, which is not a criticism that can be levelled at herbalism, as with Culpeper.
Whatever the case, the principle stands, most notably because of its absence in drugs. Drugs are chemically manufactured and are foreign to the body. They are stripped of any vital properties and become technical poisons to the body, often trivialised as “side effects”; indeed, they have to have these qualities to be patented and protect the corporate interests of the company that researched, identified and produced it. Of course, the argument is that this procedure is to isolate purer and more specific drugs for therapeutic purposes.
The conclusion from this is that ultimately it may be the loss of the vital force – for all the arguments and reasons above – that is the most significant loss in medicinal drugs. That somehow nature and at least flora need to be introduced into the equation is an argument I find compelling and even overwhelming. How this is to be done is, at present, a minefield, although it is felt that arguments such as the ones presented here may help find a supervening and unifying position. Beyond this are other apparently irrelevant factors that need to be included, such as the ritual context in which medicines are used and the deployment of supportive transpersonal positions, such as with alchemy and astrology in the past… and maybe into the future.
If the above has any validity, how did it affect me as a medical practitioner? I remained within my profession and champion it for over three decades, although this does not mean I necessarily endorsed or included approaches that are generally accepted – and medico-legally supported. I also tried and worked within a holistic philosophy, within the boundaries of my profession. Ultimately I found my position impossible to maintain.
I have not sought to become a herbalist or homoeopath, although I have respect for both as professions and some of their practitioners. Instead I have accepted my medical training as some sort of destiny, though not as a medical practitioner. I have trained in psychological medicine, psychoanalysis and psychiatry (I see no division between body and mind) to support my work and because I have a profound interest in mental health. In this last respect I do not see a fundamental difference between many, if not all, of the arguments above in the use of drugs in mental health.
I have a profound respect for drugs, but see them to have a far more restricted and defined role than is currently given. In general, when we take over the body’s functions with drugs it should because the integrity of the organism is in danger; that is, impairment or death. Otherwise I believe drugs should be used in a supplemental and organically supportive manner in health restoration and healing. The effectiveness of a drug is usually directly proportional to its potential side effects, even to define it. The consequence of prolonged or misuse is the dangers that accompany poisoning and their stresses, leading to many consequences, such as addiction and premature death. Ultimately, what is the value of the quantity of life if the quality is compromised?
I profoundly disagree with the current policy of using drugs in a regular or preventative fashion, particularly one justified by inducing the fear of death into the equation. It does not surprise me that we have an epidemic of depression, sexual problems, and stress as a consequence of this habitual policy. Without going into specific issues in any detail, the management of cholesterol, blood pressure and depression with drugs causes me great cause for concern (some of these issues are explored in the companion essay: Pathologising Physiology).
Ultimately I am an optimist and the above is written in that light. It is an argument for a saner and more humane application of the tools of the medical practitioner’s trade. it is just that it is understood that the overall system and philosophy of the pharmaceutical approach – as well as medicine itself – needs to be called into question. The above could be expanded with reference to specific drugs and diseases by applying the outlined principles as a backbone and guide. I have chosen not to do that at this stage, but this doesn’t prevent the reader from undertaking it with any enquiry, such as with what ails them… At a personal level I have faced most of the challenges that I have outlined as alternative options above and I am still alive to tell the tale.