One problem in medical practice is deciding which people with unusual symptoms are crazy. I find it helpful to ask these patients whether their illness could have a psychological component.
Patients able to reflect upon and discuss possible psychosomatic influences are usually fairly functional. People who are truly nuts typically deny the merest possibility that they might, indeed, be nuts. The hostility of the denial is often directly proportional to their degree of nuttiness.
Improbable beliefs can, of course, sometimes be socially permissible. For instance, religions can glorify ongoing belief in the face of counter-evidence. Ever greater virtue is demonstrated by maintaining faith in the face of ever greater challenges. In the absence of powerful invisible friends, however, holding a resolute belief despite overwhelming evidence to the contrary is often labelled insane - particularly if gentle challenges to that belief are met aggressively.
At a safe distance via one’s internet connection, aggression and insanity can be interesting to observe. I have therefore discovered that researching beliefs about immunisation can be entertaining. For reasons that might not be immediately obvious, medicines that promote immunity to disease also promote high emotions.
Individuals within both the pro- and anti-immunisation camps demonstrate a degree of intolerance and nutty intransigence to reality. I have, however, reached the conclusion that anti-immunisers do it best. “A special place should be reserved in Hell for the people who want to kill or maim children by preventing them from receiving vaccinations” leaves more room for discussion than, say, “Vaccinations Will KILL You!”
Knowing what one can trust is a core problem of human existence. In my early years of medical practice, an ageing consultant suggested that I should “Trust nobody”. He meant that the conclusions of other practitioners needed testing but he possibly lived by that maxim. He did seem unusually angry, miserable and friendless. Both too much and too little trust can cause people problems.
A few years earlier, as a teenage medical student, I had been struggling to understand the nature of my future trade. The penny finally dropped in the third or fourth year of my studies. The practice of modern medicine is largely about drugs. The use of drugs does, however, depend on trust.
The patients must trust the doctors, the doctors must trust the journals, the journals must trust the researchers, and the researchers must trust the data analysts. Rising life expectancy and falling childhood mortality perhaps has little to do with medicine but do reassuringly suggest that, at worst, these trusts are usually not catastrophically misplaced.
These days, I am able to teach students and trainee doctors that drugs are dangerous so we must prescribe carefully. I might say to trust nobody except I do not want to screw up their personal lives.
I also tell students that research into pharmaceuticals needs careful critical appraisal. Small differences in results can open or close multi-billion dollar markets but the fox is too often in charge of the hen house. Costly major studies can be funded and controlled by the same companies that stand to profit from positive results.
Scepticism is always necessary when research seems to support treatment of huge numbers of people who are not particularly sick - or perhaps not sick at all. It is rational to think carefully before putting ever-larger slabs of the population on, for example, cholesterol-lowering drugs, anti-depressants or hormone replacement therapy.
Pharmaceutical corporations strongly influence journal content. This once led an editor of The Lancet, one of the world’s most important medical journals, to complain that “Journals have devolved into information-laundering operations for the pharmaceutical industry”.
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