A new book critiques medicine

The doctor said the worms could cause abdominal pain, but then again in most cases they don't, so he also put him on a drug for irritable bowel syndrome.

After a couple of weeks, the stomach pain went away, but meanwhile my brother-in-law was having issues with mental coherence, drowsiness, and sleep disturbances. Other people who interacted with him were concerned about him, too. He has a mental disability and diabetes and other health issues, so our first thought was the usual suspects, not his IBS medication, but eventually I realized that neither my wife nor myself knew anything about it, so I looked it up.

It turned out the new medication was an antidepressant with a laundry list of side effect, including drowsiness and sleep disturbances. We weaned him off it, and he came back to normal pretty quickly. No stomach pain, either.

So, to sum up, the doctor saw a patient with worms and abdominal pain and decided to put him on an antidepressant for the rest of his life because the kind of worm infestation he had would only cause pain in a minority of cases.

Are some medicines probably overprescribed? Sure. Are some medicines underprescribed? Definitely.

For most medicines are there people who could benefit from taking it and aren't while simultaneously there are people who would benefit from stopping the medicine? Almost assuredly.

And medical research is what we do to try to answer these questions in ways that are helpful.

The Ancient Greeks were, in terms of medicine, almost completely ignorant. They had no idea about germs; instead focusing their medical theory around the 4 humors - blood, phlegm, yellow/black bile and miasma theory. What's good drinking water? Water that tastes clean. Vaccines? That'd come about 3,000 years later. And they engaged in hygiene habits we might find a wee bit dodgy. For instance at the public toilets there obviously were no toilet paper dispensers. Instead they'd use sponges - butt brushes. After one fellow finished his business you'd give it a swish around in some water or, for the fancier toilets - vinegar, and take your turn.

But the thing is is that they (and I am referring to the upper class here) had life expectancies that were not what you'd think. This [1] great article from the BBC has quite a lot of interesting data. For instance of some 298 recorded individuals of ancient Greece/Rome, the median life expectancy was 72 years. Some random famous names: Pythagorus - 75, Hippocrates - 90, Plato - 80, etc.

There is of course some selection bias in that sample, but you can also see evidence of longevity in other ways. For instance in Ancient Rome one could not hold the office of Consul until reaching the age of 43, first office was not available until age 30. The article also goes on to analyze numerous other sources than tend to paint a recurring picture: there was high infant and youth mortality, but people who made it to adulthood tended to have a life expectancy not all that different than we do today. It seems to suggest that a large part of our increased life expectancy is not from the trillions of dollars we've spent on trying to find a [profit making] pill for everything, but instead from very simple things like access to clean water and food.

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Finally there is a little 'paradox' that should always be brought up in medicine and in particular efforts to try to squeeze out every slimmer gains. Imagine you have a test that is 99.9% accurate for some illness. And 1 in a million people have this illness. If somebody tests positive, what are the chances that this is a false positive? 99.9%! In a million people our 99.9% accurate test will give 1,000 hits - yet only 1 person will actually have the illness. You'd probably end up seeing a negative return on life expectancy here just because of how many people you'd be scaring witless after informing them they need to come back in for follow up testing. Seriously, just take a few days off their lives and you've already gotten rid of the gains in expectancy for the 1 in 1000 guy.

[1] - http://www.bbc.com/future/story/20181002-how-long-did-ancien...

But... Seems like the sort of side effects these medicines have should give us a pause when using them on vulnerable populations. Especially when the benefits are not especially clear.