Medicine and Society: It’s A Complicated Relationship

Reflections on Modern Medicine, Social Norms, and Unintended Consequences

There May Be a Wonderful New Medicine Out There That Could Save Your Life. You Likely Would Not See it in Time.

The opioid crisis in this country is major. We are overrun by this. It makes most other drug epidemics seem like child’s play. I read last week that a Wake Forest University research team may have developed an opioid substitute. It could be as much as 100 times (!) more effective than opioids and has zero addiction risk. This is big news.

Then I read that they “hope” to begin medical trials in 18 months, followed by larger scale trials for several years. In other words, we may have an answer to the opioid crisis in hand, but it will not start saving lives for another decade. I am not one who calls for the FDA to take short cuts. Approving medicines too quickly has deadly consequences. But given modern computing and ever-improving medical data bases, one would think we could do better. We should find a safe path to test on fewer people for shorter times, apply computer analysis to the results, and make an accurate prediction of outcomes and risks.

When human genome sequencing began, it seemed that it would take forever. But one team had a breakthrough in computer analysis. The result was dramatically faster results with no loss in accuracy. Is a similar approach and outcome not possible with drug testing?

We hear constantly of stories like the one from Wake Forest. Many of us have family and friends with cancer, heart disease, dementia, and other afflictions for which a powerful treatment “is coming.” It is heartbreaking to think that it is not coming soon enough to save those we love. One hopes that an approach to faster fielding of medicines is getting serious attention.

There certainly are enough incentives. Lives could be saved. Costs for individuals could be lowered, and hospital stays lessened. Pharmaceutical companies could develop more products with lesser risks and greater profits. I know, how could pharmaceutical companies possibly make even more than they do already?  That is another conversation, one I would be glad to raise in another posting. That is another fight, but an important one. We are where we are now.

Let’s get with it on smarter, faster testing.

Measles and Other Childhood Killers are Roaring Back.  We Know Why. We Just are not Dealing with It as the Societal Issue It Is

Diseases once thought defeated are making a comeback. Many are deadly childhood diseases. How is this possible? This is not difficult to figure out. Unacceptable numbers of parents are not vaccinating their children. Some think the risk is small, since some of these diseases have not been seen in many years. Others underestimate the severity of a disease. Did you know that for many years measles was the major cause of child deaths?

But most who fail to vaccinate do so because they believe the thoroughly discredited antivaccine movement. Any vaccine carries some risk, but the science is clear, overwhelming, and definitive. Unfortunately, some states allow people to refuse vaccination on religious grounds. This is an easy handle many have chosen to grasp, with no theological underpinning.

If you do not vaccinate children, you are putting their health and lives at risk. It is that simple. People around the world do things like female circumcision and human sacrifice on religious grounds. We find that unacceptable and do not allow it here, religious objections or not. It should be the same for vaccinations.

This is important because, aside from the harm you risk for your own children, lack of vaccinations puts everyone around them at risk, even if the others have been vaccinated. This is the well documented “risk to the herd” factor. And, having some kids vaccinated and some not increases the risk of a germ or virus mutating to become vaccine resistant.

The refusal to vaccinate puts everyone at risk in a demonstrated, measurable way. That is unacceptable. One could not, and would not wish to, isolate such children enough to mitigate risk to others. The danger of this is so high that I believe extraordinary measures are justified. If you will not vaccinate your children, you give them up.

That is going to generate some angry mail to me. So be it. We don’t live in such splendid isolation that our actions are unaccountable to others when those actions carry such risk.

STDs are on a Rampage. Probably Not for the Reasons You Think.

Several recent reports state that sexually transmitted diseases (STDs) are occurring at dramatically increased rates. This includes a new strain of gonorrhea that is beginning to be resistant to all known treatments. Tough way to die. So, what is going on? Is there a parallel rise in sexual promiscuity and frequency? By all available evidence, no.

What is going on is the closing of clinics that diagnose and treat such diseases. This is due to severe funding cuts at the federal, state, and local levels. People in many areas simply no longer have access to testing and treatment. They may not know they have a disease until long after they have infected others.

Preventive medicine and free or low-cost clinics are the role models of “pay me now or pay me later.” Minimizing their availability is penny wise and pound foolish.  One of the great things about the Affordable Care Act is its emphasis on early diagnosis and accessible preventive care. This approach saves lives and saves money. It is the same with STDs.

Some may giggle when thinking about STDs; others may wag a finger at those infected for making some sort of bad choices. React how you wish. But in the meantime, could we agree we don’t want people dying from this and we don’t want innocent people infected?

More clinics and more access, please.

          Bill Clontz

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