Responsible Art

Archive for August 31st, 2011

The role of doctors in our culture is very important. Because they can be useful in treating injuries and illnesses, they have become a profession. To ensure only the best people enter the profession, there are high educational standards to meet. The training is long and difficult. But, once doctors have qualified, they command respect. This is not just for the knowledge and experience they have collected. The power of the placebo effect also relies on believing the doctors actually know what they are doing. Remember, in all clinical trials, placebos are rated as highly effective by an average one-third of participants. If someone in a white coat gives you a pill in the right circumstances, you are likely to feel better even though the pill is made out of chalk. It’s all part of the magic of being a doctor.

The profession has also made big strides in shaping public opinion. The general practitioners used to be the gods. Now, thanks to television shows like House, it’s the surgeons in the top hospitals. Not that any of them are like House, you understand. But many do feel they can do what they want. So they develop reputations for their skills and build empires inside their hospitals. This grows their income and protects them. Why? Because once a patient is allocated to a particular empire, it holds on to that patient. That means the empire gets the credit for all the fee income earned and, if anything goes wrong, no one outside the empire gets to hear about it.

In other countries where they practise socialized medicine, there’s a team approach to treatment. Instead of one doctor having a monopoly on controlling treatment, the patient becomes the focus of interest for a group of healthcare professionals representing a range of relevant knowledge and skills. There are regular meetings where groups of people discuss how best to treat the individual. Collective decisions are taken. Why is this better? Well, suppose a patient comes in and reports pain. The first doctor diagnoses the problem and begins treatment. Some time later, the patient is still complaining of pain. In our system, the first doctor might fear loss of reputation if he or she calls for a second opinion, so simply prescribes more painkillers. If the pain persists, the dosage of the painkillers is increased or stronger drugs are used. The result is our country has the highest consumption of prescribed medications in the world. We’ve been persuaded the best treatment always comes in a pill bottle. In other countries, doctors and other healthcare professional work hard to avoid prescribing drugs. This not only cuts down the long-term cost of treatment, but also tends to produce better results.

None of this takes anything away from Tramadol. Indeed, if you travel round the world, the drug is widely available for treating moderate to severe pain. Although the brand names can differ from country to country, the basic chemistry is recognized as highly effective. But outside the US, you will find Tramadol is prescribed as part of a wider range of treatments to manage the pain. Indeed, the aim is to enable you to have a good quality of life without having to depend on any drug.

When we’re born, we pause helpless for a month or so and then begin the process of exploring the world. In this, pain is a vital part of the learning process. We knock into hard objects and fall. Only when we understand cause and effect can we move around safely. If parents and authority figures are responsible, they teach us some degree of acceptance. Life cannot stop just because of a little pain. You have to pick yourself up and go on with what you were doing. This also builds self-confidence, a sense we can work through discomfort and pain to produce the results we want. Although parents are right to have a general protectiveness, all children should be allowed to develop a tolerance for pain. Should the day come when they are involved in accidents or fall more seriously ill, they should be psychologically prepared. It does no one any good if they collapse in a heap, weeping and wailing we should make the pain go away. For better or worse, we need pain to survive.

Put simply, pain is a warning system when something goes wrong with the body. Where and how we live is also full of potential dangers. Without pain, we might not immediately notice if we pick up something that’s too hot. Either way, we must know to get medical attention, or quickly drop the hot object and then get medical attention. The problem with this wonderful system then becomes all too obvious. When we’ve done the right thing and got medical attention, we cannot turn off the pain. It’s like when one of those burglar alarms starts ringing in the property next to ours and no one comes to switch it off. The noise can drive you nuts. But we don’t want to completely disable the system. Really we want to reset it so that it will sound the alarm again if there’s a new problem or the old problem gets worse.

Let’s say you have a broken leg. If medical science was able to target one set of pain receptors and switch them off, would that be a good thing? You might go from pain when moving to no pain. Except the pain is there to warn you if the way you are moving may cause more problems. If you suddenly have no pain, you might try walking as if there was nothing wrong and make the injury worse. In the general situation, having some pain is more useful than having no pain. The only time making all the pain go away is useful is when your condition is terminal. In such sad cases, there’s no point in retaining any of the pain warning system. Shutting it all down is the merciful thing to do.

For everyday living, Tramadol is the best compromise you can find. In cases of moderate to severe pain, it reduces the level of pain you feel. You should be able to go on with your life confident that, if you brush against something too hot, the pain will make you flinch away. Equally, if the pain surrounding the original site of injury grows worse, you know to get further medical help. Tramadol is the best way of managing pain.

In theory, everyone is the same except, obviously, they are not. Let’s start with age. Seniors may be physically active but, look inside, and you will find their liver and kidneys are not working as well as in days gone by. This means it takes longer for impurities to be filtered out of the blood. For these purposes, drugs are impurities. So, when an older person takes any medication, it’s processed through the stomach into the bloodstream and then circulates for longer. This means an older patient must either take a smaller dose or the time between doses must be longer. If such simple steps are not taken, it’s easy for older people to have peaks of drug concentration close to overdose levels. Adverse side effects are more common.

At the other end of the age scale, most drugs are not tested on children and young adults. It’s not considered ethical to expose underdeveloped human bodies to the risk of injury unless there’s a clearly identified need. As a result, doctors are often left guessing whether to risk prescribing drugs and opting for the lowest possible doses. Now we come to the politically incorrect question of body weight. Without getting into the speed of your body’s metabolism, thin people should receive smaller dose than those carrying more weight. Doctors often use a formula relating grams to pounds of weight.

A further difficulty is that pain is very subjective. Some people seem to be able to accept levels of discomfort that would have others rolling on the floor in agony. This is partly physical and partly psychological. As we grow up, we learn from our parents and peers how we are supposed to react when injured. Boys are supposed to be tough. It’s OK for girls to cry. Stereotypes are difficult to shake. This makes it very difficult to assess how much pain anyone is feeling. All a doctor can do is ask and try to place the answer on a scale of 1 to 10 where 10 is the worst pain imaginable. The louder the complaint, the higher the dose or the stronger the drug. For the doctor, it’s all trial and error until the patient admits to feeling less pain. Against this background, it’s interesting to see some new research into using a new technique on an MRI scanner to measure pain. Arterial spin seems to show changes in the parts of the brain associated with pain. If this research can map the brain to show more precisely which part of the brain to monitor, it may be possible to produce a more objective method for measuring pain.

This would have immediate benefits for the patient, always giving the right dose. It would also be good for society because it would reduce the risk of drug abuse. As it is, patients who are developing a dependence can exaggerate their reports of pain and get additional tablets to feed their habit. This is less of a problem for drugs like Tramadol which are significantly less addictive than the opiates. But even Tramadol can be abused if people take it for too long at too high a dosage. No matter what the diagnosis, it’s always better to have the right dosage for your age and physical size.