F. Paul Wilson
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SUNNI: Yes, you're right, Paul; and I'm sorry for being so sloppy. Earlier, you touched on what I'm trying to get at -- the practice of medicine has changed tremendously, and it seems to me, has begun attracting a different kind of person to the field today. People who do enjoy the power they have over others -- the permission slips needed to get meds, get tests done or to get medical equipment, even. People who know they don't have to stay on top of the field because HMOs and such essentially guarantee they'll have a patient base. Bureaucrats who care about forms and processes instead of individuals and helping them get healthy.
From my recent experiences, and what I've heard of friends' experiences, it seems that doctors like you -- who enjoy their work and genuinely care about the people who come to them -- are a dying breed. So I'm pretty cynical about finding any like that again. Something you wrote in Infernal comes to mind here -- how you explained Jack's brother's transformation. Let me find that ... "Sometimes I think law school's to blame .... [L]aw school teaches that the letter of the law is all that counts. Forget the spirit of the law -- the letter, the letter, the letter. So if you find a loophole or an interpretation that lets you sidestep the spirit of the law, it's okay to exploit it. .... You get caught up in a subtly escalating process that goes on until you wake up one morning and realize you're not the man you intended to be. Not even close. In fact, you're exactly the kind of asshole you despised when you started out." Do you think a similar thing happens to many in medical school? If it isn't that, what is it?
PAUL: Doctors tend to have problem-solving personalities. The trouble is you can get lost in the problem and forget about the person who brought it to you. Are you treating Joe's heart, or are you treating Joe who happens to have heart disease? Sounds like semantics, but there's a world of difference. The technological innovations in the subspecialties are amazing, but they tend to come between you and the patient. The stuff that allows us to do more for a patient distances us from that patient. I think that's most obvious in terminal cases. I don't know if it's true, but I read somewhere that half of the Medicare budget is burned up during the last six months of life. We're doing things because we can, not because we should.
SUNNI: I've seen that statistic too. One of the things I dislike most about many doctors I've dealt with -- and I used to work in a hospital, so I've dealt with plenty -- is what I see as an undeserved trust in the FDA and pharmaceutical companies, sometimes combined with a disdain for unconventional or alternative approaches. As a brief example, lots of doctors ridicule others who focus on nutrition as part of health care, especially if they advocate "megadoses" of vitamins. But I know from my own experience that taking a lot of Vitamin C every day helps control my asthma. Similarly, melatonin has been given a bad rap lately, but some pharma recently got approval for a drug that apparently indirectly manipulates melatonin levels to help patients sleep. That seems hypocritical to me. What's your view -- do docs love patentable potions better than natural ones?
PAUL: I don't remember melatonin getting a bad rap -- I've used it myself for jet lag. In double-blind studies, megadoses of vitamins have been shown to do bupkis. In fact, the beta-carotene study in Finland increased lung cancer in smokers. What does "alternative medicine" really mean? It means it's unproven, that its claims are anecdotal and testimonial, like your wheezing -- if it works for you, great, but that doesn't mean the effect will translate to a large population. Alternative medicine has no double-blind randomized studies to back up its claims. Once it does do those studies, and they back up the claim, then it's welcomed into the scientific fold and -- voila! -- it's no longer alternative.
I'd be derelict if you came to me and I recommended an unproven alternative therapy over one that's been repeatedly proven to work. I'm paid to put my knowledge to use for you. By definition, there is no knowledge about alternative therapies, only say so. The power of the placebo will blow your mind. Bear with me while I give you an example.
SUNNI: Sure.
