Sunday, March 06, 2016

A meditation on medication

The cure depends on the diagnosis

(Published on March 05, 2016 in Business Standard)

There you are in the prime of youth, skipping along barefoot, revelling in health and curiosity—taking in the odd bit of Marx, the odd pint of beer, using the odd condom, spitting out the odd bit of chicken bone—when suddenly you step on a thorny issue.

When you’re done hopping around on one foot and swearing, you prise out the thorn and wipe up the blood. Generally, it’s enough to treat the foot tenderly, swab the wound, and leave well enough alone. The antibodies in your system will gallop up to the site and do what they do best, which is to whack any bacteria senseless.

That’s all it usually takes: a short tussle between illness and the body’s natural self-help system. It’s a quiet, no-cost, natural process. Life is all about stepping on a thorny issue and getting over it without a big fuss. Most physical afflictions turn out to be minor, self-limiting and self-healing.

Sometimes a bit of bacteria enters the wound, and it gets infected. Then you have to really go at it with that swab, maybe take antibiotics. Think of it as sending the bacteria to jail and making it do some introspection, or beating it to a pulp, whichever makes it feel less cocky.

But sometimes, antibiotics aren’t enough; sometimes the bacteria are those superbug things doctors are always warning about in hospitals. Those critters are hard to beat down. Think of it like this: you keep sending the bacteria to jail, but it keeps breaking out. It’s like being infected with an idea—very very easily communicated, almost impossible to stamp out. Then you might have to confine the patient in a controlled environment, put him or her on different kinds of very strong treatment, and hope for the best.

If you bungle it—if, for example, you prescribe an insufficient dose of medication, or the wrong kind of medication—then the bacteria grow stronger than ever, and now you’ve seriously messed up, because either the body develops antibiotic resistance, or has no help at all. Then you enter dangerous territory—what if you get gangrene, necrosis, the death of tissue, threat to the whole body? Now you’re looking at life and death, people, and maybe a medical malpractice lawsuit. That’s when you call in the cavalry and bite the bullet and consider amputation. Best to cut off a foot, or a leg, to save the body. That’s the course of action any doctor would recommend, if it would save the patient’s life.

But diagnosing these things correctly to start with is tricky business. Sometimes, what looks like an infection is actually your antibodies already at work, getting rid of the really dangerous stuff; that nasty swelling is actually a healing in process. Amputation would mean chopping off perfectly healthy body parts and destroying the body in the process. Medicating it would be like putting the antibodies in jail and letting the real problem run riot—you’d be turning off the immune system, shutting down the body’s defences, and sentencing it to a raft of illnesses.

The worst of those is when the body turns against itself. Cells can suffer a mutation that makes them out-of-control aggressive, and in their monstrous zeal they engulf healthy cells, turning everything in the body into a morbid version of themselves.

The line between having a thorn in the foot and getting cancer is not a fine one; it takes a doctor of monumental incompetence to steer a patient from the former to the latter. But relax. A lot of our doctors have suspect degrees, but, as it turns out, our antibodies are superstars.

PS: This piece has nothing to do with anything.


Anonymous said...

Reading this was like watching House when drunk: all that registers beyond the blur of medical verbiage is Mr. Laurie's blue/grey eyes and a hopeless wish for some of that beautiful British accent to peek out from its chink-less US armour (which, to his credit, it never EVER does)

Anonymous said...

Then there's autoimmune disease, where your defence system gets delusional and decides to turn on your body and kill your vital organs. It's a little like mutiny, and a lot like rape, where your chowkidar becomes the perp.