Abandon Text!

W. H. Auden once said: "Poems are not finished; they are abandoned." I have been abandoning writing projects for many years, since only the pressure of deadline and high expectations ever got me to finish, or even start, anything of merit. This blog is an attempt to create a more consistent, self-directed writing habit. Hopefully a direction and voice will emerge.

Tuesday, November 21, 2006

Forever drugged

Not too long ago one of my dogs developed a gastrointestinal problem, one that made it almost impossible for her to eliminate without severe pain. Fearing some awful cancer, we popped for a high-end diagnostic. Thankfully, there was no sign of the big C, and by changing her diet and treating her with some steroids, the inflammation was eliminated.

Score one for modern medicine. This is usually where the doctor can (and does) declare victory and forget about the case. But that's not the real end of the story, because, much to my surprise, the medication was supposed to last forever. "In about 75% of cases, the animal needs to keep taking the medication their whole lives," the vet told me. "So," I asked, "How do we find out if she's one of the lucky ones?" I got a long pause from the vet; evidently he doesn't get this question very often. He knew exactly how to get a dog onto this medicine; he didn't know exactly how to get a dog off the medicine . . . nor did he provide a lot of guidance in doing it.

I might not even have asked, except for two inescapable truths:
  1. The medication cost about $50 a month, not enough to bankrupt me but certainly enough to give me pause.
  2. The medication had some really noticable side-effects; it made her ravenously hungry, and changed her from an easy-going dog to one constantly jonesing for every scrap of food.

We backed her off the medication completely. After several weeks she's doing fine, with a modified diet but no steroids. Which leads me to ask some troubling questions:

  1. Long-term clinical studies certainly watch for the effects of medicines used persistently . . . but how much do they look at the long-term effects of not using them? The problem is that the drug companies have absolutely no incentive to study the best way to get someone off a drug. And so, we shouldn't be surprised that we get drugs with instructions to "take a pill a day for the rest of your life."
  2. If the pharmaceutical companies aren't helping people (or animals) get off their drugs, what about the doctors? They don't really have a good incentive, either. Doctors are habitual interventionists; they want to do something. They also don't want to complicate matters by trying to use less of a drug; why mess with it if it's working? And let's not mention all the perks that pharmaceutical companies shower on the doctors.
  3. What about the patients themselves? I could easily, out of laziness or inertia, kept giving my dog the same pills; after all, why mess with something if its working? If I had been the one with knots in my bowels, I might not have been so eager to experiment with backing off medications.
  4. How much trouble are we making for ourselves, by accepting chronic medication? And how can we find out?



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