The Transient Truths of Medical 'Progress'
2014; Frontline Medical Communications; Volume: 13; Issue: 6 Linguagem: Inglês
ISSN
1537-8276
Autores Tópico(s)Mental Health and Psychiatry
ResumoThere is a widespread notion that today's medical practices and ad-vances--including in psychiatry--are superior the tools and therapies of the past, yet a second look at the facts will temper that perception. I might have a jaundiced view of progress but, across most medical specialties, diseases are still managed, not cured. Chronicity is almost ubiquitous among medical ailments, and no specialty can boast that it restores function completely and fully restores patients' quality of life. Psychiatry has had its share of missteps Prefrontal lobotomy is perhaps the most infamous of many discredited treatments that were introduced as a great solution severe brain disorders such as schizophrenia. (1) Prefrontal lobotomy (leucotomy) was initially heralded as a major medical advance in 1935; its originator, neurosurgeon Antonio Egas Moniz, shared the Nobel Prize in Medicine or Physiology in 1949 for what is now regarded as mayhem. Prefrontal lobotomy was widely used for many conditions--not just for psychosis--but it fell from favor rapidly after the discovery of antipsychotic drugs. A similar fate befell other treatments that were introduced psychiatry: * malaria therapy (1917) for general paresis of the insane (the condition was later recognized as tertiary syphilis) * deep sleep therapy (1920) for schizophrenia * insulin shock therapy (1933), also for schizophrenia. Those discredited therapies were lauded as significant advances, only be shunned later as harmful, even barbaric. Treating addiction is another saga of false steps. Fifty-nine different treatments for addiction have been introduced over the past few decades, many later discredited as psychoquackery. (2) In the breathless rush cure desperate conditions, there often is the risk that pseudoscience will masquerade as science. Many patients suffer needlessly before the medical community examines the accumulated evidence and discredits useless or harmful treatments. Psychiatry isn't alone in lacking cures A fitting slogan of many non-psychiatric medical specialties is to treat, perchance cure. Consider some examples: * In cardiology congestive heart failure, a chronic illness, is managed but rarely cured, and leads early mortality * Nephrologists struggle maintain a semblance of kidney function in renal failure patients, before placing them on the long waiting list for a kidney transplant. [ILLUSTRATION OMITTED] * Gastroenterologists can only hope maintain liver function in severe hepatitis, or alleviate the misery of ulcerative colitis. * Rheumatologists do what they can relieve the debilitating symptoms of rheumatoid arthritis, systemic lupus erythematosus, and Sjogren's syndrome. * Pulmonologists know they can never restore normal lung function for their patients with chronic obstructive pulmonary disease; they can only help them hang on with partial function. * Oncologists valiantly fight aggressive cancers with the hope of prolonging life for a few months or years. * Neurologists valiantly try manage multiple sclerosis, Parkinson's disease, Alzheimer's disease, epilepsy, stroke, myasthenia gravis, and amyotrophic lateral sclerosis--often with limited, if any, success at achieving remission. Internal medicine has had its share of discredited therapies, too--ones that were withdrawn because they caused harm or were of dubious or inconclusive efficacy. …
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