Wednesday, November 23, 2011

Medicine And Metaphysics

I have oft lamented the state of medicine in the United States. I find that when it comes to moralizing, the US is #1 in the world. There is so much moral baggage wrapped up in care in this country that Hippocrates must be spinning in his grave.

What do I mean by moralizing? There is a deep thread of what people "deserve" and what is "right" as opposed to what reduces suffering. For example, pain killers. Women complain less, but receive less medication when they do complain. That means that women are receiving fewer prescriptions for more pain. Why? Because women complain. And even if they are in pain, they deserve the pain because they need to "toughen up."

It is not just women. It is everyone. Doctors are fanatical about pain killers, even when a person is in obvious pain. Why? Because they don't want to give people "hits" of fun stuff. Compare pain killers to antibiotics. There are known, significant dangers to antibiotics. They can cause massive digestive problems, are breeding scary things like MRSA, and can trigger lethal allergic reactions in a significant percentage of the population. Do you see doctors withholding antibiotics? Nope. In fact, doctors are so free with them that their overuse is one of the issues causing the quick evolution of things like MRSA. There are fewer concerns because antibiotics are not fun.

Obviously, they all will couch their reticence in terms of avoiding addiction, and this does truly have a great deal to do with it, but the rest of it is a belief that having fun with drugs is "bad," and that whatever pain the patient is feeling cannot be real. This is one of the biggest issues with male doctors and female patients. Because remember, women are not actually in pain, they're just complaining.

The root is a disconnect between our knowledge of someone else and the reality. The reality is something we cannot know. I can never be in someone's mind. Our language encourages us to feel like we can, and we have mirror neurons that help us "feel" someone else's emotions. But mirror neurons can only mirror what they sense, which is behavior. So if someone happens to be stone-faced, there is nothing to mirror, and thus we cannot feel their pain as Clinton so famously said.

I have actually heard multiple doctors tell patients in regards to pain killers or other "fun" drugs like Valium, which is non-addictive, that a certain dose works for him, and as such must obviously work for the patient. Subtly saying that if the patient says otherwise, the patient is lying. This is not specific to men, but most of the people who I've seen display this hilarious bias have been men.

In an absence of information and behavior, our own biases and emotions fill the gaps. And frequently, even if we are seeing behavior, our extant biases will affect our interpretation of that behavior. I have not experienced pain of a magnitude to require twenty oxycodone, thus that pain does not exist.

I don't mean to harp on men, but their behavior is the worst. For example, a study came out showing that men more so than any other group, if they had never experienced sexual abuse, either believed that accusers were lying or that whatever happened didn't actually cause any harm. Only the men who had experienced sexual abuse believed it to be real.

I focus on men, there, but my point applies to everyone. We allow morals and a belief that I know what you are thinking! to infect our medical treatments. I know! I know your world! I know what you deserve! Because my world and your world are the same! That means that whatever ridiculous way I view the world is the right way and applies to you!

This is a wild disconnect between reality and this metaphysical world that these blithering idiots want to believe exists. Other minds do not exist. My mind does not exist to you, and your mind does not exist to me. To base beliefs on anything but behavior, on empirical evidence, is grasping at the nether. To base medical care, where other people's well being is dependent on you, on anything but rigid empiricism, is cruel and, I would argue, borderline criminal. A doctor who believes that he or she knows what another persons' world is like can be accurately described as evil. They give primacy to their worldview over the empirically verifiable care of another person.

I'm not entirely sure why, but this moral/metaphysical thread is woven more tightly through American medicine (I am obviously ignoring third-world countries, like Islamic countries where only men can be doctors, and men cannot directly look at a woman's vagina, thus necessitating exams through a mirror). Look at the jack-off pharmacists who will not provide Plan-B pills or even correct medical advice involving possible abortion or birth control. Doctors who will not discuss condoms. They don't give two shits about the actual care of the patient. They care about maintaining their worldview's consistency by forcing it on others.

It's so easy to moralize from a high horse. That is why it's always so immensely satisfying when they fall off. I'm looking at you, drug-addicted/gay/secretly-pregnant/infidelitous Republicans!

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