The Doctor and the Drug Question

The Doctor and the Drug Question (Part II)

IN 1938 a Federal law was passed requiring, for the first time, that before a drug could be approved for manufacture evidence had to be presented to show that the drug was safe to use. Not until 1962 was this law amended to require evidence that drugs are effective, as well as safe. . .

-Physician, Corvallis, Oregon, at the time this article was written

A New, Careful Look Is Begun

IN 1938 a Federal law was passed requiring, for the first time, that before a drug could be approved for manufacture evidence had to be presented to show that the drug was safe to use. Not until 1962 was this law amended to require evidence that drugs are effective, as well as safe.

In 1966 the U.S. Food and Drug Administration asked the National Research Council of the National Academy of Sciences to help study the effectiveness of three thousand drugs that had only been tested for safety. A large number of scientists were organized into thirty panels to evaluate the efficacy of those drugs still on the market that had been introduced between 1938 and 1962. The panels were called "The President's Task Force on Prescription Drugs," and these experts combined their efforts to perform "The Drug Efficacy Study."

After finishing their task, each scientist was asked for his reaction to the drug problem. One man replied: "I could not help but be impressed by the very large number of drugs which have been on the market for many years and which have been widely prescribed, for which there is no acceptable evidence of efficacy in any condition." 1 Another said: "What is needed most ... is a massive educational program for the medical profession in regard to therapeutics. The abysmally bad state is best reflected in the ten most commonly prescribed drugs in the United States today. Seven of these lack evidence for efficacy or are second or third choices for their purpose. I n regard to the remaining three, it is impossible to avoid the conclusion that they are vastly over used." 2 The consensus of this whole group of experts was, "We believe the objective of rational prescribing can be reached most effectively through improved medical education." 3

Another scientist quoted both in the final Task Force report and in testimony before a committee of the U.S. Senate said, "It usually takes two or three years of clinical experience before the full potential for harm as well as the limits of utility is realized." 4 "The average life of a new drug is something like five years. Most of them do not live much longer. Only a few survive, because the others do not live up to their original promise." 5

America's Most Popular Drug

In 1970 twelve university medical centers, supervised by the National Institutes of Health, completed an eight-year study of the effectiveness of the most commonly prescribed medicine in the United States. In 1966 more than five million prescriptions were written for this drug alone. Results of the study suggested possible harm without any evidence of benefit from the use of this drug. A controversy is raging over the matter. In the Journal of the American Medical Association, January 4, 1971, a guest editorialist writing of this controversy remarked, "If traditional and highly regarded therapy for adult-onset diabetes has no scientific basis and results in no benefit to the patient, it will not be the first cherished therapy to be abandoned."

The conclusions of the thirty-panel Task Force were reported to the U.S. Commissioner of Food and Drugs, Dr. C. C. Edwards. In testimony before a committee of the U.S. Senate in January, 1971, he said, "Our goal is ... excellence in drug quality, honesty in drug promotion, and rationality in drug use at the earliest possible time. . . . Drug misuse has become a major national problem,. . . the promotion, prescribing, and use of drugs of limited or no value, and consumption of too many drugs, often for no purpose or for the wrong purpose. Few things are more tragic than the prescribing or administration of a drug of no proven effectiveness followed by a serious and even fatal adverse reaction. . . . An adverse reaction or complication in drug therapy is found in roughly ten per cent of all drug exposures and approximately five percent of patients admitted to the medical services of general hospitals are admitted because of serious, occasionally life threatening, drug reactions." 6

God's Solution

Near the beginning of the twentieth century the medical profession under took some much needed re-evaluation. Physicians were expanding the scientific background for their methods. Increased knowledge was making it possible for them to discard many unsound practices. At this time, it will be noted, the Lord's instructions to Mrs. White began to employ the term "rational" or reason able, to describe the ideal method of treating disease. 7

In the work of healing, let the physicians work intelligently, not with drugs, but by following rational methods. --Medical Ministry, p. 29.

The first thing to be done is to ascertain the true character of the sickness and then go to work intelligently to remove the cause. --The Ministry of Healing, p. 235.

Right. . . habits. .. will be removing the cause for disease, and the strong drugs need not be resorted to. --Medical Ministry, p. 222.

A person must remember to use "every facility, taking advantage of everything that, according to his intelligence, is beneficial, working in harmony with natural Laws." --Counsels on Health, p. 382.

Science Is Catching Up

The causes of illness must be dealt with by any effective means of rational treatment known to the therapist. Outdated, irrational methods, like prescribing the same cough syrup for every cough or the same medicine for every case of fever, are not taught in any medical school today. To a lesser extent than the Lord's plan, perhaps, the best of the world's physicians go deeper in their study of disease than the usual X-ray and laboratory examinations. In addition to locating tumors and identifying bacteria, they try, if possible, to determine why the body's defenses became so weak that infection or a tumor could have developed. They ask, for example, why the chemistry of life gets so fouled up that the arteries are clogged with cholesterol. Hardening of the arteries from deposits of cholesterol is the most common fatal disease in America. And it is known to be caused, at least in part, by a group of bad habits: improper diet, lack of exercise, and smoking cigarettes.

Top authorities of the medical world are now advising patients to exchange their bad habits for simple remedies such as proper diet, exercise, and pure air. This advice brings to mind Mrs. White's last reference to the subject of drugs made in 1914: "Thousands need and would gladly receive instruction concerning the simple methods of treating the sick methods that are taking the place of the use of poisonous drugs." --Ibid., p. 389.

Are Herbs the Answer?

Many of the Adventist folk who consult me from time to time seem confused about the Spirit of Prophecy instruction concerning the use of drugs. I get the impression that there is a feeling that medicines made from synthetic chemicals really should not be used, though frequently necessary. Medications vaguely related to some plant appear to occupy a middle ground. They seem to be preferred over synthetic drugs but still are not considered harmless like herbs. Herbs seem to be commonly regarded as perhaps less powerful than drugs, but probably safe. If only doctors knew how to use herbs it would be so comforting and helpful. This sort of thinking creates quite a dilemma for many conscientious people.

An extensive survey has shown that in 1966 there were more than 54 million prescriptions written for the twenty most commonly used drugs in America. Forty-two million of these called for purely synthetic drugs. The other twelve million prescribed either codeine, digitalis preparations, or reserpine.8 Reserpine is used to treat high blood pressure and comes from an Indian herb called rauwolfia.

The herbs of which we speak are plants or parts of plants that are prepared in various ways to be used in treating sickness. Centuries ago it was observed that taking certain herbs seemed to help people with specific illnesses. Extracts of these plants were studied chemically and found to contain what are known as "active principles," meaning, effective ingredients.

The modern science known as pharmacology developed as the chemical differences between some of these active principles were studied and efforts were made to demonstrate the effect of each active principle upon each system of the body.

It was found that a single plant may contain several active principles that may not all be appropriate to the same patient. The amount of active principle present in different samples of the same plant varies considerably. For these and other reasons it is difficult, impractical, or impossible to present an accurate dose of the active principle in the form of an herb or the crude extract of a plant, like an herb tea.

With such potent herbs as opium, digitalis, and rauwolfia, inaccurate dosing can be very dangerous. Therefore, the active principles that have been extracted from these herbs are refined to pure crystalline chemicals before they are used. Codeine is made from morphine, which is first extracted from the opium poppy, and then chemically changed into codeine.

So you see, these three drugs, although derived from the vegetable kingdom, are not herbs at all, and in no sense are they natural. They are used as pure chemicals that are in no real way different from synthetic drugs.

The medical profession is just as interested now in developing new remedies from plants as it ever was. In 1956 the University of Illinois opened a new $285,- 000 greenhouse in which to grow plants they wanted to study for possible medicinal value. Instead of making herb teas or pills from powdered leaves, they will re fine, and if possible synthesize, the active principles they find.

During Mrs. White's lifetime only one reference to herbs for treating disease was included in her published works. In 1860 she wrote, "My child grew feeble. We had used simple herbs, but they had no effect." --Spiritual Gifts, vol. 2, p. 104. This seems to indicate an insignificant place for herbs, as such, in Cod's plan for healing. Not because in this one case they had no effect, but because in the mass of material she published on the subject of healing--over a period of sixty years only one sentence was published refer ring to herbs for healing.

Early in her writing Mrs. White warned of danger in the use of powerful medications generally. But she did not attempt to list the dangerous versus the harmless ones. In her personal experience she had found some simple remedies to be helpful and had mentioned these in various communications. Because of the interest of Adventists in these statements, and because some were inclined to give disproportionate importance to what she may have written in these lines, a number of references to herbs were printed in Selected Messages in 1958, not as prescriptions, but to impart knowledge on Ellen C. White's use of remedial agencies. In these quotations simple herbs like hops and catnip were mentioned as safe. Such mild remedies are not powerful enough to interest modern drug manufacturers and are not to be compared with opium, digitalis, or rauwolfia.

In the nineteenth century almost no drugs could be used rationally because no one knew what they would do to the human body. At such a time Mrs. White pointed to simple herbs as a safe substitute for the irrational drug therapy then commonly used. Why did the Holy Spirit not direct her to emphasize herbs in her published writings? Ellen White was not a physician and she did not assume the responsibility of diagnosing disease and prescribing medication, except in a very few exceptional cases called to her attention by vision.

Today our question is: Has scientific knowledge of the action of some powerful drugs upon the body finally developed to the place that there is at least an occasional opportunity to use them rationally?

Any Drug Can Be Harmful

There is not much likelihood that medications in use today can properly be called nonpoisonous even though they have come from the vegetable kingdom. The active ingredients of the simplest remedies used in excess can poison the system. In 1964 the U.S. Commissioner of Food and Drugs said, "There is no such thing as an absolutely safe drug." A 1966 report quotes Dr. Wilbur, a recent president of the American Medical Association, as having said, "All drugs are potentially toxic. . . . Any drug can do harm as well as good." 9 To these men a drug is any active ingredient of any preparation used in treating disease.

Most Knowledge Is New

The ten West Coast pharmacology professors surveyed generally agreed that, with few exceptions, scientific knowledge of the action of drugs on the body began to become available in the 1930's. But it was not until after World War II that enough of this information had been gathered to make rational prescribing of drugs possible to any great extent.

Changes in Man's Knowledge but Not in God's Plan

Since Mrs. White's time there have been numerous changes. Today re searchers who find a plant with healing properties do not suggest using it as an herb tea. Instead they try to identify its active principles and synthesize them. In this way any beneficial properties the herb may possess can be employed in known quantities with much greater safety. The number of medicines avail able has increased, their quality has improved, and some of the older drugs are no longer used. But the meaning of these words is the same. The dangers in drug treatment and the overuse of drugs deplored in the Spirit of Prophecy are still with us today, according to the report of the Drug Efficacy Study.

This study shows that all medicines, drugs, and plants used in the modern pharmacy are due for careful scrutiny. They can all be dangerous and warrant judicious, rational use. Today, after the development of some knowledge, the reform needed is rational use of fewer drugs.

It is not a matter of whether the substances used to treat disease are taken from the vegetable, mineral, or animal kingdom. Rational or reasonable treatment depends upon knowledge regarding the mode of the proposed remedies and the precise situation in which they will be acting.

Re-aiming the Emphasis

As we spread the message of better health we must take care to emphasize the most important points. Recommending vegetable remedies as superior to chemical ones emphasizes the wrong thing from the viewpoint of God's plan for healing. The elimination of drugs or the superiority of one class of medicaments over another is of minor importance compared with our major obligation to follow the Lord's instructions on health reform in order to either prevent or cure disease. "Jesus Christ is the Great Healer, but He desires that by living in conformity with His laws, we may cooperate with Him in the recovery and maintenance of health." --Medical Ministry, p. 13. "Health reform is the Lord's means for lessening suffering in our world." --Counsels on Health, p. 443.

To Every Man an Accountability

The patient and his doctor share responsibility for rational use of drugs. The least an intelligent patient should be expected to know would be whether the prescription is intended to help nature rectify the causes of his sickness or only alleviate the symptoms. 10

Consider the case of an overweight patient with diabetes. He now requires daily injections of insulin. But if he fol lows his diet and attains a normal weight the diabetes may improve until he no longer needs insulin. If the patient is unwilling to diet and continues in his over weight, the insulin continues to be necessary in one sense, but God's plan has been rejected. Our goal is to "patiently, kindly, tenderly, but decidedly," work out God's program with all who will accept it.

The Fundamental Problem

It is curative therapy for the basic, underlying, or fundamental cause of sickness that is most likely to be neglected. But here Seventh-day Adventists should shine as they teach health principles and set a right example in following the program of healthful living. It is God's way to help the patient recover resistance to disease so that he will not fall ill again.

Nature must restore herself under the direction of God's laws and by His power. Our part is to obey the laws of health, utilize the true remedies. This is essential either to maintain or regain health. These simple agencies are a part of the life of every person.

On the other hand, medicine is not in tended to be used unless a patient has something wrong with him. Only after transgression has destroyed health can drugs become useful. And all they can be expected to do is merely assist nature in her efforts at self-repair. The most up-to-date physician will not be able to suggest a medicine that will actually do even this in anywhere near every case.

Adding Wisely

God's power provides self-repair and His rational methods permit the addition of any kind of remedy when the nature of the particular disease is under stood and the manner in which the remedy will assist nature is also under stood. All rational medical and surgical treatment is in this realm of addition, and as scientific knowledge accumulates, such therapy is more frequently possible.

Appropriately applied, the true remedies are a part of every man's life, but in sickness even these must be applied with understanding. Brisk outdoor exercise is good, but not for a man on the day after a heart attack. The key to all acceptable therapy is understanding the nature of the disease being treated, its fundamental cause, and what effect the proposed treatment will have upon the sacred process of self-repair.

Avoiding Ingratitude

Without requiring us either to ask for it or thank Him, the Lord constantly provides self-healing power to both saints and sinners. Only this power can ever heal the wounds the surgeons make. Physicians prescribe all medications with the hope of hastening recovery. But it is only God's power working through the divine process of self-repair that makes recovery possible. And pills are too often given credit for the result of its work. If treatment aids recovery, it is only by cooperating with this power the Power that presents a love we cannot under stand. It is an illogical, ungrateful half-measure to take any treatment designed to aid recovery while neglecting God's true remedies.

(To be continued)

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-Physician, Corvallis, Oregon, at the time this article was written

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