Doctor’s Dilemma

In 1909, George Bernard Shaw wrote a nonfiction companion piece to his play The Doctor’s Dilemma.  It should be kept in mind that the state of organized medicine had reached a nadir at this time in its history.  Europe and America abounded in headlines regarding infamous cures and infamous practice.  At the same time, public health initiatives were making real inroads into communicable diseases.  Medicine had reached a fork in the road of professional development.  Either it would degrade further into playing upon the fears and credulity of the populace, or it would lock step with the march of scientific inquiry and practice.  Mr. Shaw stepped into this discussion with several points he felt were necessary in order for medicine to follow the latter road and abandon the former.  Please consider these concepts in light of the era it was created, as well as the work that remains to be accomplished.

1)  Nothing is as dangerous as a poor doctor: not even a poor employer or a poor landlord.

2)  Of all the anti-social vested interests the worst is the vested interest in ill-health. Mr. Shaw was very much against the profit motive in medicine, and conceptualized it as the greatest impediment to achieving truly scientific medicine.  In an early phase of this treatise, he goes on to write…private medical practice is governed not by science, but by supply and demand; and however scientific a treatment may be, it cannot hold its place in the market if there is no demand for it; nor can the grossest quackery be kept off the market if there is a demand for it.

3)  Remember that an illness is a misdemeanor; and treat the doctor as an accessory unless he notifies every case to the Public Health Authority. Mr. Shaw was for greater transparency in medicine.  He believed that much of the confidentiality advanced by organized medicine assisted the doctor’s practice more than the patient’s health.

4)  Treat every death as a possible and under our present system a probable murder, by making it the subject of a reasonably conducted inquest; and execute the doctor, if necessary, as a doctor, by striking him off the register. This may be considered an extreme form of increasing accountability.

5)  Make up your mind how many doctors the community needs to keep it well.  Do not register more or less than this number; and let registration constitute the doctor a civil servant with a dignified living wage paid out of public funds. This harks back to Mr. Shaw’s belief that the greater the number of physicians practicing in a given area, the greater the pressure on the doctor to secure an income by any means available.

6)  Municipalize Harley Street. This is a famous street where very expensive medical specialists practice.

7)  Treat the private operator (doctor in private practice) exactly as you would treat a private executioner. A bit harsh.

Also several other antibiotics, pain relief, muscle strain relaxers, birth control pills etc cialis prescription are available eon an online store. Here enjoy the ordering on buy cialis this site a cost preventing method. bulk buy cialis In some cases surgery is also done, that helps in clearing the vascular blockages. Aging comes about when cells can no longer replicate cell DNA and cialis cheap uk thus begins the gradual decline of the body. 8)  Treat persons who profess to be able to cure disease as you treat fortune tellers. Mr. Shaw perceived that most medical treatments are advanced because of habit, rather than usefulness.  It was the duty of the doctor to be above treatment based soley upon habit and tradition.  He wrote a bit earlier in this work…A respectable man will lie daily, in speech and in print, about the articles he is selling, because it is customary to do so.  He will flog his boy for telling a lie, because it is customary to do so…He will give the same boy a present on his birthday, and buy him a spade and bucket at the seaside, because it is customary to do so, being all the time neither particularly mendacious, nor particularly cruel, nor particularly generous, but simply incapable of ethical judgment or independent action.

9)  Keep the public carefully informed, by special statistics and announcements of individual cases, of all illnesses of doctors or in their families.

10) Make it compulsory for a doctor using a brass plate to have inscribed on it, in addition to the letters indicating his qualifications, the words “Remember that I too am mortal.” Mr. Shaw believed that much of the doctor’s difficulties in providing scientific treatment were the superstitions of the public.  He understood that frustrating the demands of the patient will quickly bankrupt the doctor.  Despite this understanding, he did not excuse the profession for gratifying the public need for a medical messiah.

11)  In legislation and social organization, proceed on the principle that invalids, meaning persons who cannot keep themselves alive by their own activities, cannot, beyond reason, expect to be kept alive by the activity of others. Mr. Shaw is alluding to the fact that society cannot afford to provide total care for all the needy, and that rationing care should be based upon the usefulness of the person.  A very dark proposition indeed.

12)  Do not try to live forever.  You will not succeed.

13)  Use your health, even to the point of wearing it out.  That is what it is for.  Spend all you have before you die; and do not outlive yourself. This may not be as roughly untrue as it sounds.  The evidence is piling up that antioxidants may actually reduce lifespan, since intermittent stress on the organism appears to increase length of life.  For example, exercise increases free radicals and stresses the organism, but it is indispensable to a healthy lifestyle.

14)  Take the utmost care to get well born and well brought up…Be particularly careful to have all this done at the expense of the nation, as otherwise it will not be done at all, the chances being about forty to one against your being able to pay for it directly yourself, even if you know how to set about it.

As a comedic writer, Mr. Shaw pushes concepts to absurdity in order to find humor in the mundane, such that a number of his statement shouldn’t be taken literally.  The core of his argument appears to be threefold.  First, that medicine was too reliant on ritual and tradition; all too often at the expense of the patient’s health.  Second, that organized medicine was too reliant on pushing more drugs and procedures, at the expense of the patient’s health and finances.  Third, that organized medicine was too isolated and insular, at the expense of the patient’s possible comprehension of their condition.  Regarding the present state of affairs, the gentle reader will have to judge for themselves whether the “was” in the last three sentences should be replaced with an “is.”  All in all, it is fortunate that the study of psychology was strictly an academic discipline at the time of Mr. Shaw’s excoriation of medicine.    It is likely that the Psychologist’s Dilemma would be equally unflattering.

Political Weight

Few people are desirous of additional body weight.  Few people consider their appearance to be embellished by additional body weight.  It has come to be proverbial, the billions spent on weight loss programs and systems.  Even so called medical TV programs rarely speak of medicine as they do weight loss.  It is a hook that latches onto viewers.  In order for the hook to be effective, it must be on the minds of many people.  These medically oriented programs rarely advance scientifically proven behavioral weight loss techniques.  In its stead, dietary and medicinal tricks are employed to tout rapid weight loss.  Shills are often employed to model the incredible success that remains outside the grasp of the audience.  The feared net effect is to cheapen the reputation of medical practice and increase the frustration of the target audience.

Body image and bodily health are the two important components of weight loss.  These components reflect the psychological and medical issues surrounding weight gain or loss.  In terms of body image, not everyone wants to be thinner.  Many people perceive obese partners to be particularly attractive; as evidenced by web sites thriving on the erotic portrayal of plump sexual athletes.  It is suspected that such couples are not in search of weight loss programs.  In fact, weight loss experienced by either partner may cause discord in the relationship.  It is curious that this type of couple does not generate web sites dedicated to gaining sexy weight.  Gaining weight appears to be effortless.  Gaining weight does not appear to require third party motivation.

Despite couples that revel in their sexy obesity, most couples do not seek to gain weight.  The majority does not perceive obesity to be attractive in others, nor are they pleased by weight gain reflected in the mirror.  The body image of the majority tends to favor weight loss and an athletic build.  While this is true of the current situation, different periods in history do not necessarily share the modern worship of thin.  For example, the famous Rubenesque woman painted in the 17th century.  These plump women were considered the epitome of attractiveness.  To be called Rubenesque was, in the distant past, quite a compliment.  Today, it has come to be a benign term for fat.  If we retreat further into the past, Roman women were the first group known to engage in resistance exercises!  The Roman and Greek ideal was as now; an athletic physique maintained by either sex.  An ideal body image tends to change over time, but apparently it is not in a rush.  It is probably better not to wait until your less than athletic physique comes back into style.

The physical factors responsible for male impotency and not for recreation or other purposes.Women and children are strictly prohibited from consumption http://www.midwayfire.com/wp-content/uploads/2016/07/Prevention-Form-006-Fireworks-Stand-Requirements.pdf soft tabs cialis of the drug. You cheapest viagra no prescription can have the pills with food will preserve the discreetness of the purpose of sexual enjoyment. It order generic cialis is necessary to consume this drug 30 minutes before you engage in sexual activity. buy vardenafil levitra Soft tablets and gel give a better rendition of the brothers’ compelling again story. The medical issues surrounding obesity may be as complex as the psychological.  It has long been medical dogma that body weight exceeding the average is axiomatically bad for one’s long-term health.  Public health research has revealed that the mildly obese tend to survive hospital stays significantly more than those of average weight.  The survival rate of the mildly obese, compared with those who are of less than average body weight, is especially striking.  Particular races of people tend to have bulkier physiques when compared to other races with the same percentage of body fat.  Metabolism is certain to play a role, but so does a person’s level of fidgeting.  Thin people tend to engage in unconscious fidgeting movements more than those who tend to be overweight.  It appears that fidgeting burns a surprising amount of calories.  The lack of movement in the the severely obese is a contributing factor to what is termed the “metabolic syndrome” of obesity.  This syndrome is comprised of medical factors related to coronary artery disease, stroke, and insulin-dependent diabetes.  Fortunately, this medical penalty for obesity is much less common in the moderate and mildly obese; the ones that tend to leave the hospital by the front door.

In terms of treatment, successful weight loss interventions should begin in childhood.  It is less an intervention than modeling behaviors that promote a healthy diet and exercise.  As with any childhood behavioral program, the full participation of the family is critical.  Children not only model what their parents do, but are quick to imitate a favored older brother or sister.  The focus should not be on what foods are to be avoided as increasing the consumption of fruits and vegetables.  School programs that decrease the availability of sugary foods and beverages has made a significant difference in several longitudinal studies.  Severely obese children have been the exception.  There have been no successful behavioral weight interventions with this unfortunate subgroup.

It is not only what foods are best to consume, it is also important to consider how they are prepared.  For example, a very successful behavioral intervention is somewhat counter-intuitive.  Having the child or adult participate in the preparation of the meal tends to reduce impulsive eating.  A rough analogy is rolling a cigarette as opposed to buying a pack ready made.  The additional work and attention to quality tends to lower the overall quantity.  Similarly, the mindset regarding exercise is very important to a successful program.  Profuse sweating and possible ridicule is not very motivating, unless one is attempting to increase their aversion to exercise.  It is important to start gradually and focus on feeling better physically, than evaluating oneself by how many pounds are lost.  An exercise program will be less aversive if the goal is to breath and walk with greater ease, than if improvement is measured by one’s attractiveness.  A focus on pounds and appearance is usually problematic, since no one loses weight fast enough, or suddenly becomes enamored with their appearance.  If a person employs these behavioral techniques in a consistent fashion, an attractive stranger is sure to make their appearance in the mirror.