|
|
|
|
||
|
||
|
|
||
| SEARCH | SUBSCRIBE | ||
Some related articles : |
 |
|
|
|
I am quite sure I am not the only one who has noticed this, but those low, snug jeans that Britney Spears wears with such authority do not flatter anyone else. Still, that is the style of the day, and there is nothing to do but watch the parade of hips and stomachs and wait for them to pass. Whatever is awful in fashion will eventually go away (fashion writers are heralding high-waisted pants for fall), and then, just as reliably, it will return.
Now we must ask whether it is time to bid farewell to Prempro, a drug we had thought was part of the permanent pharmaceutical landscape but may instead have been only passing through. With its attendant risks suddenly brought to light (higher rates of breast cancer, strokes, blood clots) there is not only fear but also a sense of betrayal. This combination of estrogen and progestin had been tested, approved, recommended. We had been convinced that we needed it, and in that belief we came to need it. Now we are left to battle out the hot flashes and mood swings, to find different ways of preventing osteoporosis, to worry about heart attacks. In short, we are back where we started.
What we want is for medicine to be a science. We want competent, well-informed doctors to give us consistent answers based on exhaustive research. We want them to be right. But medicine is a peculiar combination of science and fashion, half penicillin, half shoulder pads. It takes what is known at the moment, combines the knowledge with what the consuming public wants and comes up with a product. One doctor endorses the product, and while you can always go for a second opinion, it's hard to stop at just two, especially when the opinions turn out to be in direct conflict with one another. Read the papers. One doctor says to discontinue Prempro immediately. Another says more studies are needed and what we're facing is a massive overreaction. In the end it will be up to you, who never went to medical school, to make the decision your life may depend on, and while there might not be one definitive right answer, you can bet on the fact there are plenty of wrong ones.
Consider the leech. Until the 19th century, based on the sketchy knowledge of morbidity, the leech was a marvel of versatility. Now it's seen as a slimy bloodsucker, though one who has recently returned to doctors' offices to reduce the pain of arthritis. Medical history (like all of history) has been peppered with mistakes and indecisions. After World War II in America, breast-feeding was replaced by the wonders of formula, but then the breast made a strong comeback. Electro-convulsive treatment, which fell out of favor after ''One Flew Over the Cuckoo's Nest,'' is now considered again to be a logical treatment for some forms of depression. Freudian analysis is comparatively hard to find, having been made archaic by antidepressants. Fat and protein are completely in, though after all the bagels and pasta we've been eating these past two decades I would have thought they had about as much of a chance for a comeback as poodle skirts. Mammograms are at a point of uncertainty. Should we have one every year, every two years, not at all? Then there are the medical marvels that are in vogue now but probably won't be around for the long haul. A leech looks downright sensible when compared with Botox.
If sorting through the pills and procedures we have wasn't already confusing enough, the new drugs keep coming, as shiny and promising as Christmas toys and every bit as ubiquitous. Television commercials show soft-focus pictures of people on swings, picking flowers, climbing rocks or going to sleep with a smile on their faces, all ending with a very quick list of possible side effects (dry mouth and nausea seem especially popular) and the key line, ''Ask your doctor.'' They seem bent on not only eradicating every sniffle and ache; they want to create an entirely new language as well, one in which the Z and X would be the most useful letters in the Scrabble box: Vioxx, Celebrex, Zoloft, Zestril, Zyrtec, Aciphex, Tiazac, Zithromax, Zyprexa, Xanax, Xalatan. The names read like a list of unvisited galaxies for a ''Star Trek'' quest. How are we supposed to choose? Perhaps it would be safer to just swallow them all. Americans now take close to three billion prescription medications a year. Considering that the cost of these drugs is a huge part of what is making health care completely unaffordable, trimming back on our personal pill intake could be seen as performing one's civic duty. Some of these medicines will be the darlings that send the stock shares bursting off the charts, while others will engender class-action lawsuits. There will be those pills that, based on what our doctor told us and what a friend overheard and what a magazine article read in a dentist's office proclaims, we will decide are indispensable to our well-being.
Women made their way through history without the benefit of estrogen replacement before the craze hit in 1966. Women also had shorter life expectancies than they do now. Those two sentences do not have a cause-and-effect relationship, but what we want out of medicine is to lessen our suffering and stave off our death for as long as possible, and so we must weigh out the benefits and consequences of every pill. Whereas these decisions should feel informed, they in fact seem more like a trip to the craps table, betting, throwing and crossing our fingers. Chances are the key bits of information are not being withheld from us. Chances are no one is exactly sure. Estrogen is out, but wait another 20 years and it might qualify for a comeback. And when it does, we'll still be there, lining up for the pill.
Ann Patchett is the winner of this year's PEN/Faulkner Award for her
novel ''Bel Canto.''
FAIR USE NOTICE: This page contains copyrighted material the use of which has not been specifically authorized by the copyright owner. Global Action on Aging distributes this material without profit to those who have expressed a prior interest in receiving the included information for research and educational purposes. We believe this constitutes a fair use of any such copyrighted material as provided for in 17 U.S.C § 107. If you wish to use copyrighted material from this site for purposes of your own that go beyond fair use, you must obtain permission from the copyright owner.
