A pill for every ill?

By DR KHOR SWEE KHENG

Who needs stars when we can wish upon a pill? THE trouble with us these days is that when were faced with some real or imagined suffering, we reach for the bottle of pills. Our current approach to healthcare is to firstly attach a disproportional significance to our often trivial complaints. Then we refuse to tolerate even the slightest discomfort. Finally, we demonstrate an unhealthy willingness to take a pill for anything and everything, in the name of immediate relief. We may have evolved as a species, but we have definitely changed from a society that understands and accepts hardship, to one that doesnt and cant. It was a nasty world as recently as 50 years ago, when you could expect to suffer death or disability from a whole host of ailments, even one as simple as an allergy. Doctors battled real killers like smallpox and polio, and performed heroic surgery in the battlefield. They discoverd penicillin, insulin, and vaccines. They developed treatments, surgeries, and intensive care for life-threatening diseases like asthma and cancer. Advances in epidemiology and public health improved sanitation, vector control, and workplace safety. These achievements preserved human dignity in the face of terrible suffering. I want it, and I want it now As a result of that dramatic improvement in modern medicine, societal attitudes to healthcare changed irrevocably. Having conquered death, we were now afraid of hardship. But truly, do we know what hardship really is? We imagine our own ills as the end of the world, refuse to use common sense/our own body/Father Time as a cure, and demand instant relief we have become hypochondriacs with a sense of urgency. These days, we insist on being called healthcare customers or clients. We dont like the idea of being a Patient, because weve become Impatient. Doctor shopping abounds, with demands for the strongest painkillers (regardless of side effects or a logical step-up approach) or antibiotics (regardless of antibiotic resistance, and even for viral, not bacterial infection), and the latest blood test or MRI. Petty complaints are now the cornerstones of our selfish existence like constipation from a poor diet, or cough from too many cigarettes. We want to get better without an effort, and we want to get better right now! How did this happen? Firstly, the focus on the preservation of life transformed into a focus on the quality of life. More importantly, there began to be a demand for Botox for wrinkles, Viagra for ED, Prozac for depression science motivated by a client-consumer, and not necessarily a patient.

Once wars stopped and living standards improved, we stopped fretting about death and started luxuriously fulfilling our needs of food, shelter, clothing and safety. Then we began to worry about our health. Its a relative thing those days it was asbestos from a mine, and now its repetitive stress injury. That we do not seem to advance along Maslows hierarchy, is because selfactualisation means having a perfect nose? Instant gratification Unfortunately also, modern medicines great abilities bred a belief that science will cure anything, and instantly too. Added to a culture of modern speed and convenience like instant messaging and fast food, we see a doctor only when its convenient for us (even if the sore has been festering for three weeks), refuse to wait in line, and refuse to wait to get better. Everything is set up in modern society for instant gratification, to the extent that we do not know how to delay happiness for a greater gain in future, and do not know how to tolerate small amounts of physical/emotional/mental suffering. Its not healthcare-on-demand we want, its cure-on-demand, just like a 10-minute haircut or drive-through banking. Worse, society, media, and corporations compound the problem by telling us that were all unique and amazing individuals who should be happy all the time and never suffer from anything. As consumers, we can have Utopia. You can live in a McMansion and go on holiday in Paris with a supermodel when you never shed a hair again, after buying this special product, while stocks last! Everyone CAN and MUST achieve physical perfection this is a lie perpetrated by a society obsessed with health and happiness. America didnt get an annual $1.6 trillion (RM4.8 trillion) health care bill for nothing we want to lose weight, but must we exercise? If theres an app for everything, isnt there a pill for this? More controversially, healthcare has come to be owned by the rich. They can afford the premiums for insurance, have met all their basic health needs, are also more likely to be educated and to demand often unnecessary and expensive tests and treatment. The poorer has a higher threshold, often ignoring slight fevers or minor aches, and going only when there is substantial discomfort (because of money constraints, and because they have other things to worry about, like adequate food, shelter and clothing). Of course the rich doesnt have less right to healthcare, or the poor more, but this virtual monopoly by the rich skews priorities in research and funding. Theres simply more money to be made researching and specializing in hip surgery, than there ever will be for malaria. Lastly, as families become smaller throughout the world (look at Chinas one-child policy or the women who marry later if at all), we focus much more on the only child. Chinas Little Emperors and Empresses are doted on by two parents and four grandparents which child is growing up

thinking that he/she isnt the centre of the universe, and therefore shouldnt have everything they want, and right away too? As we teach them to be conspicuous consumers from an early age, why shouldnt they treat healthcare as their own birthright, much as video games and new trainers? Its a hard life Thats why we think we know what hardship is, and why were not willing to accept even the slightest bit of it. We want instant physical perfection for our very important selves, without having to tolerate any form of discomfort to achieve it. We no longer take fever as our bodys hint to rest for two days, or raid the larder for some honey for the sore throat, or clean and bandage a small wound ourselves we will see the doctor, who will give a pill, and all will be immediately right. So we clog up the emergency departments hoping for a cure for our muscle aches from too much carrying boxes at work, see a third doctor in two days because the flu just wont go away, and demand an MRI just because theres an occasional headache. We grumble if we have to wait for the doctor (the author had to handle a complaint where a onemonth-old rash wasnt seen immediately at 3am, because there was a horrible road accident victim at the same time), and complain if we dont get a cure immediately, and find another doctor who will give us our slimming, sleeping and stimulant pills. We are kings: The Customer is Always Right, and I deserve happiness and perfect health because I am A Special Individual, and I must not have any pain or discomfort. Modern society has created selfish, individualistic creatures with a distorted world-view. Is it any wonder that the most commonly used word in the English language is the pronoun I? Fifty years ago, an aesthetic physician did not exist, and there was never a disease called chronic fatigue syndrome or fibromyalgia (and here I await angry letters from their sufferers and support groups) that qualifies a patient for months off work with disability benefits, and money poured into research and experimental cures. When I told my grandmother that if I claimed I was tired and in pain all the time and the doctors cant find anything really wrong with me, I could still qualify for CFS and get disability benefits, she laughed. In my time, she said, it was called laziness and the treatment was a tight slap delivered daily until a cure was achieved. And proceeded to tell me stories about how her friends routinely worked in the farms and fields throughout pregnancy, delivered under a tree aided by their mothers-in-law, and went back to work immediately after delivery. These days, we get to choose the date and time of our Caesarian sections.

Hardship and suffering are relative for sure, but think how far have we come, from a species that fought and beat Nazism, the Great Depression, illiteracy and death. We think we are suffering in anguish from a small bruise or a fat tummy and we need immediate relief from a pill or liposuction instead of ice and exercise but try telling that to the half of the world that is truly, genuinely, and sadly, dying from unsafe water, tuberculosis, and low birth weight. Swee Kheng is a doctor who previously served in Taiping GH. He is now pursuing other interests abroad. He believes strongly in the resilience of the human species, and hopes that doctors will prescribe honestly and rationally.