"I remember how it was before penicillin. I was a medical student at the end of World War II, before the drug became widely available for civilian use, and I watched the wards at New York's Bellevue Hospital fill to overflowing each winter. A veritable Byzantine city unto itself, Bellevue sprawled over four city blocks, its smelly, antiquated buildings jammed together at odd angles and interconnected by a rabbit warren of underground tunnels. In wartime New York, swollen with workers, sailors, soldiers, drunks, refugees, and their diseases from all over the world, it was perhaps the place to get an all-inclusive medical education. Bellevue's charter decreed that, no matter how full it was, every patient who needed hospitalization had to be admitted. As a result, beds were packed together side-by-side, first in the aisles, then out into the corridor. A ward was closed only when it was physically impossible to get another bed out of the elevator.

Most of these patients had lobar (pneumococcal) pneumonia. It didn't take long to develop; the bacteria multiplied unchecked, spilling over from the lungs into the bloodstream, and within three to five days of the first symptoms the crisis came. The fever rose to 104 or 105 degrees Fahrenheit and delirium set in. At that point we had two signs to go by: If the skin remained hot and dry, the victim would die; sweating meant the patient would pull through. Although sulfa drugs often were effective against the milder pneumonias, the outcome in severe lobar pneumonia still depended solely on the struggle between the infection and the patient's own resistance. Confident in my new medical knowledge, I was horrified to find we were powerless to change the course of this infection in any way.

It's hard for anyone who hasn't lived through the transition to realize the change that penicillin wrought. A disease with a mortality rate near 50 percent, that killed almost a hundred thousand Americans each year, that struck rich as well as poor and young as well as old, and against which we'd had no defense, could suddenly be cured without fail in a few hours by a pinch of white powder. Most doctors who have graduated since 1950 have never even seen pneumococcal pneumonia in crisis.

Although penicillin's impact on medical practice was profound, its impact on the philosophy of medicine was even greater. When Alexander Fleming noticed in 1928 that an accidental infestation of the mold Penicillium notatum had killed his bacterial cultures, he made the crowning discovery of scientific medicine. Bacteriology and sanitation had already vanquished the great plagues. Now penicillin and subsequent antibiotics defeated the last of the invisibly tiny predators.

The drugs also completed a change in medicine that had been gathering strength since the nineteenth century. Before that time, medicine had been an art. The masterpiece -- a cure -- resulted from the patient's will combined with the physician's intuition and skill in using remedies culled from millennia of observant trial and error. In the last two centuries medicine more and more has come to be a science, namely biochemistry. Medical techniques have come to be tested as much against current concepts in biochemistry as against their empirical results. Techniques that don't fit such chemical concepts -- even if they seem to work -- have been abandoned as pseudoscientific or downright fraudulent.

At the same time and as part of the same process, life itself came to be defined as a purely chemical phenomenon. Attempts to find a soul, a vital spark, a subtle something that set living matter apart from the nonliving, had failed. As our knowledge of the kaleidoscopic activity within cells grew, life came to be seen as an array of chemical reactions, fantastically complex but no different in kind from the simpler reactions performed in every high school lab. It seemed logical to assume that the ills of our chemical flesh could be cured best by the right chemical antidote, just as penicillin wiped out bacterial invaders without harming human cells. A few years later the decipherment of the DNA code seemed to give such stout evidence of life's chemical basis that the double helix became one of the most hypnotic symbols of our age. It seemed the final proof that we'd evolved through 4 billion years of chance molecular encounters, aided by no guiding principle but the changeless properties of the atoms themselves.

The philosophical result of chemical medicine's success has been belief in the Technological Fix. Drugs became the best or only valid treatments for all ailments. Prevention, nutrition, exercise, lifestyle, the patient's physical and mental uniqueness, environmental pollutants -- all were glossed over. Even today, after so many years and millions of dollars spent for negligible results, it's still assumed that th3e cure for cancer will be a chemical that kills malignant cells without harming healthy ones. As surgeons became more adept at repairing bodily structures or replacing them with artificial parts, the technological faith came to include the idea that a transplanted kidney, a plastic heart valve, or a stainless-steel-and-Teflon hip joint was just as good as the original -- or even better, because it wouldn't wear out as fast. The idea of a bionic human was the natural outgrowth of the rapture over penicillin. If a human is merely a chemical machine, then the ultimate human is a robot.

No one who's seen the decline of pneumonia and a thousand other infectious diseases, or has seen the eyes of a dying patient, who's just been given another decade by a new heart valve, will deny the benefits of technology. But as most advances do, this one has cost us something irreplaceable: medicine's humanity. There's no room in technological medicine for any presumed sanctity or uniqueness of life. There's no need for the patient's own self-healing force nor any strategy for enhancing it. Treating a life as a chemical automaton means that it makes no difference whether the doctor cares about -- or even knows -- the patient, or whether the patient likes or trusts the doctor.

Because of what medicine left behind, we now find ourselves in a real technological fix. The promise to humanity of a future of golden health and extended life has turned out to be empty. Degenerative diseases -- heart attacks, arteriosclerosis, cancer, stroke, arthritis, hypertension, ulcers, and all the rest -- have replaced infectious diseases as the major enemies of life and destroyers of its quality. Modern medicine's incredible cost has put it farther than ever out of reach of the poor and now threatens to sink the Western economies themselves. Our cures too often have turned out to be double-edged swords, later producing a secondary disease; then we search desperately for another cure. And the dehumanized treatment of symptoms rather than patients has alienated many of those who can afford to pay. The result has been a sort of medical schizophrenia in which many have forsaken establishment medicine in favor of a holistic, prescientific type that too often neglects technology's real advantages but at least stresses the doctor-patient relationship, preventive care, and nature's innate recuperative power.

The failure of technological medicine is due, paradoxically, to its success, which at first seemed so overwhelming that it swept away all aspects of medicine as an art. No longer a compassionate healer working at the bedside and using heart and hands as well as mind, the physician has become an impersonal white-gowned ministrant who works in an office or laboratory. Too many physicians no longer learn from their patients, only from their professors. The breakthroughs against infections convinced the profession of its own infallibility and quickly ossified its beliefs into dogma. Life processes that were inexplicable according to current biochemistry have been either ignored or misinterpreted. In effect, scientific medicine abandoned the central rule of science -- revision in light of new data. As a result, the constant widening of horizons that has kept physics so vital hasn't occurred in medicine. The mechanistic assumptions behind today's medicine are left over from the turn of the century, when science was forcing dogmatic religion to see the evidence of evolution. (The reeruption of this same conflict today shows that the battle against frozen thinking is never finally won.) Advances in cybernetics, ecological and nutritional chemistry, and solid-state physics haven't been integrated into biology. Some fields, such as parapsychology, have been closed out of mainstream scientific inquiry altogether. Even the genetic technology that now commands such breathless admiration is based on principles unchallenged for decades and unconnected to a broader concept of life. Medical research, which has limited itself almost exclusively to drug therapy, might as well have been wearing blinders for the last thirty years.

It's no wonder, then, that medical biology is afflicted with a kind of tunnel vision. We know a great deal about certain processes, such as the genetic code, the function of the nervous system in vision, muscle movement, blood clotting, and respiration on both the somatic and the cellular levels. These complex but superficial processes, however, are only the tools life uses for its survival. Most biochemists and doctor's aren't much closer to the "truth" about life than we were three decades ago. As Albert Szent-Gyorgyi, the discoverer of vitamin C, has written, "We know life only by its symptoms." We understand virtually nothing about such basic life functions as pain, sleep, and the control of cell differentiation, growth, and healing. We know little about the way ovary organism regulates its metabolic activity in cycles attuned to the fluctuations of earth, moon and sun. We are ignorant about nearly every aspect of consciousness, which may be broadly defined as the self interested integrity that lets each living thing marshal its responses to eat, thrive, reproduce, and avoid danger by patterns that range from the tropisms of single cells to instinct, choice, memory, learning, individuality, and creativity in more complex life-forms. The problem of when to "pull the plug" shows that we don't even know for sure how to diagnose death. Mechanistic chemistry isn't adequate to understand these enigmas of life, and it now acts as a barrier to studying them. Erwin Chargaff, the biochemist who discovered base pairing in DNA and thus opened the way for understanding gene structure, phrased our dilemma precisely when he wrote of biology, "No other science deals in its very name with a subject that it cannot define..."

"There is only one health, but diseases are many. Likewise, there appears to be one fundamental force that heals, although the myriad schools of medicine all have their favorite ways of cajoling it into action.

Our prevailing mythology denies the existence of any such generalized force in favor of thousands of little ones sitting on pharmacists' shelves, each one potent against only a few ailments or even a part of one. This system often works fairly well, especially for treatment of bacterial diseases, but it's no different in kind from earlier systems in which a specific saint or deity, presiding over a specific healing herb, had charge of each malady and each part of the body. Modern medicine didn't spring full-blown from the heads of Pasteur and Lister a hundred years ago.

If we go back further, we find that most medical systems have combined such specifics with a direct, unitary apparel to the same vital principle in all illnesses. The inner force can be tapped in many ways, but all are variations of four main, overlapping patterns: faith healing, magic healing, psychic healing, and spontaneous healing. Although science derides all four, they sometimes seem to work as well for degenerative diseases and long-term healing as most of what Western medicine can offer...

Unfortunately, no approach is a sure thing. In our ignorance, the common denominator of all healing -- even the chemical cures we profess to understand -- remains its mysteriousness. Its unpredictability has bedeviled doctors throughout history. Physicians can offer no reason why one patient will respond to a tiny dose of a medicine that has no effect on another patient in ten times the amount, or why some cancers to into remission while others grow relentlessly unto death...

The healer's job has always been to release something not understood, to remove obstructions (demons, germs, despair) between the sick patient and the force of life driving obscurely toward wholeness. The means may be direct...or indirect..."

The more I consider the origins of medicine, the more I'm convinced that all true physicians seek the same thing. The gulf between folk therapy and our own stainless-steel version is illusory. Western medicine springs from the same roots and, in the final analysis, acts through the same little-understood forces as its country cousins. Our doctors ignore this kinship at their -- and worse, their patients' -- peril. All worthwhile medical research and every medicine man's intuition is part of the same quest for knowledge of the same elusive healing energy."

"...Early in this century, the evolution of medicine in much of the industrialized world was guided by the assertion (on the part of physicians) and the acceptance (on the part of policymakers, patients, and the general public) that modern medical care has a strong basis in scientific evidence. Decisions about whether to provide a particular test or treatment were thought to be determined by clear rules, based on scientific evidence, and applied more or less equally by different physicians. Given these assumptions, the discretion available to doctors and patients about treatment of a particular illness was thought to be minimal. Doctors were assumed to treat similar patients similarly. Each service was assumed to be "necessary." The quantity of medical care "required" by Americans would thus be determined by the amount of "real" illness in the American population, and would be self-governing.

But during the past fifteen years, evidence has been accumulating that much of medical decision-making is not firmly grounded in scientific evidence. Many medical practices are based more on anecdotal experience than scientific evidence, and treatment of the same illnesses are very different among physicians. Some physicians are much more aggressive than others in providing what is increasingly very expensive medical care. Yet, there is little evidence of any significant differences in the outcomes of the varying styles of practice, even though such differences lead to large discrepancies in costs.

We now have very convincing evidence that a large portion of the rising costs of medical care are due to the volume of services being provided, rather than the unit price of each service. Furthermore, we are beginning to realize that the amount of medical care provided to individuals is, at best, only loosely related to the levels of actual illness. We must therefore begin raising questions about the value of the medical services we are receiving.

Is any slight potential decrease in morbidity and mortality due to aggressive diagnostic and treatment practices worth the cost? For most medical care, we cannot answer that simple question for two reasons. First, despite the impression of most medical consumers to the contrary, precise (and sometimes even approximate) information about the effectiveness of most medical care is simply not available. Without sound information about the effectiveness of medical services, cost / effectiveness measurements cannot be made.

Second, in addition to a dramatic rise in costs, the 1980s also saw an elevation in American's infatuation with the "marketplace." Marketplace economics have come to be viewed by some as the preferred way of controlling costs and improving quality. As a result, what used to be hospital services became product lines. What used to be services to the community became market share. What used to be nonprofit became for profit. The administrators of health care organizations came to be called presidents and CEOs. The MBA replaced the degree in public health as the credential of choice for growing numbers of health care executives. Competition -- to get the largest number of patients through the door or whatever institution you worked for -- became the aim of talented people filling the newly created posts of vice presidents for marketing. The patients became clients..." (Philip Caper, MD, in Lynn Payer Disease Mongers, 1992, John Wiley & Sons, Inc. New York, Foreword)

"When I read my paper, an ad (for "The Wellness Program") asks me if I have Silent Heart Disease, and when I turn on the TV, an ad (for Mazola oil) says, "I used to think my husband was healthy, but his doctor says his cholesterol is [dramatic sounds] 218 !" A news story in another paper quotes an American Cancer Society official who says that every American woman should consider herself at risk for breast cancer, while a press release (paid for by a drug company that promotes a drug for osteoporosis) that comes across my desk tells me that osteoporosis kills more women than breast cancer, although it doesn't say at what age. In the ladies' room at an airport a poster (undoubtedly funded --at least in part -- by radiologists) tells me to have a mammogram. While fighting my way through a noisy and crowded Pennsylvania Station, I come across a small-time entrepreneur who wants to check my blood pressure; in return, I'm supposed to make a donation. On the subway coming home from a hard day at work, I'm confronted by a poster placed by a patient group that asks me to pick which of several normal-looking women has lupus; it then lists the symptoms, one of which is fatigue, with the implication that my fatigue might be due not to long hours of work and riding the subway but to lupus. Other posters ask if I have Aching Feet, which I probably do if I think about it, or Torn Earlobe, a possibility I had never even considered. And when I return home exhausted at 11 p.m., I have a message on my answering machine from a woman who has written a book about mitral valve prolapse, telling me that this condition, which I was once diagnosed as having, is not the benign condition we have been told, but really a serious disease. When I open the refrigerator door, a milk carton tells me that simply being over the age of 40 puts me at risk for diabetes.

Now I'm not a self-destructive person: I have never smoked, I limit my intake of alcohol, I exercise regularly, I fasten my seat belt, and I keep my weight within the bounds it should be for good health (depending, of course, on whom you listen to), if not for the latest fashions. I sometimes consult doctors. I enjoy comfort and freedom from pain at least as much as the next person.

But I have come to increasingly resent attempts to convince us that while we think we are well, we are really sick, riddled with all sorts of risk factors and anatomical abnormalities. We will all die sooner or later, and this gives the disease-mongers their insidious powers over us. But can the costly remedies promoted by the disease-mongers really postpone our dying? Can their remedies make us feel better? Can our money be better spent on something else? Are these messages really helping us? Or might they be hurting us?

In my 20 years as a medical journalist, I have become more and more convinced that much of the so-called information we get about our health grossly oversimplifies and distorts the reality. I know that both blood pressure and cholesterol readings are rough approximations of the risk of dying of heart disease. But I also know that the readings themselves vary greatly according to the conditions under which they are taken and that even the same readings means vastly different things depending upon your age, your sex, and various other risk factors. I also know there are studies showing that some people treated for mild hypertension are more likely to die than those who go completely untreated. I know that while four controlled studies have shown that screening mammography performed in women over the age of 50 does seem to cut the death rate from breast cancer, only one has shown any benefit in women under 50, something never acknowledged in the publicity urging women to get mammograms. I know that while osteoporosis may be a significant problem in older women, sometimes triggering a series of events that leads to death, it kills at a fairly advanced age, and everyone eventually has to die of something. And I know that even if my diagnosis of mitral valve prolapse had been correct, such diagnoses are pretty meaningless, since the consequences of the condition can vary from severe to none at all.

Perhaps most importantly, I realize that the most-heralded advances of modern medicine are simply mimicking what the healthy body does all by itself. While more people are now living to old age, there is no evidence that the maximum human life span has changed since biblical times, and some of the overall improvement may be due to natural selection, not medical intervention. As Thomas McKeown wrote in this book The Role of Medicine: Dream, Mirage or Nemesis?: "Like other living things, man has been exposed to rigorous natural selection, and the large majority of those born alive are healthy in the sense that they are adapted to the environment in which they live." Modern medicine may have a lot to offer the sick, but it should proceed with caution when dealing with the healthy.

But disease mongering -- trying to convince essentially well people that they are sick, or slightly sick people that they are very ill -- is big business. For people to use a diagnostic product or service, they must be convinced that they MAY BE sick. And to market drugs to the widest possible audience, pharmaceutical companies must convince people -- or their physicians -- that they ARE sick.

Disease mongering is the most insidious of the various forms that medical advertising, so-called medical education, and information and medical diagnosis can take. A doctor can advertise that he or she has just opened an office in the neighborhood, and that advertising informs us. A drug company can advertise that its pill is better than the pill of another drug company, and wile this message may or may not be correct, it is at least not an effort to convince well people that they really are sick. But to tell us about a disease and then to imply that there is a high likelihood the we have it, either by citing the fact that huge numbers of Americans do (and who are we to escape?) or by citing symptoms such as fatigue that are universal and normal, is to gnaw away at our self-confidence. And that may make us really sick."

Take, for example, the case of a 37-year-old man who told his new doctor, "I was fine until a year ago when I found out that my cholesterol was high" This man really did have high cholesterol -- 300 mg/dL -- and therefore was at a greater risk of having a heart attack than a man whose cholesterol was 200. But a heart attack was certainly not inevitable, particularly since he had no other risk factors; according to data from the Framingham study of cardiovascular risk, a man with his risk profile had a 6 to 7 percent chance of developing coronary heart disease in the following eight years. And there's no good evidence that by lowering his cholesterol-- particularly with drugs -- he would decrease his chances of dying an early death, since many studies have shown that while lowering cholesterol decreases death from heart disease, it increases deaths from other causes by about the same amount. The man tried dieting, but this failed to bring down his cholesterol, and he was put on lovastatin, a cholesterol-lowering drug. The patient stopped the drug because it made him feel terrible. According to Allan S. Brett, MD, of Harvard Medical School, writing in the American Journal of Medicine, "He then stopped his daily exercise because of the fear that exercise would precipitate a heart attack," precisely the opposite of what someone with high cholesterol ought to do. "Finally, he had an episode of chest pain and tingling in the arms that led to a hospital admission to rule out myocardial infarction [heart attack]. A workup proved negative, and he was discharged with a diagnosis of hyperventilation. He now complains of insomnia." This man, who had previously been well, now was sick.

While the Food and Drug Administration (FDA) regulates claims made by drug companies about their drugs, disease mongering has been essentially unregulated, and FDA rules have actually favored its practice. A drug company, for example, cannot advertise the name of a drug to either the medical profession or the general public without giving a list of its known side effects, which for most drugs is quite extensive. But the company can place an ad implying that large numbers of people have the disease for which the drug is used and advising them to see their doctor, hoping that this will result in the doctor's prescribing the company's product. Because the drug industry also funds much of the postgraduate education that doctors get, the doctor probably will...."

Disease mongering has been around for a long time, and Americans have been particularly susceptible, partly because of our love affair with diagnosis and diagnostic tests. Our belief in the sanctity of diagnosis has led to a reimbursement system that depends on it (in contrast, as we shall see, to reimbursement systems in other countries). In a sort of chicken-and-egg scenario, making reimbursements dependent on diagnosis has reinforced the reverence paid to diagnosis while at the same time undermining its validity: 60 percent of the problems seen by primary care physicians don't fit into neat labels, but under our reimbursement system the doctor must write down something, right or wrong. Hospitals buy computer programs to help them assign the diagnosis that will pay the most. As journalist Jeff Schmidt was told by his doctor's receptionist when he asked if his insurance would cover a routine physical, "The doctor will provide you with sufficient diagnoses..."

WHY AMERICANS ARE PARTICULARLY SUSCEPTIBLE

Perhaps one reason we Americans have become susceptible to disease mongering is that we lack the forceful images of disease-mongering characters found in the literature of other lands. England had George Bernard Shaw's Cutler Walpole, for example, who made himself ridiculous by diagnosing everyone as having a putrefying nuciform sac that should be removed, and today the Thames TV character Shelley talks of diseases manufactured to meet the need of the latest pills. France can remember some of Moliere's more colorful characters, whose hypochondria was exploited by their doctors.

In the early part of this century, Jules Romains's Dr. Knock, whose motto was that every well person was simply a sick person who didn't know it, captured the French imagination, and this classic parable about what social scientists call "medicalization" is still taught in French high schools. In the play, Dr. Knock purchases a practice in a small French town where, while nearly everyone suffers from rheumatism, they would no more think of seeing a doctor about it than going to the priest to cry. As a result, the doctor from whom Knock bought the practice wasn't terribly prosperous. Dr. Knock quickly establishes alliances with the sources of information -- the schoolmaster, whom he instructs to inform the people about the dangers of germs, and the town crier, who announces that the doctor will be giving free consultations. At the consultations, at which Knock determines whether his patients are able to pay and how much ("That will cost you approximately two pigs and two steers"), he begins diagnosing frightening-sounding conditions that convince his patients that they must be under his care every day, often in bed, depriving themselves of everything but water. At the end of the play, the town is completely medicalized, with all the people under Knock's instructions, taking their temperatures all at the same time, several times, every night. Not only does Knock prosper, but so do the town hotel, which has become a hospital, and the town pharmacist. When you refer to Knockism today in France, everyone knows exactly what you are talking about.

By contrast, most literary and TV images of physicians in the United States range from benign to angelic, and when fault is found, it is usually for missing the diagnosis, not for finding disease where there is none. Dorothy, of the "Golden Girls" television series, for example, travels from doctor to doctor until she finally is given the satisfaction of a diagnosis of chronic fatigue syndrome, not seeming to realize that this diagnosis simply means that someone has been tired for a long time and nobody knows why. The doctor, played by William Hurt in the movie of that title, tells his fellow patient that her brain tumor would most certainly have been diagnosed by a magnetic resonance imaging (MRI) scan that the insurance companies were too chintzy to pay for, failing to clarify that even if diagnosed, many brain tumors are still incurable..."

WHY DISEASE MONGERING IS INCREASING

But while there has always been a certain amount of disease mongering, social and economic conditions in America today make the practice particularly fierce.

· There are too many doctors for too few patients. The number of doctors has increased much more rapidly than the population over the past 20 years, thus giving each doctor fewer patients upon whom to make a living. While on paper the United States doesn't have more doctors per capita than the countries in Western Europe, American doctors are all competing for a limited portion of the American population: those who have insurance of some kind. With 35.7 million (and rising) Americans currently without health insurance, that portion is decreasing.

Specialists are fighting with other specialists over the right to treat certain types of disease, such as coronary artery disease, and in the process people with milder and milder disease -- disease so mild that the treatment may pose more risks than the disease itself -- are being diagnosed and treated. All these doctors must learn how to do the procedures on someone, and one cardiologist suggested that the ideal patient to practice on was one who probably didn't need the operation in the first place.

If the demand for medical care were well defined, competition might work to the advantage of the patient, making doctors cheaper and nicer. Certainly there are many doctors practicing who try to be honest with their patients; these doctors usually report spending a lot of time convincing their patients that they don't have the latest disease they heard about on TV or in the newspaper. But on the whole, more doctors, who have medical school loans to pay off and families to raise, will simply make more disease, particularly when most insurance companies will pay for a consultation only if there is a diagnosis given and will pay more for diagnostic tests than for time spent talking to patients.

· Doctors are scared to death of being sued for malpractice. They perceive that juries will be much harder on sins of omission (failing to diagnose a disease that is there) than sins of commission (diagnosing a disease that isn't there, making the disease seem more serious than it really is, or harming patients by doing something to them). Doctors and laboratories are fearful that if they give a patient a clean bill of health and the patient later develops a disease, they may be liable for malpractice. This may be why my preoperative chest X-ray report was something like, "We can't see very much, but we have no reason to think that there's serious disease present." Gone are the days when a visit to the doctor could end with patients learning they had nothing wrong with them.

· There are many more popular health magazines and newspaper supplements than there used to be. Often these are seen more as ways to draw advertising revenue than as serious journalism. Popular health tracts have been around since before the invention of the printing press, when they were copied by hand by monks. But the past decade has shown a mushrooming of news about health and illness, with many papers adding special sections and many new magazines starting. Some of them are pretty good. But others are simply seen as a way to increase advertising revenue, and they do this by running articles mongering diseases that the advertisers' products can be seen to prevent or treat.

· Recent changes in the way hospitals are paid have given them incentives to "up" the severity of the diagnosis. Hospitals used to be paid for whatever procedures they performed on patients, a system that gave them incentives to do as much as possible to each patient, regardless of diagnosis. They were also paid for the number of days the patients stayed, which gave them incentives to keep the patients in as long as possible. In an attempt to contain the rapid rise in health care costs, health economists devised a payment system based on the diagnosis, known as diagnosis-related groups, usually called DRGs.

The establishment of DRG was undoubtedly a good-faith effort to control costs, and ad health economist Victor Rodwin, Ph.D. of New York University, points out, DRGs were the first attempt to establish a dialogue as to how much care was appropriate for a given diagnosis. But the DRG system is based on the belief that diseases are "things" -- the folly of which will be shown in chapter 2 -- and that diagnoses were much more cut and dried than they really are. A few physicians early on identified what was to be a major problem with the DRGs: there is a large amount of uncertainty in medical diagnosis and therefore considerable leeway as to whether you diagnose something as disease A or disease B. If disease B pays the hospital more, the hospital will attempt to get doctors to make diagnosis B rather than diagnosis A. The DRG system also gives the hospitals incentives to recruit as many new patients as possible into the hospital, preferably ones that aren't too sick, since they will require less care.

The practice of assigning a slightly more serious diagnosis was baptized "DRG creep" by D.W. Simborg, on of the doctors who early on recognized its abuse potential. But by the late 1980s, some of the DRGs seemed to be leaping rather than creeping: Susan Horn, Ph.D. of Johns Hopkins University, found when looking through hospital records that a number of patients with the diagnosis of myocardial infarction (heart attack) or shock showed absolutely no signs of having these diseases...

· The pharmaceutical industry's role in postgraduate medical education has increased dramatically. From 1975 to 1988, the drug industry's funding of symposia increased fourteen fold. While some of the more flagrant practices of drug promotion, such as giving doctors frequent-flier points every time they prescribe a particular drug, are coming under criticism, the so-called educational activities are usually lauded. Indeed, many medical seminars sponsored by drug companies are of a high quality. But drug companies nearly always have some say about the topic and about who is invited to speak, and most have a "stable" of speakers, none of whom is likely to say that a disease is not very important or that it should be defined very narrowly, since that would limit the amount of a drug that will be prescribed.

· Restraints on advertising have changed. Restraints on physicians have broken down, and those on prescription drugs directly to consumers are in the process of dissolving. Some doctors are now advocating that patients be able to order their own diagnostic tests, and we can perhaps expect to see ads advising patients to come in for a Lyme disease test, for example. In theory, physician advertising was supposed to lead to price competition that would drive costs down. In practice, it has opened the doors to advertisements that convince more and more people that they are sick -- that their leg pain, for example, may in fact be a sign of a serious illness -- and costs continue to rise."(Lynn Payer, Disease Mongers, 1992 John Wiley and Sons).

About 200 years ago, a wise physician named Samuel Hahnemann, MD, had this to say: Every symptom is the body's attempt to cure itself and if the symptom is suppressed, the disease process will go inward to a more vital organ, and if the symptom of the more vital organ is suppressed, the disease process will go to a still more vital organ. Hahnemann did not mention heart disease by name, but the message is clear since the heart is the most vital organ.

Allopathic medicine is largely dependent on drugs [which are suppressive], so it is an important factor in the causation of heart disease. This also applies to cancer. Conventional physicians do not know the cause of heart disease and do not know how to cure it. That is why heart disease is the number one cause of death. They do not know the cause of cancer and do not know how to cure it. That is why cancer is the number two cause of death. According to the New England Journal of Medicine, there are more new cases of cancer per 100,000 population than there were thirty years ago -- a frightening statistic.

Orthodox medicine's batting average for chronic disease is zero!

No cure for AIDS, Alzheimer's disease, heart disease, cancer, arthritis, fibromyalgia, multiple sclerosis, Parkinson's disease, diabetes, schizophrenia, bipolar illness, epilepsy, glaucoma, obsessive compulsive disorder and many other chronic conditions.

In my opinion, the cause of this state of affairs is greed and the power of monopoly.

Alternative medicine, which is drug-free medicine and included homeopathic medicine [Hahnemann's discovery], has many effective and safe answers to medical problems. There are more than 100,000 homeopathic practitioners throughout the world.

If a member of your family were to develop heart disease or cancer, would you follow conventional medicine? I hope not. The choice is yours.

Rodman Shippen, MD

"Have you ever wondered why: Our research doctors and medical doctors can conquer Small Pox, Diphtheria, Measles and even Polio (all conquered before 1954), but are losers with Degenerative Diseases such as Diabetes, Cancer, Arthritis, Leprosy, Heart Disease except for Tuberculosis?

Have you ever wondered why: There is no vaccination, antibiotic or early detection test for these Degenerative Diseases except for Tuberculosis?

Have you ever wondered why: Tuberculosis is classified as a degenerative disease yet it can be detected early, there is a vaccine for it and an antibiotic?

Can our doctors give us a straight answer to: What's the Problem?

Let's ask them.

We are gratefully proud of you and your past accomplishments, but your treatment for Degenerative Diseases makes us into drug addicts. Which kills us -- the disease or the drugs? Death, we all must face, but you know, and we know, the suffering of our friends and relatives when afflicted with Cancer. The drugs (or radiation) are worse than the disease. You want us to take a poison to kill a disease? When in the past has this method led to conquering a disease? Surely this must bother you.

You are capable of a better solution. It took you only five years to conquer Polio.

The most saddening of all, Dear Doctors, cancer or the treatments kills more of our children than any other cause. Surely that bothers you.

What is the mystery? Why are you losers with the degenerative disease of Cancer? Is it ignorance, greed, fear of your peers, or is it elitism? Have your predecessors, like Virchow, led you down the wrong path? Are you too proud to admit it? Is the mystery to be covered up by "Consensus Medicine?

Why are you losers? Are you an accomplice? Has your profession betrayed you? Has communication broken down between the microbiologist and nutritionist and the medical doctors?

You have caused us turmoil. Our inclination is to boycott you. You monopolize the treatment via the Washington State Medical Quality Assurance Commission (MedQAC) and control insurance coverage. There is no need for you to wonder why we are taking charge of our bodies and going it alone. Still, we want you as friends and teachers rather than as drug pushers. Now the MedQAC has revoked Dr. Warner's license, taking away another chance to get out of the trap you set for us. No wonder we are in a panic. Because of your action, more of us will desert you.

You have betrayed us. We don't need statistics to prove it. When I, or my loved one, was stricken, you couldn't deliver. Your conciliation was: "You have 6 months to live. I have done all I can. Go home and put your house in order." These remarks reverberate in the ears of every friend and relative. They betray the trust we had in you. Surely such remarks of helplessness bring guilt, along with a resolve -- a resolve to try an alternative? Betrayal can work two ways.

Have you looked for an alternative? Many of us have found alternatives and they make more sense than drugs.

Immunity, building and keeping it, regaining health and keeping it is the alternative to poison and death. That is why Dr. Glenn Warner's time has come. He gives us hope. The alternatives build and keep immunity with super nutrition, vitamin, mineral and glandular supplements along with alimentary canal cleansing, exercise, learning and self-evaluation. Dr. Warner encourages us. Participants, a third of us, swear by these methods.

In your Disciplinary Action against Glenn Warner, MD you claim he harmed 6 patients. Come to Dr. Warner's Cancer Support Group and hear the heart-rending accusations against you. Hairless, ravaged bodies with voices from the depths of Hell, belie the hope they left behind in your office. Dr. Warner has thousands of patients who claim he has helped them to save their lives, adding that their health is better now than ever. They thank God for having had cancer. By comparison, count the millions of people over the years you have harmed and killed with your standard practice of surgery, radiation and chemo. You have the audacity to define "harm" as keeping patients from this poison and torture, claiming we are ignorant; we don't know what's "good" for us. It's you who should be disciplined!

The alternatives I used when I had colon cancer in '78 were Virginia Ligingston's (San Diego) immunotherapy and Dr. Max Gerson's (Mexico). Super-nutrition is the mainstay of these programs. But, get this: Dr. Livingston used vaccination (Tuberculosis vaccine - BCG) and inoculation to stimulate an immune response. This is very similar to the program that Dr. Glenn Warner of Seattle uses. Could immunization with TB help prevent one from getting cancer? That's no different from being immunized with cowpox to keep one from getting Small Pox. Immunity -- building and keeping it. Those of us who have tried it, like it.

That's not such a bad alternative, huh, Doc?

So, dear doctors, if you will open your minds and read the books we have, you can join the 20 to 50% of us already on the alternative path. If you will abandon your outdated protocol, convince your legislators to repeal the monopoly-motivated practice in the MedQAC's standard of practice for cancer and join the health revolution, we might change our opinion of you. "This is a doctor who looked into alternatives to teach his patients." -- will you have that epitaph? Will you have thousands of durable mourners, like Dr. Warner?

Past researchers have observed as have I: You will live longer without the tortuous "treatment." Dr. Hardin B. Jones, Researcher at the University of California, Department of Medical Physics, has reported to the American Cancer Society and I quote him: "My studies have proved conclusively that untreated cancer victims live up to four times longer than treated individuals. For a typical type of cancer (breast), people who refused treatment lived for an average of 12-1/2 years. Those who accepted surgery and other kinds of treatment lived on the average of only 3 years. Beyond a shadow of a doubt, radical surgery on cancer patients does more harm than good." (Cancer Control Journal Vol. 5, No. 3/4 - 147).

Just think, Doc, doing nothing is better than what you offer. If we, who are afflicted, were to stop drugs, chemo, radiation and most surgery, we would live longer and without torture! Did you ever try placebos, Doc?

With these kinds of statistics I know the meaning of your term "proven" to justify the use of surgery, radiation, chemotherapy: They are proven to kill you sooner than the cancer does. Even your definition of "cure" is tainted -- 5 years. If I die of cancer in 5 years and one day, you would say I was "cured." Yea, proven!

Here are some figures quoted by Dr. Robert Wilner in his books Deadly Deception and Cancer Solution: Each year 120,000 die of Iatrogenic disease. That is 10 times the number of AIDS deaths per year. Iatrogenic ["I-Ate-Tro-genic"] means doctor-caused! That is in addition to the nearly 500,000 that die from cancer each year. How many of these cancer patients die of Iatrogenic disease?

Something's wacky here! Somehow I feel deceived. Why?

So Doc, what is your problem? Knowing you as I do now, I know you can only offer me biopsy, surgery, radiation and chemotherapy. And wee both know the chances of survival are less than 10% even after going through the suffering with your methods. And as we have learned, to do nothing will add years over your methods, or result in recovery. So with this knowledge and forethought, seeking an alternative to your methods hardly smacks of "false hope" that you might want to lay on me. Gladly do I favor Dr. Warner's approach rather than yours! I hear you muttering "QUACKERY!" How dare you stand proud on mountains of dead, killed by your own hand, with pockets bulging with bucks, smiling over the bloody breast you hold up for your peers, pretending to cure cancer. What you won't do, you don't want others to do. You have serious problems, Doc.

No Thanks, Doc. I'll decide; I'll be in charge of my body and its health. I am not going to worship you as an idol. I am not going to kill myself with your poisons for fear of dying. I AM in charge!

I don't wonder why any longer, Doc. You want to protect what you think is your territory. But my body is not your territory! Contrary to bureaucracy (MedQAC) you have enshrined, I think Dr. Warner's time has come. Alternatives are here to stay.

Al Schaefer

3807 - 13th Ave. #5

Seattle, Washington 98119 USA

206-286-6623

Al Schaefer is active in International Cancer Victors and Friends, Seattle Chapter and Northwest Oncology's Cancer Support group."

John Robbins' latest work, Reclaiming Our Health, defines health as learning to live in vibrant harmony with ourselves, with the natural world and with one another. Health is not, as it has come to be regarded, a matter of medical technology, a commodity we get from our doctor. Robbins describes how common sense medical prevention has been replaced by a reliance on intervention from a monopolistic medical bureaucracy. In a country where 15% of our GNP goes to health care, combined with an extremely high infant mortality rate and soaring cancer rates, clearly our medical practices are "in the throes of a horrible crisis." When death rates drop as physicians go on strike, and when 300,000 deaths in this country result from diseases acquired in hospitals, something is not working.

Robbins explains that the problem lies not necessarily in the intention of physicians to heal, but in the exclusive and vested network in which they work, (e.g. the American Medical Association or AMA), and the consequent lack of training and incorporation of alternative health care approaches. Through his analysis of modern medicine, we learn how alienating and harmful it can be to think that experts always know more about our bodies and our lives than we do.

It is the AMA's historical campaign to discredit medical approaches from alternative practitioners which is of particular (and shocking) interest in this book. For example, in 1963, the AMA created a panel which called itself the Committee on Quackery, and whose over-arching, yet undisclosed mission was to "contain and eliminate chiropractic" and other alternative therapies. Using words such as "unscientific cult," "witchcraft," "fraud" and "rabid dogs" to condemn chiropractics, the Committee on Quackery quickly set about publishing books and articles arguing that chiropractors, along with massage therapists, midwives, herbalists, and Oriental medical practitioners "constitute a hazard to health care in the United States."

Robbins cites several studies which unanimously conclude that chiropractors are four times as successful in treating back pain as allopathic doctors, and cost one-fourth the amount of drug therapy and surgery. In 1977, a ten-year long court case ensued between Chiropractors and the AMA. In insidious list of immoral and illegal activities engaged in by the AMA was brought to light, including postal and income tax abuses, control of congressional leaders and the campaign to destroy chiropractic. The result: the AMA and its officials were found "guilty of attempting to eliminate the chiropractic profession" which, as the presiding judge commented, "constituted a conspiracy among the AMA and its members..." The AMA was forced to publicly acknowledge the "lawlessness of its conduct."

According to Robbins, a sad indicator of the abuses of modern medicine is in its over-reliance on technology as the final arbitrator of health. Doctors today are pushed into using the latest, most expensive medical technologies to prevent liabilities in their practice, regardless of their success rate in treating disease. In a malpractice suit, a doctor's strongest case is whether he or she chose to utilize every available technology. In birth, for example, fetal monitors are routinely used in spite of the fact that they triple the number of cesareans, they increase fetal and maternal distress, and they are of no benefit to the birth process. Robbins points out that doctors in this country are not trained in natural birth. They are trained to intervene and to rescue. Perhaps this is why cesarean sections are the most commonly performed surgery in America.

Among midwives and natural birthing clinics, the story is very different. Cesarean births account for only a few percent of all midwife births compared to 23% of hospital births. In hospitals that cater to a more affluent clientele, the cesarean rate is closer to 50%. Robbins shows that when HMOs started paying doctors a fixed amount for births, regardless of the procedures, cesareans dropped rapidly. This financial incentive for doctors to find problems and consequently profit from women's natural health care needs is a theme seen throughout the book. "By medicalizing natural life events such as childbirth and menopause, and viewing women's bodies as inherently prone to malfunction, the medical establishment today perpetuates a disrespect for women that has plagued us for centuries."

Likewise, by sponsoring conventions and a host of marketing perks, giant drug companies are shown to drive the research from which much of modern medicine's practices ensue. Looking at Estrogen Replacement Therapy (ERT), birth control, menopause, Ritalin use among children, and the modern-day witch hunt against alternative cures, Robbins leaves no doubt that the bottom line of pharmaceuticals is not our health. The effects of the medical-pharmaceutical-insurance interests are that "doctors and patients alike feel depersonalized and used."

Robbins looks at the birth of the AMA in 1847 for clues into where current medical thinking originated. The AMA began as a national trade union, an organization formed to lobby legislation "and gain an economic proprietorship" for its members. As Robbins points out, the original AMA by-laws clearly spell out its original goal "to eliminate competition." Its first lobbying effort was to illegalize abortion, which at that time was rare, safe, and even tolerated by the Roman Catholic Church. The result of this campaign was both to criminalize and stigmatize midwives and healers, and also to plunder their market share. Simultaneously, the AMA forbade doctors from providing contraceptives or information regarding fertility. As recently as 1994, "the AMA issued a policy statement declaring that physicians 'should be free to withhold contraceptive advice' from 'teenage girls whose sexual behavior exposes [them] to possible conception.'" In this position as with others, Robbins makes a convincing case that the AMA has changed very little from its original intentions.

Homeopathy and natural childbirth were vital and successful components of national health care at the time of the AMA's inception; homeopathy was often more successful at treating chronic degenerative diseases than the allopathic medicine which replaced it. Only when antibiotics and penicillin were discovered much later did conventional medicine gain popular favor. Giving credit where credit is due, Robbins is quick to praise modern medicine's high success rates in practicing emergency medicine -- setting bones and treating accident victims. Surgery, when needed, according to Robbins, is among modern medicine's finest achievements.

Never willing to attack or sensationalize, Robbins systematically reveals the names of various CEOs of major pharmaceuticals, who simultaneously preside as Chairman of the Boards of leading cancer research centers and hospitals. In an almost too friendly tone, Robbins enumerates an immoral matrix of associations and conflicts of interests, such as the fact that the AMA is the Federal Election Commission's (FEC) landlord in Washington, and, as such, receives special favors for it PAC, the second largest in the world.

The AMA's relationship with the tobacco companies is particularly nefarious. Tobacco companies have been the largest contributors to and advertisers in the Journal of the American Medical Association (JAMA). In turn, the AMA has invested and consequently profited heavily in tobacco stocks. The AMA, Robbins explains, has consistently silenced and discredited reports which link smoking with lung cancer, even though in 1950, "it was learned that no less than 96.5% of patients with lung cancer had been smokers." In 1964, less than a month after a Surgeon General's report claiming that smoking causes cancer, the AMA launched a study to determine "if smoking causes cancer." The decade long study, which has yet to find a conclusive answer, was 95% funded by tobacco companies. As damning evidence continues to mount against the tobacco interests, medical interests engage instead in red-herring studies, such as how smoking affects rats, the effectiveness of cigarette filters, and the racial differences in menthol cigarette selection. Tobacco companies spend $11 million dollars a day promoting cigarettes, a good portion going to assuage medical interests.

Perhaps the most poignant chapter in Robbin's book is his critique of the failure of modern medicine's war on cancer. As one esteemed cancer specialist describes our plight, "We have a multi-billion dollar industry that is killing people, right and left, for financial gain. Their idea of research is to see whether two doses of this poison is better than three doses of that poison." Although effective in only 2-3% of cancer cases, and costing on average $100,000 per patient, chemotherapy treatment remains the medicine of choice by doctors today. Robbins, however, chronicles safe and radically effective (up to a 100%) cancer treatments pioneered by hard working oncologists (cancer specialists). Many of these doctors have lost their licenses because medical authorities don't agree with their methods, despite never getting a single complaint from their patients. These physicians and their natural methods are documented in Robbins' book.

To date, the American Cancer Society and the National Cancer Institute have steadfastly refused to conduct double-blind, objective studies to examine successful cancer treatments before condemning alternative treatments. Robbins asks why our medical authorities blacklist alternative physicians when European nations encourage greater patient participation and alternative therapies. Europe does in fact boast of its safer, more successful, and more cost-effective treatments for cancer.

Robbins' research and the extremely high level of documentation and professionalism he brings to his book deserve respect and high praise. Throughout, Robbins is surprisingly compassionate and gentle in his tone considering the horrors he uncovers plaguing our health care system. The gifted teacher Marianne Williamson, author of A Return to Love writes the foreword to this book, and the author of The Chalice and the Blade, Riane Eisler, writes the Introduction. Robbins is persistent in saying that, as a culture, we must literally reclaim our health by taking responsibility for our every action, embracing healthy diets and lifestyle choices. Only then can our nation's healthcare be transformed for the better. Otherwise, we will perpetuate a grossly ineffective, immoral, and costly system. Robbins says, "The medical establishment will get off their pedestal as soon as we get off our knees."