Monday, April 20, 2020

Η τεκμηριωμένη ιατρική (evidence-based medicine) δεν είναι το δυνατό σημείο της ιατρικής



Για να καταλάβουμε τί σημαίνει "ειδικοί", και ότι είναι άκρως επικίνδυνοι, και ότι αποφασίζουν βάσει του τί νομίζουν ότι είναι σωστό, ασχέτως αντικειμενικών στοιχείων, ας δούμε πώς πέθανε ο πρώτος πρόεδρος των ΗΠΑ, George Washington.
Ανέπτυξε ένα οίδημα στον λαιμό. Εξ αιτίας της φλεγμονής άρχισε να συμπιέζεται η αναπνευστική οδός και δεν μπορούσε να αναπνεύσει σωστά. Όσο περνούσε η ώρα ο λαιμός του πρηζόταν περισσότερο.
Κάλεσε τους ανθρώπους του και η πρώτη ιατρική πράξη, με εντολή του ιδίου, ήταν αφαίμαξη. Μιλάμε για το 1799, υποτίθεται ότι η ανθρωπότητα είχε βγει από τον μεσαίωνα.
Μετά ήρθαν δύο ιατροί. Και οι δύο συνέχισαν την αφαίμαξη. Δεν ήξεραν τί άλλο να κάνουν. Μόνον ένας τρίτος ιατρός είπε ότι η μόνη λύση είναι η τραχειοτομή. Η διαδικασία ήταν ήδη γνωστή, αλλά όχι στην Αμερική εκείνη την εποχή.
Ο ιατρός Elisha Cullen Dick που πρότεινε την τραχειοτομή, επέμενε να αναλάβει αυτός την ευθύνη και να προχωρήσει στην επέμβαση για να σώσει τον ασθενή. Οι άλλοι δύο ήταν αμφιταλαντευόμενοι έως αρνητικοί.
Συνέχισαν με την αφαίμαξη ως "θεραπεία". Φυσικά ο θάνατος του ασθενούς επήλθε γρήγορα.
Μιλάμε για τον πρώτο πρόεδρο των ΗΠΑ, όχι για κάποιο τυχαίο πρόσωπο, για το 1799, και την χώρα η οποία επαναστάτησε κατά της Αγγλικής αποικιοκρατίας με σύνθημα την ελευθερία.
Αλλά η καθεστωτική "ιατρική" ακόμη και τότε, δεν είχε εξέλθη του μεσαίωνος.
Να δούμε πότε θα εξέλθουμε εμείς από τον εμβολιαστικό μεσαίωνα.
Η τεκμηριωμένη ιατρική (evidence-based medicine) δεν είναι το δυνατό σημείο της ιατρικής.
On 13th December 1799, after having inspected his farm on horseback in the rain, he complained of a slight sore throat, considered to be due to the beginning of a cold. The next night, between 2 and 3 a.m. he woke up and had difficulty in breathing and pain upon swallowing.
He did not go back to bed, also because the symptoms were becoming worse. In the morning, at breakfast time, he summoned his farmer and old friend Tobias Lear ordering him to proceed with bleeding him, a treatment which was very popular at that time for any kind of disease, which was practised not only by physicians but also by ordinary people.
Approximately 250 ml of blood were collected. At 10 o’clock that morning, Dr James Craik and Dr Gustavus Brown arrived, both of whom physicians to the patient, as well as very good friends. Examining Washington, they found an inflamed throat but on account of the symptoms: pain in the throat, difficulty in swallowing and pain when talking, a diagnosis of inflammatory quinsy was made, i.e., stenosis of the upper airways which can lead to suffocation.
The two doctors ordered a more copious bleeding and another 250 ml of blood were removed. As time passed and no improvement was observed, they decided to ask Dr Elisha Cullen Dick to come. This young physician from Alexandria, whom they very much admired, got his degree in Medicine at the University of Pensylvania. Whilst waiting for Dr Dick, since there was still no sign of improvement, Craik and Brown bled the patient for the third time.
At 3 in the afternoon Dr Dick arrived and after having examined the illustrious patient, he consulted with the two senior colleagues, suggesting that a tracheotomy be carried out. On account of the obstruction in the airways this was the only feasible treatment, but apparently this procedure was little known in America. Nonetheless, Dick, convinced that this was the only way that might save the life of G. Washington, declared that he was prepared to take full responsibility for eventual consequences.
Craik was, initially, in favour of proceeding, but when Brown pointed out that the patient could die during the operation, he changed his mind. The three doctors then agreed that a fourth bleeding should be performed. A total of 32 ounces of blood were removed – almost 1 litre – which added to the previous bleedings came to a total loss of blood of almost 2 litres.
The patient, obviously showed signs of weakness, but preferred to remain in a sitting position on account of difficulty in breathing. Meanwhile, his state of restlessness increased. At 8 o’clock in the evening, vescicants were placed on his legs and a fibre collar put around his throat. At 10 o’clock, breathing became lighter and the situation seemed to be improving, but at 11.30 the patient died. His doctors, devoid of resources, were beside his bed.

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