Thursday, August 12, 2010
Manifesto of a Lab Rat -- Weighing the Costs and Benefits Part I
Here is the deal. I was lucky enough, and you were lucky enough to be born after the discovery of penicillin (1928). Well, I don't know when you were born. But evidently penicillin was discovered before it became a life or death issue for either of us, or I wouldn't be writing and/or you wouldn't be reading Prozac Monologues. This is good.
In another age, my ruptured appendix might have been treated with leeches. That would not have been good.
As far as my more immediate health challenge goes, we are barely out of the leech stage. Okay, that's a bummer, the timing of my life, that is. But like I said, ruptured appendix, penicillin. It could have been worse.
Research Into Mental Illness -- Rats
In the treatment of mental illness, they have figured out that leeches don't work. They think chemicals might. They just haven't figured out which ones. They are working on it. They have lab rats, rattus norvegicus to be specific, who do the heavy lifting in this Chemistry Experiment. Some people question the ethics of what gets done to these poor rattus norvegicuses who participate with not a single informed consent form in sight. But that not only is another post, it is another blog.
Anyway, the rats can do just so much here. It isn't their problem anyway. The scientists have to figure out how to create something that approximates mental illness in rats before the scientists can try out the chemicals that might cure them. After that homo sapiens have to pick up the load. That seems only fair.
The Chemistry Experiment -- Human Beings
"I get good results from Effexor," my (previous) doctor said. She didn't mean that she took it herself.
"Will it work for me?" I asked.
"We won't know until you try it," she said.
That, in a nut shell, is the Chemistry Experiment.
Then she told me to weigh my costs and benefits.
I have participated in a number of these personal test tube trials with mostly negative, but some positive results. But any experiment is a success if it gives you information. In that sense, the failed trials were not failed experiments. Eventually the experiments led to a better diagnosis and subsequent treatment using a different class of chemicals. Which is good, because we were running out of possible experiments with the previous class of chemicals and needed to expand our horizons. Well, maybe this is good.
Today I have information that I did not have a week ago. It will inform the next trial.
The Chemistry Experiment is not fun. But there is no need to get pissy or throw a pity party or fantasize harm to myself and others. I confess I have indulged in all of that behavior in the past.
Today I make another choice. Today I woke up with a new thought. What I need to do is reframe.
If I am a lab rat, then I will be a free-range lab rat.
There. I feel better already.
Now that I am out of my cage and taking a look around this popsicle stand, I am looking for that scale where they weigh the costs and benefits. You know what? I can't find it. It's not here.
They have all kinds of formulas around this place. They call them algorithms.
Algorithm: A logical set of rules for solving a specific problem, which assumes that all of the data is objective, that there are a finite number of solutions to the problem, and that there are logical steps that must be performed to arrive at each of those solutions.
Logical rules, objective data, finite solutions. Yup. This is a lab.
There are two algorithms most prominently displayed. The first is a differential diagnostic tree. It looks like those charts that the IRS has to help you figure out whether you can take the deduction. If the answer to question #1 is yes, then go to question #2. If no, then no deduction. If answer #2 is yes, then go to question #3. If no, then no deduction. And so on. It is really irritating when you answer yes to question after question, getting more and more excited as you approach the bottom of the page, and then get dumped out with a no at the very end. No refund. After all that work.
But I digress.
The differential diagnostic algorithm is more complicated than that. You have to say yes to one out of this column, and four out of that column, factor in a time frame, ask about current events, past history, and so on. When you get to the bottom of the diagnostic tree, you find -- an insurance reimbursement code.
Well, I am glad that I have an insurance reimbursement code. But I was expecting a little something more from a laboratory full of scientists.
The other algorithm, like the first, takes input of the various symptoms, but includes more information about physical state, age, blood pressure, liver status, other chemicals already on board. Stuff like that. It yields a list of medications. That is more like what I expected.
But still, there is something missing. Where is that scale?
You Have to Weigh The Costs and Benefits
That is what the doctor said. The thing is, you don't know what the costs and benefits are. The doctor knows some of them.
The doctor knows the odds, some of the odds, and may or may not share them with you. For just about any antidepressant, you might hear, if you ask, something like: 40% efficacy, 15% insomnia, 15% mortality rate if you don't take the meds for the rest of your life. The doctor does not mention sexual side effects, unless the medication in question is that one with lower risk of sexual side effects. It still has a risk of sexual side effects. You just won't hear the odds.
So will it work for me? -- We won't know until you try it. Again with the Chemistry Experiment!
The Problem: Do I Want To Participate In This Chemistry Experiment?
I know, I know. Sometimes we are so desperate, we don't even want to know the costs and benefits. We just pop the chemicals in our mouths and hope for the best. That would be me last week. It didn't work out well, which is why last week's post was a rerun. But no permanent damage done.
If you want to skip all the numbers and this weighing without a scale and go by your gut, here is how my gut makes the calculation. I call it the hundred years principle. Today we say, concerning certain medical procedures of the past, What were they thinking?!? For example, and it took less than a hundred years to get to What were they thinking: LOBOTOMY. Enough said.
But I am a scientist. It is true that I am a lab rat, but a free range one. So I have scientific standards to uphold. And the hundred years principle is not scientific.
It is time. It is long past time for a new algorithm, a logical set of rules for processing objective data that will give me a scientific way to weigh my costs and benefits. These other guys keep telling us lab rats that it is our job. They won't do it.
So that, my friends, is what I am developing for your reading pleasure next week.
Assuming that we don't start another chemistry experiment and turn my brain to mush again.