Friday, March 16, 2007

Side Effects II

Potentilla's most recent post on her Metastases blog over at Auspicious Dragon discusses amongst other things drug side-effects. When you feel bad, is it the drug or your illness and other issues ... I'd like to quote her:

"
Whilst researching the side-effects of Cefalexin (to see if nausea was one of them, which it is, but I think my nausea was in fact because of jaundice), I read a couple of sites which allow patients to “review” drugs. I’m not that convinced about the benefits of these, since anecdotes are not evidence, but given the difficulty of finding out what side-effects are genuinely possible or probable (as opposed to the legally-driven Patient Disinformation Leaflets), they can be of passing interest.

Anyhow, I was mildly amazed by how confident many of the posters were about what actually caused their symptoms - I mean, whether it was the drug, or the original condition, or something else. (Why have I been nauseous?) OK, the human race is collectively too ready to confidently ascribe causation where none exists - but I also realise that many of the posters have something which I no longer have, which is a default state of systemic wellness. Most of the time, they feel OK; so when they start to feel ill, it must be easier to notice what the symptoms are. (I say systemic to exclude the non-systemic chronic sources of not-wellness, like myopia, or verruccas, or piles, or cold-sores).

A default state of systemic wellness is the norm in rich countries. When we are systemically ill, we at the very least have sympathetic allowances made for us, possibly formal ones if we are, for instance, sitting exams; and if we are a bit worse, we actually opt out of normal life for a while. I was recently reading something about “national IQ” studies, including the fact that “national IQ” for many African countries, especially sub-Saharan ones, is lower than for rich countries. As you might expect, there is much discussion and dissension about possible reasons for this (measurement effects, culturally inappropriate tests, malnutrition in infancy, genetics); but one possible reason that does not seem to be much considered is that systemic wellness is not the default state in the relevant areas. In a poor country, even if you practically always have one, or several, untreated systemic infections, you can’t afford to opt out of normal life. It seems really quite likely to me that a significant proportion of people being IQ-tested in such countries are, by rich-country standards, ill. (And of course, ill people in rich countries mostly don’t take IQ tests, which would increase the effect). Being systemically ill certainly can have an effect on cognitive ability, as I know from personal experience. Perhaps the researchers need to recruit self-sacrificing people who are willing to sit IQ tests both when they are systemically ill and when they are well, to try to get an idea of the size of the adjustment that would be appropriate. Assessing what proportion of testees were systemically ill would probably be easier."

In the "developed world" we take good health very much for granted.

1 comment:

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