physicians, symptomatic treatment, Sir William Osler,

On Chasing Tails and Rabbit Trails

On Chasing Tails and Rabbit Trails

© 2006 Wellness Clubs of

Anyone who has ever watched a dog chase its tail knows that it is an exercise in futility. Around and around it goes, as fast as it possibly can, nipping vainly in an attempt to grasp the illusive streak of fur as it dangles tantalizingly in front of its nose. Eventually the poor animal collapses, panting, having failed to capture its prize.

Canines are also known for their tendency to get sidetracked. Even some well-trained hunting dogs occasionally become distracted and follow a rabbit trail through the woods. While not as comical in appearance as tail chasing, the practice of following rabbit trails is equally non-productive. While appearing to be in hot pursuit of its prey the animal is actually moving further off track with each step it takes.

These behaviors are expected in dogs. They are at times comical and at other times frustrating, but they are, given the animal’s basic nature, predictable. It would be nice to think that humans, with our superior intellect, avoid such exercises in futility. Unfortunately, we engage in similar activities quite often.

Tail chasing and pursuit of rabbit trails have become common medical practices in the United States. The consequences are tragic for physicians and patients alike.

Medical tail chasing results when physicians are taught to treat symptoms rather than the actual causes of disease. Sir William Osler, the esteemed Canadian physician who went on to teach at the Johns Hopkins College of Medicine and at Oxford University once said, with good reason, “It is the primary responsibility of the physician to teach his patient not to take medicine.”

I appreciate the wisdom of that statement more with each passing year. Medicines may temporarily relieve symptoms, but they cannot cure disease. The root cause of the disease lies at a depth no drug yet patented can reach.

Whenever a person begins taking drugs to deal with symptoms he is apt to start “chasing his tail.” The drug blocks the appearance of the bothersome symptom, but itself creates new symptoms. Another drug is added to deal with these symptoms, which leads to additional symptoms. Soon the individual is taking multiple drugs to ease the discomfort while the cause of the illness is not addressed and the illness worsens.

An example of this is the individual who begins to experience joint pain from deterioration of the cartilage, a condition called osteoarthritis. Rather than dealing with the nutritional deficiencies causing the wasting of the cartilage an anti-inflammatory medication is prescribed to relieve the joint pain. The anti-inflammatory drug weakens the protective mechanisms of the stomach and also lowers the efficiency of the kidneys in clearing fluid and waste from the body. A drug is prescribed to shut off the manufacture of stomach acid. This adversely affects the body’s ability to absorb important minerals.

The loss of minerals coupled with the inefficiency in kidney function causes an increase in blood pressure for which an antihypertensive medication is prescribed. The blood pressure medicine affects the levels of neurotransmitters in the brain and the person becomes depressed. An antidepressant is prescribed, which triggers constipation necessitating the use of a laxative. Within a relatively short period of time the hapless patient finds himself taking five prescription drugs, feeling worse than when he was taking none, and wondering why his health has deteriorated so quickly. He is “chasing his tail” and will ultimately collapse from exhaustion, having failed to capture the prize of better health he had been seeking.

Pursuit of rabbit trails in medicine has less to do with the habit of prescribing drugs than it does with the enthusiasm for ordering laboratory tests in pursuit of a diagnosis. It is not uncommon today to find individuals who have spent a small fortune on tests trying to find an answer to the problem they are facing. The problem with pursuing laboratory tests is that abnormal results may themselves be viewed as the cause of the disease, rather than simply an additional symptom.

There is a tendency to think that something that is felt is a symptom and something that is found in a laboratory is a cause, but nothing could be further from the truth. Disease affects the body in many ways. It can present with physical signs or symptoms or it can present with abnormal chemical or x-ray findings. The difficulty comes when the abnormal test results are viewed as the end rather than an additional symptom of the underlying abnormality.

An example of a medical rabbit trail is that of a young lady who began experiencing sharp pains on the right side of her chest. Although the pains were unrelated to when or what she was eating her physician decided to check out her gall bladder. An ultrasound was obtained, which was completely normal.

Unfortunately, the well-intentioned physician had forgotten the nature of her original complaint and was absorbed in his pursuit of the rabbit trail he had found. Not satisfied with the normal ultrasound result he ordered a HIDA scan, a test of gall bladder efficiency. The gall bladder did not function properly at the time the scan was performed, so the patient was advised to have her gall bladder removed.

Being a teacher she elected to wait until the school year was completed to undergo the procedure. I saw her two weeks before her gall bladder was to be removed.  I listened to her story, recognized that the pain she was having was not typical of gall bladder disease, and examined her chest and spine.

I discovered that one of her ribs was not seated properly. This was causing excessive strain on the muscles of the chest wall resulting in painful spasms. A simple rib adjustment corrected the problem and she was able to keep her gall bladder, something that will serve her well for years to come.

I am hoping to make three points. The first is that if you have been taking a drug for longer than two weeks it is unlikely that the root cause of your illness has been identified. It is not possible to identify the root cause or causes in every situation, but they should be pursued nevertheless.

The second is that if you are taking multiple drugs it is quite possible, indeed likely, that you are “chasing your tail” and that the drugs are contributing more to your disease state than they are relieving.

Finally, pursuing a diagnosis rather than addressing the known causes of illness is, in many cases, nothing more than following a rabbit trail. It is unhelpful at best and harmful at worst. Find a good listener who is well versed in the causes of disease and invest in his or her wisdom rather than impressive and expensive x-rays and lab tests. You will, in most cases, be rewarded with a much better quality of life.

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