…and what are PIM’s?

This blog was prompted by an email I received last week from a reader. “Did Bernard…” she wrote, “…make any direct contribution to human wellbeing”.

Imbued with the philosophy of René Descartes – that one should always doubt and then search for proof, Bernard was a fully-qualified doctor who then refused to practise medicine. His basic tenet was that most medicines at the time were ineffective or of unproven value. “Current treatments are nothing more than human experimentation…” he said, “…I prefer to experiment on animals.”

In his lectures to medical students, he insisted on avoiding guesswork and tradition in the choice of therapies: their value had to be proved before being used. He also emphasized that all medications were potentially poisons, especially if taken in higher doses. Conversely, he also showed that many poisons used in smaller doses could prove to be valuable medicaments.  Above all, he enlarged on the teaching of his one-time master, François Magendie. When asked by junior doctors what medication they could prescribe he often replied: “Have you tried doing nothing?”

Indeed many illnesses – and particularly in the young – are self-limiting.

Potentially Inappropriate Medications (PIMs) are a topical subject, and the use of multiple medication (polypharmacy) is particularly common in the over-65 age group. A few years ago Garfinkel and his colleagues in Israel discontinued on average 3 drugs per patient in half the residents of a nursing home. Over the next year this half survived twice as long as the other half whose treatment had been unchanged. Also during this year, acute problems arose only half as often in the first group as in the other residents.

Over-subscribing is rife throughout the world – it is costly, and above all dangerous.

I think you would agree that Bernard contributed grandly to human wellbeing – if only we had listened!



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