My cynacism shows

I started out heading toward health care ministries when I was a seminary student. I served two consecutive internships at the Hinsdale, Illinois Wholistic Health Care Center and focused a lot of my attention on the relationship between skills nursing, medical physician care and pastoral counseling. At our clinic we offered the services of professionals working as a team to care for the spiritual, psychological and physical health of our clients. It was an interesting time to be paint close attention to the research surrounding mental health care. Psychopharmacology was exploding with new drugs being offered on a regular bases. Many chemical solutions were explored and some seemed to be very promising. There were a host of medicines that produced reduction in stress levels and relief from other symptoms. Some of those medicines came with a high cost in terms of side effects. Some of them mysteriously worked quite well with some patients, while not working at all with others. The clinical trials and the research, much of it funded by the National Institutes of Health were increasing our understanding of brain chemistry.

What we didn’t notice at the time was that the increased funding for chemical research and the promise of drugs that affected psychology was also giving rise to an enormous pharmacology business. There were huge profits to be made in developing and selling drugs and the industry was growing by leaps and bounds.

Less noticed was that the emphasis on chemistry was allowing medicine to pay less attention to electrophysiology. Scientists have known for a very long time that the human brain is a complex organ affected by chemistry and electricity. Synapses fire. Receptors receive signals. And the relationship between electronic signal and chemical interactions is complex. We are not beings with two separate systems that can be treated independently, but rather possess an interconnected system. Chemistry affects electrophysiology and electrophysiology affects chemistry.

There were some interesting and promising studies being done, but in the days before advanced brain imaging, there was a lot of trial and error. Electroshock therapies in those days were almost barbaric in their use of huge amounts of current and the imprecision with which it was administered. While some patients did experience a decrease in symptoms from early electroshock treatments, they often came at the cost of memory loss and other severe side effects.

The scales tipped in favor of chemical treatment of mental illness for decades. As neurofeedback therapies were developed and are now being refined in clinical settings, it has been very difficult for researchers to obtain funding for their experiments. Most insurances do not cover the cost of neurofeedback therapies even though they have now been shown to offer significant promise for those who suffer from a wide variety of illnesses including PTSD.

There has been a bit more balance when it comes to research into heart disease and conditions that affect the coronary system. Perhaps it is because a basic diagnostic tool for heart health has long been the stethoscope. Physicians listen to the rhythm of the heart to determine what is going on. As a result cardiologists have develop skills in both the chemistry and the electronics of the heart. These days a contemporary cardiology practice will employ both specialists in the “plumbing” of the vascular system and electrophysiologists who work with the “wiring.” Both are trained in chemistry and employ medicines in their work.

All of this is a bit of background into the announcement yesterday that the three largest health care systems in South Dakota are combining to undertake studies in the use of hydroxychloroquine for the treatment of COVID-19. President Trump has enthusiastically promoted the medicine as a treatment for novel coronavirus. Last month, the Food and Drug Administration granted emergency approval to allow hospitals to use hydroxycloroquine from national stockpiles. The State of South Dakota has obtained 100,000 doses for the trial.

Skeptics, myself included, worry that this massive trial, effectively involving an entire state, is a bit misguided. Earlier trials have shown little evidence that the drug works. Worse yet, multiple other clinical trials in other states and other nations have been suspended because patients taking the higher doses of the anti-malarial drug demonstrated irregular heart rhythms and increased risk of potentially fatal heart arrhythmia.

It would be so nice and so simple if there was a pill that could be taken to treat COVID-19. But we human beings are complex entities.

And here is where my skepticism turns to cynicism. I have no doubt that the governor and the administrators of the hospital have signed on to this study because they want to find an effective treatment for the disease. A disease that is wildly communicable and that is resulting in the death of so many deserves the best that science can bring forward and discovering an effective treatment would be a wonderful thing. There is, however, nothing ground-breaking about the South Dakota studies other than the scale. Trials of the drugs in the South Dakota study have been undertaken in China, Brazil, and multiple states in the US including New York. The cynic in me wants to explore other possible motivations for such a study.

Is it possible that the pandemic has placed health care systems in precarious financial circumstances? There isn’t a lot of money in treating the disease at the moment. And with massive unemployment resulting from efforts to slow the spread of the disease, hospitals will see more and more patients who don’t have insurance. They have also suspended many elective procedures, the very procedures that result in the most income for hospitals. A large clinical trial brings in research dollars that are desperately needed by the hospitals in this time. That much isn’t my cynicism.

I’m married to a woman who had a near-fatal reaction to a drug that caused a heart arrhythmia. Her reaction to the drug resulted in her heart stopping twice. She received CPR and was intubated and survived the episode. The first day of her treatment resulted over $150,000 being transferred form medicare and our supplemental insurance company to the hospital. Subsequent treatments brought the transfer of funds to nearly a half million dollars. That’s the kind of money that even a huge medical system can’t afford to ignore.

I’m not saying that the doctors administering the study aren’t aware of the risks. I’m not saying that they are being cavalier in their trials. I’m just saying that I’m skeptical and there are moments when I can become cynical.

A vaccine will be developed. New treatments will be discovered. But I’m not holding my breath for South Dakota to be the source of the solution.

Copyright (c) 2020 by Ted E. Huffman. I wrote this. If you would like to share it, please direct your friends to my web site. If you'd like permission to copy, please send me an email. Thanks!