the main gist here is that it is not fun to have an illness with no name, no clear prognosis, and, insofar as someone thinks it is necessary, no clear, commensurate-to-symptoms treatment plan. the need to restate this grew out of recent discussions around malaria diagnosis and treatment of malaria and the broader range of illnesses that can cause malaria-like symptoms.
the introduction of diagnostics into the SOP of addressing malaria results from the change in WHO policy away from presumptively treating all fever with malaria medication. using malaria meds as the answer to all fevers has led to over-use of malaria meds, lowering the mojo of their api. and, the likelihood of mistreating a fever as malaria is rising as underlying malaria epidemiology changes. as such, this seemed like good moment to reflect on other common understandings of the causes of symptoms and how they should be treated, as well as the desire for some treatment that matches the symptoms. i focus on a few US/UK examples, especially as we move into cold season.
the first confession is the nearly obscene number of times i have watched this sketch, in which john cleese teaches his students to defend themselves against fresh fruit, which he sees as the weapon of choice of most criminals as well as the root of most illnesses (or the cure for illnesses, including flu, depending on which version you watch). cleese fears fresh fruit – far more than point-ed sticks – and therefore proposes it as the cause of any problem with nebulous threat, as well as enacting fairly disproportionate treatments given the threat.
the second confession is how much i didn’t care for the article i am about to summarize. at the time, as one of the first reads in my first medical anthropology class in undergrad, it seemed awfully mundane in the face of a selection of many more romantic and exotic articles about places i had not yet been and diseases which i had not yet heard of, let alone had. but, i have ended up returning to it many times – more than some of those other articles. this is mccombie’s piece on ‘folk flu and viral syndrome.’ the article is quite amusing, interesting, and worth reading in full. mccombie describes that in the southwestern US, at least, people use ‘flu’ as a catch-all for feeling crappy, including covering a probable hangover. this ‘folk flu’ and misinterpretations of ‘flu-like symptoms’ can be a real impediment to appropriately treating the actual cause of the symptoms. similarly, better understandings of ‘folk malaria’ and how to convince people that their symptoms are caused by something else would be useful (some research has, of course, been done on this, including by mccombie; i’d suggest that additional qualitative work would be quite helpful). the second half of mccombie’s article covers the same type of catch-all for non-specific, undiagnosed problems by providers, who label a problem as ‘a virus’ when ‘they aren’t sure’ what is wrong with you. it’s better than being told that you are imagining things, of course, but not all that much.
the third confession is that i am/was an airborne junkie at the first sign of illness, especially in the face of symptoms with no clear bacterial or otherwise medicate-able diagnosis with something more than fluids and rest. this craving extends to using echinacea lollipops (found only in the US, i presume?), terrible zinc tablets that make one vomit, etc – almost anything (not mint) to feel like i am being proactive. if there ever were a place where it makes sense to try to introduce placebos as an actual treatment option, the ‘treatment’ of non-life-threatening viruses that make you feel generally crappy must be it. it would limit the temptation to mis-treat with powerful drugs whose powers we all benefit from preserving. (see @danariely on the excellent placebo qualities of airborne for guidance on the way forward.)
so, fourth confession, i wish we could introduce placebos as an actual treatment option, for ‘flu’ and ‘malaria.’ if you’ve watched the birdcage (the robin williams & nathan lane version), you’ll know the value of ‘pirin’ tablets. as for the ethics of this and the providers’ ability to keep the secret, that’s for another debate.
but the initial point holds. people want a named diagnosis that makes sense, that has some sort of prognosis, and that has a treatment that fits our conception of the problem. so, we may not be able to do placebos but we also probably don’t need to release a tiger to tackle a man wielding a banana or loganberries, threatening though that can seem. once a tiger’s (antimalarial, antibiotic) out, it’s kinda out. you need to give people a comforting way to feel proactive without calling down the thunder.