The cross : On time where general practitioners are lacking, medical surgeries are invaded by what you call the “non-diseases”. What is it about ?
Luc Perino : Intuitively, these are thought to be diseases that doctors fail to put a name to. In reality, it is the opposite: a non-disease is a disease diagnosed but without symptoms. The most eloquent example is that of intracerebral arterial aneurysms, which have begun to be detected massively with the development of scanners.
In theory, informing the patient of this anomaly is commendable, since the aneurysm threatens to rupture and lead to death or serious sequelae. But should we be alarmed at the slightest anomaly, knowing that the only recourse is an operation from which the patient has only a one in two chance of coming out alive? To what anguish do we condemn him, even though there is only a tiny risk of a ruptured aneurysm occurring?
Are technological advances necessarily accompanied by drifts?
L. P. : They are not problematic in themselves, on the contrary, but in medicine as elsewhere, they can create new risks. In the case of serology, for example, the progress in two decades has been dazzling, so much so that we have not had time to integrate them intellectually. Result, we track all over the place: sugar, cholesterol, not to mention the Covid. In addition to representing a significant cost, it does not always benefit the patient.
Has modern medicine lost sight of the interest of the patient?
L. P. : In any case, she tends to neglect her subjectivity. Blood tests and MRIs show nothing? Then the patient is not sick, even if he complains! What is more surprising is that the citizens themselves have integrated this omnipotence of biomedicine, even if it means denying their suffering. However, health is something eminently subjective: to be in good health is first of all to feel as such. And vice versa.
You go so far as to say that going to the doctor can be dangerous. Aren’t you exaggerating a bit?
L. P. : The best therapy is sometimes abstention. It’s not me who says it, it’s Hippocrates. Obviously, this is not to say that cancer is cured naturally. But in some cases, such as hypertension, the wisest course is often to do nothing.
When it is mild or moderate, the risk of worsening hypertension is very low. The benefit of the treatment for the patient is therefore less than the side effects that will affect his daily life. Despite the very low probability of a stroke, many doctors will opt for treatment.
How to explain it?
L. P. : This is sometimes due to the insistence of the patients themselves. The most caricatural example is that of the PSA assay (a protein made by the prostate, editor’s note) to screen for prostate cancer. The Haute Autorité de santé may formally advise against it, but some doctors give in to the pressing demands of patients, a bit like they sometimes feel obliged to prescribe antibiotics.
Another reason is their lack of interest in pharmacovigilance. The idea that the authorities could have authorized treatments that are not safe or even likely to cause harm seems inconceivable to them. Major scandals such as that of the Mediator have however shown that we must remain vigilant and that the omnipotence of the market does not spare health.
What is a good doctor in your opinion?
L. P. : It is a doctor who evaluates what is good for his patient, not only in terms of results of examinations or a hypothetical illness, but for his quality of life. That’s being reasonable, and medicine isn’t that much anymore. On the one hand, antenatal screening is practiced to avoid malformations; on the other, premature babies are resuscitated to the limit where the risk of future disability is extreme… The role of the doctor of tomorrow will undoubtedly be this: to protect citizens against the excesses of medicine.
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Its compass: the Cochrane Library
“The lack of medical publications not subject to the influence of the labs is problematic”, launches Luc Perino, regretting that research sometimes yields to the sirens of pharmaceutical lobbies. For him, there are few trustworthy magazines: on the French side, the monthly Prescribe ; British side, British Medical Journal et “a little” The Lancet, whose reputation was however tarnished in 2020 by the publication of a controversial study on hydroxychloroquine in the treatment of Covid, which was finally withdrawn. Doctors therefore rely more readily on the Cochrane library, whose reviews are compiled by the international network of the same name, which is independent and non-profit. A model “free from conflicts of interest” which, in his opinion, would benefit from development.