April 10, 2021

Today is Tommy’s birthday. He would be 56 today if he were still living. Perhaps it’s fitting that I spent the day performing for his beloved Opera Birmingham in the inaugural performances of a shortened outdoor romp in the park version of The Pirates of Penzance. He was with me today. I could feel him running around the ampitheater, redecorating the set, supervising the front of house staff, and turning up in the pirate chorus. Gilbert and Sullivan weren’t really to his musical taste but he was all in on any project he had a hand in, whether he personally liked the material or not. He would even have appreciated the weather, with last night’s thunderstorms dissipating by about nine this morning and everything sunny and relatively cool by show time. Other than some minor bobbles with my police choreography in the second show (marching and singing in a mask is enough to make anyone tired), I personally felt it went well and the audience was more than appreciative to at long last attend a live music/theater entertainment conceived to be Covid caution compliant for both performers and spectators.

Many of the patrons were older and therefore have had their vaccines for some weeks and are now venturing out after a year of confinement. The state’s mandatory mask order expired as of yesterday (and our governor is not renewing it but is also not standing in the way of any local ordinances or business decisions) but the city of Birmingham’s remains on the books for a while longer and the audience was compliant with masks and social distancing without complaint. Local numbers have been trending up again the last few weeks, mainly among younger unvaccinated folks. Jefferson County cases, which over the last two weeks had trended down from 80 to about 30 new cases a day, suddenly spiked at the end of last week to over 100 again, likely the result of spring break. Hopefully, it’s a momentary spike and will immediately trend down again. Total US cases keep going up – we’re over 31 million now with more than 561,000 deaths. Only about 60,000 more to go until Covid surpasses the Civil War in terms of death toll and that took four years. On a more modern scale, the number of dead just surpassed the population of Albuquerque to become the 32nd largest city in the country.

I’ve been casting about for a medical topic to write about and it hit me yesterday when one of my patient’s brought in some new patent ‘brain food’ they’ve been taking to stave off the memory loss of aging. I always ask that people bring me the bottles of such things so I can scan the ingredients and determine if there’s anything in them that might interfere with other medications or might cause unpleasant side effects. Most of them are vitamin and mineral supplements (not harmful for the most part, but often not necessary) with various herbs added (potentially problematic depending on the blend and strength). As a physician with a relatively holistic approach to health, especially with the aging (most older people understand their bodies quite well, having lived in them a long time and know what to do to keep them well balanced), I never discourage people from doing what they think is best for themselves, I just try to give them any information I have based in science so that they can make educated choices.

I have a local chiropractor I trust to whom I refer as they can sometimes be more helpful for low back pain than allopathic medicine. I also refer to an accupuncutrist/herbalist locally. There’s a local complementary medicine clinic run by a well trained doctor who works well with the anxious and somatisizers and who is smart enough to refer back to me when he recognizes some real pathology. I don’t see any of these as being any sort of problem for the right patient. So much of medicine is getting people to tap into their own body understanding and wellness that these are just additional tools to do that.

I’m not as fond of the pills. Actual herbs and extracts used in traditional ways are fine but the lumping of a lot of things together, slapping a pretty label on it and advertising it all over late night television is something else. The manufacturers of such products who had long run riot selling pretty much anything in a bottle, were brought to heel by the Dietary Supplement and Health Education Act of 1994. This piece of legislation allows these products to be classified legally as nutritional supplements and therefore exempts them from regulation by the FDA as drugs. In return, they are not allowed to be promoted as a cure for any sort of disease and the labels are, in theory, supposed to match what’s actually in the bottle. (Multiple studies of proprietary studies show that about 1/3 do not contain what’s listed on the label and another 1/3 contain active ingredients which are not listed. A 2013 study of supplements found over 750 varieties that contained unlisted pharmaceutical drugs which should be FDA regulated). That’s why the ads always say things like ‘not intended to cure any disease’ and they are sold for vaguely defined conditions such as ‘wellness’ or ‘more energy’. I gently try to steer people away from them.

At the same time, I do recognize the desperation people feel when faced with serious illness in themselves or a loved one. I’ve felt it myself when confronted with two husbands critically ill with conditions for which I could offer nothing other than love and presence. If I thought there was healing magic in a bottle available, I would have raced out and gotten it, no matter the obstacles. My training, however, makes me understand that miracles are rarely obtained in capsule form. This wasn’t always the case. A couple of generations ago, in the depths of World War II, brilliant minds finally figured out what Alexander Fleming’s orange mold penicillium was actually good for. When applied to injured battlefield troops, it prevented the wound infections and septic shock that had always killed the majority of soldiers and the antibiotic era was born. After the war was over and there was enough of the new wonder drug left over for the civilian population, previously fatal infections were beaten back. Mix this with an intact infrastructure (the only one in the Western World after World War II) and the idea of American exceptionalism in medicine was born and, in the immediate post war years, was absolutely true.

The idea that miracles can be found in pills took full root in American culture and to this day, everyone wants a quick fix two week course of something. While this model works fine for acute infectious disease in the young, it’s not so helpful for the usual chronic diseases of the elderly. The best thing for these is primary prevention, keeping them from ever setting up shop in the first place and this usually requires an understanding of good health habits and a willingness to partake of them routinely. Most would rather do what they want when they want and then demand a fix from the doctor when things have broken down enough to require serious intervention and repair. This does not sit very well with the baby boom in particular. They’re going to be livid in another decade when they finally figure out that neither I nor any other physician in the country has a copy of Ponce de Leon’s map tattooed on our hineys and we can’t turn back time. (Sorry Cher).

If you knew Tommy, give him a thought today. And have some carrot cake in his honor.