At 23:30 18/06/2007, you wrote:
>Well it is true that those who could afford treatment probably fared worse
>than those who could not. It is quite remarkable that they did suffer
>voluntarily, but this was down to the widespread belief (mediated by
>religious and social conviction) that pain was a necessary route to cure. I
>suspect that any comfort obtained was more to do with appeasement of those
>beliefs. The social standing of the medical profession prior to the setting
>up of the Colleges was the pits and probably with good reason. They were on
>a par with household servants and were considered party to the sufferance
>which had to be endured. History sees them as ineffectual or worse. It is my
>worry that the same judgement may be held about the rapid emergence of
>polypharmacy that we are seeing in the early 21st century. Current studies
>tend to look at individual therapies and I believe that we have
>underestimated the many different dangers of polypharmacy. In chronic
>patients (on loads of medication) a disturbingly high proportion of symptoms
>we manage are side effects of the treatments. I suspect these are
>undereported and that the 'side-effect' is as much orphan to the medical
>profession as is pain.

There is an interesting dichotomy between the reputation of the 
predecessors of pharmacists - the quacks who sold medicine, sometimes 
after rudimentary consultations, the barber surgeons, and the doctors 
who provided care and comfort with or without medication.

It's true that the social standing of doctors has varied, but there 
are many portrayals of doctors in post renaissance art that do not 
suggest scorn or lack of respect, and others where the scorn is at 
people who do have social standing but may not entirely deserve 
it.  The role and position of doctors during the plague was 
interesting, with heroes and villains as you would expect.

In other cultures Witch Doctors and Medicine Men have their own place 
in society which is very far from the bottom.  They may not deserve 
that status, but it does seem to be part of the package.

Of course there is some truth in what you say.  A major part of the 
care needed for cancer patients having chemo or radiotherapy is 
management of the side of effects of treatment.  In a sense almost 
all post-operative care is the management of side effects of 
treatment.  Powerful drugs whether alone or in combination are a 
risk, and we have a major responsibility to give advice and 
information that balances that risk.  Sometimes we should refuse to 
prescribe.  However a blanket refusal to prescribe more than one drug 
at a time would be a nonsense, and I can't imagine this is what 
you're suggesting.  Hence, while we may use different language, may 
place a different emphasis on the balance, I'd like to know what you 
would really do differently?

Julian