Sunday, November 23, 2008
Blimey. That mild expletive apart, posting is proving difficult as I have the worst case of jet lag ever and one of the most persistent chest infections - both signs, I suspect, that life's off-ramp is somewhere round the next bend. My chest has never been much good - as a chest at least. Every winter for the last five years or so I have caught a cold that turns into a sinus infection followed immediately by a chest infection. The solution is two courses of antibiotics accompanied by inhalations of Seretide, a steroid in powder form which I suck in from a small hole in the side of a purple plastic flying saucer. Bones increased my Seretide dose this time round - yep, that's the off-ramp - and, returning for my second lot of antiobiotics, I remarked that this higher dose gave me a slight steroid rush. This rush will be familiar to anybody who has been on high doses of oral steroids - it's pleasant in that it gives you energy but unpleasant in that it destroys your concentration. Bones responded to my rush report by saying, 'Hmmmm, it's supposed to have only a local effect.' Translation: 'You're imagining the rush.' I found this troubling. Obviously, at one level, I simply can't be imagining the rush. Only I have access to this rush and, if I feel it, then it's happening. But that's precisely the kind of epistemology that screws up doctors and drugs companies. If they have to acknowledge the legitimacy of every reported side effect, then the warnings on American TV drug ads will wipe out the schedules, every time you turn on the TV on the Holiday Inn Express you'll be told that Seretide can give you a mild rush and the little slips of paper that come with your drugs will be replaced by telephone directories. They will say, of course, that I am not to be believed as Seretide's effect is purely local - probably an aspect of molecular size - but this is unpersuasive as we now know that drugs have wildly different effects on people, probably because of subtle genetic variations called riflips. This is all further confused by the placebo effect. It's worked on me - since encountering Bones's scepticism, I haven't been getting the rush. I might up the dose further just to convince myself a non-local effect is possible, so if the next thing you read is my obit, you'll know what's happened. This liminal land between subjectivity and science is, as ever, a fun and risky place to be.
Posted by Bryan Appleyard at 10:42 am