Medical Lifeboat

Hi, Doc Contrarian here. Yes, I’m a real MD, but that’s not my real name. I’m not telling you my real name, because that would be telling. Sometimes I like to rile people up with my opinions, or as I like to refer to them, my irrefutable truths. Other times I just like to sit around and think about medicine, because I’m a colossal nerd. All doctors are really, even the surgeons. Especially the surgeons. They’re nerds that will cut you.

Ahem. Anyway we’d like to apologize for that last paragraph, which has nothing to do with the theme of this post, which asks the following question:

What are the most important medicines? If you were marooned on a desert island and only bring one medication, what would it be? How about ten medications? If it’s a shipwreck, are we talking a Navy guided missile cruiser full of healthy seamen, or a typical cruise ship, in which case half the passengers crawled on board needing an ICU anyway? Are we talking tropical island or something like the South Shetlands? How long are we going to be there? A week? A year?

Wow, that’s a lot of questions. Let’s make a few assumptions. There is someone on the island with enough medical knowledge to correctly give out medications. But there are no needles or scalpels or refrigerators or sterilizers. Let’s begin.

If you could only take one medicine, and only one, that would be a no-brainer. It would have to be a broad spectrum antibiotic. Probably one of the tetracyclines.

What about people who are allergic you ask? Welp, the 99.5% of people that aren’t really allergic but are mistaken or just being drama queens will be fine. The other 0.5 % will be removing their defective genes from the pool, so there’s that.

Antibiotics are the most amazing thing. Probably nothing, not spinning jennies, not Rotherham swing plows, not even cell phones has done more to revolutionize human life and create the modern world. Too bad doctors hand them out like candy as a get out of my office parting gift, for conditions that antibiotics don’t actually treat and thereby help to create resistance. (Doctors do this because it takes too long to satisfy the customer without tossing them a bone, that is a hopefully harmless prescription.)

Let’s make it more interesting. What about ten medicines? That’s actually a lot of medicines. You see, 75% of medications are just “me-too” knock-offs, timed releases, enteric coated, syrups, capsules, I don’t know, suppositories, combination medications, “active isomers”, (a shuck to allow drug companies to extend their patent protection) and so on.

Take NSAIDS (nonsteriodal anti-inflammatory drugs) like aspirin. Drugs such as ibuprofen, piroxicam, naproxen, voltaren etc., etc. They’re all just aspirin with some slight modifications. Some don’t work as well, that ‘s the big difference. Some you can take a little less frequently. And all, no matter how coated or packaged will eat right through your stomach lining just the way aspirin does. That’s how NSAIDS work.

So behind door number 2—aspirin. It’s not just a floor wax, it’s also a dessert topping! It ‘s a very effective pain killer, it’s an antinflammatory, and an antipyretic (lowers temperature.) In addition, it’s a fairly effective blood thinner, which will be helpful if your shipwreck is a cruise ship and you have a lot of fellow castaways with various heart and circulatory problems.

What should be behind door number 3?

Tune in for the next post of Medical Lifeboat to find out.

Disagree with our list so far? Got a suggestion? Leave us a comment.