TORONTO — Imagine treating a pregnant woman’s morning sickness with an injection of cocaine. How about prescribing cannabis for epilepsy? Or tobacco smoking for asthma?
These are but a few of the strange recommendations found in the first Merck Manual for physicians, a 192-page, pocket-sized reference book of the “chemicals and drugs usual in modern medical practice,” published in 1899.
How medicine has changed.
That the healing arts of Hippocrates and Galen have undergone a radical transformation even in the last century is no more evident than within the pages of Merck’s most recent offering, the revised Home Health Handbook for consumers.
At more than 2,300 pages, the hefty tome details the symptoms, causes and treatments of thousands of conditions — from eye and lung disorders to cancers and infectious diseases — as well as health issues specific to men, women and children.
The third edition of the Merck home health guide, first introduced in 1997, took three years to update and called on the expertise of more than 300 medical specialists, says editor-in-chief Dr. Robert Porter.
“What I think that illustrates as far as what’s really changed between 1899 and 2009 — or 1969, for that matter — is how we tell what works,” says Porter, contrasting the contents of the pharmaceutical company’s inaugural reference book to its latest one.
That first slim, black-covered volume provided an alphabetical listing of common diseases, each with its own often lengthy column of drugs and chemicals recommended for treatment, but no explanation of the disorder or how to diagnose it.
“Yes, there were quite a number of very, shall we say, curious remedies then, and some things that were clearly toxic,” concedes Porter, citing uranium to treat diabetes as one example.
“They did get a few things right or that we still think are right. They had salicylates (like ASA) for fever, digitalis for heart failure, intravenous saline solution for people with cholera who were dehydrated. So there are a few things that are still actually used.”
“Obviously there is a lot more information now than there used to be,” says Porter. “And the other thing that’s changed is how much information people as patients want to know themselves and are, in fact, expected to know.”
The Merck manual is just one of a slew of medical reference books aimed at consumers. They include the American Medical Association Family Medical Guide, the Mayo Clinic Family Health Book and the Canadian Medical Association Complete Home Medical Guide.
Dr. Cathy Younger-Lewis, the editor-in-chief who oversaw the 2001 and 2005 revisions of the CMA guide, agrees that many patients given a diagnosis will want to research the illness or condition beyond what they’ve been told by their doctor.
While she strongly endorses patient self-education, the former family practitioner advises Canadians to be careful when reading editions written and published outside Canada.
“The basic information of what is rheumatoid arthritis, what is a heart attack, that’s going to be the same,” she said. “But the medical guidelines are often different, the drugs are often different and our health-care system is very, very different.”
“It can be very frustrating as a family doctor … to prescribe something or say something and the person would go off and they often come back and say, ‘But in this source it says this’ and ‘why can’t I get that?”’
Still, Younger-Lewis believes it’s important for consumers to have a medical reference at the ready, and not just for an unhurried perusal. Most books contain advice on dealing with potentially life-threatening situations, such as recognizing the signs of a heart attack or what do when someone has ingested poison, reacted to a bee sting or been bitten by an animal.
While the Internet has lots of information, being able to thumb through to the critical information in a subject-indexed book would likely be quicker in an emergency than firing up a computer and searching online, she said.
“I think there’s still a big place for a book like this in someone’s house.”
Porter likes to think of the Merck Manual as the first stop on the medical information highway.
“So when something first comes up, so when the doctor says: ‘Oh, your mother’s had a stroke’ … the manual is the place where you can go to get a full but concise soup-to-nuts description of what that medical condition is, how doctors recognize it, what they do for it, what the prognosis is,” he says.
“What we do is make it much easier for you to understand more detailed or more complicated information, because with the manual you’ve got full background and you really are starting to speak the language of that disease.”
Porter says such guides, written and reviewed by top medical experts, provide an all-in-one source of trustworthy, validated content.
“With the Internet, you can do a Google search and you can get just about anybody’s site and they could be good, they could be bad, they could be biased. And it’s a little hard to tell, so having everything in one source is still helpful.”
That’s not to say only bibliophiles can access the information. With another nod to changing times, Merck is offering its Home Health Handbook as a downloadable iPhone application, which can be purchased through iTunes for about a quarter of the cost of the hardcover.
One other change Porter has made is to integrate all the material from another title dealing strictly with geriatric medicine, so all stages of life are now covered between the handbook’s covers.