The inspiration for today’s question, comes from (1) LITFL friend, and Twitter’s @ketaminh, who mused on an Aristotelian quote:
We are what we repeatedly do. Excellence, then, is not an act, but a habit.Aristotle
and (2) the inimitable and peerless @precordialthump who suggested the thorny habit of benzodiazepines and back pain/muscular spasm as a topic.
Aristotle was the next generation of Greek Philosopher. He was the student of Plato (the chronicler of our man Socrates), and a tutor of Alexander the Great. His philosophical legacy was extensive, and he pondered as much on science as philosophy, with treatises on topics such as biology, physics, metaphysics, as well as politics, ethics and rhetoric.He also had much to say on ‘habit’. The derivation of the above quote is unutterably complex, and beyond the scope of this section, but I would refer you to the IEP article on Aristotle: Ethics if you have a spare lobe of your brain you are not using for a couple of days.
But – ‘habit’ in medicine? It can be ‘excellence’, but alternatively, can also be questionable, and sometimes downright wrong. The habit of prescribing benzodiazepines for back pain; in particular diazepam for the muscular spasm that accompanies this:
- Are there GABA receptors we’re not aware of?
- Does this have a role centrally?
- More importantly, does it work?
- Is this just reflex, mechanical prescribing masquerading as habit?
- Or, does it work – does it add to the tricky pharmaceutical management of this common presentation?
What are your thoughts?
We open this to our faithful readers…
Addendum: Check out PHARM Podcast 27 – Benzos for Back Pain