>After my post the other day, on the subject of resistance to personal medicine from doctors, there were a few interesting comments, which I figured merited their own entry.
The first comment, from Will, implied that I think all MD’s are idiots – which is far from the truth. I’ve met idiot doctors before (such as the one that told me a collapsed lung was psychosomatic), and some very bright doctors (such as the one that asked me about 10 questions, listened to my chest, told me I had a collapsed lung and then sent me back to the hospital right away.) Like all professions, there are good ones, and there are bad ones. However, like all professions, the exceptional doctors, by definition, are few and far between.
And, as a scientist, I can appreciate why that is: doctors are to the human body as mechanics are to our cars, and a car is a relatively simple piece of machinery, when compared with the human body. Even more frightening, a lot of the human body is simply a “black box” in the sense that we know what we put in, and we know what comes out, but we rarely understand all of the intricacies of the processes that are occuring. So when it comes to my car, if I had one, I’d trust a guy named Garry who doesn’t have a high school education to be able to figure out what went wrong and fix it, but when it comes to my body, I expect the person doing the fixing to have about 10 years of higher-education.
But what is that higher-education? It’s not necessarily a biochemistry degree, or even a molecular biology degree – it’s typically a higher level overview of how the body works: anatomy, histology, immunology, and the various other “organ-level” subjects. We don’t expect the average physician to be able to describe how transcription factors, polymerases, gyrases, ligases or any of the host of other molecular tools work, or what their effect is on the human body. Thus, physicians are handcuffed by their high level view of the complex systems upon which they use.
And, of course, that leads us to the major issue. Dealing with complex systems at a high level can only be done by applying rule based solutions. For instance, if you see a broken leg, you splint it. You don’t need to know about osteoblasts and osteoclasts and how they work to rebuild bone. We don’t look at the molecular signals that they need, or what to do to encourage them, you just expect the doctor to apply the rule. If something goes wrong and the bone doesn’t heal, then (and only then) your doctor starts looking for another rule to apply. That’s not a bad thing, really – but that’s how we have come to expect modern medicine to work.
The article I linked to in my earlier post wasn’t about doctors being idiots or stupid, it was about doctors being influenced in their rules and the application of those rules in ways that aren’t productive. When doctors are influenced by other doctors around them (group mentality) to do unnecessary or unproductive treatments, despite the lack of evidence to show the treatment works, that’s not a good thing. When doctors use rule based medicine that’s outdated, that’s also not a good thing.
While I don’t have independent stats on it, the article certainly made it seem like those are common occurrences – and that makes it appear that modern science isn’t doing a very good job on matching diseases with treatments. When that starts to sink in to a patient’s mind, they start looking for alternatives, which leads you to alternative medicines. In my mind, alternative medicines are any form of treatment for which there is no scientific evidence that it works. If you could show me in a properly controlled trial that waving a crystal pyramid over aching joints actually did better than placebo, I’d have no problem considering it a real medical treatment.
So what does alternative medicine have to offer? Hope and faith. Having nothing to believe in is a scary concept, and when science based rules let you down, there’s alternative medicine, waiting to lure you in like a cult. Of course, I don’t mean to say that alternative medicines have nothing to contribute – but the vast majority of them (in my humble opinion) are complete garbage, made up by people who want to make a living on someone else’s misery and doubt.
Of course, our current medical practices aren’t much better, in many cases. (See this example for Lipitor’s Number Needed To Treat. It’s worth a quick read.)
And that’s what brings us to personal medicine. Like the rule based approach, personal medicine isn’t a huge change, but it does introduce a new layer.
The advantage of he new layer is twofold: The first is that rules that were based on “bad practice” should slowly melt away, and the second is that the number needed to treat should be drastically reduced, since treatments will now be indicated for conditions that can be more closely matched with the cause (not the symptoms.)
And, best of all, it still lets the doctors operate in a rule based environment. The shift may not be as big, after all – it just means retraining all of our MDs. In some countries, that education will be mandated by the organizations that pay them, and the transition will go quickly. Only in the places where no one monitors how treatments are done will the switch be slow.
So really, I think the time is ripe to update the rules, don’t you?