Medicine walks a difficult line between a trade and science. The difficultly arguable comes for the requirement that execution of the trade usefully help people, either to a cure, recovery, or with palliative care. Science doesn’t progress as easily when ethics don’t allow a range of scientifically useful tests or practices. I tend to regard modern medicine as science in progress. In principle, collection of the aggregate experience of every patient contributes to the corpus of knowledge, and helps the science advance. Eventually we hope this gathered evidence can lead to modifications to treatment regimes, the identification of ineffective regimes, and uncover unexpected useful correlations that can inform future treatments. But this is going to be slow progress by itself.
Medical science, as informed by pure research helps with new knowledge. New knowledge about the operation of our bodies, new knowledge about the range or pathogens and maladies that might beset us. But the application of that knowledge to treatment is not a simple thing. We have learnt that our bodies are capricious things, and what looks like an obvious a clearly sensible idea on paper can fail, or worse, for many unexpected reasons. If it were not for the imperative of people wanting, needing, and expecting to be treated, the new therapies would remain lab based for decades or more. So there is a balance. Probably the single biggest enabler of progress is statistics. That is what divides the quack treatments from real medicine. But, as we know, statistics in medicine are not trivial. Placebo effects abound, and yet there are times where a proper double blind trial is simply not ethically possible. And there are times where you will never get a cohort of enough size that can have perturbing influences normalised out. So things are never easily clear cut.
IMHO - there is a social contract in modern medicine - one that is sometimes not a totally happy one. Undergoing treatment for serious or inevitably fatal conditions adds to the corpus of knowledge. We may have no hope ourselves, but in some small way, the added knowledge of our experience can aid the future. Sometimes sadly as a small statistic that says “this is not a useful path”. But as a whole medical science needs this. It informs evidence based treatment.
Having grown up in a medical family, and seen the practice of medicine from both sides, I will confess that over time my faith in the profession has been shaken to some degree. Again, IMHO, a lot of this comes from some of the rigid structures that have arisen of the decades. A great many specialists become rather closed to the world outside their own little area, and the level of conservatism that can arise is worrying. Institutional cultures arise which can become corrosive towards progressive practices. Not just adoption of newer treatment regimes, but even things like institutional processes. I have witnessed first hand indefensible violations of simple protocols in one of the local major teaching hospitals. And these violations were dismissed with “these don’t apply to me”. Yet one resulted in a friend undergoing a series of highly distressing and painful procedures to ameliorate the failure of process. I could go one, but I won’t. This is GQ.
OTOH, I have had the pleasure of being treated by some of most pleasant and smart people you might care to meet. Perhaps the take home is that the medical profession and medical scientists are ordinary folk as well. We take the execution of their art with the same risks as any other trade. But given the nature of the beast, we can’t expect perfect outcomes as much as we might desire them.
If you want a modern example of this, look at obesity treatment. Short of surgery, treatments for obesity are almost totally ineffective for the majority of people who undertake them (only a small minority of people are able to both lose weight and keep it off permanently via lifestyle changes alone)
Someone may go into a doctor’s office, they give advice about treating their obesity and people end up just as fat if not fatter than before. Right now about 30% of the human race is too fat from a medical pov, and that number is even larger if you count people who have poor waist to height ratios or high body fat but low bmi etc.
But it hasn’t slowed people down from offering advice that is almost totally ineffective. So I assume it was like that in the past with bleeding etc. Doctors give advice, the patients stay the same or get worse so the doctors give the same advice.
Also in modern medicine, much of preventative medicine is ineffective for the vast majority of patients. Of people who take statins for 5 years for primary prevention, 1 in 104 will avoid a heart attack. So 99% see no benefit over 5 years. Lots of preventative measures have similar nnts, but they are still recommended.
Even that subject (using antibiotics to cure a bacterial infection) not cut and dried. Research shows most people who take antibiotics for common bacterial infections like ear infections, sinus infections, bronchitis, Strep, etc either see no benefit or very minor benefits (maybe recover one day sooner).
We really need ai to sift through all this information. I think medical knowledge is predicted to double every few months by 2020. Of course I’m sure there is a massive quality decline with that doubling, but still there are patterns that we are missing.
This. Any time you have noisy data - ESPECIALLY if you’re not scrupulously keeping track of outcomes, and ESPECIALLY if you’re not comparing your treatment outcomes to the outcomes of an untreated control group - it gets very hard to see what works and what doesn’t work. 500 years ago, the village barber didn’t rigorously document what happened to all of the patients he treated, and he sure as hell didn’t keep track of all the patients from whom he withheld treatment.
Even in modern medicine, noisy data is a problem. Cutting through the noise takes a lot of samples, at which point research can get very expensive. I once saw an example analysis for a hypothetical multiple sclerosis treatment showing how many subjects would need to enroll in order to provide reasonable certainty as to whether the treatment was effective or not. Because a significant number of MS patients exhibit spontaneous remission, you can’t just have a handful of subjects in your experiment and control groups; you need a lot. It gets worse if the treatment’s actual effectiveness is much less than 100%. At some point you need very large, very expensive clinical trials to see through the noise and have some confidence as to whether any observed difference between the experiment and control groups is due to the treatment or due to random chance.
Cancer also sometimes exhibits spontaneous remission, which makes for similarly difficult clinical trials. So go back 500 years, and if the village barber bleeds every patient who comes to him with a tumor, and 10% of them recover, he thinks to himself “tumors are difficult, but it looks like I’ve got a 10% success rate”; he doesn’t realize that 10% of the tumor sufferers he doesn’t treat also recover, which means his treatment is actually useless. Or maybe more of the untreated people recover, which means his treatment is detrimental.
Actually, I was reading about the growth of battlefield medicine in the 17th and 18th centuries when gunpowder weapons started making a mess of soldiers. One thing they became very good at was figuring out whennot to treat wounded or give them the minimum needed for comfort.
In the 19th century medical technology and knowledge improved and survival rates plummeted, as they now had to do “something”. Plus the mostly abandoned earlier practices of washing and cleaning patients and doctors.
Prima facie, using mercury to treat syphilis or blood-letting to treat a fever is no more ridiculous than poisoning people with chemotherapy and hoping they don’t die.
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For starters, the many people with hematologic malignancies and testicular cancers cured by chemotherapy would find your statement ridiculous.
And chemotherapy despite its drawbacks has had markedly beneficial effects in treating other cancers.
I’ve heard that some use leeches to reduce the swelling of bruises. I also read decades ago about them being used for headaches, but I don’t know if that held up over time.
Leeches have a role in finger and limb reattachment.
Modern medicine no longer subscribes to the traditional four humors. But medicine has definitely adopted “humoral” views on immunology, endocrinology, etc.
And it works. Besides the placebo effect, there is another effect- when a caring professional says you will get better and seems to care that you do- your chances are also improved.
There is little malaria in The United States and it’s not banned in places where malaria is common. :dubious: The problem with DDT is the same as with the neo-nictoniods- over use. DDT is fine, used in moderation. But they used to spray whole towns with it and every crop. Repeatedly.
statushttp://www.nbcnews.com/health/malaria-cases-hit-40-year-high-us-8C11505324Nearly *2,000 people were diagnosed with malaria in the U.S. in 2011, a 40-year high for the infection, health officials reported Thursday.
Most were among U.S. residents or citizens and virtually all cases were brought back from other countries, the U.S. Centers for Disease Control and Prevention reported. People need to watch out for the mosquito-borne infection, the CDC cautioned.
“In 2011, 1,925 malaria cases were reported in the United States,” CDC said in a statement.
“This number is the highest since 1971, more than 40 years ago, and represents a 14 percent increase since 2010. Five people in the U.S. died from malaria or associated complications.”*
Actually, they had few if any effective herbal remedies. Willow Bark, for example, does contain a aspirin precursor. But it tears up your stomach like a muthafucker.
I am unable to find this “opinion paper”, but courses aimed at enhancing prospective physicians’ communication skills have been around for quite awhile.
“Students were given the opportunity to develop their basic communication skills in peer role-playing scenarios and role-playing sessions with simulated patients. The use of simulated patients or actors has proven to be a particularly effective method for training communication skills. Parallel to participation in these exercises, the students developed guidelines on physician communication, which covered the core elements in patient-physician communication according to the Kalamazoo Consensus Statement. These guidelines were then used as a basis for further teaching to provide the students with a manageable tool focused on the primary issues of good patient-physician communication. The guidelines included short descriptions of skills relevant to each of the following domains: (1) building the doctor-patient relationship; (2) opening the discussion; (3) handling emotion; (4) exploring details; (5) reaching agreement on further procedures; and (6) summing up the consultation.”
I have an MLA citation, but it’s in a book that is in storage that I can’t get to. I’m going to get it out of storage sometime in August; I’ll definitely respond when I do. I narrowed down the year though—1994, and sometime between January and October.
I’m about 98 percent sure that’s it. The names sound familiar, and now that I think about it, it was a short piece—only a page or two, maybe even just a few paragraphs.