WHAT A COLUMN ON THE TRIVIALITY OF MEDICAL PHYSIOLOGY REVEALS ABOUT THE STATE OF MEDICINE
While I don’t agree with the insinuation found in the title of the brand new MedPage Today article by renowned cardiologist, Dr. Milton Packer (Do Physicians Need to Know How the Body Works?), some of the points he makes are not only brutally candid but spot on. For the record, Dr. Packer doesn’t agree with this assertion either, but let’s discuss some of his revelations as he makes his point.
MUCH OF WHAT IS LEARNED IN SCHOOL IS WRONG:
Packer says that much of what he learned back in the day (Penn State / Jefferson Medical College / Albert Einstein College of Medicine) concerning the heart and cardiovascular system was flat out wrong. I could probably say the same thing about most health-related topics.
While enrolled in Kansas State University’s dual degree, exercise physiology / nutrition program (mid 1980’s) I learned how evil DIETARY FAT was, but that carbs of all kind were fine because they couldn’t make you fat — only fat could do that (HERE). I also erroneously learned that both SALT and EGGS were death to the cardiovascular system. Once I got to professional school, I was (INCORRECTLY) taught that if you wanted to get patients better with chiropractic, they must be adjusted over and over and over again for long periods of time. I could go on and on and on, but suffice it to say that Dr. P is 100% correct in this assertion.
“When I was a freshman in medical school, I was told that 50% of what I would be taught for the next four years would be subsequently proven to be invalid. So we attended classes knowing that we needed to make a life-long effort to keep checking the validity and updating the usefulness of our information. The only way to do that was through medical practice.”
Sounds nice until you realize that what this really means that an entire generation of physicians will have to retire for things to (slowly) change — repeat. It also leaves you, the patient, as THE ULTIMATE GUINEA PIG for treatments that will one day be looked back on with “horror” (HERE).
MUCH OF WHAT IS LEARNED IN SCHOOL IS A WASTE OF TIME, EFFORT AND EXPENSE:
Packer states, “students routinely memorize thousands of facts that they will never put into practice,” which is absolutely true. Is there any way around this? If there is one thing I’ve learned over the years, it’s that excellent instructors make the science of medicine relevant to the practice of medicine. “There is a non-severable link between understanding a disease and treating it, and also between treating a disease and understanding it.”
While I wholeheartedly agree with Packer’s statement, just realize that because this relationship is rarely taught with excellence, there is an undeniable chasm between the research side of medicine and the practice side of medicine (HERE and HERE are two proofs of this assertion).
DOCTORING IS NO LONGER DOCTORING:
Not that doctors don’t get to play the role of doctor at all these days, they just don’t play it nearly as much as they should be. What do I mean? Packer reveals yet another of medicine’s dirty little secrets; that “Physicians spend more time on administrative details and struggling with third-party payers than thinking about disease mechanisms.” This is true.
In fact, the latest research (HERE) reveals that only about a quarter of a physician’s time is spent with patients, while the rest is spent on “administrative duties” (code word for paperwork). Why? Because “insurance companies drive the decision-making process.” Not surprisingly, the result has been PHYSICIAN BURNOUT on a scale unmatched by virtually any other profession — something touched on in Packer’s article.
“When I see a physician for a medical problem, I am not looking for someone who will be satisfied with checking boxes that some society or insurer has created. I am seeking a thoughtful and compassionate professional who will discover what is going on and will treat my illness on an individual basis.”
When Dr. P makes a statement like this, he already knows that there is a strong and growing probability that thanks to the very nature of what the practice of medicine has become, thoughtful and compassionate care is far less likely to happen simply because it requires relationship, and relationship requires time.
TREATMENTS CAN BE HARMFUL:
While this isn’t news (HERE, HERE or HERE), Packer reiterates the obvious — the practice of medicine is dangerous. “I have been closely involved in nearly 30 clinical trials of new interventions in heart failure, and most showed that the proposed new treatment did not work or was harmful.” The problem is that in many cases and for many reasons (HERE are a few), just how ineffective and harmful is not determined (OR AT LEAST NOT MADE PUBLIC) until decades after approval, much of which has to do with the way-too-cozy relationship between Big Pharma and the FDA (HERE).
WE DON’T REALLY UNDERSTAND MOST DRUG MECHANISM’S ANYWAY:
This is not only true (HERE) but intimately tied to the previous bullet point. “Drugs are so complicated that we really never know how they work. We can only guess, and our guesses keep changing.” Whatever the mechanism(s), DRUGS WILL AFFECT NUMEROUS METABOLIC PATHWAYS AND SYSTEMS, leaving people with an array of misunderstood and typically DRAMATICALLY UNDERREPORTED side effects (HERE are some that have to do with antibiotics). In fact, dozens upon dozens of studies show that the rate of reporting drug errors and drug side effects is closer to 1% than it is to 10% (HERE).
DISEASES HAVE ALWAYS BEEN HARD TO FIGURE OUT AND ARE ONLY GETTING HARDER:
I wrote about this several years ago in a post titled WHY ARE THE HEALING ARTS INCREASINGLY INEFFECTIVE?. As people are exposed to greater numbers and amounts of chemicals of all sorts (HERE, HERE, HERE, HERE, HERE, HERE, HERE and HERE are some examples), become more sedentary, don’t GARDEN or eat well, become FATTER and more addicted to technology (HERE), etc, etc, etc, this point becomes easier to make.
“Patients do not come to physicians with classical descriptions that are found in textbooks. They present with complicated stories, consisting of interwoven elements filled with incomplete and contradictory patterns, potentially representing one or many disorders.”
And here’s the rub. Unlike the health problems faced by GENERATIONS GONE BY, the biggest part of what Dr. Packer is describing here is SELF-INDUCED, making healthcare as we currently know it more “UNSUSTAINABLE” with every passing day.
DRUG RESEARCH IS NOT AS IMPORTANT AS WE’VE BEEN LED TO BELIEVE IT IS:
“Most decision-making in medicine is not based on the findings of randomized clinical trials or even observational studies. It is based on our expectations of how the body works.” While one can argue whether or not this statement is true or not, what cannot be argued is the sordid state of affairs in academic medicine — particularly when it comes to research specifically related to getting and maintaining FDA approval.
I’ll not belabor this fact because I’ve written about it at length in my EVIDENCE-BASED MEDICINE COLUMN. The harsh reality is that most (that would be most as in way over 50%) drug studies (not to mention “TREATMENT GUIDELINES“) have been tweaked, tinkered with, finagled, jimmied, fudged, manipulated, exaggerated, embellished, faked, forged and distorted to the point that TRUTH CAN BE ALMOST IMPOSSIBLE TO RECOGNIZE (HERE is a great article on this point written for a medical journal by my brother, a practicing MD).
As you might suspect, the point of Packer’s article was not really to illuminate these various points, but as a ‘gentle’ rebuke — ‘diatribe’ or ‘scree’ are far too harsh, although if written by someone with less class it could certainly have become that — against PA’s (Physician’s Assistants) and NP’s (Nurse Practitioners).
“The theory of medicine is critical to the delivery of personalized and effective care. An understanding of disease mechanisms may be burdensome and may often be wrong. But separating theory from practice means relegating both patients and physicians to the status of a commodity. And we deserve better than that.”
While I am not going to debate the veracity of Packer’s statement, his use of the word “COMMODITY” is interesting in this context because I’ve repeatedly used this same word to show you, the patient, that in our modern age of corporate medicine, it’s all too often exactly how you are seen from the moment you enter the waiting room to start filling out paperwork.
My goal with a column like this is simple — to help you avoid the MEDICAL MERRY-GO-ROUND. Or to help get you off of it if you have been dizzily spinning your life away (HERE are some of the people I’ve helped). If you are interested in stepping outside the box that is mainstream medicine, I’ve created A POST just for you. No sales pitches or gimmicks. Look at it with the proverbial grain of salt, but at least look at it. And if you are interested in reaching the people you love and value most with something that could ultimately prove quite helpful, be sure to like, share or follow us on FACEBOOK.