Looking Back to 2004

If you believe the doctors, nothing is wholesome:
If you believe the theologians, nothing is innocent:
If you believe the soldiers, nothing is safe.
Lord Salisbury – (1830-1903).

It is time to look back to 2004.

Most of us are worried about our health. What did 2004 do for us? Did we make any significant gains to achieve good health? Did medical science make any progress in that direction?

Viox has gone off the shelves after initially being promoted as the magic drug. Looks like Celebrex and other painkillers will go the same way. These events remind us once again that medicine is an imperfect science, clouded with uncertainties

We have experts in all kinds of fields. But experience of life teaches us that we should be careful of what the experts have to say. An article in the British Medical Journal (BMJ) says, “Despite the exponential growth of medical information, the effects of healthcare interventions are often uncertain or controversial.”

I cannot recollect any major scientific breakthrough this year that changed medical practice in a positive way. Most headlines related to medical practice were of negative nature – withdrawal of Viox, outbreak of diarrhea in Calgary and Montreal, shortage of flu vaccine in US etc.

We continue to fight the old battles against obesity (including trans-fatty acids), smoking, cancer, heart disease and trauma. These are the big five causes of most diseases and disabilities in our society. This has not changed in 2004.

The editors of the journal Science have put out a list of top 10 scientific achievements of 2004. But the list does not contain any medical breakthrough to improve our health in the immediate future. For example, here are the top three scientific achievements of 2004:

The most important scientific achievement was the landing and discovery of water on Mars by NASA’s two rovers, Opportunity and Spirit.
The second was the discovery on the Indonesian island of Flores of fossils from a species of tiny humans. These humans were one meter tall with a brain less than one-third the size of modern humans. They lived about 18,000 years ago.

Third most important scientific achievement was the cloning of human embryos by South Korean researcher Woo San-hwang and his colleagues.

Why progress in medicine is so slow?

According to the BMJ article the major hidden barriers to better health care:

-uncertainty as a result of lack of convincing evidence because of delayed or obsolete data from clinical studies;

-uncertainty about applicability of evidence from research to the patient’s bedside;

-and uncertainty about interpretation of data.

Because of these uncertainties, there is overuse, misuse and sometimes underuse of medical technology with associated errors. Patients undergo excessive investigations and sometimes inappropriate treatment.

The BMJ article asks, “Can the fog that enshrouds the medical practice be lifted?”

Yes, the article says, if we can find evidence that is judged to be important for practicing doctors. Unfortunately, most existing evidence is irrelevant or unreliable.

Yes, if we can train doctors to make decisions under uncertainty.

Yes, if our leaders and the public understand the inherent limitations of medical knowledge and the role of research in reducing uncertainty.

Unfortunately, uncertainty influences virtually all of medical decision making. And this has not changed in 2004. So, we just have to keep fighting the old battles!

Thought for the week:
To like and dislike the same things, that is indeed true friendship.
-Sallust 86-34 BC

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