Monthly Archives: January 2010

100 years of science and medicine

A couple of recent NPR radio pieces talked about the state of medicine in the late 19th century, how doctors were educated largely by private medical schools that let anyone in that could pay tuition. Those doctors were not trained in the scientific method, had no labs, and did not necessarily study anatomy or physiology. Going to them had about a 50% chance of being beneficial for the patient!

It was after the automobile, the airplane, the telephone and other discoveries that people begin to see the value of science and started to believe in the use of a learned medical professional. Doctors eventually became ingrained in our culture and known as respected members of a community rather than as snake oil salesmen.

One of the main things that started to change medical schools for the better was the Flexner Report. This was a comprehensive report commissioned by the Carnegie Foundation that reviewed all the major American medical schools at the time. It was a game changer. It brought curriculum that was based on science, created standards and pushed medical education to the realm of universities.

I think lately we’re seeing the reversing trend. After 100 years faith in experts many people are increasingly skeptical of those who claim to know it all. (I find myself among that group.)  Medicine seems to be based on science less and less, with business influence and profit taking a lead again. A negative outcome from going to the doctor is still a very real possibility, with an increasingly likely chance of picking up some nasty bug at a hospital or getting the wrong dose of prescription drug.

On the 100th anniversary of the Flexner report, academics are wondering what the focus would be if a similar study were underway today.  I surmise a new report might include information on how doctors should deal with patients who disagree with them or bring them research they find on the Internet. There would be a recommendation for training on complementary and alternative therapies (if nothing else but to better converse with their patients on these topics). There should also be a major focus on wellness and prevention rather than just treatment. Good science would take precedent over the recommendations of professional organizations, lobbyists or big business.

A rethink of medical education is in order and I’m remaining hopeful that we’ll eventually see a trend towards better care  that takes a holistic approach to health.

Mad as Hellers

An interesting radio piece from a couple of days ago commented on a new group U.S. President Obama should pay attention to in his State of the Union speech, the Mad as Hellers. The presenter was talking about how there are essentially two groups- those on the right who are worried about big government and those on the left who are worried about big business and finance. Personally, I’m worried about both. But what I find even worse is the collusion of the two.

When the former head of the CDC goes on to lead the vaccine divison at Merck or the former Monstanto exec gets nominated to negotiate agricultural policy, this hardly seems like coincidence.

I’ve heard some say that it’s because these folks are highly trained in their field and have industry experience, so are desirable recruits for the administration. That could be true. However, it doesn’t give me much faith that they’ll focus on doing the right thing. We need to be able to trust watchdog groups, like the Center for Food Safety or the FDA, will safeguard the public interest. How can this leadership come from people who spent their careers aligned so strongly with one side of an issue over another?

Getting money out of politics in the way of campaign finance reform, Robert Reich’s solution at the end of his piece, is likely to help. However, I think it’s going to take a much bigger change to shake the foundations of our current system. Americans are starting to wake up, but what is that really going to do? Just being mad as hell is not enough. It’s going to require action, and at this point nobody seems to have the pull to bring the various groups together towards any meaningful consensus.