"Doctors don't cure nothing"

By Razib Khan | January 1, 2012 2:00 pm

NSFW


As I observed before, modern medicine is subject to some of the same statistical issues as social science in its tendency to put unwarranted spotlight on preferred false positive results. Trials and Errors – Why Science Is Failing Us:

This doesn’t mean that nothing can be known or that every causal story is equally problematic. Some explanations clearly work better than others, which is why, thanks largely to improvements in public health, the average lifespan in the developed world continues to increase. (According to the Centers for Disease Control and Prevention, things like clean water and improved sanitation—and not necessarily advances in medical technology—accounted for at least 25 of the more than 30 years added to the lifespan of Americans during the 20th century.) Although our reliance on statistical correlations has strict constraints—which limit modern research—those correlations have still managed to identify many essential risk factors, such as smoking and bad diets.


I need to look at the difference between mortality and morbidity here. The two are clearly related, but if modern medicine has decreased morbidity, then it is still worthwhile to a greater extent than simple life expectancy calculations might indicate. But the reality is that the more and more I look at modern medicine the more worried I get that the age old heuristics and biases which allowed medicine to flourish as a form of counterproductive psychotherapy up until the early 20th century are now coming back to the fore. The issue here is less the profession of medicine, as the incentives and impulses which drive the need for a “cure” from the demand side.

All this brings to mind a passage from the book Religion Explained:

E. E. Evans-Pritchard is famous for his classic account of the religious notions and beliefs of the Zande people of Sudan…one day the roof of a mud house collapses in the village…People promptly explain the incident in terms of witchardcraft…Evans-Pritchard points out to this interlocutors that termintes had undermined the mud house and there was nothing particularly mysterious in its collapse. But people are not interested in this aspect of the situation. As they point out…they know perfectly that termites gnaw at the pillars of mud houses and that decrepit structures are bound to cave in at some point. What they want to find out is why the roof collapsed at the precise time when so-and-so was sitting undernearth it rather than before or after that. This is where witchcraft provides a good explanation.

With all due respect to modern scientifically trained physicians, but the demands that their patients are now making upon them in terms of curing diseases whose causal roots are less than clear are transforming them into latter-day shamans. As it was, it will be?

CATEGORIZED UNDER: Culture, Medicine
  • http://math-frolic.blogspot.com Shecky R

    not to mention that the cost of this demand and latter-day shamanism is becoming prohibitive

  • http://www.parhasard.net/ Aidan Kehoe

    “(According to the Centers for Disease Control and Prevention, things like clean water and improved sanitation—and not necessarily advances in medical technology—accounted for at least 25 of the more than 30 years added to the lifespan of Americans during the 20th century.)”

    But those are part of advances in medicine, in a more broad sense. Doctors do public health too, and were involved in the beginnings of clean water as a public health idea.

    One thing that has surprised me about the rise of India and China is that they haven’t done more drug and medical device development themselves, given that they can set their own ethics requirements, and that setting them lower than the west (which there’s a good bit of scope to do, without getting horrifying about it) should speed time to market. I’m sure with data from sufficient actual patients in those countries the EU and US would yield to customer pressure to allow them licences in the rich world.

  • Wil

    I believe the pace of scientific and medical achievement seen each decade for the last 150 years is extremely high, as compared with the pace over the last 8000 years.

    However, the “low hanging fruit” is always the first, the fastest, the simplest, and the cheapest to pluck. Since the mid 1800′s, scientists and engineers have been plucking the low hanging fruit – and gradually moving higher. As we invent increasingly powerful medicines and machines, the expectations of patients and users has also risen. Perhaps for the first time in history, some people consider metaphysical perfection to be at least a possibility in the real world.

    The challenges ahead of us are exponentially more expensive and difficult to master than the ones we have already achieved. But our tools are far more powerful and sophistocated than ever before. Science, and scientists, are not failing anybody.

  • Doktor Grisha

    I wonder if there is any value at all to the entire expensive field of oncology. Countless times I hear of folks who dropped dead after painful therapies, but the conclusion is always “if only there had been earlier detection!”

    I think Steve Jobs had the right idea and probably prolonged his life by first declining surgeries that would have resulted in metastasis.

    How many women would be better off NOT knowing about every little node before it gets reabsorbed by the body? It’s as if mastectomies (and prostate therapies like Rudolf Julie-Annie submitted to) are signifiers for upper-middle class health insurance coverage or something.

  • Sandgroper

    #4 – That’s bullshit. Find out about the effectiveness of screening for early detection of bowel cancer before you opine.

  • simplicio

    @4 The survival rate for Job’s cancer for patients for whom detection was as early as the detection of Job’s tumor was was something north of 90%. For people that delayed treatment or who had the cancer detected later in its development, the survival rate is much much lower. Jobs probably killed himself by waiting, as he himself later acknowledged.

    There are certainly “heroic measures” in oncology where the success rate is low enough to question whether its worth undertaking at all, but there are also plenty of procedures that have a very strong and easy to measure positive effect on survival rates.

  • AG

    People are willing to do anything to save their life even though cost/effect is very questionable for cancer or chronic diseases. But if you have a broken bone or bleeding injury, you better believe doctors can save your life.

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This blog is about evolution, genetics, genomics and their interstices. Please beware that comments are aggressively moderated. Uncivil or churlish comments will likely get you banned immediately, so make any contribution count!

About Razib Khan

I have degrees in biology and biochemistry, a passion for genetics, history, and philosophy, and shrimp is my favorite food. In relation to nationality I'm a American Northwesterner, in politics I'm a reactionary, and as for religion I have none (I'm an atheist). If you want to know more, see the links at http://www.razib.com

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