Thursday, June 14, 2018

A new biomedical insight?

Here is a thoughtful and timely quote:
". . . . as no single disease can be fully understood in a living person; for every living person has his individual peculiarities and always has his own peculiar, new, complex complaints unknown to medicine—not a disease of the lungs, of the kidneys, of the skin, of the heart, and so on, as described in medical books, but a disease that consists of one out of the innumerable combinations of ailments of those organs. This simple reflection can never occur to doctors . . . . because it is the work of their life to undertake the cure of disease, because it is for that that they are paid, and on that they have wasted the best years of their life.  And what is more, that reflection could not occur to the doctors because they saw that they unquestionably were of use . . .  not because they made the patient swallow drugs, mostly injurious (the injury done by them was hardly perceptible because they were given in such small doses). They were of use, were needed, were indispensable in fact (for the same reason that there have always been, and always will be, reputed healers, witches, homÅ“opaths and allopaths), because they satisfied the moral cravings of the patient . . . . They satisfied that eternal human need of hope for relief, that need for sympathetic action that is felt in the presence of suffering, that need that is shown in its simplest form in the little child, who must have the place rubbed when it has hurt itself. The child . . . . feels better for the kissing and rubbing. The child cannot believe that these stronger, cleverer creatures have not the power to relieve its pain. . . ."
The language seems a bit arcane, and this is a translation, but its cogency as a justification for today's Big Data feeding frenzy is clear.  People who are ill, or facing death, will naturally grasp at whatever straws may be offered them.  In one way or another, this has been written about even back to Hippocrates.

Of course, palliation or cure of what disorders can be eased or cured should be the first order and obligation of medicine.  Where nothing like that is clearly known, trials of possible treatments are surely in order, if the patient understands at least the basic nature of the research, for example, that some are being given placebos while others the treatment under investigation.  Science doesn't know everything, and we often must learn the hard way, by trial and error.

Given that, perhaps the most important job of responsible science is to temper its claims, and to offer doses of the reality that life is a temporary arrangement, and that we need to get the most out of that bit of it to which we are privileged to have.  So research investment should be focused on tractable, definable problems, not grandiose open-ended schemes.  But promises of the latter are nothing new to society (in medicine or other realms of life).

The problem with false promises, by preachers of any type, is that they mislead the gullible, and in many cases this is known by those making the promises--or could and should be known.  The role of false promise in religion is perhaps debatable, but its role in science, while understandable given human ego and the struggle for attention, careers, and funding, is toxic.  People suffering, of poverty, hardship, or disease, seek and deserve solace.  But science needs to be protected from the temptations of huckstering, so that it can do its very important business as objectively as is humanly possible. 

By the way, the quote is from about 150 years ago, from War and Peace, Tolstoy's 1869 masterpiece about the nature of causation in human affairs.

No comments: