Skeptical Inquirer January/February 2014 Zatonski, M Problems with Modern Medicine: Too Much Emphasis on Disease, Not Enough

gh on Managing Risk (Commentary) 10/16/2013 (1st Proof)

COMMENTARY ]

Problems with Modern Medicine: Too Much Emphasis on Disease, Not Enough on Managing Risk
MA C I E J Z A TON SKI

am a doctor. A surgeon. I was taught to make sick people healthy and to make those who cannot be cured comfortable. I am lucky also. Major advances have benefitted us all. We have learned how to put people to sleep during surgery; we have developed antibiotics to battle bacteria; we have started to transplant organs from those deceased. We have created technology that allows us to look into a living body and even observe metabolic processes on the cellular level in real-time. We developed effective vaccinations and prevented millions from dying

in accidents, from strokes or complications of chronic diseases. We have used modern scientific methods to analyze huge amounts of data, and we have managed to change the perception of medicine as a form of art and turn it into a hard science. But it all happened at a price ... Nowadays we try to improve our past discoveries, but we probably will need to wait for another breakthrough. In the meanwhile, our old discoveries are becoming available to increasingly larger numbers of people. And the more people we diagnose, the more diseases we find. But are doctors still making sick people healthy? Our definition of sickness and health is evolving, but does not seem to catch up with current medical advances. We can detect can-

cers before they give us any symptoms. We scan, screen, and diagnose more and more individuals using the most advanced technology. But are we always helping our patients? Who actually benefits from early treatments? How many suffer from complications? How many are harmed, physically or emotionally? These are hard questions to answer, and we are looking into them. We know that every advanced disease (cancer, for example) had to have a very early stage. It can start as a single mutation in our DNA. Historically, we were not able to pick those things early enough. The tumor had to be of a size that would be detectable with our fingers or eyesand it often meant that it was too late for a cure. We have learned to look inside our bodies to identify tiny lumps that are invisible to the eye and impossible to feel or touch. Later came newer technologies that allowed us to spot abnormalities in tissues, cells, and even on the molecular level. We thought that this is good, because every advanced disease had to start early. And the earlier we pick it up, the better our chances to survive. Well, it is true to some degree. The problem is that we do not know if every detected pathology will become a real problem. Not all abnormalities develop into symptomatic diseases. We dont

Skeptical Inquirer January/February 2014 Zatonski, M Problems with Modern Medicine: Too Much Emphasis on Disease, Not Enough on Managing Risk (Commentary) 10/16/2013 (1st Proof)

know which of them will. And we probably never will, as an attempt to investigate this issue would raise severe ethical issues. Medicine today is not only about making sick people healthy. It is be coming a risk-management and quality-of-life improvement service. We need to needlessly treat hundreds of people with a mild hypertension to prevent a single death. Since not all people with hypertension die from its consequences, we have to treat a lot of people for one person to actually benefit. We dont know who this lucky person will be. Its like a lotterylots of people have to play the game, so we can have one winner. Therefore we treat everyones abnormal findings. And this would be totally okay if there were no side effects from the treatment. If you play in a lottery you might lose just a few dollars. If you play with your life, the price to pay can be much higher. The closer we look, the more diseases we find. Recently National Health Service in the U.K. announced a nationwide Health Check program, where healthy people are encouraged to visit their doctors. Some lives will be saved. But how many people will be turned needlessly into patients? We dont know exactly, but the estimations are alarming. It was easier to trust the doctors when we could see the results of their treatment immediately. But when doctors manage risks of possible (but not at all guaranteed) future problems, this undermines patients trust in modern medicine. Treatments are often expensive and can make previously healthy people feel sickboth physically (from side effects) and psychologically (due to their changed perception of their own health). Doctors dont give advice to their patients anymore. They give them options. We are told that this is good: it respects patients autonomy, beliefs, and expectations. But it also takes a lot of responsibility away from doctors and leaves the decision regarding the treatment in the hands of the least qualified

person. Its a part of the phenomenon called defensive medicine. Doctors will always put their safety (and the financial safety of their families) first. This allows charlatans to thrive. Think about it: if you only prescribe sugar pills (such as homeopathy)you can actually give any advice to your clients without putting yourself at risk, as each piece of advice is technically identical and risk-free. Its easy to actually advise a patient to take sugar pills, instead of presenting him or her with treatments, statistics, and decisions to make. If I knew enough to make a proper therapeutic decision, would I need to consult a doctor in the first place? Dont get me wrong; I am not saying that the idea of offering a choice and providing information to patients is wrong. Its the best way we know. However, this great idea is flawed: after years of practicing medicine I would struggle to make a good decision myself. And if its our life at stake, we tend to make irrational choices. There is a reason why many doctors admit that they would never consider treatments for themselves that they offer their patients. It is a complicated problem that might be impossible to solve in current legal and ethical realities. Perhaps instead of battling homeopaths it would be better to educate patients and doctors about the concept of medical risk-management (in the mathematical meaning). Under standing of statistics is poor among doctors and the general publicbut in a world flooded with big data, basics of statistics (and its implications) should be a mandatory part of every primary school curriculum. Are our expectations of modern medicine too high? We dont have a cure for loneliness, feeling down, lack of hope, or rejection. We dont even have a cure for most common diseases. We can manage certain conditions, reduce risks, prolong life. But we still cannot cure many illnesses. But neither can the alternative medicine shamans. My impression is that we need to redefine our conception and definition

Skeptical Inquirer January/February 2014 Zatonski, M Problems with Modern Medicine: Too Much Emphasis on Disease, Not Enough on Managing Risk (Commentary) 10/16/2013 (1st Proof)

of health and disease and introduce the concept of risk-management of possible future health benefits. Perhaps skeptics can actually make a difference and lead the world into the changes that modern medicine needs. I invite the readers to share their ideas and opinions. n
Maciej Zatonski, MD, PhD, is a surgeon and researcher working at BHR University Hospitals NHS Trust in the United Kingdom. He is a founder of Polish Skeptics Club and specializes in debunking unscientific therapies and claims in medicine. He is a leader of public understanding of science in Poland and is actively engaged in promoting evolution and evolutionary sciences. Visit his website at www.zatonski.com and reach him by email at zatonski@doctors.net.uk.