Thursday, March 22, 2012

e pluribus unum ~ the one

Or... Bastardizing Medicine for the one!

"Truth is one, paths are many."~ Gandhi
But in deference to Gandhi, do all paths really lead to the ultimate truth?

Outside the window is a beautiful image of the mountain enriched with trees and a smattering of homes, a chimney top and winter swept white snow. It is gorgeous in all its resplendent glory. But obstructing that view are these branches of a large hunter fir tree. The branches sweep across and limit half of the view. Annoying to say the least. After having half a thought to have the tree cut down, I have relented.

There is something about the sweep and brazen nature of these branches that attracted my attention. The branches at their anchor are bereft of the fir but trailing to their periphery they are burgeoning with life. More interesting is the reach of the branches to gain access to the sunlight. The branches seek the light and using the ingrained Fibonacci mathematical construct of arrangement, the branches have sought out the most advantage. “The tree design made 20% more electricity and collected 2 1/2 more hours of sunlight during the day. But the most interesting results were in December, when the Sun was at its lowest point in the sky. The tree design made 50% more electricity, and the collection time of sunlight was up to 50% longer!” (13-year old Aiden Dwyer ~ )

And then there is the squirrel that jumps from one branch to another in an apparent playful mode with its bushy tail wagging behind always in search of an acorn. He tracks back to the trunk and then down to the ground and disappears. Leaving behind to plod its way on the web, is a tiny spider hard at work with its spinnerets creating a silky trap for its future meals. 

An ant tracks up the trunk of the tree in search for something as it weaves its way around the Rhitydome. 

Such wonders to behold in the near and we are constantly being pulled by the far.

As often these musings go, my thoughts wander over to medicine. We are losing the battle about the “forest for the trees.”

Each individual is a unifying glory of life. Each deserves the best we can offer in support of their health and future promise and yet, I see a large battle cry for the masses. We have suddenly jumped from the unifying principles of all patho-physiology of one and dumbed it down to the health of a society and even to the health of the world. Why and when did it happen?
Funnel Plot

We propound population-controlled studies with univariate and limited multi-variate determinants to fashion an arguments for the many, forgetting in the process the mischievous strange attractor of Lorentz. And of course one cannot forget the other jargon in popular mode today with terms like, “regression analyses,” “meta-regression analysis,” “meta-analysis,” “poisson distribution” and the “Chi-squared” virtues of epidemiological data, 

have all but abandoned the real basic and clinical science of prospective analysis where a hypothetical posit is experimented and the results validated with more experimental data. Now it is the virtuosity of the statistically inclined to create a new reality.
Poisson Distribution

No now we just jump into “data-mining” and formulate a diktat! So much for real science, now we just transmutate any collected data to suit a pre-defined purpose. You know like the one “broccoli is good for you one day and the next day it isn’t” stories. You may substitute, alcohol, PSA testing, Mammography, Chest X-Rays, CT scans and any of the other medically related diagnostics or consumables at liberty.

Didn’t it take an Edward Jenner, helping a 9-year old child of a gardener to create the focus that ultimately saved millions of lives against smallpox? Did it not take Jonas Salk to try the first polio vaccine on himself, his wife and children before committing to the world at large. 
Barry Marshall

And who can forget the Nobel laureate doctor, Barry Marshall, who swallowed a glass full of Helicobacter Pylori laden water to convince the world that peptic ulcer was indeed an infectious disease and not just about “stomach acid.”

You see, in dealing with one the process meets the demands for the many. The motto “e-pluribus unum” serves us all well. And yet, I see that now medicine is taking a tack contrary to the well-served path by using massive data files of the many to comport the medical care to the one.

Medicine is the same you know:

"Mr. Jones how are you today?"
"I am fine doctor, except for this lingering discomfort over here."
"Here, lets have a look."

It is the expressive palette of that word "here" and the limbic-prattle of his emotional nuance of discomfort that Mr. Jones displays and the doctor interprets it as a medical problem. No, the tweeted or emailed version of the same could never meet the same rigor of comprehension by the reciprocal right sided brain's Werniecki's  area .

All things change, some for the better and others for the worse. It is the intellectual property of the human mind to decipher between the two. Bastardizing medicine through regulatory fiat premised via a non-medical motive will hurt people. Medicine has long stood on the shoulders of doctors, each has cared for and mitigated many an illness, lets leave a good thing well enough alone.

Think individual and that will serve the global and not the other way around. (But please don’t bombard me about the discovery of Cholera by John Snow of England after the local disease had caused three epidemics worldwide, that the root of the problem lay in the bacterium vibrio cholerae. Yes there is a legitimate purpose for true epidemiological studies (you know like the triangulation method or better yet the wheel method, whereby all available information is availed of). The condemnation is for the abuse, via the fiat of data-mining and statistical magic to prove a presupposed internal bias - like for instance, the longer index finger is a risk factor for prostate cancer ~ that kind of horse manure!)

Don’t forget the tree for the forest, or the health for the dollar.

Think individual!


Small is the number of people who see with their eyes and think with their minds ~ Albert Einstein

No comments:

Post a Comment