At the heart of medicine is the expansion of knowledge and
its governance. Let us explore that a bit as we go along on this journey
together…
First imagine forcing a cotton thread through the eye of the
needle; the fibers catch the sides of the eye and the thread twists and turns
making the progress difficult. Science too works through fits and starts, from
moments of eureka to utter despair. One cannot force a braided thread through
an eye of the needle that does not cater to those dimensions. It is akin to
forcing a square peg through a round hole. Dimensionally, that is a challenge.
So, first some elation; these are some of the tales of human ingenuity forged
through diligence and perseverance …
The first part of knowledge is an old streaming
phantasmagoria of the past; an acquired information that is understood and then
verified. Take Marie Skłodowska (Marie Curie) for example; only one of two
people in history to have received the Nobel Prize in disparate fields of physics
and chemistry. One has to look at two other greats in science who paved the way
for her discoveries; Wilhelm Roentgen discovery of X-Rays in 1895 and Henri Becquerel
discovery of the penetrating powerful rays from Uranium salts. From those
humble beginnings and pitchblende arose Radium and Polonium via differential
crystallization. All in all, a magnificent feat of human endeavor!
Marie Sklodowska
Another simpler time brings back a past shared by a certain
Edward Jenner, who through keen observation had determined that milkmaids were
somehow immune to Smallpox. His assumption was that the pus from the blisters
on the milkmaids’ hands were rendering them immune. Harkening to his mentor Sir
William Osler’s advice, “Don’t think, try!” he inoculated an 8-year old James Phippes,
the son of his gardener with cowpox and rendered him immune to Smallpox. During
the 18th century Smallpox had decimated 20% of the population. In
2015 through vaccination, we have extinguished the disease.
Edward Jenner
Now a couple of tales that don’t get out of the bathtub and
make you run naked through the streets…
Top among such human foibles is the Tuskagee Syphilis
experiment. Between 1932 and 1972, 399 impoverished individuals with known
diagnosis of Syphilis were observed without available treatment to determine
the disease progression and timeline. ( Here) Or another in the name of science was the
Japanese experiments during WWII on native Chinese inducing vivisection without
anesthesia, induced gangrene, live weapons testing, germ warfare infections,
and other such macabre testing in the name of science. While the story of Thalidomide and children
born with phocomilia is well known, ( Here ) there is little heard about a 2007, drug
trial with THN1412, a leukemia treatment that caused significant harm and death
to the participants.( Here ) Josef Mengele’s experiment on eugenics and twins is another
lasting memory of despair.
Tuskagee victims
What would make humans conduct such experiments? It boggles
the mind. Yet as the Stanford psychology Professor Philip Zimbardo’s prisoner
experiment clearly shows humans when given the power use it without discretion.
And to further the damage the ones treated as prisoners develop varied forms of
the Stockholm syndrome; acceptance! ( Here )
Today most of the “science guys” are happily running with
the banner of “Optogenetics” (modifying the cerebral genes into being switched
on and off, on demand. ( Here ) We think of the Large Hadron Collider as a means to
discover the “Big Bang” and in doing we as yet have not mathematically or
through physics determined whether we might create an abyss that has its own
virtual event horizon.
In medicine (you knew I was going to go there, weren't you?)
there is the newest version of experimentation that seems to have ignited the
mind of the scientific world. This experimentation arrives at us through the
aegis of the Economists. To boot they seem to have a predilection to the
Keynesian world of thought…It starts and ends with costs!
The driver of today’s experiments is money, period! There is
little in the name of patient care and benefit and more in the purpose of
costs. Our focus has shifted from one of curing the maladies of yesteryear and
today, to the potential only of saving dollars. The louder the cry, the more
the economists and their agents seem to be benefiting from such diatribes. They
seem to point fingers as they gather large reals estates and flashy, fancy
cars, all in the name of public good. The scientific journals are filed with
jargon and meaningless pseudo-intellectualism.
Pyramid
to
....Plate
As we mightily profess the wonders of End of Life discussions in a myriad of ways that exposes all the virtues of Tantalis, we seem to forget in those many ways how it is to Live our Lives; to take care of ourselves rather than be dependent on the most mundane of newest "studies" that this potion extends survival and that pill rips your rectus abdominus. That, there is fear boiled into every moment of our living by the many informants, is the curse of this information age! The asymmetry of information is forced upon us as reality. The Orwellian doublespeak is over-polished and rules our days and nights.
1. Learning from history is good if you are not blinded to
repeat the past. The answers lie in front of us.
1. 2. If you experiment use basic science, not the
fiat of correlational junk science. Use the correlational data to go further through
verification from basic science.
2. 3. Use the p-values more for the next step in validation
rather than as an incontrovertible truth.
3. 4. Expose the economists at their own game…follow
the money trails. Fiat (not the car) by any other name is fiat!
4. 5. Always have the goodness for the human, in human
experiments, in your thoughts.
5. 6. Refrain from using experiments as a means of
self-enrichment. They eventually get found out and fame is replaced by infamy.
Good science will bring its own rewards.
6. 7. Think how to advance the knowledge without harm when
you conduct experiments.
