Angry Doctor

Thursday, December 08, 2005

Guns don’t kill people…

… bullets going through body cavities at three times the speed of sound do.

Still, I usually hold the guy pointing the gun at the target to begin with accountable.

But that’s not the point of this post. The point was made by Anonymous in his/her comment on the post on Numbers Needed to Treat.

"I am just making a point that while statistics is a useful tool it cannot be used without human discretion. … I am also sure that you are aware that although evidence based medicine relies heavily on stats, people can manipulate it to look acceptable."

There’s the rub.

I believe in statistics, which is why the only gambling game I will play in a casino is poker.

Medicine, it has often been said, is both a science and an art.

Of the two, I account science the first and greater component.


Without science, all the art in the world will not make you different from a quack – someone who professes an ability to heal which he does not in truth possess.

With science but no art, you can still be a cold, efficient doctor, with patients who are alive, healthy, but none too grateful. You may not have made them happy, but at least they are alive and free to find happiness.

Now I’ve always believed that God is kind to doctors, in that he made the science of medicine possible. Certain conditions give certain sets of signs and symptoms, which allow doctors to make diagnoses. And certain diagnoses respond well to certain treatments. Although nothing, of course, is 100% certain.


Still, the largely consistent trends allows us to study diseases and their treatment, and for us to compare them and see which of the treatment we apply produce the best outcome.

That has always been the foundation of medicine, although it is only relatively recent that the term ‘Evidence-based Medicine’ had been widely used and codified.

It is now the new religion.

But the problem with evidence, and indeed all sorts of information including what you read in this blog, is that everything that you are presented with is there because someone wants you to know it.

With modern technology, the amount of sheer information a doctor has available is huge, and it becomes a real problem trying to know everything and to separate the wheat from the chaff. We end up relying on summary papers and weekend lunch-talks by experts.

Most doctors know that the information they get is not what they want, but what 'related interests' want them to know and base their practices on.

I always feel a little angry when I read about the latest 'head-to-head' trial between two drugs. I mean, when you watch a commercial on how this new detergent 'makes your clothes 20% whiter than Brand X detergent', do you really think the people at the detergent company just wants you to look your best? It seems a terrible waste to spend so much time, money, and brains trying to get a bigger market share on an established (and profitable) 'market' when there are still so many (less lucrative) diseases to be cured.

We seem to have painted ourselves in a corner now, having decided and proclaimed that we will henceforth base almost all our judgements on 'evidence' alone, but not having secured a say over the source and type of information we want.

I don't think it a very satisfactory state of affairs, although I must say I don't know how we can rectify it.

All I know is: Happiness is a Warm Gun.

7 Comments:

  • hey doc don't brood over the subject anymore. Cheer up =)

    By Anonymous JY, At December 08, 2005 10:59 pm  

  • Yeah cheer up angry doc.

    People will talk all they want but when they have problems they will still come running to us doctors anyway.

    By Anonymous Dr Oz bloke, At December 09, 2005 11:32 am  

  • well, it's a matter of finding the right balance between the science and the art of it. there devil is in finding that balance.

    one thing about evidence-based medicine though, i'll always remember this thing that a prof said to me

    just because there's no evidence for it doesn't mean it's not there

    By Blogger andrew, At December 10, 2005 12:09 am  

  • I'm just glad your professor became a doctor rather then a judge then. :)

    By Blogger angry doc, At December 10, 2005 8:06 am  

  • just a piece of news if you haven't read about it.

    "- A top editor of The New England Journal of Medicine says that he was stunned to find out that data linking Vioxx to cardiovascular risk was deleted from a major study his journal published five years ago--and that it appears that Merck researchers may have deleted that data. "

    Taken from here

    http://www.forbes.com/technology/2005/12/08/merck-vioxx-lawsuits_cx_mh_1208vioxx.html?partner=sti

    By Anonymous Anonymous, At December 12, 2005 12:13 am  

  • Why should the Editor of the New England Journal be surprised that drug companies are liars and will kill people for money ....... its just a business to them and they are corrupt ...... as a pharmacist, I knew drug companies were scum by 1990 ...... these people are literally incapable of telling the truth and lying is their modus operandi. They have infiltrated the medical and pharmacy school with their monstrous budgets ... They corrupt everything they touch .....I could go on and on but if you really want to know what's going on, read "The Truth About the Drug Companies" by Marcia Angell, MD who was herself and editor for the New England Journal of Medicine for twenty years.

    By Blogger Rick, At August 23, 2006 10:55 am  

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