As physicians we practice modern medicine. However, we must not become confused about what this means. True, we may be more medically knowledgeable than our predecessors of a generation or two ago; but let this not suggest that our knowledge is reality and theirs was not. Reality is massive and intricate, paradoxical and overwhelming. As humans, we simply do not have the perspective to gauge it accurately.
Medical knowledge is limited to our own personal experiences, the perspectives of others who have told us what they think reality is, as well as hard data that has been recorded over lengths of time. Consider this unsettling hypothetical: What if all forms of medical knowledge suddenly disappeared? What would we do to rebuild our knowledge banks?
We would probably do what medicine has always done. Break our understanding of the world into pieces, form conclusions, and test them. We would, in essence, make models of the world; small insights of predictability that represent a working knowledge. And this is exactly what we do today. We work with medical models – not reality.
Some of today’s models seem to sensibly represent the world. They appear efficacious for the most part. Other models, however, make little sense. They survive because the political clout which birthed them continues to fight for their existence today.
We must be careful about what we believe. The history of science is filled with preposterous “truths” that stood lifetimes – even centuries – to be finally discarded as rubbish. Certainly, some of today’s most cherished medical beliefs will meet a similar fate. “Why?” you might ask. For the same reason those others were discarded: they are not tenable. Once the political and financial matrix that holds them in place disintegrates, they will lose support. Other models with more efficacy will nibble at their edges, then devour them. Old models will be replaced by new models; which will, hopefully, be more workable mechanisms of thought. However, if stronger political or financial incentives arise that support less workable models, they may replace their predecessors instead. When this happens, medicine, in a sense, steps backward.
Medicine is constantly marching. It may take two steps forward, one step back, then a step to the side. This is not a march to reality, but rather from one vague point in the past to another vague point in the future. Surely, some aspects of medicine will improve, while others will actually become more harmful. Many models and treatments will change neither for better nor for worse. Technology continues to improve, yet breast cancer is increasing. Bubonic plague may no longer be a threat, but AIDS is a pandemic. Tuberculosis was well-controlled twenty years ago, but more and more resistant strains are developing around the world. Although immunizations have saved millions of lives, only one disease has been completely eradicated.
Many of our twentieth century victories may be hollow. They may not even be victories at all. Instead, they may be no more than a natural or technological reprieve from the onslaught of future ills.
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Stephen Typaldos, D.O.
July 1994