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From: geb@cadre.ARPA (Gordon E. Banks)
Newsgroups: net.med
Subject: Prevention, science, etc.
Message-ID: <497@cadre.ARPA>
Date: Wed, 21-Aug-85 11:09:44 EDT
Article-I.D.: cadre.497
Posted: Wed Aug 21 11:09:44 1985
Date-Received: Sat, 24-Aug-85 17:50:08 EDT
Reply-To: geb@cadre.ARPA (Gordon E. Banks)
Organization: Decision Systems Lab., University of Pittsburgh
Lines: 49

References:

I recently picked up a copy of Discovery (Aug '85, p. 85) 
in a waiting room, and saw a good essay by Lewis Thomas
which bears on some of the issues we have been discussing.
It is called "Medicine needs more research, not more `caring'."
It isn't a whitewash of all the problems engendered by
the high-tech approach to medicine, but it puts in perspective
just how significant the contributions of research have been.
Some excepts:

"The diseases that ranked as the great menaces to human health
when I was a medical student ...were...tertiary syphillis of the
brain (which filled more asylum beds than schizophrenia), pulmonary
tuberculosis (especially in the very young and very old, for whom
it was a flat death sentence), and acute rheumatic fever (far and away
the commonest cause of disabling heart disease and early death).
Also, of course, poliomyelitis.  These four were feared by everyone,
as cancer is today.  Thanks to some excellent basic science, and some
exceedingly classy clinical research, all four have nearly vanished
as public health problems, and the vanishing involved the expenditure
of pennies compared to what we would be spending if any of them were 
still with us...depending on how hard the investigators in our 
youngest generation work and how lucky they are, we'll do as neat a job
on schizophrenia and Alzheimer's..."

"Pay attention to what the social scientists are saying about medicine,
but don't let them argue you away from science.  If anyone tells you---
and many will---that today's doctor is too obsessed with the disease
of his patient, and not enough concerned with the patient who has the
disease, don't let the moment pass without comment.  Remind the critic that
the disease is the main point, not the only point but the main point,
of the encounter between physician and patient.  Until that question is
settled---and it can only be settled by science---nothing else matters,
not the home environment, nor the family relationships, nor the patient's
job satisfaction, nor the time of day.  The first task of the doctor is
to learn whether there is a disease, then its nature, then what to do
about it.  If, as turns out in about 80 percent of encounters, there's
no disease, there'll be other things to do for comfort and caring, but 
these must come later, after the question is settled.  If I become ill,
I want a doctor who can look for, and quickly recognize, the earliest
signs of cancer, or heart disease, or whatever.  I'll be more comforted
by the presence of a physician who knows how to feel for the tip of my
spleen, and what it means if it's there, than by any doctor whose
education prepares him first of all to feel for my mind.  My mind can
wait a while, but none of the disorders which enlarge my spleen can."

I don't entirely agree with his sentiments, but about 90% of it.
Well said.