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The nuances of modern medicine

Modern medicine has achieved significant success - and today it knows how to treat diseases that no one suspected existed 100 years ago. However, getting competent qualified medical assistance is still not easy - and all because there are nuances. Some of these nuances will be discussed in this article.


Low qualification of doctors is the norm, not an exception


Many watched (or heard about this) the series "House MD", in which a brilliant doctor treats difficultly diagnosed diseases. However, if you look closely, he does not do anything ingenious - he does not invent either new drugs or new diagnostic tools - he does not develop medicine, going beyond the scope of known knowledge, as other geniuses in other areas of scientific knowledge do. He just does his job well - just does what absolutely any doctor should do. This is not Dr. House genius - all the other doctors are extremely illiterate. We are so used to it that in the case of serious illnesses, raising money for treatment in Germany, rather than going to a local GP, seems completely normal.

The doctor is not responsible for the results of his work


The doctor simply acts according to the instructions. If a patient suddenly dies as a result of following these instructions, it is not the doctor who made a mistake, this is “medicine is powerless here” ©. If the disease has not disappeared, it’s not the doctor who did his job poorly, it was the patient who had an incurable disease. Medical error does not mean death of the patient - all are mortal. A medical error means improper execution of instructions.

It is difficult to imagine a situation where aircraft built according to the same drawings do not take off, or do not reach their destination - but they continue to do and do it - because this is not an engineer’s problem, and not a designer’s problem, and not a pilot’s problem, but the problem of airplanes. And no one doubts their qualifications - since they have written in their work book “engineer” or “designer” or “pilot” - that means they are doing everything correctly by definition.

No one is depriving a doctor of a license if he could not cure the patient, while another doctor could. And more than once or twice, when it can be attributed to randomness and statistical outliers - but on a regular basis. Regional therapists continue to work as therapists, while seriously ill patients continue to raise money for treatment, if not in Germany, then at least in the capital.

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If the “engine malfunction” light suddenly blinks in your car, do you really need to go to the car repair shop before it is completely out of order? No, you need to glue this light bulb with a piece of electrical tape so that it does not distract the driver from driving with its annoying blink. This is exactly the logic of symptomatic treatment - masking irritating factors, and not at all the treatment of anything.

The real doctor, of course, knows that, for example, coughing or fever is a defensive reaction of the body, the suppression of which aggravates the problem rather than overcomes it - and is used only in borderline cases when these symptoms begin to pose a danger in themselves. But the patient is not at all interested in such nuances - the patient is interested in miraculous healing here and now.

Symptomatic treatment certainly has the right to life - but only as a "first aid", which is sure to be followed by real treatment. In reality, this is quickly forgotten by both patients and the doctors themselves. We are so accustomed to this that the actual elimination of the causes of the disease for treatment is not considered and at best perceived as "alternative medicine", and at worst - as unscientific errors that have no right to life. The doctor, of course, can advise in a phlegmatic tone to quit smoking, move more and limit himself to eating - but no one takes these obvious banal truths seriously enough to strictly follow them at all costs. We still go to the doctor for a magic pill, and not for teachings about the right lifestyle.

A doctor is not a doctor yet


A doctor is not an angel from heaven at all, whose only joy and meaning of existence is the treatment of other people. He is the same person as we are with the same needs, and the key difference between us and him is not at all that he works as a doctor and not as a programmer. Remember, children:

The doctor is a carrier of medical knowledge

and nothing more. It does not at all follow from this that once in the same room as the patient, the doctor immediately rushes to treat him. It does not follow from this that, faced with a difficult case, the doctor will lose sleep, peace, put aside all his personal affairs and throw all his strength and aspirations to the cure of a single patient. It does not at all follow from this that he can (or wants) to solve all your health problems in a single dose, especially if this dose is paid. And it also does not follow from this that his medical knowledge is relevant, complete and consistent.

Medicine is a business


It seems to be an obvious phenomenon in capitalist society, but many stubbornly pretend that this is not so. It does not follow from this that medicine cannot be trusted in principle - it follows from this that it is necessary to critically interpret what is happening and not to trust everything blindly. The basic law of the market is that “demand creates supply” - and as long as there are people who are ready to pay any money for their health - there will be people who are ready to accept this money. It doesn’t matter if a real medicine or its homeopathic illusion, real surgical intervention or symptomatic lifelong support is provided for this money - it is important that there will be no medicine without money, and the patient is the main and not secondary regulator of this market, since it is he who decides who to pay , and to whom not.

No matter how altruistic the drug manufacturer is, they also want to eat, live in comfort and confidence in the next day, and the production of anything without profit is impossible. And where there is profit - there is a desire to maximize this profit by all available means, including of an ambiguous ethical nature.

Evidence-based medicine is not medicine yet


The term "evidence-based medicine" has successfully replaced the "scientific medicine" thus transferring medicine from the field of science to the field of marketing. The problem with this approach is that, with the help of statistics, if you want, you can prove anything, even without obvious distortion of the facts, but only by providing suitable conditions for testing. A typical representative is the popular flu cure, the effectiveness of which in advertising is justified as “the most prescribed remedy” - that is, a purely bureaucratic factor.

In contrast, the scientific rationale for the action of the drug is much more difficult to fit - because it can be verified by other, financially disinterested specialists. And if, according to the annotation, the principle of action of the already mentioned drug is unclear(provided that there is indeed a positive effect) - the negative effect of this medicine is also not very clear - and, as a result, the doctor can neither take into account nor compensate for it. Of course, from clinical practice, over time, you can collect negative statistics - but this will only be a limited set of symptoms only in fact, without the predictive effect and influence of combinations with other drugs. It is unlikely that someone from their own experience would want to know that the drug causes irreversible impotence or congenital malformations in children.

The priority of evidence instead of scientific does not cause rejection, perhaps because we are used to evidence in mathematics. However, the evidence in mathematics is of a completely different nature and is not tied to statistics in any way. The task of evidence in mathematics is to demonstrate the connections and their consistency, the task of statistics in medicine is to demonstrate the presence of a correlation between drug administration and recovery. The nuance is that directly from the presence of correlation neither cause-effect or any other relationships follow - because correlation is a purely mathematical operation on two arbitrary data sets and nothing else is taken into account when calculating it.

Statistics, by definition, considers systems whose internal structure and operation mechanism is not known or too complicated for analysis, and it is not always possible to simply influence the input data of a system. If the mechanism of the system’s operation is understandable, then there is no sense or need to use statistical methods — except for the purpose of demonstrating correctness in individual cases. It makes no sense to sort through all sets of values ​​with checking for inequality in Fermat's theorem, if there is already an analytical proof of it. There is no need to do a discrete Fourier transform if we already have the transfer function of the system, originally calculated to amplify a specific frequency band.

It does not matter to the patient how many people and in how randomized trials have proven the effectiveness of the drug. The one and only case is important to him - his own. And if the patient is diagnosed incorrectly or if he simply has an individual intolerance to the drug, evidence-based medicine will not help him.

Medicines do not work magically


Many medicines, including practicing doctors, are treated as if they were working magically. But this is not so. When a medicine enters the body, not a miracle occurs, but a chemical reaction that has a beginning, an end, and decay products. At the same time, the drug interacts not only with the body, but also with other drugs, and even with food - and this interaction is often negative than positive. However, more important here is another -

Medicines not only treat, but also cripple


If you read the annotation for any real (non-homeopathic) drug, all of a suddenit turns out that the list of undesirable side effects is much larger, wider and more interesting than its useful, and not always explicitly prescribed action. And be sure - all that is described in undesirable side effects is not theoretical assumptions, but the phenomena actually recorded in clinical trials of the same mere mortals (and not chronic losers at all, who are always unlucky in life). And if the annotation says “can cause multiple congenital malformations in newborns” - be sure that this knowledge is obtained at the cost of ugly children from unhappy mothers who treated candidiasis during pregnancy. And that is why doctors categorically oppose any form of self-medication - a mindless reception of surrogates with unknown properties, that of real farming.drugs are more likely to harm even more - if not by action, then by inaction.

Sarcasm Spoiler
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Rummaging through the history of farm. You can find many examples in the industry when a medicine is not only withdrawn, but also transferred to the category of hard drugs, the production of which is transferred from legal to illegal by the efforts of enthusiasts. Typical examples are the once popular sleeping pill and the well-known cough medicine .

Self-medication is not evil, but good


If self-medication does not mean the thoughtless use of chemicals (as doctors generally understand), but the fact of getting rid of the disease, then this is not and cannot be anything bad. An adult has the right to independently solve his problems - especially if he is responsible for the consequences.

However, it is important to understand that making diagnoses and prescribing medications in accordance with them is a tool of the doctor, not the patient. The main tool of the patient is the search and elimination of the causes of their health problems - regardless of how they are classified in the directory of diseases. Typical reasons are - smoking and other bad habits, lack of motor activity, unbalanced diet, lack (or excess) of specific vitamins or other substances, the specifics of professional activity. As soon as these causes disappear, their negative consequences will disappear (or at least simply weaken).

Our main doctor is hygiene and immunity.


If we consider the treatment of individual diseases as the killing of pathogenic bacteria, then it is most effective to kill them before they enter the body, and the effect of toxic drugs on health will be minimized. It was hygiene that made the main contribution to a qualitative improvement in health and an increase in longevity.

Immunity, in turn, can cope with diseases that modern medicine does not yet have - typical representatives of which are influenza viruses and their variations. Flu shots, of course, can accelerate recovery or even prevent a fatal outcome - but they themselves do not cure and are only “information for consideration” for immunity.

The human body is not static. It develops and adapts to the environment both in the course of life and in the course of evolution as a whole. Immunity and other subsystems of its vital activity are developing and adapting. Therefore, from the point of view of evolution, there is nothing supernatural in the independent (and spontaneous) cure of deadly diseases that were once in the past.

But here everything is not easy - hygiene and immunity are almost in conflict. Excessive hygiene of hygiene can reduce immunity, since it deprives him of "information for thought." Excessive (chemical) stimulation of the immune system can provoke autoimmune diseases. Finding the best balance between all this is a separate interesting task.

The real cure must be final


If a doctor with pharmaceutical drugs kills fungi and parasites inside the body, this is a treatment. If a doctor pulls an arrow out of his leg, which prevents walking, or pulls out a rotten tooth, which interferes with chewing, this is also a treatment. But if instead the doctor prescribes painkillers, anti-inflammatory, ointments, antidepressants, which must be taken until the end of life, otherwise fear, pain, hell, painful death - this is no longer a treatment. Service, at best. After all, the more often the patient will encounter diseases - the larger the list with the drugs necessary for regular use, and the richer the set of side effects from them that gradually accumulate in the body.

The actual treatment (not) should be the same


If different doctors make different diagnoses and prescribe different treatments to the same person, then this is not science, but shamanism with the pronunciation of scientific words. The content of actual scientific knowledge does not depend on its carrier, the results of mathematical calculations do not depend on the status and salary of the person who performs them, the laws of physics do not change from engineer to engineer. Errors in the program do not change from whether they are found by live programmers or static code analyzers.

There is another extreme - a universal cure for any disease. At different times, aspirin, penicillin, vitamin C and more radical ones played the role of mercury, radiation, trepanation / lobotomy, purification by fire ... Here, obviously, we are also dealing not with scientific knowledge, but with a variation on the holy grail - even if the scientific basis is summed up under it.

Conclusion


The purpose of this article was not to cast a shadow on doctors or medicine in general. There are real doctors working for the idea, and real surgeons, whose work is not ashamed, and real scientists who grow real medicines in real test tubes. The purpose of the article was to show that in modern realities not everything is what it looks like in the information space by default, and what we ourselves would like to see. It is also possible that such a vision of the world is only the result of a lack of the right drugs in the cerebral cortex - we are waiting for the real doctors and other specialists in the comments.

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