Nuances of modern medicine

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Modern medicine has achieved significant success - and today it is able to treat such diseases, the existence of which no one suspected 100 years ago. However, it is still not easy to get competent qualified medical care - and this is all because there are nuances. Some of these nuances will be discussed in this article.

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Low qualification of doctors is the norm, not the exception​

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

The doctor is not responsible for the results of his work​

The doctor just follows the instructions. If the patient suddenly died as a result of following these instructions, it is not the doctor who was mistaken, it is “medicine is powerless here” ©. If the disease has not gone anywhere, it was not the doctor who did his job poorly, it was the patient who had an incurable disease. Medical error does not mean the death of the patient - everyone is mortal. Medical error means that instructions are not followed correctly.

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

Nobody revokes a doctor's license if he was unable to cure a patient, while another doctor could. And not once or twice, when this can be attributed to accidents and statistical outliers - but on a regular basis. Regional therapists continue to work as therapists, and seriously ill patients continue to raise money for treatment, if not in Germany, then at least in the capital.

Symptomatic treatment is not yet a cure​

If in your car a “engine malfunction” light suddenly blinks - is it really necessary to go to a car repair shop to repair it 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 blinking. This is exactly the logic of symptomatic treatment - masking irritating factors, and not at all treating anything.

A real doctor, of course, knows that, for example, a cough or a fever is a defense 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 be dangerous on their own. 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 will necessarily be followed by real treatment. In reality, both patients and doctors themselves quickly forget about this. We are so accustomed to this that the actual elimination of the causes of the disease is not considered a treatment and at best is perceived as "non-traditional medicine", and at worst - as unscientific delusions that have no right to life. The doctor, of course, can phlegmatic advice to quit smoking, move more and limit food - but no one takes these obvious banal truths seriously enough to strictly follow them at any cost. We still go to the doctor for a magic pill, and not for instructions on the correct way of life.

A doctor is not a doctor yet​

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

The doctor is the bearer of medical knowledge
and nothing more. It does not at all follow from this that, once in the same room with a patient, the doctor will immediately rush to treat him. It does not follow from this that, faced with a difficult case, the doctor will lose sleep, peace, move away all his personal affairs and throw all his strength and aspirations to cure 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 appointment, especially if this reception is paid. Nor does it follow from this that his medical knowledge is 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 you cannot trust medicine in principle - it follows from this that you need to critically interpret what is happening and not 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. And it doesn't matter whether a real medicine or its homeopathic illusion is provided for this money, a real surgical intervention or symptomatic life-long support - it is important that there will be no medicine without money, and the patient is the main, not a secondary regulator of this market, since it is he who decides who to pay, and who does 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 very production of anything without profit is impossible. And where there is profit, there is also a desire to maximize this profit by all available means, including those of an ambiguous ethical nature.

Evidence-based medicine is not medicine yet​

The term “evidence-based medicine” has successfully replaced “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 desired, you can prove anything you want - and even without explicit distortion of facts, but only by providing suitable conditions for testing. A typical representative is the popular influenza medicine, 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 tested by other, financially uninterested specialists. And if, according to the annotation, the principle of action of the already mentioned drug is unclear (provided that there really is a positive effect from it), then the negative effect of this drug is also not particularly clear - and, as a result, the doctor can neither take into account nor compensate his. Of course, over time, negative statistics can be collected from clinical practice - but this will be only a limited set of symptoms only in fact, without a predictive effect and the influence of combinations with other drugs. It is unlikely that someone on their own experience wants to know that the drug causes irreversible impotence or congenital deformities in children.

The priority of evidence over scientificness does not cause rejection, perhaps because we are accustomed to proofs in mathematics. However, proofs in mathematics are of a completely different nature and are not tied to statistics in any way. The task of proof in mathematics is to demonstrate connections and their consistency; the task of statistics in medicine is to demonstrate the existence of a correlation between drug intake and recovery. The nuance is that neither cause-and-effect nor any other relationships follow directly from the presence of correlation - because correlation is a purely mathematical operation on two arbitrary data sets and nothing else is taken into account when calculating it.

By definition, statistics consider systems whose internal structure and mechanism of operation are unknown or too complicated for analysis, and it is not always possible to even simply influence the input data of the system. If the mechanism of the system's operation is clear, then there is no point or need to involve statistical methods, unless only for the purpose of demonstrating correctness in individual cases. It makes no sense to iterate over all sets of values with a check for inequality in Fermat's theorem, if there is already an analytical proof of it. There is no need to do the discrete Fourier transform if we already have the system transfer function originally calculated to amplify a specific frequency band.

Medicines don't magically work​

Many people, including medical practitioners, treat medicines as if they work in a magical way. But this is not the case. When a drug enters the body, it is not a miracle that occurs, but a chemical reaction that has a beginning, an end, and decay products. In this case, the drug interacts not only with the body, but also with other drugs, and even with food - and this interaction is more often negative than positive. However, something else is more important here -

Medicines not only cure, but also cripple​

If you read the annotation to any real (non-homeopathic) remedy, suddenly it turns out that the list of undesirable side effects is much larger, wider and more interesting than its actual useful, and not always explicitly prescribed action. And rest assured - everything that is described in the unwanted side effects is not theoretical assumptions, but phenomena actually recorded in clinical trials in the same ordinary mortals (and not at all chronic losers, who are always unlucky in life). And if the annotation says "can cause multiple birth defects in newborns" - be sure that this knowledge was obtained at the cost of ugly children from unfortunate mothers who treated candidiasis during pregnancy. And that is why doctors are categorically opposed to any form of self-medication - a thoughtless technique of surrogates with unknown properties, or real pharmaceuticals.
Sarcasm spoiler
Digging into the history of farming. In the industry, you can find many examples when a drug is not only withdrawn, but also passes into the category of hard drugs, the production of which is shifted from legal to illegal by the efforts of enthusiasts. Typical examples are the once popular sleeping pill and the well-known cough medicine.

Self-healing is not evil, but good​

If by self-medication we mean not the thoughtless use of chemicals (as doctors generally understand it), but the very fact of getting rid of the disease, then there is 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 according to them is a doctor's tool, not a patient's one. The main tool of the patient is to find and eliminate 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 physical activity, unbalanced diet, lack (or excess) of specific vitamins or other substances, the specifics of professional activity. As soon as these reasons disappear, their negative consequences will also disappear (or at least simply weaken).

Our main doctor is hygiene and immunity​

If we consider the treatment of individual diseases as killing 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 the qualitative improvement of health and an increase in life expectancy.
Immunity, in turn, is able to cope with diseases with which modern medicine does not yet exist - typical representatives of which are influenza viruses and their variations. Flu shots, of course, can speed up recovery or even prevent a fatal outcome - but they do not cure by themselves and are just "food for thought" for the immune system.
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 in general. Immunity and other subsystems of its vital activity develop and adapt. Therefore, from the point of view of evolution, there is nothing supernatural in independent (and spontaneous) recovery from diseases that were once fatal in the past.
But here, too, everything is not easy - hygiene and immunity practically contradict each other. The more a person is fond of hygiene, the lower his immunity, since he loses "information for thought." Finding the optimal balance between them is a separate interesting task.

Real cure must be final​

If a doctor kills fungi and parasites inside the body with pharmaceutical drugs, this is a treatment. If a doctor pulls an arrow out of a leg that interferes with walking, or pulls out a rotten tooth that 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 is no longer a treatment. Service at its best. After all, the more often the patient encounters diseases, the larger the list of drugs necessary for regular use will be, and the richer the set of side effects from them, gradually accumulating in the body, will be.

The real treatment (not) must be the same​

If different doctors make different diagnoses and prescribe different treatments for the same person, then this is not science at all, 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 performing them, the laws of physics do not change from engineer to engineer. Errors in the program do not change 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 - mercury, radiation, trepanation / lobotomy, purification by fire ... played here, obviously, we are also dealing not with scientific knowledge, but with a variation on the theme of the holy grail - even if there is a scientific basis for it.

Conclusion​

The purpose of this article was not at all to cast a shadow on doctors or medicine in general. There are real doctors who work for the idea, and real surgeons, for whose work you are not ashamed, and real scientists who grow real drugs 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 infospace by default, and what we ourselves would like to see.