Hippocrates

Medicine today suffers almost as much from political intervention as ever it did from priests, shamans and religious dogma of the past. Reform, liberalism, and political correctness marginalize Hippocrates, the hippocratic method, and with him the sacred, ethical, humanitarian and scientific charactor of the profession.

Ideals of reform, political control, regulation, commercialization, political correctness and well intended lay ideals of social progress erode the authority, self regulation and ethics of the profession. Imagine lawyers without the standards and restraints of "The Bar."

Imagine doctors without the standards and restraint of peer review, held only to the gray areas of legality with profit, cynically, the only motive. The evolution of greed seems more and more evident at many levels. I fear that medical school reform proposes to adjust curriculum in order to accommodate this sad reality.

Take the now universal after hours sign off to 911. When did local medical societies decide that a doctor no longer needed to provide after hours availability for response to after hours emergencies or complications? I think in fact it was hospitals, not the medical society that made that change. Was there economic motive? You bet. Hospitals are now a multi billion dollar monopoly with legal sanction. For myself, I thank God for the VA and trust only the mainstream medical school.

On a historical level, medicine has suffered before and recovered; it will do so again. For the medical student, read Hippocrates, travel to some of the great medical schools abroad, be a humanitarian, a poet, a musician and always a scientist. Own a microscope. Do good works.

Quantum Biology

Richard P. Feynman in his published lectures, The Strange Theory of Light and Matter QED, wrote,

"The theory of quantum mechanics ... explained all kinds of details, such as why an oxygen atom combines with two hydreegen atoms to make water and so on. Quantum mechanics thus supplied the theory behind chemistry. So, fundementally theoretical chemistry is really physics."

The parallel in molecular biology is quite obvious. We deal with DNA at the molecular level. The next great step will be a theoretical explaination of molecular biology at the electron, photon and particle level, the level of quantum intanglement. Thus the theoretical understanding of molecular biology will also really be physics.

2,450 years ago Greek medicine was called physics. Aristotle had contemplated the existence of particles. The enquiry into how things worked, especially physiology was called physics and the stem of our word physician is indeed physics. With quantum biology we have come full circle.

23 and Me

23andMe posted a letter to its customers announcing that after two years of work they are now able to  share the wellness implications of their customers DNA directly to its customers. They promis a report by year end. 

The 23andMe database appears to be the biggest in the World and academic institutions are buying into the data for research. Furthermore, the vault of stored samples remains available for further research while the data remains anomonous with the individuals information remaining the property of the individual rather than some other institution or the government.

This becomes a breakthrough for clinical medicine, which heretofore faced a roadblock over confidentiality, the position of nearly all specialty groups and the assumption that the information would be too sensitive for the patient to have access to. Now, the clinician will have access to a patient history containing multiple SPN traits that are of preventive as well as diagnostic value, a great day for translational medicine.

Molecular Biology

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As we attempt to accept the data afforded by genomics, the greatest challenge to health remains nutrition and poverty. While the science accelerates the issues of fresh produce, healthy eating and poverty languish. Why is that?

Wrong Diagnosis

Share |Suprise, surprise, as medical schools scramble to introduce curriculum reform to keep pace with mediocrity, they eliminate the microscope, the doctor's personal lab, the autopsy, and in the name of confidentiality and privacy, bedside teaching is all but forgotten. Sub standard medical schools are a growth industry. Best evidence concentrates so on treatments that we have treatments in search of a diagnosis, particularly expensive highly profitable procedures or drugs. We teach with "standardized patients" a synanym for actors who can never teach the student the reality of a disease or its diagnosis. In our haste to produce alternative providers, we treat health care at the lowest denominator of competence. Any one with a stethescope around their neck is a provider. There are still true physicians, but they are fenw and far between. We still have great medical schools but they are under pressure to make the big bucks, to be self sustaining. Physicians today struggle with commercializations as renasance physicians struggled with the church.  

5 Disasters of the Afordable Care Act, Obama Care

1. It is indeed a tax, progressive fortunately, but inequitably so.

2. There is no provision for autopsy or a physician's own small laboratory, prohibited.

3. There are lots of provisions for providers without adequate medical school training.

4.  The Act allows drug companies to charge what ever they want and prohibits negotiation.

5  it encourages the recording of false or erroneously superfluous diagnosis.

What it has done is acknowledge the need for universal health care,but it needs to morph into a dual system private coverage competing with a universally available single payer system.

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Autopsy

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http://www.pbs.org/wgbh/pages/frontline/criminal-justice/post-mortem/without-autopsies-hospitals-bury-their-mistakes/

Four years later and autopsies remain the forgotten basis of scientific medicine. Headlines read, autopsy rates are falling, but they cannot fall from the near zero percent presently undertaken. Some new hospitals do not even provide examining space for autopsies. The NEJM publishes CPCs on living patients. A pity today's epidemic of curriculum reform does not include autopsies, a further sad accommodation to today's reality. Check the PBS link, it's well done.

The renaissance of modern medicine was lead by the microscope and the study of anatomy; it became clinical with the routine practice of autopsy by Marie Francois Bichat in Paris 1793, the stethescope, Rene' Laennec 1822 and the classical bedside teaching of the great Scottish and Irish physicians in the early 1800s. From Bichat, over the door to his autopsy room, "Death comes to the aid of the living." 

Cynically speaking -- we have all but legislated these practices out of existence, the autopsy for money, bedside teaching for privacy, basic science for curriculum reform with greater emphasis on preceptors and, ah the stethescope, it hangs around the neck in color coordinated pastel colors only to pretend to hear something through the patient's clothing. An anatomy professor recently commented, "They have a microscope down in Seattle under glass so students can see what one looks like."