Doctors Be Doctors

Some physicians are scientists, but most physicians are practitioners like me.  There’s a difference.  Right now, we need doctors to be doctors.

Scientists study disease and test treatments by applying the scientific method to clinical trial enrollees.  The more scientists know about individuals in their study, the more likely that bias creeps in and pollutes the conclusions.  That’s why the best clinical trials are large, randomized, double-blinded and placebo controlled.  They are focused on populations instead of individuals.  Subjects in a clinical trial are part of a science experiment; rather than receiving cutting edge treatment, they may be getting no treatment at all.

The scientific method requires strict discipline.  Anecdotal data is anathema to true scientists, to the point that “anecdotal” has become synonymous with “unscientific” and “unreliable.”  These words are often used pejoratively to malign the reputation of a report, an observation, or an individual.  But it need not be so.  Science is not the only path to reliable information.  

Practicing doctors use a different method to understand disease and guide treatment.  Practitioners look at patients one at a time and tailor treatment individually.  The more that physicians know about their patients, the better their treatment results.  These doctors watch the outcomes.  Treatments that consistently produce better outcomes are favored over those that do not. 

The experience of each encounter feeds back into a doctor’s therapeutic approach with other patients.  For example, if a patient has a poor outcome after taking a particular drug, the doctor prescribing the drug will be less likely to prescribe it in the future.  On the other hand, if a patient has a good outcome after taking a particular drug, the prescribing doctor will be more likely to use it when treating other patients.  Communication of these experiences among doctors quickly optimizes treatments.

It is not science, but it is not wrong either.  It is more like a search engine algorithm, like A/B market testing, or like crowdsourcing.  These are effective methods of finding efficient pathways well known to the technology sector.  It is AI, except it is not artificial; it is just intelligence.  That is what it means to be a doctor.

Collectively, doctors are a massive learning machine, plowing through data one point at a time.  It is not surprising that doctors can find new uses for old drugs.  It is not surprising that these old drugs can have long established safety records, even if they are no longer patentable.  It is not surprising that repurposed drugs can be effective treatments for COVID-19 despite the absence of supporting clinical trials.  

Science is an important tool for understanding reality, but it is not the only way to find truth or effective therapies.  Not all medicine is based in science; there is also art in medicine which values anecdote.  Over-reliance on science eliminates the opportunity for people to benefit from the power of information collected by practicing doctors, one patient at a time.  

Like any tool, science can be abused or manipulated.  The integrity of science is the same as the integrity of the people doing science.  People who oppose treatments based on the absence of supporting scientific data are bullies, misusing science to get their own way.  These science chauvinists have let us down.  Worse than that, doctors who have forgotten how to be doctors and who rely exclusively on science have let their patients down.  

When all of this is over, when the world turns around, brave doctors will have to rebuild healthcare from scratch, earning public trust again, one patient at a time.