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Open Wide – a case for open source medicine (pt1)

All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal. – Hippocratic Oath

Medicine is full of secrets. I should know, since I’m a doctor.

While some philosophers will argue that there is no such thing as ‘good’ and ‘bad,’ our own personal system of values usually classifies everything relative to those two concepts.

Even secrets.

It sounds fairly simple, right? Good and bad are complete opposites, so the thing under consideration is either one or the other.

Medicine deals with human beings and their humanity; with all its complex systematic social interactions. Anyone would agree that keeping a patient’s medical history secret is a good thing.

What happens if a married patient contracts a sexually transmitted disease because he has been sleeping around? Telling his wife about it could potentially destroy his marriage. Suddenly the simple secret becomes a complicated burden. Ethics committees would like you to think that there is only one correct answer, and lawyers know that there is only one answer that will keep you out of court. To actually be thrust into the middle of such a situation is not a pleasant task at all.

You learn that something can be both good and bad at the same time.

Then there are other secrets in medicine… secrets that leak out from time to time… and suddenly aren’t so secret anymore. For example, modern medicine for all its remarkable achievements at prolonging life (or at least quality of life), is still plagued with false assumptions, charlatans and snake-oil salesmen. Sometimes your doctor is doing what he was trained to do, but this method, drug or procedure was the fashion at the time of training — more simply, “because it’s what everybody else is doing.”

There have been many interesting revelations lately in popular press,  about back surgeries that offer results that are no better than physiotherapy, about drugs that don’t do nearly as well as the pharmaceutical companies claim they should, about stents and bypass surgery being no better than treatment with pills — and yet nothing is new.

As far back as the 1970’s Archie Cochrane started taking a long, hard look at the practice of medicine and basically asked, “Is what we are doing as effective as we think it is?”

This is a vital question in a science such as medicine.

The scientific method is not only about answering the question and designing experiments — but sometimes data has actually to support the claims. The status of science is the only reason we doctors are allowed to literally take people’s lives into our hands and do things to people that no homeopath or chiropractor is allowed to do.

When we speak we are supposed to be supported and guided by absolute, verifiable and reproducible facts.

But then someone like Cochrane comes along and begins to turn medicine on its head, by showing that some of the things we have been doing as ‘standard procedure’ has no additional benefit, compared to not doing them at all.

Which brings us to the next step – if it has no benefit, then why bother doing it? After all, patients aren’t coming to visit us as a social call. They realize that medicine has limitations — but they want a combination of the most effective treatments at the cheapest cost and the minimum intervention.

So why do these bad little secrets creep into what is apparently a solid, peer-reviewed and highly regulated profession?

The answer is simple.

Medicine is a vast field that embraces many disciplines — from physics and biochemistry to statistics and sociology — passing briefly through traditional medical fields like anatomy, physiology and pathology.

That trend is growing at a geometric — if not exponential rate. Several  I learned at medical school are now obsolete. Non-physicians are aware of this change. Especially those who follow the constant, “aspirin is good/aspirin is evil,” 20-year-old debate. Even basic CPR has been changed again. Imagine what is happening to immunology or oncology.

There is no way someone can keep up.

We are human, so we try to hang on to a rock when we are in danger of being swept away by change. This rock is often stubbornness or our own judgment and critical thinking. We read about new things, and then we choose to believe them or not. If a new study, “sounds good and logical,” we accept it, and if it, “sounds badly designed or illogical,” we reject it.

Suddenly medicine has stopped being a science, and turned into a belief.

Compound this with two facts:

  1. All medical research is profit driven (either by a university, a corporation or an individual)
  2. Some studies are completely false — even peer-reviewed ones.

Now you have a recipe for disaster.

Suddenly, someone is out to convince the doctor that this new machine or this new medication works. All they have to do is convince him and present an idea that, “sounds right and makes sense.” Sound familiar?  Sounds like a snake-oil salesman.

In the second part of this series, we’ll look at the current state of medical equipment and how the ‘open source’ concept could benefit everyone — even the manufacturers and vendors of snake oils.

Steven Miron, MD is a licensed practitioner with many years experience operating a private practice. However, nothing he says in this magazine should be construed as medical advice and you should always talk to your personal doctor before making medical decisions.

You can find this article and many more in Issue 01 of Citizen Science Quarterly

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