The Contribution of Scientists in Medicine
I wrote an article in this blog "Are Doctors Clinicians or Technocrats?" just hours ago.
Here, in this small article, I thought I should continue my thoughts that medical scientists should not be left out with their hard earned scientific data for the advancement of medicine
What I wrote earlier, of course does not mean clinical practice should only
be confined by just looking at the history of the patient, by just looking at
the signs and symptoms, do a clinical
examination.
All these methods are very subjective depending entirely on the clinical acumen of the doctor but without any concrete objective measurements and without any data, and then just prescribing the treatment.
All these methods are very subjective depending entirely on the clinical acumen of the doctor but without any concrete objective measurements and without any data, and then just prescribing the treatment.
This approach in modern medicine would be grossly wrong if medical
technology can come to the aid of the
doctor with their advanced objective measurements and investigations.
Clinical Data Just as Important:
Clinical data can then be collected to look at the extent of
the chemical and physiopathology, which would also be very valuable for
follow-up treatment and monitoring
It would be utterly unacceptable if lab technology if
available to confirm a diagnosis, but denied to the patient especially if they
are cheap and cost effective
Furthermore, there are many things in medicine we do not
know, such as how do we defeat cancer yet not wanting to consult our scientists
colleague who have the expertise in molecular biology, genetics and epigenetics, who
can study malignant cells express themselves, the behavior of their genetic codes, codons and switches and their highly
complex signaling pathways…etc., etc.
But to understand disease, we need to call in our scientific counterparts
working silently in research laboratories, and through their R & D develop
rapid diagnostic procedures and drugs that may eventually give the tools to clinicians to effectively manage cancer and
many other unsolved and difficult diseases
Scientific Medicine:
But if we do not wish to use scientific methods but confine our practice to just history taking, and physical examination, medicine
will immediately come to a standstill for everybody – for the
doctor, the patient and worse of all, the public.
Then there will be many, many diseases like autoimmune
disorders like SLE, lupus, polycystic ovary syndrome, multiple sclerosis, cystic
fibrosis, Crohn's disease, motor neuron disease, and even the entire range of
reemerging infectious and communicable
diseases becoming unresolved, if not
growing bigger and bigger a threat
They are also the ones who study their therapeutic action, their toxicities, work out the dosage, their interactions with other drugs or nutrients, their indications and contraindications, pharmacodynamics (mode of action), their pharmacokinetics (absorption, distribution, retention time, mode of excretion, etc.), and teach the doctor how to use the drug besides educating them on the precautions, etc. etc.
The doctor won’t know these because the drugs are not designed or invented by them. They are just the end-users together with the patient
Drugs like TV Sets
All he is interested is how to use them by reading and following the manufacture’s pamphlets enclosed with the drug.
Hence if a doctor refuses to acknowledge most of the credits to be given to his scientist colleague, then he will stand alone forever taking only medical history, looking for signs and symptoms, palpating and percussion the patient body, and auscultating the patient for heart murmurs, lungs for rales, rhonchi, stridor and pleural rubs, and elsewhere for bruits and bowel sounds.
The Contribution of the Scientist
If the doctor does not wish to bring in the scientist as
part of the health-care provider, but only himself as the stand alone contributor,
then how is he going to treat the patient?
Where then can he get the medication because all the drugs
including vaccines and diagnostics are the inventions of the scientist in his research
into R & D. This includes the medical engineers who invented and developed
all those different types of scans and imaging machines
It is the drug scientists who not just formulate and model
the drug or the vaccine, but they were actually the ones who study their
actions on body as well as its chemistry of the pathology.
They are also the ones who study their therapeutic action, their toxicities, work out the dosage, their interactions with other drugs or nutrients, their indications and contraindications, pharmacodynamics (mode of action), their pharmacokinetics (absorption, distribution, retention time, mode of excretion, etc.), and teach the doctor how to use the drug besides educating them on the precautions, etc. etc.
The doctor won’t know these because the drugs are not designed or invented by them. They are just the end-users together with the patient
This is exactly like a consumer who buys a television set, a
house computer, a smart phone, a microwave oven, a washing machine. All the
consumer needs to know is how to use them by following the manual that comes
together with the product. It is not their responsibility how the gadget works
or manufactured, and even if told, he is hardly likely to understand either
because pharmacology is not their field with just two months lectures about
drugs during their medical training
All he is interested is how to use them by reading and following the manufacture’s pamphlets enclosed with the drug.
Hence if a doctor refuses to acknowledge most of the credits to be given to his scientist colleague, then he will stand alone forever taking only medical history, looking for signs and symptoms, palpating and percussion the patient body, and auscultating the patient for heart murmurs, lungs for rales, rhonchi, stridor and pleural rubs, and elsewhere for bruits and bowel sounds.
This he will do round and round in circles forever getting nowhere
for him, or of any benefit to the patient
He has no choice if he wishes to use other methods to diagnose
and treat the patient, he must give due
credit to the scientist who work brought to him all the lab diagnostics and
scans available for him to proceed further, much more than mere clinical examinations
round and round, benefiting no one.
Treating the Disease, the Person or the Patient:
Unfortunately, the doctor does not study or research into
disease. His role is merely to diagnose and prescribe the medication, but the medication
is actually administered by the nurse. Sadly he treats the disease but not the
patient as a person. He looks at everything from the medical point of view and
forgets the patient is actually a person, and not a biochemical machine, but with social and spiritual needs which must
also be holistically treated, and not just by
giving the medicine
The medical scientist on the other hand, only studies the
disease, its chemistry and pathology, but does not treat the patient, let alone
treat the patient as a person. He is only interested in research to give
something new for the doctor to use, like a manufacturer producing a smart
phone or a television set, and sell it
to a user to use it Both are grossly guilty of their short coming
Thus clinicians, no matter how competent they may be, must give way to scientific
methods of investigation in order for medicine to advance. They just cannot
confine their practice using just clinical methods without lab investigations. Then they will get nowhere, and all of us in society
will also suffer too because there is no way to diagnose a complicated case effectively,
and no treatment can then be offered
Clinicians have no choice but to work hand-in-glove with
medical scientists and researchers who actually are the frontiers of their scientific
and medical knowledge. The scientists impact these knowledge to them through
their publications in learned scientific and medical journals provided the
doctors read them.
But all these scientific research in medicine and medical
sciences must be able to be translated from bench into bedside through the
middle party called translational medicine, and emerging field of medicine so
that a medical graduate will turn into not just a clinician, but a
clinician-scientists capable of handling complex scientific research.
At the moment it is the scientists, not the doctor who does 99.99 percent of the research work in medicine. However, neither the clinician nor the medical scientist can work separately, ignoring each other valuable work.
At the moment it is the scientists, not the doctor who does 99.99 percent of the research work in medicine. However, neither the clinician nor the medical scientist can work separately, ignoring each other valuable work.
Both are to be given equal tribute in the
health care profession, because the doctor cannot work stand alone. Many other
health care partners are also involved in a holistic approach to fight disease,
pain and sufferings
The Nobel Prize in Medicine or in Physiology:
In fact all the prestigious Nobel Prizes in Medicine or in
Physiology are awarded mainly to the scientists these days. They are actually
the ones who work silently in their research laboratories except during
clinical trials when both may emerge in public, else only the doctor and the patient are in view
The Nobel Prize in Physiology or Medicine is widely
considered to be the highest accolade in modern healthcare. Once a year, the
Nobel Assembly at the Karolinska Institutet in Sweden announces a prize to
recognize the significant medical contribution of up to three healthcare
researchers.
In a paper published by the Royal Society of Medicine in
London, it was reported:
“We studied the overall trend in prizes and awardees to note
that the proportion of clinicians receiving this award has been diminishing
year on year. In the past 100 years of awards to medical scientists (excluding
war periods where Nobel Prizes were not awarded to individuals); over 79% of
Nobel Prizes in the first 30 years were awarded to clinicians. This contrasts
significantly with the last 30 years, where only 26% of prizes have been
awarded to clinicians”
(J R Soc Med. 2011 Sep; 104(9): 387–389).
Thus we can see the advancement of medicine has now been taken over by medical researchers and
medical scientists instead of by medical doctors and clinicians unlike 3
decades ago. The scientists are
deservingly recognized as the actual
frontiers and contributors of medical knowledge and medical advances only possible by their hard work hiding behind
the screens and corridors of the health
care profession
The Scientist Contribution:
In fact they contributed 99.99 percent of the advances in
medicine by developing new diagnostics, new range of drugs, all the various
scans and imaging techniques from X-rays to ultrasound, CT down to MRI and PET
scans – all of them are developed by medical scientists and researchers, and none by clinicians.
So did medical scientists find out causes of various diseases
and how to prevent them? Very few of these studies came from medical doctors
The highest accolade in the form of Nobel Prizes in Medicine
or in Physiology are praiseworthily given to the research scientists for their
immense contribution to medicine
But if we were just to depend history taking and clinical
medicine without any drugs formulated and designed by the pharmaceutical
chemists, studied by the toxicologists, molecular biologists and evaluated by
the pharmacologists, then absolutely no disease can be treated by the doctor.
They will have nothing to offer?
The Long Dark Tunnel
The health-care industry is like a long dark tunnel
Hidden all along the sides of this tunnel are the unsung and
unseen heroes, the medical researchers, scientists, inventors, and discoverers working
silently towards the end of this tunnel just for two recipients to benefit
their hard and unsung work
At the end of this
tunnel you will see a very bright light where you will see only two persons who
are recipients sitting in the open of a bright glare. One is the doctor, the other the
patient. The doctor gets the most limelight
But each year, the Nobel Prize Committee for Medicine or
Physiology will call out just one or two most glaring contributors hidden
somewhere at the side of this tunnel to come out to receive this world’s most
prestigious Prize in Medicine to be in the real glare
There the tunnel is opened completely, not just at one spot
at the end of this tunnel, but in broad daylight for the entire world to see
the real hero
Ironically, more and more of these unsung heroes hidden in this
dark tunnel are now being called out into the open to receive this most converted
and glaring Prize and the doctor and his patient at end of the tunnel are asked to retreat into darkness and oblivion
Obviously the medical community has to acknowledge and give
way to the clinician’s scientific counterpart in order for them to progress for
the benefit of the public. None can stand alone, as the scientific world is now
multidisciplinary requiring expertise from various scientific disciplines
lim ju boo BSc PG Dip Nutr MD PhD FRSPH
Fellow, Royal Society of Medicine
London
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