The Contribution of Scientist in Medicine

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.

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

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

Drugs like TV Sets

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 

The Clinician- Scientist Partnership:

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.  

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.

The Royal Society of Medicine in London bemoans:

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