“What gets us into trouble is not what we don't know.
It's what we know for sure that just ain't so.”
Mark Twain

Mark Twain, aka Samuel Langhorn Clemens, went right to the mark in so many of his aphorisms. The one above seems to fit quite well with much that circulates in the modern media and particularly with the state of modern medical knowledge and information. Media and medicine go together frequently in the present day. For good or otherwise.

The simple state of things is that much of what we take for fact and truth – in this case regarding the medical field – is really tainted and twisted, biased and conflicted, incomplete and inadequate. Often not close to what might be called correct knowledge.

“Well, how can this be the case?” you may wonder. Let’s cover a few – but hardly all of the reasons.

• Science-based knowledge is subject to change, frequent change. So do we believe yesterday’s vogue in medicine, or today’s? Or should we wait for tomorrow’s pronouncements?

In the medical as well as the mundane world, what we take as true and factual may be updated, modified or even reversed tomorrow with quite opposing evidence. Public medical pronouncements come and go regularly, sometimes being drastically changed in months or years. The reader probably can recall cases that fit this picture.

A favorite story comes to mind from a generation or so past at the Harvard Medical School. It is told that the school’s Dean, Dr. Charles Sidney Burwell, made it a habit to meet and speak with the incoming students on their first day. He gave a similar pep talk each year and always threw in a proviso about their medical education, “Half of what we teach you here will be outdated or simply shown to be untrue in twenty years. The problem is that we don’t know which half that is.”

In a similar vein, let us take such a simple thing as human nutrition. Even into recent times, experts have admitted that, “the energy requirements (calories) of man and his balance of intake and expenditure are not known.” (J.C. Waterlow) Estimates of nutrient requirements can be made, but medical scientists do NOT know. A similar state of things exists in wide ranges of medical teaching and practice. Name a medical topic and there are likely to be huge holes in present-day understanding.

• Neither science nor medicine are pure. The public and the media – to a large degree – consider the words which pour from the mouths of medical authorities to be almost sacred. But, all evidence, testing, and interpretation passes through flawed human minds and thoughts, hands and lips.

Conflicts of interest, money, status, power, etc. creep in from all sides. Most of these impediments stand quietly hidden from public eyes as they are part of the very substance of those professions as well as of modern life. Read Otis Brawley’s How We Do Harm. Brawley was for many years the highest ranking physician employed by the American Cancer Society. His book might well have been subtitled How Money Runs Medicine.

• Medicine is not even a science. Lewis Thomas has called medicine the “youngest science.” But it really does not deserve that designation. Medicine and science are so often used in the same sentence. The public thus takes them as being synonymous. But, medicine is only loosely based on science regardless of claims made otherwise. Factually stated, medical practice is largely based on “educated guesswork.”

Medicine used to be a “healing art,” but has become the premiere “health science.” Unfortunately, medical schools teach courses neither in health nor in healing. Art is rarely spoken of in training. At the same time, science predominates; students being required to take many science courses in college and most professors being employed not for their teaching abilities but because of their research and publication records.

 
• Science and Medicine have become the Churches of modern times. Churches of Religion ruled for centuries past. Hospitals and clinics have taken their place and become the Temples of the times. And physicians the priests of the day – to a greater or lesser degree.

Robert Mendelsohn, the medical heretic of a generation past, has much to say on the faith which is placed in clinics, hospitals, and medical centers. Churches used to be the focal points of many communities. Now, the Faithful turn toward medical complexes, insurance companies, and banks.

• The human race – at least in the West – is habituated to drugs. Artificial - man-made and concocted – pharmaceuticals fit the modern paradigm which seeks a quick response to any ill or symptom which might be brought to a medical practitioner. Human beings are drawn to simplistic, “this-for-that” kinds of remedies. And drugs fit that bill quite clearly. So, what Pharma publicizes has huge sway with the media and the public. Pharma’s financial support of medical institutions may have an even greater effect on western life and health – or ill health.

• The stamp of the American Medical Association has large clout and a relative lock on mainstream media attention. There are alternatives and complements to orthodox  western medicine. Osteopathy and chiropractic have held toe-holds on the field of medicine for generations, but money has been attracted in bundles toward “provable, scientific” methods. If orthodox medicine was really as scientific and successful as touted, its practitioners would never have taken time and money to squelch their “unscientific” rivals.

Furthermore, with all its power and financial resources, where all the “cures” which have been longed promised by orthodox medicine and science?

This writer was an early member of the American Holistic Medical Association (started in 1978), as an attempt to broaden the practice and principles of standard medicine. In order to approaches human ills in friendlier, more sympathetic ways. AHMA conferences were much different than usual medical meetings with lively presentations, music and humor, family-type environments. At the time, many of us thought, “Holistic Medicine is the way of the future.”

But not surprisingly, AHMA’s days were numbered. It was not entirely shocking recently to find that the organization now exists in name only, having been absorbed into the Foundation for Alternative and Integrative Medicine.

To get significant attention from powerful media outlets, one has to be “a member in good standing” of the guild, club, professional clique in power. S/he has to fit modern scientific thinking – lest being immediately considered unscientific, unfounded, discredited, a practitioner of pseudoscience. That even though large swathes of modern science and medicine are themselves pseudoscience. The vast majority of medical practices have never been proven according to what are considered scientific standards.

• Medical practices often produce illness and disease while intended to do the opposite. This seems to be the obvious, evidence-based case. Misinformation surely stands behind many of those practices.

This fact was covered at length in Ivan Illich’s book called Medical Nemesis written in 1974. Illich identified three broad categories in which Medical Practice produces illness: clinical iatrogenesis, social iatrogenesis, and cultural iatrogenesis.

We are more aware of clinical – office/hospital – produced ills. The other two stand in the background and are involved in the creation of all sorts of problems for ourselves by medicalizing the whole of western society. Clinical iatrogenesis includes things like mistaken prescriptions and Adverse Drug Reactions (ADRs), hospital-acquired infections and surgical blunders, and misdiagnoses and a host of other human errors. These problems are experienced by millions of patients every year; many are reported while probably even more are just shrugged off by patients and/or physicians.

Iatrogenesis means physician-caused. Medical practices often turn out, in a greater or lesser degree, to be our own nemeses [adversaries]. Nemesis (in ancient Greek thinking) was the inevitable punishment for attempts to be a hero rather than a human being.

Much of orthodox medicine is heroic in nature. Human patients like heroes, when most of them and their physicians are far from real heroes. While generally well-intended, a great deal of medical practice creates more problems than fewer – and even if only in the face-to-face clinical end of things.

In many, many cases, patients who go for medical attention usually appear with just one problem. But, they go home with two or more: their presenting complaints plus the effects of their commonly complicated visit. The latter puts them, already hurting or stressed, through tests and procedures which will more likely add to their ills than relieve them. Patients will also, in a majority instances, go home with one or more prescriptions to which their bodies will have to adapt to as well as the frequent side and ill effects attendant on their consumption.

 
There are surely other reasons for the state of Misinformation as well as what passes for Information where Medicine is concerned. But, the reasons discussed above should suffice to get the point across that Misinformation is “part of the package” where Modern Medicine is concerned. We live in an imperfect world and medical practice demonstrates that in many ways.

This essay was originally completed by adding ways and means to attain sound Medical Information. But upon reflection, we decided to let readers sit with the ideas now shared for some time. And, to allow us time to embellish our list in a followup essay.

So, look for Part 2 on Medical Information in a month.