The Frontier of Medicine

Now that I am about two and a half months into my first year of school, I've formed a few initial impressions.

The most astounding thing thus far has been my learning about just how limited our current collective medical knowledge is. Frequently in class -- across our wide-ranging discussions of human biology -- we are served mere sketches of the mechanisms of normal physiology and disease. A professor will describe and explain a system or process, only to stop short and say "...and that's all we know at this point." The knowledge we do have is impressive and inspires confidence, but it is nowhere near what I'd expected. And I say that as someone fairly acquainted with science. I think the general population thinks we know far more than we do.

A related point is that the idea of "disease" is far murkier than most people think. While it's usually clear-cut when a bacterium or virus can be detected, it's far less so for chronic disease and cancer. Normal and disease states can produce indicator values whose normal ranges often have substantial overlap. Scientists are left to draw a line at an optimal value, but that inevitably results in missing some disease and mislabeling some normal people. Some people who could benefit from treatment miss out, and others who don't need it are harmed by unnecessary intervention. Add to this that health and disease are not a binary states. Disease is not an on/off switch. Development of disease is often a gradual, incremental process. All heart disease is not created equal and neither are all cancers. I raise this point not to be critical of medicine, but merely to illuminate. It's a tough thing to navigate, especially when explaining it to a patient or his family members. Most people tend to want black and white answers, and it's just not that easy.

Finally, despite our current limitations, our knowledge and power in medical and related biology are advancing at paces that I think none but a very small, insular group truly appreciates. This advance is soon going to create dilemmas with which we as a society and world will be ill-educated and ill-equipped to cope. I'll write about that at much greater length in the future.