Monday, March 10, 2008

Whatever happened to medical progress?

By an odd bit of synchronicity I'm simultaneously engaged with leading edge research in "Translational Bioinformatics" and refreshing my very dusty knowledge of family medicine.

How dusty? It's been about ten years since I took care of a patient, though other work has kept me somewhat connected to clinical practice. My medical school ended in 1986, so we're talking antique knowledge with dust on it.

Problem is, my old knowledge is more topical than it should be.

In 1983 I wrote a friend an enthusiastic note boasting of how quickly medical knowledge was moving. I was sure that the future was bright for treating and preventing diabetes, the "Haitian disease" (later HTLV, then HIV), rheumatoid arthritis, ALS, autoimmune disease, osteoarthritis, lupus, hypertension, heart disease, migraine, asthma, schizophrenia, dementia, viral and bacterial infections, multiple sclerosis ...

Ok, so I was a tad naive -- but the twenty years from 1962 to 1982 had been amazing. Infectious disease, nutritional disorders, thyroid disorders, insulin, hypertension, angina, -- we were doing great. All we had to do was keep up the pace ...


We hit a wall. Now we're relearning how to fear bacterial infections, and the antibiotic pipeline is dry. We can't even treat menopause any more -- estrogen is a bad word. Lipitor and Glucophage are great, but we thought Diabetes Mellitus would be cured by now. We can slow the progress of HIV, but we still don't have a vaccine. Our progress against everyday medical conditions has been lousy over the past twenty years. Mostly we've learned to stop doing silly things, like given people with heart oddities antibiotics prior to minor dental work.

Forget the propaganda about zillions of articles being published -- that's not translating to big changes in people's lives. Yes, we do make progress -- but automobile-style progress, not computer-storage type progress. No wonder we're expecting to spend 99% of our GDP on health care -- we're not getting any big productivity boosts from breakthrough treatments.

Which brings me back to the "translational bioinformatics" stuff. This is the dream that we can apply enormous progress in computational power, and basic science breakthroughs in genomics, to the intractable diseases that have been jeering at us for 20 years.

I'd really like to see us knock off just one of those suckers before I retire. Multiple sclerosis would be a good start. Make my 20 year old knowledge completely obsolete. Please!

No comments: