Category Archives: Culture of Medicine

Therapy AND Life

Posted by on February 17, 2011 102 comments

UPDATE: The Daily Mail article cited below was not only silly, it appears to have been dishonest. I’ve received the following email:

There is an article on your website about me (17/2/2011). Yes, I’m Judith Fine and that article was in the Daily Mail. Firstly, they completely twisted everything that I said so that it makes it look as if I have severe eating problems. Most of that article was a complete pack of lies, neither is it me in the photograph. Could you please, immediately remove it from you website as I am in the process of picking this up with the Daily Mail.

I’ve edited the post to remove content related to Judith. — PAJ

“Orthorexia” has been in the news recently, for instance in this Valentine’s Day article by Diana Appleyard in the Daily Mail:

We all know the type. They never let wheat, yeast or dairy pass their lips. They’ve cut out alcohol and caffeine. They’re obsessed with healthy eating — yet every day, they look more unwell and unhappier.

These are the symptoms of a condition called ‘orthorexia’ by dieticians….

Orthorexia was coined in 1997 by Californian doctor Steven Bratman in his book Health Food Junkies, and means ‘correct appetite’ (from the Greek orthos for right and orexis for appetite). It is a fixation with eating ‘pure’ food that, far from doing you good, can become so extreme that it leads to malnutrition, chronic ill health and depression.

Well, I don’t eat wheat; I didn’t even know yeast was a food; and though dairy is a big part of my diet, alcohol and caffeine modest parts, I recognize that milk proteins, alcohol, and caffeine can be problematic.

Given that none of these foods are necessary for good health, it’s not obvious to me why excluding them would lead to malnutrition, chronic ill health and depression.

But from the rest of the article, it looks like the real trouble with orthorexia is not the fixation with healthy eating, but faulty ideas of what constitutes a healthy diet. The article’s leading example of an unhealthy “orthorexic” diet is one that excludes fat.

Any fat-less diet is bound to be malnourishing. Perhaps the trouble is not orthorexia, but mistaken ideas about nutrition. Diets people think are therapeutic are, in fact, damaging.

Therapy versus Life … sometimes

Which brings me to a recent essay by Kurt Harris, “Therapy versus Life.”

It’s almost impossible to excerpt, so I’ll just assume you’ve read it. It’s strongly worded, but the ideas are familiar:  I suspect at least 90% of medical doctors would agree.

Doctors are healers, God bless ’em; but every day they have to face patients they cannot heal. This breeds a certain mental toughness.

As I often say, malnutrition, food toxins, and chronic infections are the primary causes of ill health. In some cases, like Judith Fine’s inability to have periods, it’s easy to recognize malnourishment as a likely cause. But the causes of most patients’ impaired health are much less obvious.

Unfortunately, doctors generally cannot diagnose or treat either bad diets or chronic infections. Doctors are great at treating acute disease, and can mitigate many symptoms that chronic diseases generate, but most are helpless to remedy mild, chronic ill health.

Doctors may believe that a patient’s declining health is simply natural aging; or that genuine health impairments may be undiagnosable, untreatable, or incurable. Kurt says it in his forum:

[T]he healthy should not assume they are sick and even the sick may be wasting their time trying to fix what can’t be fixed.

When patients learn that doctors can’t help them, they often turn to experimental self-treatment.

99% of the time, this works out badly. As Kurt’s car metaphor shows, there are many more ways to damage your body than to heal it.

And the 1% of the time it works, the patient doesn’t go tell the doctor. But when it backfires, the patient goes back to the doctor worse than ever. So the doctors see this method fail 100% of the time.

This reinforces the doctors’ consensus: Be prudent. Try to live normally – as healthy people do. Eat like healthy people, live like healthy people, and bear with your incurable maladies as best you can. Thrashing and groping for cures will only do harm.

Therapy – experimental self-therapies – are damaging to life. Choose life, not therapy.

But Diet Is Therapy

But that’s not all there is to it … because the right diet can fix many health problems.

Kurt says this himself:

[T]here is a dietary metabolic milieu that we are adapted to, and the best chance we have of optimizing our health is to try and emulate it …

The human body often can [fix itself] if we just stop ruining it.

We agree. The Perfect Health Diet is, in essentials, identical to Kurt’s PaNu. And when people in ill health eat this way, they commonly get better.

So the right diet is therapy. Choose this diet as therapy, and you’ll have a better life.

What If Your Life is Malady-Inducing?

I chose life over therapy for decades. I rarely went to the doctor. I focused all my energy on life. But I ate a lousy diet.

This isn’t the place to tell my story – that’s coming – but a lousy diet and a focus on life, not therapy, gave me a disabling chronic disease.

And a therapeutic diet gave me my life back. The Four Steps of our book are essentially the steps I took to cure a disabling neurodegenerative condition. With antibiotics, they worked.

So when Kurt asks,

Do you think every problem in your life can be fixed by changing your diet?

I can honestly say: every health problem was fixed!

Therapy for Life

If the Ewald hypothesis and Jaminet corollary are right, then we all stand in need of dietary therapy. As we age, our infectious burden increases and our immune system gets less effective. Sooner or later, infectious diseases threaten us all.

Our rescue is not from medicine, which does not yet know how to treat chronic infections. Our best chance for a long, healthy life lies in diet, nutrition, and immunity-enhancing behaviors like fasting.

Fortunately, the scientific evidence is accumulating to tell us what the right diet is. Specialist professionals still can’t see the forest for the trees, the elephant for its parts; but generalists, aided by respect for ancestral/traditional diets and for evolutionary selection, have blazed the trail. Kurt lists some reliable guides.

Conclusion

Diet is the best therapy. A good diet is life-giving. Good diet and nutrition may cost a few extra minutes a day, but can add decades of happiness.

So I say: choose therapy AND life. We can be healthy centenarians together. Let’s do it!

Jaminet’s Corollary to the Ewald Hypothesis

Posted by on February 11, 2011 46 comments

In Tuesday’s comments, Kriss brought up Paul Ewald, father of the “Ewald hypothesis.” (Also brought up by Dennis Mangan here.) Ewald did some of his work in collaboration with Gregory Cochran, who may be familiar to many for his appearances on blogs (notably at Gene Expression) and for his recent book The 10,000-Year Explosion.

In a 1999 Atlantic article, “A New Germ Theory,” Judith Hooper summarizes Ewald’s hypothesis:

Darwinian laws have led Ewald to a new theory: that diseases we have long ascribed to genetic or environmental factors — including some forms of heart disease, cancer, and mental illness — are in many cases actually caused by infections.

Regular readers won’t be surprised to hear that we wholeheartedly endorse the Ewald hypothesis. We believe that nearly all diseases are caused by infections and bad diet. Malnourishing, toxin-rich diets impair immune function and create vulnerability to infectious disease.

The Ewald Hypothesis

Ewald’s reasoning goes as follows. Quotations are from the Atlantic essay.

First, genetic causes of disease are unlikely. Any gene that led to impaired functioning of the human body would be selected against and removed from the genome. Therefore, genetic diseases should have the abundance of random mutations – about 1 in 100,000 people:

As noted, the background mutation rate — the ratate which a gene spontaneously mutates — is typically about one in 50,000 to one in 100,000. Not surprisingly, genetic diseases that are severely fitness-impairing (for example, achondroplastic dwarfism) tend to have roughly the same odds, depending on the gene.

Diseases that are fitness-impairing and reach higher prevalence – and this includes nearly all major diseases – must have a cause other than genetic mutations.

Germs, on the other hand, are plausible candidates as causes for disease. Germs can benefit from doing us harm. At a minimum, they would like to modify human functioning in order to make us better hosts for themselves — by suppressing immune function, for instance. Also, they wish to induce behaviors that help them spread to new hosts – like sneezing, coughing, diarrhea, or sexual promiscuity.

Germs evolve quickly. Gene exchange, and lack of error checking during gene replication, modifies genomes quickly. Short reproductive time scales – on the order of 20 minutes – mean that helpful mutations proliferate rapidly. Big evolutionary changes can occur in a few weeks:

“The time scale is so much shorter and the selective pressures so much more intense [in microbes]. You can get evolutionary change in disease organisms in months or weeks.”

This means that germs quickly optimize their disease characteristics through natural selection. For example, virulence, or the severity of the disease that a pathogen causes, is rapidly optimized.

One factor determining virulence is how easily the organism can spread to a new host. If the organism can spread easily, there’s little cost to harming the current host, and microbes produce severe disease. If it’s hard to spread, on the other hand, organisms will be mild and peaceable toward their hosts. It pays to keep their hosts alive and healthy.

Ewald and his students collected empirical data supporting their explanation for virulence:

The dots on Saunders’s graphs made it plain that cholera strains are virulent in Guatemala, where the water is bad, and mild in Chile, where water quality is good. “The Chilean data show how quickly it can become mild in response to different selective pressures,” Ewald explained…. Strains of the cholera agent isolated from Texas and Louisiana produce such small amounts of toxin that almost no one who is infected with them will come down with cholera.

In the last few decades, evidence has only grown for the infectious origins of most diseases. In 1999, over 80% of serious diseases were known to be caused by pathogens:

Of the top forty fitness-antagonistic diseases on the list, thirty-three are known to be directly infectious and three are indirectly caused by infection; Cochran believes that the others will turn out to be infectious too. The most fitness-antagonistic diseases must be infectious, not genetic, Ewald and Cochran reason, because otherwise their frequency would have sunk to the level of random mutations.

If this analysis were repeated today, the percentage would be still closer to 100%. More cancers are now known to be caused by viruses, and the links between microbes and cardiovascular disease, dementia, and multiple sclerosis are stronger than ever.

I think Ewald and Cochran are correct in asserting that mental and neurological illnesses are especially likely to be infectious in origin. These illnesses tend to have a big impact on number of descendants, supporting the evolutionary argument for an infectious origin. And, due to their dependence on glucose, neurons are unusually susceptible to infections.

Schizophrenia is a good example of a disease that must be infectious in origin:

From the fitness perspective, schizophrenia is a catastrophe. It is estimated that male schizophrenics have roughly half as many offspring as the general population has. Female schizophrenics have roughly 75 percent as many. Schizophrenia should therefore approach the level of a random mutation after many generations.

Ewald and Cochran suggest we need a “Human Germ Project”:

In Ewald and Cochran’s view, evolutionary laws dictate that infection must be a factor in schizophrenia. “They announced they had the gene for schizophrenia, and then it turned out not to be true,” Cochran said one day when I mentioned genetic markers. “I think they found and unfound the gene for depression about six times. Nobody’s found a gene yet for any common mental illness. Maybe instead of the Human Genome Project we should have the Human Germ Project.”

I concur. Medical research should make much bigger investments in detecting, understanding the effects of, and developing treatments for human infections. Many existing lines of research, including many of the “autoimmune” and genetic hypotheses for disease origins, are not panning out, but continue to monopolize funding.

Jaminet’s Corollary

In the last century, sewage and water treatment has cleaned up our water supply and removed sewage and water as a vector for disease transmission. Hygienic methods, such as daily bathing and the use of soap, also tend to inhibit disease transmission.

Just as cholera is an extremely mild constituent of gut flora in hygienic Texas, but creates acute disease in unclean Guatemala, so we can expect that germs that created acute disease in (unclean) 1900 will have evolved to create mild chronic infections in (hygienic) 2011.

This is Jaminet’s corollary to the Ewald hypothesis:  Microbes are evolving away from severe acute disease toward milder chronic disease.

The focus of modern medicine on acute conditions, and its neglect of chronic conditions, adds to the selective pressures on microbes. Any pathogen that creates acute disease is subject to the full arsenal of modern antimicrobial drugs. But pathogens that create mild chronic disease are generally left untreated.

Modern medicine has created a powerful selective pressure on pathogens to generate chronic illnesses that are just mild enough, and that resemble aging closely enough, to elude the attention and antimicrobial arsenal of medical doctors.

Why No Dementia in Kitava?

Staffan Lindeberg in the Kitava Study found no evidence of stroke, diabetes, dementia, heart disease, obesity, hypertension, or acne on Kitava.

Why were these diseases absent? Partly due to the Kitavans’ excellent toxin-free diet, no doubt, but partly also due to an absence of the pathogens that cause these diseases.

Why was there no multiple sclerosis in the Faeroe Islands until British troops were stationed there in World War II? Because the pathogen that causes MS was absent from the islands, until the Brits introduced it.

Why has the incidence of chronic diseases increased tremendously in the last century? Partly due to longer-lived populations, but also, I believe, due to evolution of pathogens toward these diseases.

I predict the incidence of chronic disease will increase further in decades to come; and we will gradually come to appreciate that nearly all forty year olds today are not fully healthy, but are mildly impaired by a collection of chronic infections.

Conclusion

Fifty thousand years ago there were a few hundred thousand humans in the world. Today there are over 6 billion.

If a pathogen today wants to adapt to a specific host, its best bet is to adapt to humans. And within humans, its best way to flourish is to develop a chronic infection that persists for many decades.

The evolutionary arms race is not over. It has simply moved to a new field of battle. And medicine will have to evolve as the microbes do. The microbes are developing a new style of fighting. Medicine needs to shift its focus toward this rising threat of mild chronic diseases.

The Philosophy of this Blog, With A Parable

Posted by on September 14, 2010 12 comments

One (dis)advantage of the Internet is that it offers a forum for rants: passionate expressions of opinion.

Of course, one man’s passionate opinion can, from another perspective, appear to be nutty-as-a-fruitcake insanity.

My Nutty Post on the Corruption of Medicine

An incisive comment from Christopher M points out that my recent rant on the corruption of medicine is silly:

I think you go too far in your criticism of creeping disease-ification. You seem to have embraced the idea that we should ignore damage and decay to the human body if it is somehow “natural” — i.e., major muscle loss in the aging and elderly. But this is silly. Human suffering, decreased quality of life, and death are problems whenever they occur. Now, maybe the “disease” model isn’t always the best way to think about these questions. But I can’t imagine why we would want to carve out certain forms of decay and suffering as parts of the human experience to tolerate rather than try to avoid — with whatever imperfect means we can.

Now this is obviously correct. Human suffering and decay should be remedied wherever possible.

Christopher could have added to his critique. Doctors, scientists, drug companies, politicians and bureaucrats – all are well-intentioned, eager to heal the sick. How can it be fair to say that their industry is, in some ways, corrupt? Their intentions are good and they work tirelessly in the hope of turning their good intentions into good deeds.

And if they make a lot of money, what of it?  The laborer deserves his wage.

The Black-Box Perspective of Medicine

Conventional medicine is largely based around drug treatment, and drug treatment is based on a reductionist model of human health.

In this model, the human body is a sort of “black box” of which we know little. Drugs are interventions that affect the black box. Health is an output of the black box, characterizable by observable markers (such as, is the black box warm and moving, or cold, stiff, and still?). Medical research is conducted empirically. We do an intervention – provide a drug to the black box – and the black box tells us if it feels better or worse (or we look to see if its box-heart still beats). Millions of drugs are sorted through to find a few thousand that make the black box perform its box-functions a bit better, at least in the short term.

Obviously, this black-box model made a lot of sense before we knew about the human genome, before we could do molecular and cellular biology. It is how our Paleolithic ancestors discovered medicinal herbs. Many early drugs were refined from traditional herbal medicines.

In the modern genomic era, this black-box model of medicine has persisted with a reductionist approach to molecular medicine. Now that we’ve sequenced the human genome and can design drugs to target individual proteins, biologists can at will eradicate the function of any human gene or protein we choose. Much pharmacological research in recent decades has been devoted to “targeting” individual proteins or genes, and seeing if these interventions produce beneficial results in some disease or other.

So, from this perspective, it makes sense to say:  Let’s make a drug that targets a human enzyme – say, HMG-CoA reductase – and see if it can provide any benefits in some disease. Since HMG-CoA reductase is needed to make cholesterol, and cholesterol is correlated with high rates of heart disease (and low rates of infectious disease and cancer), perhaps targeting HMG-CoA reductase will have benefits in heart disease patients. So let’s do a trial, see if HMG-CoA reductase inhibitors make heart attacks less frequent. If so, let’s stuff heart disease patients with these inhibitors at a cost of $25 billion a year.

And this makes great sense – if all you know about human beings is that they resemble black boxes.

An Alternative Perspective

Now step back from that conventional perspective on health, and consider an alternative point of view that extrapolates from a few facts:

  • The human body is the result of a long evolutionary history. Our ancestral genome reached its current size, about 20,000 genes, prior to the Cambrian explosion. For over 500 million years, the thrust of evolution has been to make the gene-protein network as sophisticated as possible, as densely networked with subtle interactions between as many molecules as possible. Every gene has an important role to play in that network, and directly influences perhaps a hundred partners. Thus, targeting a single gene will not only deprive the body of that gene’s function; it will also deprive that gene’s hundred partners of the benefits of its interactions, and thus impair their function, which will have ramifications upon their partners, until the whole genome has been affected. Thus, all interventions in the human body have systemic effects. It is not possible to confine effects to a single “target.”
  • Hundreds of millions of years of selective evolution have optimized the human body to work very well if it obtains appropriate inputs: a good diet that is nutritious and free of toxins.
  • However: the human body is not alone. It is saturated with microbes – trillions of them –which have evolved independently to be effective parasites upon humans. These microbes sabotage the immune system, steal nutrients, obstruct the functioning of human proteins. Their goal is their own reproduction, and human health is only incidental to that goal. Some of them benefit from a healthy host, and these microbes are called “probiotic.” Some benefit from harming their host, and these are called “pathogens.”

From this perspective, what is likely to cause disease? Three factors are most obvious:

  • A malnourishing diet may deprive the body of needed nutrients.
  • Toxins, especially food toxins, may poison the body.
  • Pathogens may sabotage the body in pursuit of their own advantage.

If disease results from these causes, then we are forced to look to diet and nutrition as the first step toward health. And then to infections, which may be treatable with antibiotics, as the second.

If the human body is a highly-optimized densely-networked system, then we must be skeptical toward the “black-box” school of medicine – especially in its new, reductionist, human-gene-targeting form. If evolution has optimized the human gene network to maximize human health, then targeting human genes and proteins is sure to sabotage health, probably in unexpected and insidious ways.

A Parable

I often use economic analogies, because there are a lot of parallels between the cooperative functioning of people in a complex modern economy and the cooperative functioning of cells and molecules in the human body. Let me offer an economic parable.

Imagine a world in which every person manages a complex factory. This factory has tens of thousands of workers, and complicated machinery of thousands of varieties, which all has to work together cooperatively if the output of the factory is to be high.

Suppose that from time to time a factory suffers a loss in output. The workers don’t seem to be as effective; they occasionally fall down and die in the middle of the workday. Machinery breaks down for no apparent reason.

Suppose that, in fact, this is due to an invasion of the factory by malicious monkeys, who steal machinery parts, and ravenous wolves, who kill the workers. Suppose that food poisoning in the factory cafeteria has left the factory security guards and workers weakened and unable to defend themselves and their machines. Suppose further that the malicious monkeys and ravenous wolves are invisible.

One day your factory experiences such a slowdown, and you hire a “factory doctor” to help you fix the problem.  He explains that the reason for the decline in factory output is that your workers and security guards have gone bad. The factory has an “autoimmune” syndrome in which rogue security guards kill workers. Workers have been damaging machine parts. The solution?  Hire a sniper team and kill some workers. Remove the damaged machine parts and don’t replace them. Lock the security guards in the break room. The cost? A mere $20,000 a year, charged to your insurance company.

Now suppose another consultant comes to you.  His explanation: your factory has been invaded by monkeys and wolves. Food poisoning has prevented the security guards from driving them out. His solution?  Give better food to the security guards. Put a fence around the factory to prevent more monkeys and wolves coming in. Find an “infectious monkey and wolf doctor” who can “diagnose” the infection, making the monkeys and wolves visible. Then use his “antibiotic” team of monkey and wolf assassins to kill the invading animals. DO NOT KILL ANY OF YOUR WORKERS OR LOCK UP YOUR SECURITY GUARDS. The cost of this analysis? $25 – free if you can assemble the diagnosis from information scattered across hundreds of blog posts.

The Problem of Underemployed Sniper Teams

Now suppose that factory owners are not hiring enough sniper teams at $20,000 per year. So the factory doctors start going to factories with high output and saying to the owners, “Your factory has pre-disease. Although nearly all your workers and security guards are functioning well, a few have gone rogue. If you hire our sniper team and let us assassinate some security guards and workers, your factory will perform even better. Won’t you hire a few snipers?”

The $25 consultant responds with a nutty rant.

Conclusion

This parable is a work of fantasy. It bears no resemblance to any medical industry or blogger you may have encountered. Any resemblance to any actual medical industry or blogger is purely coincidental.

Has the Medical Profession Been Corrupted?

Posted by on September 7, 2010 23 comments

There seems to be more soul-searching in the medical profession lately. A few pieces caught my eye.

The Money Scramble Corrupts Diagnosis

First, an editorial in the British Medical Journal begins:

Who decides what constitutes a disease and what is normality? Over the centuries such decisions have been the preserve of the medical profession, aided more recently by modern medical science. But the profession has grown too close to those who profit from developing drugs for new diseases and is no longer fit to make these decisions. [1]

The idea is that researchers, doctors, and drug companies are highly motivated to expand the medical industry by inventing new “diseases” that provide new scope for drug treatment.

The recent suggestion that statins be distributed over the counter at McDonald’s restaurants is one example of such a push. The editorial cites new diagnostic categories created by drug-company affiliated scientist-doctors:

[P]rehypertension [is] a condition that along with preosteoporosis and prediabetes has the potential to transform most of the world’s adult population into patients….

Of the US guideline committee that first created the diagnostic category of prehypertension in 2003, 11 of 12 members eventually declared multiple ties to industry. [1]

These “pre-diseases” could be given a more accurate name:  “wheat and vegetable oil consumption syndrome.”

Another example of an emerging disease is sarcopenia, or muscle weakness in the elderly. The New York Times reports:

[G]eriatric specialists, in particular, are now trying to establish the age-related loss of muscles as a medical condition under the name sarcopenia, from the Greek for loss of flesh. Simply put, sarcopenia is to muscle what osteoporosis is to bone.

“In the future, sarcopenia will be known as much as osteoporosis is now,” said Dr. Bruno Vellas, president of the International Association of Gerontology and Geriatrics. [2]

FuturePundit comments: “[B]y all means, label every change we experience while aging as a vile disease. How about hair graying and hair loss? Surely diseases…. Don’t feel as flexible as you used to? That’s a disease. Don’t have the energy of a 17 year old? Disease, horrible malady. Needs a cure. Finding yourself needing reading glasses in your early 40s? Don’t kid yourself. That’s a disease. Demand a cure. Stem cells, gene therapy, nano repair bots, whatever it takes.”

Has the Medical Industry Become Parasitic Upon Its Patients?

Somehow or other, we have developed a government-industry-medical complex that extracts tremendous amounts of money from taxpayers and patients, but damages health. Subsidies for wheat and soybeans and corn make toxic foods cheap; junk science like the “lipid hypothesis” promotes their consumption; elite doctors appointed supreme authorities by government bureaucrats declare biomarkers of wheat, corn, and soybean oil consumption to be diseases requiring drug treatment; the drug industry sells tens of billions of dollars of drugs to the afflicted persons.

Qui bono? Elites do well – elite doctors on the review and funding panels, bureaucrats, politicians, and pharmaceutical companies. Public health suffers.

Bureaucratization of Medicine

Bruce Charlton, the former editor of Medical Hypotheses, argues that medical research has been failing at its mission of making health improving advances in knowledge:

When people are asked about the success of modernity, they usually refer first to medicine….

I have even heard the whole thing boiled down to immunization and antibiotics, or to ‘anaesthesia’ – the existence of which are said to justify modernity against history; as in ‘how would you like to live in a world without ‘*’….

I have previously written about the failure of medical progress from the mid-twentieth century, and that for half a century we have been living through a medical research bubble –

http://qjmed.oxfordjournals.org/cgi/content/full/98/1/53

Yet the failure of medical research, defined as above, is stark: in broad terms we have not discovered any new classes either of antibiotics or pain killers for many decades. [3]

Medical research is very focused on incremental progress in an established research paradigm. Since many established research paradigms are mis-conceived – are cul-de-sacs that lead nowhere – incremental progress down these blind alleys translates into “no progress.”

When stuck in a cul-de-sac, one should reverse course and try some new direction. But medicine is increasingly unable to do this, Dr. Charlton says, due to the bureaucratization of medicine, and consequent stifling of independent creative research:

The reason we have failed to sustain medical progress are doubtless manyfold, but in essence I think it is because modernity has chosen bureaucratic expansion above creative individual discovery.

http://medicalhypotheses.blogspot.com/2010/04/cancer-of-bureaucracy.html

We prefer process over results – consequently we have a truly massive and expanding medical research process with zero or negative results. [3]

Nothing stifles creativity like a monopoly. Concentration of decision-making power in a few hands gives those hands an overwhelming incentive to obstruct change: for innovation could undermine the established social structure and deprive the decision-makers of power, income, wealth, and status. There is no surer way to achieve stagnation than a centralization of funding and decision authority.

As power has spread from individual doctors and researchers to distant bureaucracies, the medical profession has been demoralized:

As I look around medicine it is my impression that doctors know less, can do less, have less spirit, less sense of vocation (or none at all), are less able, make fewer breakthroughs, suffer greater losses of knowledge, have poorer judgment, do worse science, are less honest and have more wrong ideas than they did a generation ago. [3]

Conclusion

I have previously argued that we need a democratization of biomedical funding. Each taxpayer should be able to donate, say, $300 to the research of his or her choice. Projects seeking funding should be displayed on a public web site. This would force scientists to serve real people with real (or anticipated) health problems. This would create competition for public trust, and reward creative approaches to successful healing. No longer would the “old boy network” or peer-review clique control everything; a researcher would need only “1000 true fans”.

Doctors need more freedom to follow their clinical judgment. Let patients, not juries or medical boards, review doctors’ competence. Fear of loss of career and income – of sanctions from juries or medical boards – prevents doctors from prescribing unconventional treatments and engaging with their patients in the cooperative clinical experimentation that in the past led to so many breakthroughs.

Dispersal of power would have major benefits: increases in conversation, and of knowledge. Needing to find true fans, scientists would engage the public in conversation. Provided with funding power, fans would be motivated to learn how to use that power.

The medical profession is suffering from institutional centralization and stifling of individuals by elite authorities.  It needs a healthy dose of creative destruction.

References

[1] Fiona Godlee, “Are we at risk of being at risk?” BMJ 2010; 341:c4766. http://www.bmj.com/content/341/bmj.c4766.full.

[2] Andrew Pollack, “Doctors Seek Way to Treat Muscle Loss,” New York Times, August 30, 2010, http://www.nytimes.com/2010/08/31/health/research/31muscle.html.

[3] Bruce Charlton, “The decline of medicine refutes modernity,” http://charltonteaching.blogspot.com/2010/09/decline-of-medicine-refutes-modernity.html.