Map of life expectancy at birth from Global Education Project.

Monday, January 31, 2005

Walking the Walk

One of the most important reasons that social scientists are not like, say, physicists or chemists or mathematicians or even biologists, is the reflexive property of what we do. Although it is true that human beings are physical entities, made of chemistry and biology, that doesn't cause a great deal of confusion for scientists because the intellect and philosophy we use to study those elements has the privilege of standing outside of them, or at least pretending to. The personal experiences, cultural background, even the religion of scientists doesn't muck up those endeavors. (Creationists are people whose religion causes them to reject the foundation of biology, but they are not scientists and indeed they have a fundamentally different epistemology.)

But I exist in that lifeworld of illness, I interact with the world of medicine, and I communicate every day with the entities whose intercommunication I study. I'm a part of it with my intellect, my emotions, my experience. However hard I try to step away to that remote, indifferent summit of scientific contemplation, I am only deceiving myself if I believe I am truly there.

My father had a stroke many years ago, and although he partially recovered, he then began a slow slide into progressive dementia. Although his neurologist has told my parents that he has vascular dementia, and does not have Alzheimer's Disease, I'm going to overrule her. If he doesn't have Alzheimer's Disease, I don't see how anybody can tell the difference or what difference it makes. It is also rather strange that this ethical healer has prescribed two drugs for him that are only indicated for Alzheimer's Disease, and have no known benefit in vascular dementia.

What is perhaps most strange of all is that the neurologist, and my father's primary care physician, both encouraged my parents to go ahead with having both of my father's knees replaced, as his mobility was somewhat impaired by osteoarthritis and he was using a stairlift. Having lived through the consequences of that decision, I am now more inclined than ever to question the predisposition of physicians to intervention. They always seem to prefer to do something, damn the torpedoes and full speed ahead. A major focus of this diary has always been that medicine is about tradeoffs, not miracles. Benefits come with costs and risks, often unknown, and risks, by definition, are not predictable. But doctors, as a general rule, don't fully inform people about the costs and risks of intervention, because they believe - probably correctly -- that the way most people evaluate risk will make them less likely to accept intervention than physicians, who are trained to think in so-called "rational" statistical terms.

This posting is just a set-up for a more interesting discussion (I hope), but I'd be interested to hear if it resonates with anyone's experience so far.

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