Map of life expectancy at birth from Global Education Project.

Thursday, May 30, 2013

Patient Centered Outcomes

Okay then, even if we don't know exactly what a disease is, as people with bodies and minds, we know what we want, right? Whether or not my inability to grow hair on top of my head counts as a disease would seem irrelevant. Either I care a about it a lot, a little, or not at all. If I care about it a lot, I want a "cure." Ditto with all the bodily afflictions of aging or the spiritual afflictions of being a sentient social being. Who cares what you call it if you can fix it, right?

Wellll . . . it's not quite that simple either. to take the most straightforward case, there's a pill I can take that supposedly will reverse, or at least retard, baldness. But it might reduce my sex drive and there's a possibility, we aren't really sure, that it could increase the risk of developing a more virulent, clinically significant form of prostate cancer. Do I want to take it?

Ever since the Thalidomide disaster, we've required that drug manufacturers show evidence of safety and effectiveness before they are allowed to market their potions. Leaving aside, for now, the important question of the strength and credibility of the evidence they are required to submit, before you can define effectiveness you need to define what they are being effective against (or for, however you want to look at it). And that means you need to (drum roll please) name a disease and specify measurable indicators of its presence, severity, or symptomatology. And then you need a nosology of adverse effects. And you need statistical methods to relate use of the purported remedy to these outcomes, good or bad.

So we can't get away from it. We need to classify and name and measure. But who does this? And why should we agree with them?

Is a science of medicine possible that avoids questions of personal values and philosophy of the good? Why no, it isn't. A science of human biology might be possible without a moral dimension,* but medicine, no, because that is the fundamental difference between medicine and biology. So if your doctor claims to have the one true scientific answer to some question about your health or well being, no, she's mistaken.

* Though I doubt humans would be capable of practicing such a science. We can do it with fruit flies, but not ourselves.

1 comment:

Don Quixote said...

But of course, people follow preachers and religious zealots who claim to possess a panacea for life's ills. At least doctors, of all people, should have to--somehow--follow the Hippocratic Oath. There's a lot to be said for first doing no harm!