Humanism and reasoning versus cookbook medicine

Soledad Delgado
 

From "criaderas" to "soleras"

At the onset of autumn, my land fills with the smell of must. Freshly extracted from the pressed grape, it ferments and then passes to American oak barrels for ageing. The containers are stacked at three levels. From the lower one, the "solera", a third of its content is extracted for consumption. That part is filled with wine from the intermediate level, the first “criadera", and the same happens with this one, which receives wine from the upper level, the second “criadera". It's the one who receives the fresh must, full of life and potential. This wine, still young, is mixed during its ageing with matured wine, from which it takes some characteristics and to which it gives back the freshness of new aromas and flavours. The two wines are enriching each other, sheltered by the flower veil that promotes biological ageing. 

For a more conservative medicine

@varelalaf

Last week I discussed the influence of machine learning on clinical practice, a dynamic loaded with chiaroscuro and, for this reason, I think it is worth echoing today the manifesto "The case for being a medical conservative" written by four doctors: John Mandrola (cardiologist), Adam Cifu (internist), Vinay Prasad (oncologist -haematologist) and Andrew Foy (cardiologist). The authors clarify that their manifesto has nothing to do with politics, but that, given the dazzle of technology and the pressure of consumerism; they are forced to embrace conservatism, a way of saying enough when nobody is willing to do it.

Medical Schools: reductionism versus empiricism

Competitive eagerness has reached the medical faculties and now produce batches of new doctors with a higher scientific preparation, priorities arranged by factor of impact, a competitiveness for research funds and, to a lesser extent, clinical practice. Young doctors know that in order to fight for the most coveted places they must show a resume full of publications, while the clinical skills, although present, will not be the differential element. What is observed, then, is that the educational reforms driven by academic success.

What are the objectives of cancer prevention programs?

Vinay Prasad and Adam Cifu in "Ending Medical Reversal, Improving outcomes, Saving lives" affirmed that in order to interpret the meaning of secondary cancer prevention programs, three objectives must be kept in mind: 1) cancer ought to be discovered ahead of time, 2) specific mortality ought to be reduced and 3) overall mortality should be decreased.

The authors say that what really matters is objective number 3, given that the first two are purely instrumental. After all, if a healthy person accepts a screening, this is supposed to be because he or she wants to live longer. Unfortunately, the data shows that preventive programs (cancer of the colon, prostate, breast, cervix and lung) obtain the following results (with small nuances among them): a) objective 1: achieved, b) objective 2: weak, and c) objective 3: not reached.

Medical schools: reductionism versus empiricism

The current competitive drive has reached the medical schools to the extent that it now delivers batches of new doctors with higher scientific preparedness whose priorities are influenced by their impact, competitiveness for research funds and, to a lesser extent, clinical practice. Young doctors know that in order to fight for the most coveted positions they will have to show a curriculum full of publications, while the clinical skills, although present, will not be the element that differentiates them. What is apparent is that educational reforms are part of the mechanism which is focused on academic success.