Too often, doctors prescribe a contradiction

The number of new studies that get published increases dramatically from year-to-year. Research that wasn’t practical or even possible just a few years ago, can now be done, literally, by high school students [using online, very advanced tools, including animal studies, that are available to anyone with a credit card].

There is a strong voice that is growing in the research community and beyond, that is demanding that data from both successful and failed studies be published online. When doing large-scale data analysis, millions of collected records from failed studies could still contribute critical information to understanding any number of topics.

In the midst of all of this, one can find themselves almost in a Monty Python type of situation, where every statement is immediately countered by another research’s conclusions. Let me demonstrate with a few examples.

I am presently looking at a study from the topline medical journal JAMA, that concludes that physical activity counseling should be a priority in clinical practice. Said more simply, family and other primary care doctors should tell patients to be active and even exercise. This seems like a very straightforward and almost self-evident conclusion, but, clearly, it still merits publication  in the best journals.

Just the other day, I was reading another journal article that spoke to the fact that once a person crosses a certain BMI [which is one type of measure of how fat a person is] i.e., they are “too obese,” being fit does not offer a protective effect against a whole variety of diseases. This particular article was arguing that the concept of “fat but fit” does not exist. So now we have to step back and tell the doctors who read the first article about physical activity counseling not to waste their breath on patients who are already above a certain BMI.

Well, at least, doctors can advise these obese patients to continue to try to lose weight by virtue of altering their diet. I read another article today that argued that the physical presence of fat on the body acts to fight against fat loss. In other words, once you have crossed a certain BMI, you are facing more and more of the Sisyphean task to lose weight. It would seem then that the family doctor who read the first article about physical activity counseling should also tell his or her patients that trying to lose weight once you are already obese is doomed to failure. Perhaps the best thing that the family doctor can tell an obese patient is to wait until somebody publishes an article with successful recommendations for losing weight.

Over the course of the last few months, I have read a number of articles about the effect of the normal and healthy bacteria that reside in our bowels. It turns out that these bacteria are incredibly important for our normal health status. I read yet another article claiming a link between the early use of antibiotics in children and weight gain later on in life. It is now suggested that this has to do with an alteration in the healthy bacteria that reside in the child’s bowel. So our family doctor who is trying to give valuable advice about staying healthy should first look inwards and stop him or herself from excessive use of antibiotics [which almost every doctor is guilty of].

I read another article today, based only on studies in rats, whereby one can achieve very significant weight loss by blocking certain enzymes and proteins in the body. This is the foundational work for a “skinny pill.” Whether it is this research or other research that determines what particular genes and proteins need to be activated or deactivated, the time will come when there will be a “skinny pill” that a person will be able to take and thus avoid significant weight gain, or promote significant weight loss. I should point out that these types of medications will most likely be abused and will very likely end up killing a significant number of people who simply don’t have the most basic intelligence to follow the simplest of instructions. One can insert any comments about Darwin awards that they wish at this point.

Science seems to be moving ahead very quickly. But in fact, it is moving far more slowly than it could. It is not just because of so many research studies that seem to have contradictory conclusions. When I was a medical student, had I suggested that bowel bacteria can affect multiple systems in our body, I literally would have been laughed out of school. Of the very many “self-evident” conclusions that I have heard over my decades of practice, most have fallen by the wayside. One definitely gets the impression that, were it not for human arrogance, we would be far more advanced in our scientific knowledge. A true scientist learns all that there is to know, but then does not allow him or herself to be prejudiced by existing knowledge. Apparently, this is actually quite a rare trait. Nevertheless, we do move forward and science continues to amaze us.

I could go on, and I could demonstrate a similar trend towards contradictory research in many other fields. The point is that we are still very much at an early stage in fully understanding ourselves. We are collecting millions, if not billions, of data points on a daily basis. At some point, all of these data points will reach critical mass. Especially with the use of advanced computing and data analysis, there will be a sudden “Big Bang” which will exude new medical knowledge on a scale never before witnessed. Suddenly, all the pieces will fit together and apparently unrelated medical events will be shown to be part of a single process that can be effectively and safely manipulated to improve our health and quality of life.

I would not even dare try to predict what role doctors will play in what is primarily a data collection and analysis process. The whole world of medicine is changing on a daily basis, and it is becoming more focused on the patient rather than the doctor’s wallet. We are on the right path. I for one hope to live long enough to see a world where people are treated like people, independent of whatever illness they may be suffering from. People will no longer need to suffer due to the hubris of the healthcare keepers around them.

We are close. It still may be many decades until we can really battle back all disease. But it will be decades, not centuries. Such hope for curing the ills of the world has never existed. We should all appreciate how lucky we are to live in such a time.

Thanks for listening.

About the Author
Dr. Nahum Kovalski received his bachelor's of science in computer science and his medical degree in Canada. He came to Israel in 1991 and married his wife of 22 years in 1992. He has 3 amazing children and has lived in Jerusalem since making Aliyah. Dr. Kovalski was with TEREM Emergency Medical Services for 21 years until June of 2014, and is now a private consultant on medicine and technology.