Response to Use of My Web Site by Faculty at Medical School
At least one medical school faculty has chosen my web site as a point of attack on modern clinical medicine and promote themselves as the source of all relevant knowledge in medicine. To address this type of phenomenon, I have written the following comments for medical students.
First, one must understand the paradigm from which medical schools come. Medical school faculty are isolated from the full context in which medicine is practiced. The academic environment depends for its credibility on the presumption that it is the source of all relevant knowledge in medicine. Like some religions, it believes it knows, indeed owns THE TRUTH (in medicine), even though it admits THE TRUTH is changing.
At medical schools, people wear (some would say “strut”) their curriculi vitae around to prove they know something. They are funded by government and pharmaceutical industry grants and are thus not obligated to make it in a competitive marketplace. Clinicians in the real world marketplace must rely on treatments that work. If our treatments do not work, we are soon out of business. Just to be a bit facetious, I would say that when treatments given at a medical school do not work, one applies for another grant (more money) for a study called “Why The Last Treatment Didn’t Work.”
Many effective treatments (in fact surveys indicate 70 % of those commonly used in medicine) have no placebo-controlled, double-blind, p<0.5, etc. studies to back them up. Aspirin is a common example; coronary bypass surgery is another. What clinicians in the real world care about is effectiveness. Furthermore, patients do not care if these studies exist; they want effective treatments. It is fine if these studies do exist, but the culture of medicine in the real world does not require them. Academicians, on the other hand, live and die by these studies almost as much as they live and die by their curriculi vitae. (Patients do not care about your curriculum vitae either. They know when they get results and they know when they do not get results and that is what they care about — dose of reality for academicians.) Medical students should indeed be instructed in rigorous scientific thinking, and they should also be introduced to the real world in which clinical judgment and treatment application do not depend soley on a bibliography of studies.
As I am a real world clinician, I do not concern myself with the paradigms and prejudices of medical schools. My only objective is to provide reliable information which is useful to people to achieve optimal health. Apparently my effort has been successful judging by hit counts of over 4 million per year.
I presume I am reaching some medical students here, so let me have a few words with you. When you leave the academic environment you will have choices to make which will determine your success or failure, satisfaction or dissatisfaction with your profession. The key leap you must make, and one for which medical students are not prepared by training, is to think for yourself. Your professors would have you believe that you do not need to think, only to learn what they have to teach and then go apply it or alternatively to scan the literature and learn only what the literature has to teach and go apply it. This has resulted in several successive generations of brain-washed physicians who do not think for themselves.
The problem with that point of view is that the medical journals have long ago been effectively purchased by the pharmaceutical and medical technology manufacturing industries which supply their only source of income (advertising and “grants”). Anything which contradicts the vested interest of the advertisers is deleted from publication.
So, when you finally say goodbye to academia, I advise you to find and join an association of doctors who create, discover, share and teach each other cutting edge medicine — methods which work to get people well in the real world. I can personally recommend the American College for Advancement in Medicine (www.acam.org), and there are others.
Finally, when you go to work, go to work for yourself and for your patients, not for an HMO, an insurance company network and not for a group of other doctors or a government agency. Be brave. Leave the womb. You can make it on your own. Regardless of where you live or what specialty you practice, be an old fashioned country doc. Make house calls if necessary. Learn to love and love to learn. Love your patients more than you love your bank account. People are disgusted with the way medicine is practiced now. Set a new trend by following these simple principles and your patients will love you, your practice of medicine will be profitable and a joy to you for life. Diverge from them and you will count the days until you can retire or escape into academia.
You will not encounter original thinkers about the politics of medicine on medical school faculties just as you will not encounter the instructions for opening a box printed on the inside of the box. Please understand that through grants the medical industries now effectively own the nation’s medical schools and control its curriculae. Original thinkers about the politics of medicine have long since disappeared from academic medicine. (Original thinkers are never for long in the employ of others.) If you care to delve deeper into this area, please click here for my articles on this subject:
I encourage to sign up for the On-line course in the upper left. for a continuing education in relevant clinical medicine as practiced in the real world, and also the Medical Vocabulary Course in the lower left for weekly medical vocabulary lists.
Wishing you good health and the means to achieve it,
Ron Kennedy, M.D.