it makes me sad that this is what modern medicine has turned into.

power struggles, name and fame, publications, presentations.

and the patient has long been forgotten.


a few days ago, I presented the preliminary results of my clinical trial.

a phase I study in patients who have failed all other treatment.

and I asked one of my colleagues- don't you agree that the patient is much better since he started recieving the study medication, even if there is limited objective response at this point.

so he said, well, what I know is that he is recieving a lot of attention and care from you.

and then some of the people said that if those are going to be the resuts they are unpublishable.

right, the fact that a patient who was almost bed-ridden, is now planning a weekend with his wife, is totally unimportant if his spleen only decreased from 20 cm to 17, which is a very minor respose.

and if it is true that the care and attention that I am giving him, is making this difference, then what does it mean? that so many other patients who are almost bed-ridden could have been so much better, had they recieved such care?

I personally don't think that I have such magical powers, and I do believe that a good part of it is due to the treatment he is recieving, but it may be right that this also has to come with true dedication and care.

it reminds me that when I was a med. student I did a study on non pharmacological approach to pain in child birth.
at first the gynecologists were very skeptical about it, but at some point they couldn't ignore the fact that my patients were doing so well, so one of them came to me and said that it is impressive, but how do I know that it is my intervention that is doing it and not just placebo effect.

I didn't have a good answer then, because like many physicians I regarded "placebo" as some "noise" that was interfering with our ability to see the "true" effect of what we are doing.

I didn't realize then that "placebo" is an essential part of patient care. it is the result of the true patient-physician relationship, based on mutual trust and respect and the joining of their forces in fighting illness and disease.

and modern medicine, unfortuantely, is pretty much devoid of that.

alice