Today's post is only indirectly about autism, it is more to do with what expectations are realistic from medical science in 2013.
I come from a family full of doctors and two engineers. As one of the engineers, I know that engineering is a true science, and I had assumed that so was medicine. In engineering the answers are either right or wrong, maybe or sometimes is not acceptable. If you build 100 aeroplanes, full of maybe millions of components, you expect them work (ie not crash) everyday for 30 years. An acceptable failure is much less than 1%, over the entire life of the planes. So the science needs to be fully understood to the tiniest detail.
The more I am reading about medical science, the more clear it becomes how little is really understood and how trial and error is behind many breakthroughs. Many drugs, particularly in neuroscience, work for reasons not fully understood; or there are several proposed methods of action, perhaps one of which is correct. This really is not science.
Once you start thinking about medicine as an art rather than a science, things become clearer. It also means that the old fashioned approach of 20-50 years ago might actually be more appropriate, than that of today.
This also means that medicine is more about probability. So, some new hi-tech anti-cancer drug may work in 60% of patients, but if you are one of the 40%, why suffer those horrible side effects? or indeed pay for it. Or, for your allergy medicine, the doctor may prescribe you say, Claritin, but he probably does not tell you that in X% of patients it will not work. Perhaps he should say, here are four antihistamines try them all and choose the two that work best, then just alternate between them.
I have been reading about thyroid hormones. I am amazed by all the nonsense written about them, including in mass market books by experts. The question is actually very simple, there is a prohormone called T4 with a long half-life and an active hormone called T3 with a much shorter half-life. To optimally treat hypothyroidism you just need balance the dosage and frequency of T3 and T4 and you need to know that T3 is needed throughout the body and for it to be produced locally from T4, requires special enzymes (D1, D2, D3) to be present in sufficient quantities. As a result, some people may need to be given T3 in addition to (or instead of) T4. How complicated is that?
So how does this apply to autism? Well, it means that perhaps we should not be critical of the "trial and error" approach of some US autism doctors. "Trial and error" does need to have boundaries and safety is clearly the most important issue. It also means that it is totally "normal" to find therapies that work in one group and yet are ineffective in another. It means that applying complex statistical analysis, from sciences like engineering, to evaluate tiny clinical trials in autism is really a waste of time. Not surprisingly, none of these trials stand up to scrutiny later. Those scrutinising these mini studies are making the same mistake I did, thinking medicine is a "hard" science. Maybe it will be in 500 years, but not in 2013.
Much can be learnt from Monty, age 10 with ASD, whose piano teacher tells me "if a pill works, keep taking it". Hundreds of millions of people have benefited from taking statins, but as I learnt, 99% for the wrong reason.
I come from a family full of doctors and two engineers. As one of the engineers, I know that engineering is a true science, and I had assumed that so was medicine. In engineering the answers are either right or wrong, maybe or sometimes is not acceptable. If you build 100 aeroplanes, full of maybe millions of components, you expect them work (ie not crash) everyday for 30 years. An acceptable failure is much less than 1%, over the entire life of the planes. So the science needs to be fully understood to the tiniest detail.
The more I am reading about medical science, the more clear it becomes how little is really understood and how trial and error is behind many breakthroughs. Many drugs, particularly in neuroscience, work for reasons not fully understood; or there are several proposed methods of action, perhaps one of which is correct. This really is not science.
Once you start thinking about medicine as an art rather than a science, things become clearer. It also means that the old fashioned approach of 20-50 years ago might actually be more appropriate, than that of today.
This also means that medicine is more about probability. So, some new hi-tech anti-cancer drug may work in 60% of patients, but if you are one of the 40%, why suffer those horrible side effects? or indeed pay for it. Or, for your allergy medicine, the doctor may prescribe you say, Claritin, but he probably does not tell you that in X% of patients it will not work. Perhaps he should say, here are four antihistamines try them all and choose the two that work best, then just alternate between them.
I have been reading about thyroid hormones. I am amazed by all the nonsense written about them, including in mass market books by experts. The question is actually very simple, there is a prohormone called T4 with a long half-life and an active hormone called T3 with a much shorter half-life. To optimally treat hypothyroidism you just need balance the dosage and frequency of T3 and T4 and you need to know that T3 is needed throughout the body and for it to be produced locally from T4, requires special enzymes (D1, D2, D3) to be present in sufficient quantities. As a result, some people may need to be given T3 in addition to (or instead of) T4. How complicated is that?
So how does this apply to autism? Well, it means that perhaps we should not be critical of the "trial and error" approach of some US autism doctors. "Trial and error" does need to have boundaries and safety is clearly the most important issue. It also means that it is totally "normal" to find therapies that work in one group and yet are ineffective in another. It means that applying complex statistical analysis, from sciences like engineering, to evaluate tiny clinical trials in autism is really a waste of time. Not surprisingly, none of these trials stand up to scrutiny later. Those scrutinising these mini studies are making the same mistake I did, thinking medicine is a "hard" science. Maybe it will be in 500 years, but not in 2013.
Much can be learnt from Monty, age 10 with ASD, whose piano teacher tells me "if a pill works, keep taking it". Hundreds of millions of people have benefited from taking statins, but as I learnt, 99% for the wrong reason.
Hello,
ReplyDeleteI m afraid the good medicine, looking for the best treatment for your unique body, is expensive and perhaps almost impossible.
Regards