The Breakthroughs in Medicine
by James V. Me Connell
(1)1 read with great delight Lewis Thomas' "The Medical Lessons of History" (July 3). It is good to know that such a wise and scholarly physician believes that we can learn from our past mistakes, and that he has some hope for the future of the medical sciences. It is a pity, however, that Dr.Thomas seems not to have learned the real lesson that history offers us—namely, that the “great breakthroughs” in any technology are always preceded by a radical change in how we view ourselves, and how we behave.
(2)Take penicillin, for example. As Dr.Thomas points out, its benefits were derived us for a decade after its discovery by Sir Alexander Fleming. Dr.Thomas holds the medical doctors failed to put penicillin to use because they “disbelieved” it could do what plainly it did. Well, that's a nice way of explaining matters. But in truth Fleming's colleagues ignored him for 10 years because they refused to accept scientific data showing that penicillin "worked". Just as a century earlier, the medical leaders in Vienna refused to accept Semmel weiss s studies showing that the death rate for childbed fever could be cut from about 26% to about 2% if the attending physicians would only wash their hands before delivering babies. In fact, medical doctors ( like most of us ) are highly reluctant to judge their actions solely in terms of the objective consequences of what they do. Like most other humans, MDs usually prefer that they be evaluated according to their intentions and feeling. Any reader who doubts my contention might remember that, in malpractice suits, the physician's defense typically is,“I followed standard medical procedure," rather than, "I did what was necessary to cure the patient. "Just ask your own family physician some time what his or her own particular “cure rate” is for a given medical problem and demand statistical evidence to back up the claim. My guess is that you will shortly be dismissed as a patient.
(3)As Dr. Thomas suggests in his article, medical technology is at another of those difficult crossroads. For the medical profession has blossomed in the past 100 years by taking the viewpoint that most human woes and miseries are biologically determined. In fact. man is not a purely biological animal ； we are social and psychological animals as well. The longterm medical “cure rate” for obesity is less than 10% ； the behavioral cure rate is about 60%. Yet most physicians continue to prescribe pills and fancy diets for weight loss, when what 90% of the patients need is encouragement in learning how to eat properly. These "cure rate” data have been reported in dozens of scientific journals for dozens of years. Yet just a month ago a man 1 know informed me that his doctor had told him, "You are too damned fat. If you don t lose weight, you're going to die, and it will serve you right." Needless to say・ the man became so depressed that he went on an eating jag.
(4)For almost a decade now, I have been sending behaviorally trained undergraduates into hospitals to help physicians learn how to handle their patients in more humane, rewarding ways. We have demonstrated that we can take some of the most difficult patients imaginable and, using both love and behavioral technology, increase certain "cure rates” dramatic ally.
(5)Most of our techniques involve rewarding patients for following good medical regimens and teaching patients how to handle their own emotional and behavioral problems. Since we have an example objective proof that our techniques save lives, you'd think that the medical profession would be beating down our doors asking us to teach them our skills. Alas, what we get mostly is the response "This patient is a medical case, not a psychiatric problem, and only pills and surgery will help."
(6)Despite what Dr. Thomas has said, the next great leap forward will come when medical students are routinely taught that the way they act toward the patient ——and the way the patient is taught to think, feel, and behave—are as important in achieving a lasting "cure" as are drugs and surgical procedures. That's the real "medical lesson of history". I do hope that Dr. Thomas and his colleagues learn that fact before It's too late.
5.In treating a patient, Me Connell holds the belief that ______.