2000 : WHAT IS TODAY'S MOST IMPORTANT UNREPORTED STORY?

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Irving Assistant Professor, Department of Surgery, Columbia-Presbyterian Medical Center
The True Nature of Much of Human Illness Eludes Mankind.

We routinely tolerate concepts that challenge our perceived reality. Electrons are allowed to spiral through the air transmitting information and sprouting quarks, yet we insist of a very concrete, biomedical understanding of our body.

The body is sacred and our provincial understanding of its workings in imbued with cultural biases that are bred from birth and dominated by guttural rather than cerebral influences. The resulting theology of the medicine insists that all citizens having heart attacks must have chest pain, or smoke, or have type A personalities, or have high cholesterol, or be obese. The observation that half the victims of mankind's largest killer do not fit this profile eludes the public. And how do these risk factors explain why heart attacks are most likely to occur on Monday mornings? We make the error of assuming that medicine, which describes tendencies rather than certainty, is a mathematical field rather than a statistical field. Even the act of observing disease in the form of a patient-physician relationship can alter the natural history of the illness, the medical equivalent of the Heisenberg uncertainty principle in physics. This may explain the well know placebo effect and its dark relative, the nocebo impact.

Religious and scientific explanations for disease crisscross frequently in the brain. How about the eyesight you use to read a sentence describing your grandmother's love for you. We can describe how you can see the words on the page, and even how you know what the words mean and how they fit together. We can understand the memory processes that allow you to recall you grandmother's face, but how do you know that the image you are seeing is your grandmother? Do you have an individual brain cell reserved for each object you ever see with one being reserved a young grandmother and another for a more mature memory? At some point we push our scientific understanding into the abyss of art and become surrounded by the seeming darkness of theology. What makes this experience particularly frightening is the associated realization that we, as individuals, are so unique that cookie cutter answers offered to humanity on losing weight or avoiding heart disease are unlikely to work. We each have to shoulder our own burden in seeking these answers on our journey through life.