Sometimes patients complain when they discover a doctor’s views are out of date, even in the face of evidence. Well, that’s not new: here’s a quote from the guy who won the Nobel Prize in physics, in 1918:
“A new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die, and a new generation grows up that is familiar with it.”
~ Max Planck (Wikipedia)
This quote was cited by Thomas Kuhn in his incredibly important book The Structure of Scientific Revolutions, which recounts the tremendous social barriers to adopting new thoughts. Even the concept of bacteria subjected physicians to ridicule: “Pus is caused by invisible evil creatures? That’s witchcraft!” And in cancer, the importance of angiogenesis (cancer’s ability to grow new blood vessels as its fuel supply) was ridiculed for decades. Same for the bacteria that causes ulcers, and on and on.
Those of us engaged in changing culture – the culture of medicine – often experience this. The establishment “knows it’s right” and disses people whose experience runs counter to it; Kuhn says science is, amazingly, a fashion industry, where if you don’t wear the right glasses or shoes, you’re scorned. (The irony, of course, is that the scientific community is supposed to be evidence-based, and Kuhn established forty years ago that it’s not.)
A current, non-biological example of Planck’s point is doctor-patient email: most doctors today refuse to do it unless they can bill for each email, saying it will bankrupt them, but the residents I’ve met who are fresh out of school say “Of course I’ll do email – waddaya mean??” The resisters will eventually die out, their reasoning discarded and quaint.
It’s funny: most docs who won’t email are convinced – through anecdotes, not evidence – that email will ruin their lives. Most skeptics I’ve spoken with even doubt Kaiser-Permanente’s ten years of evidence that email reduces the number of doctor-patient touches, and they discount the obvious fact that it’s faster to read a sentence than to listen to someone speaking it. They’re still sure it’ll ruin their lives.
Meanwhile, my physician, Dr. Danny Sands, co-authored an article in 1997 on how to do it successfully. And on a different note, closer to home, most kidney cancer patients never hear about high dosage interleukin-2, which saved my life.
The lesson for engaged, empowered patients: if you discover something that you know is worth pursuing, pursue it; if you feel something in your body that you know is true, speak up about it. As Dr. Spock said at the start of his baby book, “Trust yourself. You know more than you think you do.” You can’t be a good partner for a participatory physician if you don’t.
I just ran across a related quote, which I’m sure is also mentioned in Kuhn’s book:
“In science the credit goes to the man who convinces the world, not to the man to whom the idea first occurs.”
It’s attributed here to Sir William Osler, the legendary physician who among other things reportedly conceived the idea of teaching medical students by having them work with a slew of actual patients – i.e., by being residents.
Both quotes point to the reality that science isn’t nearly as scientific as we think – not even as scientific as we were taught to think in our first science classes. Important for e-patients to realize, because both items (from truly venerable scientists) teach us that there may well be knowledge available beyond what we see in conventional channels. So it’s worth looking.
“Science advances, one funeral at a time.” That quote is attributed to Planck. As true as it ever was!