The breakthroughs and failures of medicine

There is a pervasive tendency to turn to medicine looking for magic. Patients and health care professionals alike generally expect medicine to be able to cure diseases, alleviate symptoms, and relieve suffering. Historically, medicine has met and exceeded these expectations in a variety of ways.

However, in some cases, these expectations can cause a blurring of the lines between hope and reality, resulting in false “promises” and preventable disappointment.

You may be wondering what the word “magic” and “medicine” are doing in the same sentence, to begin with. We believe in science around here, not superstition! And yet “magic” is an appropriate word in that it evokes the sense of wonder and awe that accompanies revolutionary medical breakthroughs. Occasionally, along with the science that enables these breakthroughs, there is also an element of mystery or happenstance. The discovery of penicillin, for example, was an accident.

There is no shortage of medical breakthroughs that demonstrate that medicine can seem like magic. After the smallpox vaccine was developed in 1796, there was a worldwide vaccination campaign, which resulted in the disease ultimately being declared eradicated in 1980. In 1928, the advent of penicillin made it possible to easily treat infections that had previously been feared as potentially fatal. In 1983, HIV was identified as the virus that causes AIDS. The antiretroviral drugs that were subsequently developed to treat HIV/AIDS provided such dramatic benefits that health care professionals referred to the transformation of patients’ clinical state as “The Lazarus effect.” These patients were quite literally being rescued from the brink of death! More recently, direct-acting antivirals were developed as a cure for hepatitis C.

Given this track record, it’s understandable why people continue turning to medicine looking for magic. After all, history reveals that extraordinary outcomes not only can happen, they have happened. So, a patient may reason subconsciously, perhaps medicine can provide an equally impressive outcome for me too. At least it’s not out of the question, right? It’s not only one’s own internal hopes that cause someone to look to medicine for magic; external pressures such as direct-to-consumer pharmaceutical advertising actively encourage this.

Peter Mansfield points out that direct-to-consumer pharmaceutical advertising “often works by creating or exacerbating unhappiness or anxiety about symptoms or normal experiences (such as occasional erectile difficulties), and by creating high expectations of benefit from drugs. The combination of heightened unhappiness and high expectations can cause severe distress when a drug is unaffordable or when its effects are disappointing.” Although medicine inarguably benefits many people, its complexity necessitates that both the risks and benefits of any medication or intervention are given equal and appropriate consideration.

As we marvel at the advances that have been made in medicine, we must also keep in mind that it has been tarnished by numerous failures. The Lown Institute points out several of the more prominent “medical reversals” over the years — occasions when “a drug, test, or procedure is adopted as the standard of care based on existing evidence or bio plausibility, but is later found to not be beneficial based on new, better evidence.” Examples of medical reversals include “stenting for stable angina, hormone replacement therapy, antibiotics for ear infections in children and PSA testing for prostate cancer screening in low-risk men.”

My hope is that consciously holding the reality of both medicine’s successes and failures in tension will give us pause when we (or our patients) are tempted to turn to medicine looking for magic. Yes, medicine has a lot to offer! But for many patients, for many conditions, it is not magic — at least not yet. We have to accept this while still holding hope that perhaps one day we will be there, and we will have more answers, and maybe even a cure.

Shannon Casey is a physician assistant.

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