Medicine & Internet

Very old and very new sources of medical knowledge

Krystyna Knypl

We have different sources of medical knowledge: Personal Experience Based Medicine, Evidence Based Medicine and a new source – Computer Based Medicine.

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Personal Experience Based Medicine

The Hippocratic Corpus, the oldest written work from the years 440-350 BC, remains the original source of medical knowledge. The Hippocrates’ method was based on the patient’s examination, observation and the physician’s personal experience (https://upload.wikimedia.org/wikipedia/en/4/44/Vat-gr-277-10v-11r.jpg).

Hippocrates introduced such medical terms as diagnosis and prognosis. He was a master to his students and so it was for centuries, as well as an authority for patients who did not have access to medical knowledge.

The basis of the doctor’s knowledge was: intuition, personal experience and knowledge of clinical biochemistry and pathophysiology. 

Evidence Based Medicine

Evidence based medicine (EBM) – the name itself is very perverse and suggests that there is another medicine based on fiction. ;)

The original roots of EBM reach the epidemiological data and undoubtedly have delivered a lot of valuable information to medicine (http://jamanetwork.com/journals/jama/fullarticle/182722).

The greatest contribution in this respect is The Framingham Heart Study (https://www.framinghamheartstudy.org/about-fhs/history.php), conducted on a selected group of residents of a small town near Boston. It is on the basis of such studies that we have learned about the dangers of smoking and the need to treat hypertension.

The Seven Countries Study, which provided data on the impact of diet and lifestyle on our health, is one of the pillars of EBM. It is thanks to this study that we know that the excess sodium ion in diet is very harmful to our health.

Further development of EBM was associated with big pharmaceutical industry business. The findings made on the basis of carefully selected groups of patients participating in the evaluation of the effectiveness of drugs have a specific meaning, and stretching them to the whole population is not always accurate.

It also happens that the clinical trial protocols based on false pathophysiological knowledge and common sense end tragically, as the history of rimmonabant or recently the BIA 10-2474 have shown.

Computer based medicine

The prevalence of computers and the internet have changed the source of knowledge. Patients often do not ask the doctor what was wrong with them, but after contacting their personal GP, called Dr. Google, notify doctors about the diagnosis and expected treatment. Doctors can use more sophisticated sources of knowledge, such as Medline, Cochrane.

Today, filling out electronic documentation (Electronic Health Record, EHR) is inherent in medical practice around the world. The doctor who has seen many patients is an experienced doctor.

Can a computer which gathered data about many patients turn into a super-doctor? ;)

The temptation to formulate such a thesis can be strong. The first steps towards the practical use of information from large databases and an attempt to draw diagnostic conclusions have been made based on medical records of 25,000 patients with breast cancer, but it proved impossible to achieve them automatically. There is a similar situation with the human genome.

The environment “is exciting, but frustrating”, says Dr. Barrett Rollins, chief scientific officer at the Dana-Farber Cancer Institute in Boston. “While we all see what big data could potentially do, we’re frustrated because we don’t yet have all the tools or fully understand how to use it.” (http://www.modernhealthcare.com/article/20160409/MAGAZINE/304099981).

Today we have medical data from different sources: electronic medical records, genomic data, social media data, medical gadgets data… Will these sources create “new medicine”?

Text and photos
Krystyna Knypl

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