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Archive for November 19th, 2010

Nosodes Redux: “I hate those meeces to pieces!”

Life and medicine generate facts and experiences that require conceptual frameworks that aid in understanding.  It is no good have a pile of facts if they cannot be understood within a broader understanding.

The practice of Infectious Diseases, while certainly aided by understanding anatomy, physiology, microbiology, chemistry and the other sciences that form the core of medicine (referred to in Medical School as the basic sciences), gains a broader  appreciation from the concepts of evolution.  Infectious Diseases, at its most fundamental level, is applied evolution, and understanding evolution often adds greater insight into infectious diseases.  Me find bug, me kill bug, me go home may be my motto, but it is meant in jest.

There have been papers or books that have added conceptual frameworks to my understanding of the natural world and medicine.  Besides evolution, there was Observations on Spiraling Empiricism a classic that all health care providers should read, as it outlines the cognitive errors we all make in prescribing medications; I have discussed this article before.

There is  The Drunkard’s Walk: How Randomness Rules Our Lives by Leonard Mlodinow.  So often the explanation of why something  happens is a shrug of the shoulders; feces occurs. The book formalized my understanding that much of what happens is random and without cause.  The challenge in medicine is trying  find a pattern in the randomness of life upon which to base a diagnosis. It is equally important to recognize when patterns are not there. All too often what is seen as a pattern is our imposing structure on what are random events.  Or maybe that really is a bunny in the clouds.  Clinical study results often occur by chance and having a significant ‘P’ value may still be due to randomness if the study is measuring nonsense.

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