• 25 NOV 13

    Progress occurs by leaps and bounds not by incremental change

    Progress occurs by leaps and bounds not by incremental change. Author Robert W. Gorter, MD, PhD.

    Progress occurs by leaps and bounds not by incremental change Author: Robert W. Gorter, MD, PhD.

    The incremental improvement of standard therapies through improved surgical techniques, radiation, chemotherapy or medications that can be patented or slight changes in treatment protocols are only cosmetic changes. They are procedures embedded within an incomplete paradigm. What is needed is a new and broader perspective that will offer a significant decrease in death rates.

    Generally, clinical improvements, just as cultural changes, do not occur incrementally, they occur as large tectonic shifts. For example, in the early 19th century nearly 25% of women who delivered their babies in hospitals died from childbed fever (puerperal sepsis) which was caused by Streptococcus pyogenes bacteria.

    The Austrian physician in the 1840’s, Dr. Ignazius Semmelweis, observed that woman in the maternity wards who were treated by medical students had three times higher death rates than those staffed by midwifes. He hypothesized that the medical students were carrying the infection directly from the autopsy room to the woman in labor.

    He then ordered the students and physicians to wash their hands with chlorinated solution before and between examining patients. This resulted in a large drop in the death rate to less than one percent for the woman in labor.

    Equally, it was the accidental re-discovery of penicillin by the British bacteriologist Alexander Fleming in 1928 that colonies of the bacterium Staphylococcus aureus could be destroyed by the mold Penicillium notatum. The same observation was made earlier in 1896 by a French medical student, Ernest Duchesne.

    Fleming’s discovery demonstrated that disease causing bacteria could possibly be destroyed by antibiotics; however, the medical applications of this discovery was not recognized until the 1940’s when Howard Florey and Ernst Chain isolated the active ingredient and developed a powdery form of the medicine.

    Like the discovery of penicillin, we argue that the hints and discovery for a more comprehensive pro-health approach in the treatment of cancer have probably already been discovered and re-discovered such as fever therapy and enhancing the body’s innate immune system. All that needs to be done is recognize and implement the new approach as a viable treatment. Culturally, we tend to be strongly attached to ideas and concepts we think are true; thus, most people do not change their minds easily (especially not doctors), one has to wait until the promulgators of the old incomplete/wrong ideas/concepts have retired or died.

    Medical doctors tend to pose an extra hurdle to change concepts (paradigms) and improvement of new therapy modalities. To become a medical doctor is not too difficult. One needs to have a good memory more than being intelligent. A medical student succeeds when he can pass all his multiple choice exams.

    The essence of multiple choice questions is that one eliminates all answers which are untrue or unlikely. At the end, one has one or two answering options which are most likely true. One is then chosen. But as a patient, one expects from his physician that he knows what the patient has and not what he most likely does not have. As for initiating a therapy or prevention, this is extremely important.

    There are strong economic interests from the pharmaceutical industry not to change concepts (paradigms) of health and disease, and therapy. More than 85% of all “evidence-based” clinical studies are paid for by pharmaceutical companies. Pharmaceutical companies will only invest money in development of new medications if they can (hopefully) obtain a patent. To be rewarded a patent, the drug or medication must be new. If a drug company obtained a patent, it has a world-wide monopoly for the duration of 25 years. Therefore, there is no money of any significance available for development of established therapies or therapies, even successful, where the reward of a patent for the drug company is unlikely.

    To our knowledge, there is not one university independent from the drug companies. Not only the clinical development is being paid for by the drug companies but also the salaries of personnel (including the professor and staff physicians) at university hospitals and they receive all or a main part of their salaries and other costs from the pharmaceutical companies. Therefore, one could postulate that, in case of medicine, universities are no longer independent centers of research.

    After the initial discovery which is a radical change in perspective, the ongoing incremental changes in modifying and discovering different antibiotics continue to improve clinical outcome; however, it was the initial shift in perspective to use antibiotics that made most impact. The analogy is similar to transportation.

    The radical shift occurred with the development of the internal engine and the car. It totally changed and replaced the horse-drawn transportation system. The conceptual change was the invention of the car; the small incremental improvements made the car more usable and comfortable; however, the initial invention was at the beginning of the 20th century the unappreciated ground shifting event.

    Similarly, many inventions were initially unrecognized events at the time of discovery yet radically changed the world in which we live. Think of the discovery of electricity, the telephone, the air-conditioner, the computer, television, airplane, lasers, x-rays. Each was unrecognized at the time as a significant change agent and totally uprooted established industries (typewriter companies, trans Atlantic ships for passengers, etc.);

    These are the unexpected events which are labeled Black Swans by Nassim Nicholas Taleb (2007) in his remarkable book, The Black Swan- The impact of the highly improbable. It is the highly improbably, which upon hindsight we would say, it is obvious and why did they not know it in the same way as we think of the stupidity of the 19th century physicians who did not wash their hands. In this example, hand washing was the unusual, the highly improbable which had a major impact on stopping diseases from spreading and health.

    The five percent drop in cancer death rates since the 1950s suggests that we still live in a delusional mediocracy. We tend to accept the standard models of cancer treatments because of the cultural hypnotic induction that what is, must be true. Everyone, especially authorities such physicians and researchers, believes this to be true; thus, it must be true.

    The status quo is strengthened by the financial incentives for pharmaceutical industry to earn money from patented drugs, for the high technology industry that supports the imagery industry such as mammograms and MRIs and the process of getting research grants from the government. Each supports and maintains the status quo.

    Economic incentives and medical reimbursement continue the diagnostic and treatment strategies such as mammography and chemotherapy because it appears to be the correct model. To have a different opinion that the present treatment model is incomplete and possibly incorrect is to shout into the wilderness. It is much more reinforcing and safer to work on the incremental change without ever daring to ask, “Is this really an appropriate treatment approach or is it more of the same?”

    To support the unconventional the out of the box models means making many investments with a very low return rate and the rare unique return which may not be recognized until years later. In the same way, the internet was not developed for public use but for rapid research and military information exchange.

    Is it more like the emperor without clothes and some day we will look back at present day cancer treatments and shudder in our thought, how could medicine have been so deluded and destructive to think that by killing the cancer cells and also destroying the person many healthy cells, health can be created. We will look back in the same way as we look back now to the 19th century treatment of bloodletting which caused the death of George Washington, the first president of the United States of America.

    The overwhelming scientific dogma and bias limits research in improbably but high return research and new clinical treatments. Also, the medical industrial complex with billions of dollars at stake in the present day treatment approaches such as mammograms and chemo therapy are resistant to change. At the same time, grants are awarded and research supported for the present dogma which is based upon historical and past perspectives. For cancer research, this dogma focuses on funding more of the same research which has lead to limited insignificant change in the death rate through research in chemotherapy, radiation, surgery, immunology, genomics, and viruses.

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