On June 10, 2010, Claire Cain Miller wrote that, “When a doctor recommends a test or a procedure, most patients simply go where the doctor tells them to go.”
Well, not exactly, at least as I see it. It’s more like, “When a doctor recommends a test or a procedure, most patients…ask their doctors who does the best test, then find out that their insurer won’t cover that facility or person, then find out that their doctors don’t know the providers of services that their insurer will cover, then find out that the people on the insurer’s list no longer accept the insurance, then do the test with someone no one knows and find that the doctor who recommended the test can’t understand the results submitted because the person who interpreted the test didn’t answer the question asked because his or her equipment was inadequate or he or she didn’t have sufficient experience with the problem to interpret it correctly.
Right. Comparison shopping—by the insurers, with quality or communication not a priority. Big savings, eh?
Before I sat down to fume over the first article, Nicholas Wade wrote, on June 12, 2010, that the genetic map, one decade on, has yielded few of its promised cures.
I did not find this second article to be a surprise—it is evident to any practicing doctor—but my eyebrows did rise at the statement midway through the article: ‘“Genomics is a way to do science, not medicine,” said Harold Varmus, president of the Memorial Sloan-Kettering Cancer Center in New York, who in July will become the director of the National Cancer Institute.’
Funny. I wrote about the distinction between science and medicine—citing a then-unnamed Harold Varmus—in my 1998 book, Guarded Prognosis (Hill and Wang), chapter 4, page 156 (actually, the whole chapter is about this topic).
In 1996 Dr. Varmus was Director of the National Institutes of Health, and I was Acting Director of one of its Institutes, the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). Dr. Varmus and I had argued about the budget for my Institute, and I, following that discussion, had gone home thinking about a patient of mine for whom contemporary science offered no answers and whose plight seemed to be a matter of indifference to the scientists.
I wrote about that conversation: “Use only the criteria of other scientists, he seemed to say [to set your budget], while I was more willing to use my own judgment…developed over three decades as a practicing physician. We had different priorities, the scientist and the doctor.”
Clearly, Dr. Varmus said the same thing to Nicholas Wade in 2010 that he said to me in 1996, except then he was trying to tell me that focus of the National Institutes of Health and of the National Institute of Arthritis and Musculoskeletal and Skin Diseases was medicine, not science, if, indeed, there is a distinction. Now he makes the distinction to explain why his priorities for NIH failed to achieve their goals.
Sad. The United States has a National Science Foundation, which is for science, and which is distinct from the National Institutes of Health, for medicine. If I read the quote from Dr. Varmus correctly, he argues that NIH achieved its goal because it did good science, even though it failed to achieve a useful result for medicine?
I guess we still have different priorities, the scientist and the doctor.