JAMA: Skeptical of Skeptics, English, 1991 (physician with CFS)

[cassava7]

by Thomas L. English, M.D.
appeared in the
Journal of the American Medical Association
February 27, 1991

Skepticism permeates our profession. It is ingrained during medical training and reinforced by professional experience. (…) Skepticism is widely perceived as the prudent, conservative way to deal with ambiguous situations — times when even experts are confounded. Healthy skepticism is the “in” attitude for intelligent, discriminating physicians.

But healthy for whom?

Four years ago I was diagnosed as having chronic fatigue syndrome (CFS). The experience has given me a new perspective of my profession, one that is not always flattering.

[…]

(…) CFS may frustrate you, but it is equally fascinating and rewarding. Resist the temptation of hurried, superficial evaluation. This is no illness for cookbook doctors. It is a disease for medical intellectuals with supple and open minds.

JAMA article: https://jamanetwork.com/journals/jama/fullarticle/385105

Full text on the New Jersey ME/CFS Association’s website (posted Feb 2010): https://www.njmecfsa.org/2010/02/13/skeptical-of-skeptics/

Thanks to @Lucibee for sharing this piece.

 

[SNT Gatchaman]

Thanks for posting @Lucibee and @cassava. Greatly appreciated - this resonated strongly.

Four years ago I was diagnosed as having chronic fatigue syndrome (CFS). The experience has given me a new perspective of my profession, one that is not always flattering.

Yes, I echo this sentiment. Previously I was incredibly proud of medicine and my role in it. I knew there were limits and I certainly knew I had limits, but we could often do "magical" things as a matter of routine. It was not good to realise just how badly wrong medicine had got a major illness, with substantial prevalence; compounding its misery.

Is CFS a real disease? I believe it is, but I cannot settle that here. I would only plant this seed in the mind of skeptics: What if you are wrong? What are the consequences for your patients?

What are the consequences for families, society, economies and in fact for medicine itself? I firmly believe that the biological explanation for ME/CFS will accelerate understanding and treatment for a large number of diseases, across many domains.

I have talked with scores of fellow patients who went to our profession for help, but who came away humiliated, angry, and afraid. Their bodies told them they were physically ill, but the psycho speculation of their physicians was only frightening and infuriating — not reassuring. It told them their doctors had little understanding of the real problem.

It's over 30 years later ...

I have been very lucky. After being ill for a year and a half, I began painfully slow improvement. Despite repeated setbacks, I have progressed to the point where I am no longer continually miserable. My career, however, is but a faint memory. There is little demand for absentminded surgeons, even if I had the stamina.

Partial-ditto.

I have survived because of caring friends and fellow patients and because of a few committed physicians who kept their minds open. They truly listened. They thought long and hard.

This is no illness for cookbook doctors. It is a disease for medical intellectuals with supple and open minds.

Quite.

Hugs across the decades, Dr English. Thank you for writing this.

 

[RedFox]

Yes, I echo this sentiment. Previously I was incredibly proud of medicine and my role in it. I knew there were limits and I certainly knew I had limits, but we could often do "magical" things as a matter of routine. It was not good to realise just how badly wrong medicine had got a major illness, with substantial prevalence; compounding its misery.

The body is weirdly simultaneously resilient and pathetic. Get in a car crash and break a bunch of bones? You might survive. Blood decides to clot somewhere in your heart or brain? Oops.

Medicine is much the same way. People live to 90 because we can treat infections, heart disease, diabetes, cancer, etc. Then their brain starts falling apart due to Alzheimer's and we throw up our hands in confusion. We do mountains and mountains of research on what makes HIV/AIDS or cancer tick...but we know basically nothing about ME/CFS, fibromyalgia, long Covid, autism, mental illness, etc. There are strange blind spots.

 

[Sean]

A blast from the past. I remember it well.

I would only plant this seed in the mind of skeptics: What if you are wrong? What are the consequences for your patients?

Indeed. What would that look like?

Answer: Exactly the situation we have now.

I firmly believe that the biological explanation for ME/CFS will accelerate understanding and treatment for a large number of diseases, across many domains.

I agree. Solving ME specifically is going to fundamentally change medicine more broadly.

 

[Jonathan Edwards]

I agree that much of the is sympathetic butDrEnglish seems to be confusing two different things.

Skepticism permeates our profession. It is ingrained during medical training and reinforced by professional experience. (…) Skepticism is widely perceived as the prudent, conservative way to deal with ambiguous situations — times when even experts are confounded. Healthy skepticism is the “in” attitude for intelligent, discriminating physicians.

Nope. Skepticism, as regarded as healthy, intelligent and discriminating, is saying what if you were wrong'. Which is what Dr English prefers. Conservative skepticism, or mistrust of anything you don't already believe in, is the opposite. The medical profession has always suffered from that and it has nothing to do with the intellectual scientific skepticism that had its heyday in the 1980s and has now largely faded out of site - except of course on S4ME.

 

[cassava7]

I agree that much of the is sympathetic butDrEnglish seems to be confusing two different things.

Skepticism permeates our profession. It is ingrained during medical training and reinforced by professional experience. (…) Skepticism is widely perceived as the prudent, conservative way to deal with ambiguous situations — times when even experts are confounded. Healthy skepticism is the “in” attitude for intelligent, discriminating physicians.

Nope. Skepticism, as regarded as healthy, intelligent and discriminating, is saying what if you were wrong'. Which is what Dr English prefers. Conservative skepticism, or mistrust of anything you don't already believe in, is the opposite. The medical profession has always suffered from that and it has nothing to do with the intellectual scientific skepticism that had its heyday in the 1980s and has now largely faded out of site - except of course on S4ME.

Fair remark. Nonetheless, there is a trap in that conservative skeptics view themselves as healthy skeptics, so Dr English was right to remind those who read this piece of what healthy skepticism should actually be. Hopefully, this made them think twice about their interpretation of skepticism.

 

[FMMM1]

Where to start ---

A guru of public administration here [Maurice Hayes - Permanent Secretary in the Northern Ireland Department of Health and Social Services] remarked that within the Department their moto was - "health is too important to leave it to Doctors".

I think Jonathan posted that most of the recent advances in medicine were via genetics - genes don't lie.

Most Doctors are technical folks seeing patients, trying to spot patterns and dishing out whatever off the shelf medicine is available. Some like this Doctor* are carrying out research to improve understanding, care/treatment - great they should be supported by the system and e.g. patient community lobbying for funding.

A long time ago a former colleague, who suffered from Cystic fibrosis, quoted her Doctor - research was needed. He was right of course, research has produced the drugs, although access to the is still problematic - a Doctor, in the same position, would now know that there are drugs ---.

To state the obvious, we don't know when the treatments will come along. However, e.g. GWAS provides a potential way to make progress, focus research ---.

OK the attitude of Doctors can make a big difference in supporting people, but the real progress may come from something like genetics i.e. not [directly from] the medical profession.

*
https://www.s4me.info/threads/uk-ab...e-understanding-of-fatigue.33400/#post-475930