Inefficiency, public health, and our weaknesses.

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

adamj61

Fck'm Bucky
10+ Year Member
5+ Year Member
15+ Year Member
Joined
Jun 15, 2004
Messages
876
Reaction score
1
I thought I would make a thread out of my post in the public health thread.

I have a botany/ecology/poli sci prof that comes down on docs very hard, especially in the arena of public health. He claims that docs tend to know way too much and cannot tell good narratives, and they are also not scientists because they do not collect data etc. He is right on, especially when he uses the example of public health with respect to the plague. It wasnt quarantine or knowing all of the answers that slowed the plague, it was public health...speading people out. The plague kept comming back in a delayed negative feedback loop, and the only reason it kept getting smaller was because of public health. It has also been public health (ie move the sewage out of the well) that has curbed more disease than we can traditionally treat. When 2nd world countries (Russia) with antibiotics and no control produce a disease that could be resistant tuberculosis combined with an HIV or similar features, we need to be able to prevent and solve this problem. He argues engineering inefficiency into the system is key...for example:

Which city is bigger, San Diego or San Antonio? Half of americans get this question wrong...where as forgeiners get it right 100 percent of the time. Why? Because they don't know that san antonio exists...simply knowing makes you interpret the information, and therefore sometimes you make the wrong choice. We need to learn to manage the system as a whole Think about democracy, it is so inefficient that the slack in the system provides a stable structure (ie electing Bush :laugh: ) Churchill once said it was a horrible form of government, but better than all of the rest. I guess one of his big points in the end is that we need get away from trying to learn everything, and take a step back if we want to solve some future complex problems.
 
Wow, your professor has a lot of degrees and yet still doesn't know a thing. That's impressive.
 
kinetic said:
Wow, your professor has a lot of degrees and yet still doesn't know a thing. That's impressive.

Very nicely said. Sounds like a typical academic idiot who's full of hot air and feels small because he teaches botany, of all things... Let's toast to botany PhD's, because they provide so much to our community... +cough+

Weebs
 
Ok, you guys are ignorant. First of all he has his PhD in ecology from Whales University. Second, he is not a botanist...he is more of a theorist. Third, his theories on supply side sustainability are ground breaking...he has more awards and honorary degrees than you will ever have a crack at. And I'm sorry...but as great as medicine is, he is right. I would love to see someone prove him otherwise. He has a ton of books you could read...then maybe you can make a comment 🙄
 
Wow, since he's written books I guess I'd better shut up!
 
Ok, to put it in context it is up the alley of Jared Diamond (guns germs and steel)...look for Diamonds new book on collapse of human societies btw. Oh, his name is TFH Allen...he was on the cover of the times I believe, he does get a lot of press...this isnt some random ass guy making **** up. The "Hierarchy Theory: A Vision, Vocabulary and Epistemology" is a good place to start. Here is a link to some more info

http://botany.wisc.edu/allen/bio.htm

You guys are just proving his point...saying we contribute the most to society, thinking that we can somehow through brute force solve all of our problems. I think we can at least agree smart public health has saved more lives than surgeons. We are taught to be arrogant...and I think that is good for many things...but not large scale problem solving.
 
I think adam is right that we need theorists to solve major health epidemics (AIDS, malaria, etc.) but these people help the public, while doctors help people. A public health worker might come up with some great ideas on how to slow/stop the spread of disease but they won't have clue one on how to diagnose or treat the disease. Likewise, a doctor specializes in treating individual patients as opposed to populations so a doctor probably isn't the best choice for treating epidemics.
 
my professor is better than your professor :laugh: . so there :meanie: !
 
I don't know why you guys are coming down so hard on someone who's trying to instill some interesting discussion into this thread. And the way you're talking about an 'academic idiot who's full of hot air' really makes you sound like the ones who are 'premed idiots who are full of hot air'. You think because you're going to be doctors that makes you better than an ecology professor? That just supports the point that docs are pompous and out of touch with the big picture reality of public health.

Adam, that sounds interesting, but I'm not sure I understand what you mean when you say that "He argues engineering inefficiency into the system is key". The argument of public health and epidemiology tends to be that by understanding the processes of disease in population we can make our approach to solving the problems more efficient and funnell resources where they need to go...
 
boardchic said:
I don't know why you guys are coming down so hard on someone who's trying to instill some interesting discussion into this thread.

Because we read the post.
 
dnelsen said:
I think adam is right that we need theorists to solve major health epidemics (AIDS, malaria, etc.) but these people help the public, while doctors help people. A public health worker might come up with some great ideas on how to slow/stop the spread of disease but they won't have clue one on how to diagnose or treat the disease. Likewise, a doctor specializes in treating individual patients as opposed to populations so a doctor probably isn't the best choice for treating epidemics.

Personally, I think this is why MD/MPH dual degrees are so valuable. I think knowing approaches to a variety of aspects of disease - biological, social, individual, population level - can be essential to designing useful research and translating that research into both individual care and systemic-level policy and public health programs. Also, public health is useful for more than just infectious diseases... the whole concept of a 'risk factor' is an epidemiological construct.
 
I'm just not really sure I get your point. Does anybody argue that public health is bad? Wouldn't you want a surgeon available if you needed a tumor removed? Everybody can't focus on the big picture or you'd have nobody to treat the details. It's honorable to want to help the world, but it doesn't work if everybody is focused on public health of an entire nation, or the whole world.
 
adamj61 said:
Ok, to put it in context it is up the alley of Jared Diamond (guns germs and steel)...look for Diamonds new book on collapse of human societies btw. Oh, his name is TFH Allen...he was on the cover of the times I believe, he does get a lot of press...this isnt some random ass guy making **** up. The "Hierarchy Theory: A Vision, Vocabulary and Epistemology" is a good place to start. Here is a link to some more info

http://botany.wisc.edu/allen/bio.htm

You guys are just proving his point...saying we contribute the most to society, thinking that we can somehow through brute force solve all of our problems. I think we can at least agree smart public health has saved more lives than surgeons. We are taught to be arrogant...and I think that is good for many things...but not large scale problem solving.

Too funny -- I was just thinking how much your thread reminded me of a passage from Guns, Germs & Steel that I read Friday during my commute home on the bus.

While I agree that Public Health advocates may have saved more lives en toto over the years, doctors are generally trained to deal with problems on an individual (micro) basis. And this is where their focus should remain, unless they desire to move into the realm of public health, which is a quite different line of work from traditional medicine. Thus, I disagree with your theory that dealing with public health issues is a "weakness" of doctors, when in reality they can only deal with the problems of the patients they encounter. Remember, someone always has to deal with the current and present suffering of the victims of an epidemic disease, while others are free to solve the problem on a larger scale.
 
tigress said:
I'm just not really sure I get your point. Does anybody argue that public health is bad? Wouldn't you want a surgeon available if you needed a tumor removed? Everybody can't focus on the big picture or you'd have nobody to treat the details. It's honorable to want to help the world, but it doesn't work if everybody is focused on public health of an entire nation, or the whole world.

I'm not saying everyone has to be focused on the public health of an entire nation, I'm just saying that things aren't necessarily as clear cut as 'theorists help population; doctors help individuals'. There are many conditions and diseases (asthma, diabetes, pregnancy complications, hypertension) whose origin, course, and treatment is not so easily separated from the society in which the patient lives. I just think doctors in general need some awareness of the interplay of social and biological factors in disease. It's essential to treat individuals, but, to use an old silly adage, "no man is an island".
 
Quentin Quinn said:
Too funny -- I was just thinking how much your thread reminded me of a passage from Guns, Germs & Steel that I read Friday during my commute home on the bus.

which passage? I admit Guns, Germs, and Steel is my favorite book, but I don't recall a passage on this topic (haven't read it in over a year though)
 
boardchic said:
I just think doctors in general need some awareness of the interplay of social and biological factors in disease. It's essential to treat individuals, but, to use an old silly adage, "no man is an island".

As far as I can tell, med schools go to great lengths to teach about "the interplay of social and biological factors in disease." At least the ones I'm familiar with. But as somebody said before, you have to be able to draw the line somewhere, because doctors really do treat the individual, and while they must see this individual in the context of their society, they can't focus on society too much. I think trying to teach med students or doctors more public health would only distract them from their task of treating the patient.
 
Also I just want to say, I found the OP's posts a bit pretentious. I don't have a problem with intelligent conversation, but he sort of comes across as trying to sound better than everybody else. Is it just my imagination?
 
first of all, there are many doctors who are scientists and "collect data," just as there are many doctors who are in the field of public health.. if you are speaking of doctors who are solely clinicians, it is true that for many of them (but not certainly not all--ie community medicine, infectious disease, etc) their focus is individual-based rather than population-based, but this does not make them any less significant. i am sure that if you fall ill, you want your physician to be more concerned about your individual well-being than about macro societal health outcomes..
also, quarantine has long been a part of public health and was integral to many societies' fight against the plague (as in quarantining ships off the coast), so i am not quite sure what your point is there...
as for public health, it certainly a necessary field, but this in no way undermines the role of the physician... it's a matter of culture. americans value individualism. car crashes for instance are a major source of mortality in the US, but you don't think americans are going to stop driving do you? no, they are going to continue driving. but what they do want, is to feel confident that if for some horrible reason they end up in an accident, there will be doctors and other healthcare workers there to try and save them--those whose sole purpose at that point is the individual, not society at large.
illness has many causes--macro and micro--and to combat the broad range of disease definitely takes more than a reductionist approach to medicine, but don't mistake public health and biomedicine as being mutually exclusive..
 
He claims that docs tend to know way too much and cannot tell good narratives, and they are also not scientists because they do not collect data etc.

I don't know exactly what he means about narratives, but I do know that there's nothing wrong with knowing a lot. A lot of times , it is people who know the best that know to keep it simple stupid.

About doctors not being scientists since they don't collect data, this is pure BS. I'm sick and tired of academic PhD's looking down on MD's and thinking that research is real science and that it's the pinnacle of what they can do. Research and clinical are two sides of the same coin. Without each other, there would be no other one. Neither one is any more superior than the other.

I think we can at least agree smart public health has saved more lives than surgeons. We are taught to be arrogant...and I think that is good for many things...but not large scale problem solving.

No offense, but this is a stupid point. Of course public health saves more lives than surgery or probably medicine in general because YOU'RE DEALING WITH THE ENTIRE PUBLIC!! One change in public health that might take a week to do may save a million lives. How the hell are surgeons supposed to do a million surgeries in one week??


In conclusion, from the description given, this guy is insulting MD's for not doing things that they should not be doing and that are not their responsibility.
MD's are not PhD's and are thus not going to be data hacks that number crunch and such. For example, I was at a pharmaceutical drug conference a couple months ago and when the subject came up of drugs that have been found for illnesses that they weren't produced for, the moderator said that docs could look out for other benefits of drugs and keep track if other illnesses than what the drug was prescribed for have improved. The MD on the panel immediately said "bad idea, real bad idea. that's not our job, we're not data gurus who collect copius amounts of data and do the required statistical tests. there are people that specialize in that."
Also, MD's are not in public health. People in public health are in public health (not to sound too obvious).

So basically this guy can kiss my ass 😀
 
brucecat said:
illness has many causes--macro and micro--and to combat the broad range of disease definitely takes more than a reductionist approach to medicine, but don't mistake public health and biomedicine as being mutually exclusive..

This is basically my point, in case it didn't come across this way. Well said, Brucecat.
 
Weren't MD's part of the team mobilized by the world health organization to help identify and treat the initial cases of SARS.

Additionally I agree with Adam more emphasis in clinical training of MD's should be public health oriented, but maybe that's because that's what interests me--clinical medicine as it applies to social justice and public health infrastructure.--Ben.
 
I hate to tell you Cardsugguy, but there are many MDs in public health... In fact, your profile says you're getting an MBA in Health Care Administration, which is of course one of the major subsets of public health... so I guess you are already in the field of public health, you just didn't know it..
 
brucecat said:
I hate to tell you Cardsugguy, but there are many MDs in public health...

Well, my basic point is that not ALL MDs can be in public health, just like not everybody in public health needs to be an MD. Yes, they compliment each other, and it's great to have people dedicating themselves to public health, which is a noble and worthy cause, but I don't think that should be the goal of every MD. I happen to find the field of public health fascinating and I feel deeply that it is important for the world, but for my own life I can't focus on that, I'm going to focus on each case as it comes, because that's who I am. So in some ways the OP is suggesting that this is bad, wrong, not helpful, but I very much disagree; I say it's necessary.
 
You guys bring up some good points. We live in a post modern world, and science is a privilege to us. Telling narratives is more important than just the facts. You can look at the genocide of native americans and see many different stories based on the same facts. This applies to all scientists...you can't just use big machines to solve all of the problems. Many people agree our biggest problem in science today is simply handeling this massive amount of info we have (ie the genome).

Its also really cool to think about america from Wilson to where we are today....a big up swing, then lbj tried to throw tons of money at our emerging post modern society, then cult like things from RR...and the system needs to reset itself eventually

Guns germs and steel is related to the topic when talking about the spread of disease.

For inefficiency, I am saying since we are so efficient at what we do, we need to engineer the inefficiency. The !Kung tribe in africa may be "inefficient" to us...but they may be around in a hundred years if our system collapases under a K4 (capacity contraints like the plague) such as the tuberculosis I mentioned. There is another cool example with this tribe who raised pigs for food, but had a pig taboo...but they ditched it when times were rough, it forced a stable system.

I think it is helpful for those like myself who fall into the surgeon type, keep our minds open.
 
tigress said:
which passage? I admit Guns, Germs, and Steel is my favorite book, but I don't recall a passage on this topic (haven't read it in over a year though)

see pp. 202-06 of Chapter 11, discussing how improved agricultural technology enables increased population density, which results in rapid spread of disease-carrying microbes. Essentially, "crowd diseases" (epidemics) cannot thrive and spread w/o crowds is what it boils down to. Great book... really makes you think, and I can't wait to finish it tomorrow on my long commute!
 
Top