Is Medicine Really Science?

[DendWrite]

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I've been thinking about this for a while, and this is just based off my observations, so I might not be seeing the big picture. But it seems to me that science and medicine are two different roads. I'm not saying that medicine does not harness the principles of science to improve patients' lives. But, here's the thing: step outside the bounds of "accepted" medical practices and you risk getting sued or worse. You can't "experiment" on patients, and for good reason. But it seems to me that whenever I watch a doctor, they are really just following a heuristic every time. Oh, this is the protocol for treating X. Maybe with surgical cases there is a little more inventiveness since each case is somewhat unique. But still, there is an accepted way to -do things-, and if you want to try something new, you don't really do that on a patient, you do it in the lab. Yet stuff you do in the lab that seemingly works has to go through a huge approval process (that is often political, drawn-out and driven by the deep pockets of pharmaceutical companies and lobbying friends) before it ever has a chance of seeing incorporation into "medical practice."

It just seems to me that statistically, the best doctors are the best "information grabbers" ... those who can pick up on minute details of symptoms, synthesize these into a diagnosis, and then pick the "treatment" for whatever disease is going on off the shelf and follow protocol. It just doesn't seem like science. And another thing is that it may become even more of a worry with the healthcare reforms on the horizon, since they will surely encourage efficiency over "experimentation." I see scientists hard-pressed to make a case for experimentation and discovery when we can tug at the heart strings of voters and talk about the millions that we leave uninsured (because it is, of course, our duty as Americans to pick up the tab, for everyone) in the name of intellectual hijinx.

I know that supposedly physician-scientists are supposed to "span the gap" between the clinic and the lab, but all of the physician-scientists I have met absolutely loathe clinic work, and only do it because they have to per their contract with the university. Also, whenever I go to listen to a scientific talk, I often hear doctors mumbling about how "I forgot biochemistry years ago," and rushing to sign their little "continuing medical education form" so they can get out the door as soon as possible (with as much free food as is possible to smuggle out in their coat pockets).

I guess my concern is that I love science way more than I love memorizing a bunch of rules and then following them day in day out. Would I be unhappy being a clinician? I hate the idea of working every day with ideas of experiments to try to see if something works better only to not have enough time to do it because I'm already working 60-70 hours a week. I've yet to meet a physician who does it both -- labwork and clinical work -- and is actually satisfied with their work. It might be that I've just not met the right people yet, but the people I have met, I've had a discussion about this with them, and they've told me directly why they are scientists and not clinicians, even though the pay for clinicians is undoubtedly higher (is this as it should be?). I'd argue that the post-doc still making barely above a grad student salary who is troubleshooting an experiment is working way harder, probably just as long hours, and suffering a lot more than an attending rounding on patients and writing some prescriptions.

 

[Drrrrrr. Celty]

i like to think of medicine as a philosophy and a art
critical thinking and artistic and proper movement are what make doctors great

 

[Shinobiz11]

....I don't understand how you don't see medicine as science. Medical diagnosis is literally the scientific method applied to patients. You have a hypothesis, make observations, run tests, make a conclusion and change you hypothesis if needed, this is PURE science. Also giving medicine and treatment to a patient is also like a "chemistry" experiment. You add something to the original compound and see if it becomes to your liking or not. Every single treatment invented used the scientific method and other forms of science to come to the best treatment to do.

You are right about the things you say, but you really need to learn what science is.

 

[sgtbrushes]

Yes.

 

[csmittyB]

You are right about the things you say, but you really need to learn what science is.

Bold for a high school student🙄

 

[Shinobiz11]

Bold for a high school student🙄

I mean like, the various faces and purposes of science. 😀

 

[Evergrey]

DendWrite, I've struggled with the same things myself. I guess I've resolved to still pursue medical school despite those same concerns, because I'm going to pursue some serious bench research in medical school to give me the training I need to be a physician-scientist (Without the MD/PhD. As a humanities major I'm not qualified, nor do I want to put in the extra years. I am thinking about MD/MS programs though, but there's only a handful in the nation).

I feel that, ultimately, it comes down to your specialty and how you approach your practice. It's true, a lot of physicians give up their "scientist" side and emphasize the "clinician" part (which can become repetitive at times). I suppose one of the best ways to really break out of this trap is to be involved in research.

Ultimately though, I think people tend to underestimate how much science, and even mathematics, are used in certain specialties. I spoke with a urologist about his profession, and he explained to me that quite a few specialties need to have your scientific and mathematical thinking skills honed quite well. (I think he was referring to some surgical subspecialties in particular, but I don't recall specifically which ones).

Bottom line, though I feel that it may not be the norm, I do believe that there is definitely room in medicine for science. If the science is what's important for you, then I would definitely recommend the MD/PhD or PhD track over the MD track. But medicine is more focused on humanism and it can definitely be artistic. You would be giving up that aspect if you were to go pure scientist.

 

[Evergrey]

Also, see this thread: http://forums.studentdoctor.net/showthread.php?t=659828

 

[slants]

 

[LizzyM]

Medicine certainly uses science for the purpose of assessing a patient, making a presumptive diagnosis, administering treatment and providing a prognosis. Assessment of the patient requires a knowledge base of human anatomy, physiology, and pathophysiology as well as a little bit of biochemistry and even genetics. Making a diagnosis depends on fitting the data (subjective and objective measures) to the facts known about a wide variety of disorders, gathering more data, fitting it to the known characteristics of the possible conditions causing the problem, and repeating until a diagnosis is made. In some ways, it is like the freshman chemistry lab where you figure out a chemical "unknown" based on its boiling point, specific gravity, etc. Administering treatment for common conditions is often by an alogrhythm that has been tested and found to be effective in most cases. The challenge is to improvise when there is a contraindication to the standard therapy, or when the usual therapy has failed. In some cases, knowning the pathophysiology of a rare condition and the mode of action of a drug marketed for some other use, may lead you to use a drug "off label" to solve a problem for which there is no "official" treatment. You are going to administer the treatment, observe the results, make a record of the results and change your approach if needed. In some cases, experience with off-label drugs is published as a retrospective research study to provide information to other clinicians treating similar patients. Finally, systematic observations of groups of similar patients in similar circumstances can be used to make predictions about the prognosis of a given patient. Again, this is based on probabiltiy and statistics, a branch of mathematics.

 

[Sammich117]

Medicine comes from the latin phrase meaning "the art of healing"... I think that's appropriate.

 

[Eyti]

What are the main impurities for each field then?

 

[randombetch]

....i don't understand how you don't see medicine as science. Medical diagnosis is literally the scientific method applied to patients. You have a hypothesis, make observations, run tests, make a conclusion and change you hypothesis if needed, this is pure science. Also giving medicine and treatment to a patient is also like a "chemistry" experiment. You add something to the original compound and see if it becomes to your liking or not. Every single treatment invented used the scientific method and other forms of science to come to the best treatment to do.

You are right about the things you say, but you really need to learn what science is.

+1

 

[sunshinevet]

It just seems to me that statistically, the best doctors are the best "information grabbers" ... those who can pick up on minute details of symptoms, synthesize these into a diagnosis, and then pick the "treatment" for whatever disease is going on off the shelf and follow protocol. It just doesn't seem like science. And another thing is that it may become even more of a worry with the healthcare reforms on the horizon, since they will surely encourage efficiency over "experimentation." I see scientists hard-pressed to make a case for experimentation and discovery when we can tug at the heart strings of voters and talk about the millions that we leave uninsured (because it is, of course, our duty as Americans to pick up the tab, for everyone) in the name of intellectual hijinx.

What you describe here though, is the application of the scientific process. Analysing the data you have, applying the evidence presented to you, and formulating a plan to join the two and achieve a result. Just because doctors see a lot of the same data and apply a lot of the same evidence doesn't mean its any less scientific. You are right, the best doctors are the "information grabbers" - those who pick on the minute detail of a case which is important in the data set, and can change the evidence you apply. I'm sure when you look at it like this, the process seems a whole lot more scientific, hey?

*cut*

I guess my concern is that I love science way more than I love memorizing a bunch of rules and then following them day in day out. Would I be unhappy being a clinician? I hate the idea of working every day with ideas of experiments to try to see if something works better only to not have enough time to do it because I'm already working 60-70 hours a week. I've yet to meet a physician who does it both -- labwork and clinical work -- and is actually satisfied with their work. It might be that I've just not met the right people yet, but the people I have met, I've had a discussion about this with them, and they've told me directly why they are scientists and not clinicians, even though the pay for clinicians is undoubtedly higher (is this as it should be?). I'd argue that the post-doc still making barely above a grad student salary who is troubleshooting an experiment is working way harder, probably just as long hours, and suffering a lot more than an attending rounding on patients and writing some prescriptions.

To me it sounds as though you want to have your cake and eat it too. You don't get to find the cure for cancer and then apply it to every person on the planet. Medical research and the practice of medicine are fairly discrete, as they have different demands. In general, research is extremely consuming, and needs to be given "its all", if you know what I mean. I don't think its realistic to think you can be doing hardcore research and seeing patients on the side - if you don't use it, you lose it.
There is some overlap in the areas of clinical research, and perhaps this is what you are more interested in? And in that case, there is a lot of "experimenting" happening on patients.
If you want to work in research, I think you need to learn to let go of the need for personal satisfaction. You might discover something great - but don't expect to be standing at the bedside when it is first implemented. I feel the role of medical researchers is to discover tools to hand over to the clinical physicians. It sounds like you don't like this idea?

If you really want to see some experimentation with patients, go shadow a vet sometime. Especially one out in the country. With difficulty gaining patient histories, little to know diagnostic imaging/bloodwork, and limited blood tests etc, cost restrictions and limited pharmaceuticals, theres a lot of "well, i think this might work, lets give it a go...". Not that I think this is a bad thing - I mean, we would love to all have ultrasound/mri/digital xray/CBC, but it just doesnt happen, and so you have to learn how to interpret your information that much more. I think theres a lot more lateral thinking, and a lot less protocol following. (Mainly because the protocols arent there).

And I wouldn't bash attendings for what they get paid. Sometimes working in the veterinary industry and having people yell at me over money, because im "heartless", because their dog is lame and another dog that was hit by a car was seen before them, how unfair, makes me wish I was all alone in my research office. I can't imagine what its like for an attending in a busy ER on a friday night. I think I'd rather shoot myself.

 

[HolySmokes]

As a math major, I feel compelled to say: 👍.

 

[JediZero]

OP, I think you're right in that doctors tend to follow protocols most of the time (especially in fields like primary care where you see the same common problems that have established treatment methods). The science comes in the process of developing the protocols. Obviously, every specialty is going to require investigatory scientific skills at some point. But if you're really dedicated to the kind of creative science that you're talking about, then yeah, you should probably look more toward research than clinical medicine.

Also, your question about whether scientists work harder/deserve better compensation than clinicians is a gigantic can of worms that I do not want to get into right now...

 

[azrael87]

I would say medicine is a science for all the reasons stated above...it's just applied science.

Also, using the same techniques and treatments over and over doesn't make something any less scientific. General research uses a lot of the same techniques as well. Since the goal of research is to discover something new, you are just more likely to encounter something which requires a new technique. However, I would say 9 times out of 10 you are going to be using known techniques and tests in your experiments. Medicine is the same. If it's something that can be dealt with using currently known treatments, it will be. If not, new treatments are attempted.

As for the compensation difference, I think that's pretty simple to explain. In clinical work, you are usually doing work that produces positive, visible results relatively quickly. A researcher makes discoveries that may or may not turn out to be productive. Also, it usually takes a very long time to get those results. In addition, it's not uncommon for months of research to have basically inconclusive results. Pay is generally based on the employee's probable output, not just their possible output. This of course brings to question the idea that if scientists were better compensated, wouldn't they be in a better position to produce good data? Probably.

Unfortunately, that's not how it works. It seems scientists need to produce good results before they can get in a position to receive good compensation. On the other hand, if a doctor does not produce the good results which are standard, he stands to be sued or fired. The risks are there, so it isn't as if doctors are overcompensated; rather it's just possible scientists are undercompensated, albeit for a somewhat logical reason.

 

[boaz]

Medicine is a science as much engineering is mathematics.

 

[Shinobiz11]

+1

My calc teacher last year would always pester me and my friend about this because I am a biochem major/premed and my friend is a biophysics major lol.

 

[searun]

Is football science? Aren't the best coaches really math guys? Making choices in life is about probability, which is math, and making decisions in a football game is really about probability, so yeah, football is math, life is math, God probably is math. Is God an equation? Is Bellicheck an equation? Punt on 4th down? Do the math. Actually deciding to become a doctor really comes down to math. Or being able to analyze your debt load.

 

[scotsdoc54]

Medicine is a science as much engineering is mathematics.

👍

This

 

[demayette]

I've been thinking about this for a while, and this is just based off my observations, so I might not be seeing the big picture. But it seems to me that science and medicine are two different roads. I'm not saying that medicine does not harness the principles of science to improve patients' lives. But, here's the thing: step outside the bounds of "accepted" medical practices and you risk getting sued or worse. You can't "experiment" on patients, and for good reason. But it seems to me that whenever I watch a doctor, they are really just following a heuristic every time. Oh, this is the protocol for treating X. Maybe with surgical cases there is a little more inventiveness since each case is somewhat unique. But still, there is an accepted way to -do things-, and if you want to try something new, you don't really do that on a patient, you do it in the lab. Yet stuff you do in the lab that seemingly works has to go through a huge approval process (that is often political, drawn-out and driven by the deep pockets of pharmaceutical companies and lobbying friends) before it ever has a chance of seeing incorporation into "medical practice."

It just seems to me that statistically, the best doctors are the best "information grabbers" ... those who can pick up on minute details of symptoms, synthesize these into a diagnosis, and then pick the "treatment" for whatever disease is going on off the shelf and follow protocol. It just doesn't seem like science. And another thing is that it may become even more of a worry with the healthcare reforms on the horizon, since they will surely encourage efficiency over "experimentation." I see scientists hard-pressed to make a case for experimentation and discovery when we can tug at the heart strings of voters and talk about the millions that we leave uninsured (because it is, of course, our duty as Americans to pick up the tab, for everyone) in the name of intellectual hijinx.

I know that supposedly physician-scientists are supposed to "span the gap" between the clinic and the lab, but all of the physician-scientists I have met absolutely loathe clinic work, and only do it because they have to per their contract with the university. Also, whenever I go to listen to a scientific talk, I often hear doctors mumbling about how "I forgot biochemistry years ago," and rushing to sign their little "continuing medical education form" so they can get out the door as soon as possible (with as much free food as is possible to smuggle out in their coat pockets).

I guess my concern is that I love science way more than I love memorizing a bunch of rules and then following them day in day out. Would I be unhappy being a clinician? I hate the idea of working every day with ideas of experiments to try to see if something works better only to not have enough time to do it because I'm already working 60-70 hours a week. I've yet to meet a physician who does it both -- labwork and clinical work -- and is actually satisfied with their work. It might be that I've just not met the right people yet, but the people I have met, I've had a discussion about this with them, and they've told me directly why they are scientists and not clinicians, even though the pay for clinicians is undoubtedly higher (is this as it should be?). I'd argue that the post-doc still making barely above a grad student salary who is troubleshooting an experiment is working way harder, probably just as long hours, and suffering a lot more than an attending rounding on patients and writing some prescriptions.

Yes medicine is science. However, it is not a hard and fast science like physics.

 

[causalinference]

There are some good points in this thread and some other points that are not so good. A common misunderstanding that I'm seeing--a misunderstanding that would be cleared up if one studied the philosophy of science--is the idea that science is nothing more than the application of the "scientific method." Science is more than just a "method"; it is a strategy for investigating the world, and it involves politics and a definite social structure.

I agree with the sentiments of the original poster. I would offer the following suggestion: distinguish between academic medicine and clinical medicine. Academic medicine fits the general description of science much better than clinical medicine, which usually doesn't involve much science at all. Diagnosis might resemble the scientific method to some degree, but that doesn't make clinical medicine inherently scientific. It can be, but it generally isn't. The same thing applies to engineering.

Yes medicine is science. However, it is not a hard and fast science like math.

Mathematics isn't a science.

 

[RogueUnicorn]

a lot of science isn't really science.

 

[BBender716]

Like that movie, "Weird Science".

 

[TheMightySmiter]

I don't consider myself a science person at all.

 

[vin5cent0]

So, because scientific experiments aren't tested on patients, medicine isn't science?

How is this even a question?

 

[Charles English]

i was once blinded by science. she did it.

 

[jason3278]

Medicine is scientific. It applies knowledge gained from science. However, that alone does not make it a science. The goals of science and the goals of medicine are fundamentally different. Science aims to acquire knowledge through the pursuit of truth. Medicine, on the other hand, is focused on the promotion of health through the treatment and prevention of disease.

 

[Narmerguy]

Medicine as a practice certainly isn't applied like any common science. It's almost more of a cookbook art. Which ingredients to get which final product. The science of what each ingredient does and why is left for others to figure out, the chefs just use them as it's been explained.

 

[LizzyM]

Medicine as a practice certainly isn't applied like any common science. It's almost more of a cookbook art. Which ingredients to get which final product. The science of what each ingredient does and why is left for others to figure out, the chefs just use them as it's been explained.

Cookbook medicine is usually used by physicians as a pejorative.

Science comes in when you need to improvise. Just as there are those who "experiment" in the kitchen, there are some physicians who are willing to try something unconventional because, based on knowledge of the natural world, this unconventional thing might work to solve the problem. Knowledge of the natural world isn't scientific inquiry but it requires a desire to constantly keep up with new discoveries in the biological sciences and new discoveries in pharmaceuticals and devices.

 

[chman]

Actual diagnosis, most of the time, when definitive = science.

Knowing what to look for to even do the test in the first place = art.

 

[LizzyM]

Actual diagnosis, most of the time, when definitive = science.

Knowing what to look for to even do the test in the first place = art.

I disagree. There is a huge fund of knowledge that is tapped when one hears the chilef complaint and the history. Without putting it into so many words, a constellation of symptoms, the patient's demographic characteristics and the patient's environment, may lead a physician to suspect that there is a high probability (based on epidemiology, population based information) that problem is x, y or z. Tests to help rule out or rule in x, y and z but again, clinical epidemiology (a science based heavily on probabilty and Baysian theory) assists in determining which test to run and which to skip, if one has the knowledge of the pre-test probabiltity of the condition, and the characteristics of the test (how often those who have a positive test truly have the disease, etc). It is not art, it is a memory for scientific facts and skills related to observation (again a science, not an art), that helps direct the diagnostic work-up.

 

[chman]

I disagree. There is a huge fund of knowledge that is tapped when one hears the chilef complaint and the history. Without putting it into so many words, a constellation of symptoms, the patient's demographic characteristics and the patient's environment, may lead a physician to suspect that there is a high probability (based on epidemiology, population based information) that problem is x, y or z. Tests to help rule out or rule in x, y and z but again, clinical epidemiology (a science based heavily on probabilty and Baysian theory) assists in determining which test to run and which to skip, if one has the knowledge of the pre-test probabiltity of the condition, and the characteristics of the test (how often those who have a positive test truly have the disease, etc). It is not art, it is a memory for scientific facts and skills related to observation (again a science, not an art), that helps direct the diagnostic work-up.

While I agree that there is for sure science involved when deciding which test to run, I have to respectfully disagree that it is not an art. If it was pure science then new doctors would be just as good at deciding which tests to run as more seasoned doctors because they know the science of it. Most of the time this is not the case and the seasoned doctor has to use both science and the art of figuring out the best scenario.

 

[175961]

is science really science

 

[LizzyM]

While I agree that there is for sure science involved when deciding which test to run, I have to respectfully disagree that it is not an art. If it was pure science then new doctors would be just as good at deciding which tests to run as more seasoned doctors because they know the science of it. Most of the time this is not the case and the seasoned doctor has to use both science and the art of figuring out the best scenario.

The science is not cell biology, it is epidemiology. The more experience, the more likely one knows that in a person of this age, and sex the finding of a rash and fever is more likely to be x than y. Because they have an eye for papular rashes or because, over the years, having seen 80 patients who presented in the same way and recalling that 40 had x, 30 had y and the other 10 were zebras the more seasoned doctor more quickly hones in on the likely problem?

 

[chman]

The science is not cell biology, it is epidemiology. The more experience, the more likely one knows that in a person of this age, and sex the finding of a rash and fever is more likely to be x than y. Because they have an eye for papular rashes or because, over the years, having seen 80 patients who presented in the same way and recalling that 40 had x, 30 had y and the other 10 were zebras the more seasoned doctor more quickly hones in on the likely problem?

Yea, but I am actually talking about the zebras more so than the horses. What makes a doctor think about running a certain test when all the science points to not doing so and the doctor ends up being right? Is that art or science? To me that is an art, an art acquired over time. This is just my opinion. Again, a agree that it is mostly science, but I also think that there is art involved as well.

 

[LizzyM]

Yea, but I am actually talking about the zebras more so than the horses. What makes a doctor think about running a certain test when all the science points to not doing so and the doctor ends up being right? Is that art or science? To me that is an art, an art acquired over time. This is just my opinion. Again, a agree that it is mostly science, but I also think that there is art involved as well.

It is not art, only memory for scientific facts. With the zebras it is even more a memory for the rare event and an understanding of the science that might lead to the symptoms.

If there is anything that is an art, it is the ability to read people and ask questions in such a way that people tell you the truth. I'm thinking, for example, of the person who tells you they have been in an monogomous relationship for 10 years and never used IV drugs. This seems to make HIV unlikely but as everything seems to point that way, you have to ask the question, has your partner been unfaithful? Sometimes it means asking the partner. There's a lot of art and diplomacy there and maybe that's where entertaining the diagnosis of HIV deciding to order the HIV test may seem like an art.😎

 

[chman]

Specific tests are ordered based on symptoms/chief complaints. Zebras are less common than you think.

Perhaps I am oversimplifying why I think medicine is an art, as well as a science. Aside from test and diagnosing, there is finding the best way to deal with patients, fellow coworkers, family members etc. Aside from what I said above, which I do stand by, these are other reasons why medicine could be considered an art.

 

[chman]

Since when is communicating with others an art?

Type in art and communications into google and see what comes up. Otherwise I would suggest taking a communications class if you have not already. It should then be pretty clear why it is an art.

 

[causalinference]

Since when is communicating with others an art?

"Art" has many different definitions. Loosely speaking, you could consider effective communication an art. Do we really need to debate the semantics of a vague term?

 

[chman]

I'm college educated, I talk with strangers about various things everyday. I don't need to be told to take a communications class to learn how to speak to others.

You didn't get the point of my post anyways.

I was not trying to insult your intelligence. You said, "since when is communications an art," and I gave you an avenue to reasons. Just because you went to college does not mean that you could not benefit from a communications class. It may just be my bias, but I think it should be a required class.

 

[jason3278]

+1

My calc teacher last year would always pester me and my friend about this because I am a biochem major/premed and my friend is a biophysics major lol.

-1.

I hate this sort of reductionist BS.

(Referring to the cartoon above. It didn't copy in my post.)

 

[BozoSparky]

most medicine is the application of known science...

the "art" of it all, in my opinion, are situations where experience helps that doctor see where things are headed. call it pattern recognition, whatever. so for the trainee, everything seems new - lots of discovery. let me tell you, i feel like a scientist quite often.

but it's still different from being in a lab, knowing you truly are the only one on the edge of understanding...

a big difference between medicine and science are the attitudes. i see outrageous confidence in physicians that they are correct (maybe they have to be? - ever heard the phrase "often wrong, never in doubt"). scientists are more willing to consider other possibilities, and there is less posturing...but they don't have someone's life on the line.

 

[TheMightySmiter]

-1.

I hate this sort of reductionist BS.

(Referring to the cartoon above. It didn't copy in my post.)

I'm pretty sure the cartoon was xkcd, in which case it was definitely not meant to be fully serious.