Is half of what we think we know still wrong?

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In the first hour of the first lecture that I had at medical school we were told a few truths. One was that we were spending 5 years of our lives learning stuff and half of it was going to be wrong. This was a totally different approach to the approach from school where everything we were taught was “true” and indeed any argument or disagreement with what was written in stone was met with a “well, it will be right in the exam”.

I think as medical students we quickly got the idea that real knowledge was in flux and that truth did not really exist in any solid form. Some felt that meant that it was not worth learning anything as it would be better to learn it when we actually knew everything properly – not all of them did very well! Some decided to focus on more concrete subjects such as anatomy with its history spanning the centuries rather than the “new” subjects such as immunology, which was then rather confusing, which was looked at suspiciously and was viewed as a subject not worth putting much time into.

The approach at the medical school was very good in that it was encouraged that we read and interpreted original papers along with textbooks. This certainly gave me the feeling on the tenuousness and greyness of knowledge. This was later amplified when we were moved into clinical medicine where it was not unusual to be taught by one consultant that this technique was the only way to examine a patient and another consultant an entirely different one.

In some way looking back over the last 25 years of being a physician you could look medical knowledge as a yacht tacking backwards and forwards and often taking an almost 180 degree turn but gradually seeming to get closer and closer to the eventual “everything”. Of course the occasional wind- shift changes the objective and although we are still a long way off the total knowledge of everything medical, we are very much closer in many areas both theoretically and in lives saved than we were 25 years ago. Then the Star Trek health scanners were CT scans then MRI scans and perhaps now are PET scans.

When a patient is resistant to the latest idea that we have to tell them to get healthy I am often confronted with a kind of health malaise. A fatigue of being told that doing something is healthy only to be told that this approach is wrong and that they should do the opposite . I have some empathy for this because our ideas and views of what works does change - these tacks back and forwards happen all the time.

Ulcers used to be all about acid and that’s all. They then discovered the helicobacter pylori which strangely is present in 50% of peoples stomachs, but once you have an ulcer – the ulcer will not heal properly unless you first get rid of the bacteria. So there we were and still are giving antibiotics for stomach ulcers! This still seems a little strange.

Eggs have been good for us ( go to work on a egg!), bad for us, very bad for us ( salmonella!!) and now maybe good for us if the chickens eat real food that chickens have always eaten, and get to run around a little.

Early in the last century the anti-bacterial benefit of sunshine was well known as a treatment for tuberculosis, then until a couple of years ago we were then told that any sunshine would give us skin cancer. Children were kept inside in fear that they would die of skin cancer. Now, once again, some sunshine is said to be good for us and maybe we should at least have some, there are even papers suggesting that those with the worse skin cancer do better if they spend more time in the sun.

I am not sure that half of what we “know” now is still as wrong as it was 25 years ago but whilst there is still a lot that we are doing wrong and very expensively. People are much healthier but at the cost of taking handfuls of pills, and expensive health care costs. I would like to think that we are getting more than half of it right now but part of me suspects that the glass is still not more than half full, even if it is not less than half empty – there must be easier, simpler ways of living healthier.