From the vault
A few stories to introduce you to my thinking
In light of the current unpredictability of Twitter and the hostility of its new owner, I am experimenting with moving some of my spontaneous thinking over to Substack. While Substack is also a private company, the ability to export your subscriber list charms one into believing that there’s the possibility of a clean breakup should the need arise.
As a way to introduce readers to my thinking, I’d like to share a few articles I’ve written over the years. You can see more of my work on my website.
Medicine is neither a planned community nor a city of monuments. I think there is wisdom within the chaos of the clinic or hospital. The power of evidence based medicine is its isolation of an intervention, which promises to clarify some universal principle. But many solutions in medicine are self emerging and local, not engineered and universal. The look of relief on a patient’s face will never surrender itself to a metric, nor will the wellbeing of my community. If the outcomes themselves can never be fully defined, medicine’s tools and structures must also incorporate leniency.
Are medical errors a huge problem that’s simple to fix? - The BMJ Blog, 2018
As I’ve progressed in my medical training, I’ve wondered why I’ve grown less comfortable with the patient safety movement. Watching To Err is Human, the sentiment crystalized: instead of being engaged scientifically or humanely as a physician, “safety” often feels like a sales pitch. No doctor would passively accept the words of a pharmaceutical industry representative describing a new drug that’s perfectly effective, without side effects, and eminently affordable. Yet doctors today are expected to absorb the claims of “patient safety experts” or be branded reckless cowboys.
Confessions of a 'High-Yield' Doctor - Medscape, 2019
Meanwhile, what doctors choose to call “knowledge” is evolving as well. The growth of evidence-based medicine has threatened much of medicine's traditional sources of educational authority. The randomized trial has replaced self-assured textbooks as medicine's most-respected source.
Yet, hard evidence often falls short. In my experience, the result is that medicine's “facts” quickly dissolve into factionalism. Guidelines and experts, some beset by commercial interests, battle for influence in the absence of definitive data. Social media and investigative journalists have put a spotlight on this historically internal fight.
The Vaccines Are Coming. It’s Time to Call Your Mom - WIRED, 2020
In the end, our friends and family ask us to answer silly questions or debunk some cousin’s Facebook post because they’re uncomfortable and scared. This has been a year of unprecedented experiences, at least for those of us who didn’t live through the 1918 flu. Some trepidation is reasonable. You don’t have to be a doctor to adequately address these concerns. You have to practice love, patience, and understanding.
The FDA is a melting iceberg - The Atlantic, 2021
This is the tragedy of the concerned citizen: We are personally destined to fail. Just as switching to an electric car or turning your lights off won’t cool a warming planet, a minority of idealistic doctors won’t stop the flood of ineffective treatments.
Long COVID Could Be a ‘Mass Deterioration Event’ - The Atlantic, 2022
Indeed, if—as these numbers suggest—one in six Americans already has long COVID, then a tidal wave of suffering should be crashing down at this very moment, all around us. Yet while we know a lot about COVID’s lasting toll on individuals, through clearly documented accounts of its life-altering effects, the aggregate damage from this wave of chronic illness across the population remains largely unseen. Why is that?