Monday, November 4, 2013

Getting Personal With Medicine

As you know, one of the aims of the second half of my career is making medicine available and understandable to everyone. That is the reason I wrote How To Think Like a Doctor and Como Pensar Como un Doctor and the reason I am here in Nicaragua teaching medicine to providers at all levels of experience. It is also one of the reasons why I write this blog.
One problem with modern (Western) medicine is that we physicians tend to treat individuals as groups of people. Medications are tested on large populations; they are approved for mass consumption; and side-effects are noted for "common" reactions. Not all medical traditions treat people like this. Chinese and Indian  medicine (Aruvedic) for example take an individualized approach to health care: what works best for YOU?
We used to say that Rheumatology was the discipline of treating the untreatable. Which means people were were dosed with medications that caused HUGE problems like corticosteroids and non-steroidal anti-inflammatory drugs (NSAID's). Don't get me wrong: I love Western medicine and I'm impressed with modern medical technologies. What I don't like is the shotgun, or in the case of the U.S., cannonball approach to therapy. And secondarily, I don't like being told by mainstream physicians and the government that that is the only way to treat people.
That is now going to change. It first started in the 1990's or the "Decade of the Brain" when neurologists and psychiatrists decided to focus on what happens inside our heads instead of what we manifest as speech and behavior. This line of research continues at such places as the Amen Clinics where therapy is prescribed only after a definitive diagnosis is made only after a full history is taken (including input from family and friends) and a full physical exam is performed. Additionally, brain-imaging studies are used to narrow down the possible diagnoses and the patient can then be treated with the medication, dose, and timing specific for THAT individual patient: (Note: I don't approve of Amen's commercialism. The whole thing reminds me of an Infomercial. But the science is still good).
Which brings me to the crux of today's blog. A friend of mine works at a company that uses genetic tests to determine proper medication use for a whole host of "regrettable maladies," from breast cancer to depression. Yes, depression. Remember Dr. Mangold's Rule of Psychiatry: in the long run, psychiatric problems are neurological issues. Check out the site if you can. They are located at Print up their brochure and bring it to your doctor if you think you can benefit from their testing. Make sure your doctor is listening.

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