How Doctors [And many Politicians!] Think -- Part One of Two

Editor's note. Don't forget that the repeat of the "Fetal Position" episode of House that we've written about so much is on tonight on the USA Network. If you missed it the first time, by all means watch it and drop me a line at daveandrusko@hotmail.com.

There is so much to read that often I just file articles away, hoping that I will get to them later. That's what happened to David Brown's review in last Sunday's Washington Post of How Doctors Think, by Jerome Groopman, M.D.

The book review is worth reading on its own merit. (www.washingtonpost.com/wp-dyn/content/article/2007/04/05/AR2007040502325.html) However, in light of this week's grim Senate vote in favor of S.5, see if this explanation of how physicians make clinical errors – "a whole taxonomy of misperceptions and wrong conclusions"-- doesn't ring a bell.

Groopman (who writes frequently for the New Yorker) describes a woman who for 15 years was incorrectly diagnosed as suffering from bulimia and anoxeria. She "was fitted into the single frame of bulimia and anorexia nervosa from the age of twenty," writes Groopman. "It was easily understandable that each of her doctors received her case within that one frame. All the data fit neatly within its borders. There was no apparent reason to redraw her clinical portrait, to look at it from another angle."

According to Brown, "Many of the mistakes Groopman describes are variants of this one. They come from the physician's inability to keep his or her mind open, a reluctance to abandon initial impressions or received wisdom, and a willingness to ignore (often unconsciously) contradictory evidence."

If you have a chance to read the transcript of Wednesday's debate over S. 5, the parallels practically scream out at you. As you remember S. 5 would mandate federal funding of the type of stem cell research that requires the killing of human embryos.

Let's discount the usual cynical suspects, the Ted Kennedy's whose talent for demagoguery is matched only by their determination to advance the anti-life agenda. Kennedy, for example, enlisted the plight of brain-injured solders, men left in wheelchairs, patients "battling against the tremors of Parkinson's disease," and teenagers suffering from juvenile diabetes to attack those who would stand athwart the embryonic stem cell juggernaut. Of course, gone unsaid is that there have been no trials in humans, which alone could provide any empirical basis that embryonic stem cells could remedy, let alone cure, any of these diseases and injuries.

If that weren't bad enough, Kennedy insisted that S. 5 is abuse-proof (as he defines abuse). "As has been pointed out, science without ethics is akin to a ship without a rudder," he intoned. "For that reason, the legislation establishes essential ethical safeguards for stem cell research--enormously important--and has been reviewed earlier during this debate."

The truth quotient on that statement was the same as his earlier assertions: zero.

But the Kennedys of this world aside, there were no doubt senators (and earlier, members of the House) who, like the physicians described by Groopman, were unable to keep their minds open, reluctant to abandon initial impressions, and willing to ignore--maybe even subconsciously--contrary evidence.

It is astounding how evidence can barely make a dent in the initial understanding about embryonic stem cells. (See Part Two.) It is as if nothing has changed, as if all the promises and hype over their alleged near-miraculous properties had not failed to be borne out. As if all the wonderful breakthroughs using other sources didn't exist.

But even Kennedy joined 69 others senators who voted for S. 30 (sponsored by Senators Norm Coleman, R-Mn., and Johnny Isakson, R-Ga.), a bill to encourage research on stem cells obtained in ways that do not require the harming of human embryos. Who didn't?

Sadly, twenty eight senators didn't, including Senators Barack Obama (D-Il.) and Hillary Clinton (D-NY). Now THAT qualifies as hard-core.

If you have any comments or questions, please write Dave Andrusko at daveandrusko@hotmail.com