Skip to comments.In Science-Based Medicine, Where Does Luck Fit In?
Posted on 09/19/2006 8:29:52 PM PDT by neverdem
Several years ago, an obese, diabetic patient of mine insisted on knee-replacement surgery against the wishes of her doctors, who believed that it would be too dangerous. She came through with flying colors.
While everyone rightly praised the efforts of her surgeon and physical therapist, another factor in her recovery was ignored: luck. Why are doctors and patients so reluctant to discuss a phenomenon that permeates medicine every day?
The likeliest reason that luck good or bad is so often disregarded is that at first glance, it appears contrary to the scientific basis of medicine. That is, doctors employ the best scientific knowledge available to diagnose and treat disease. How well patients do thus reflects this acumen.
Luck seems to have become particularly anathema in an era of evidence-based medicine, in which physicians and patients are encouraged to learn the latest relevant data to guide decisions. Dr. Peter A. Ubel, a University of Michigan internist and author of Youre Stronger Than You Think, believes that his patients prefer biological explanations of why they are sick, rather than hearing that they have bad genes or bad luck.
But given the biological variability within given diseases, like cancer, and the fact that variable genetic makeup leads different individuals to respond differently to diseases and therapies, even better scientific knowledge will not eliminate the role played by luck. Chance, the British physician R. J. Epstein wrote in the Quarterly Journal of Medicine, ensures different outcomes within given sick populations.
A few examples? Roughly 1 percent of North American whites are highly resistant to H.I.V. infection because they lack a certain cell surface protein. Lucky. Roughly 5 percent of people infected with the hepatitis B virus develop chronic active hepatitis, an often serious liver disease. Unlucky.
This phenomenon can be seen...
(Excerpt) Read more at nytimes.com ...
Without an operational definition of luck, it remains: "superstitious behavior."
If it weren't for bad luck, I'd have no luck at all.
Paging Alexander Fleming....please pick up the white courtesy phone.
The place where luck would seem to come into play is in diagnosis because while there are scientific reasons for illnesses we actually know very little about what causes many illnesses, and methods of treating symptoms are often figured out by a little scientific testing and a lot of trial and error.
Medicine is a lot like weather prediction. We know a lot about how things work, but what we still don't know is a lot more than what we do know, so the science helps us make good guesses rather than poor guesses a lot of the time.
Successful medical treatment, even in spite of all the contraindications, is not so much a matter of luck, as high expectations of success and positive mental attitude on the part of the patient. Persons who have been told they have very little chance of a good prognosis, still carry within their minds, this picture of themselves as being healthy, and with this mental picture, they do not succumb to degeneration and invalidism. The mind, focused on a positive outcome, forces the body to respond.
Just another extension of the old saying, a person is about as happy as they make up their minds to be. If it makes them happy to get up and walk around, they will get up and walk around.
It's not luck. It's positive mental attitude. Essentially, you MAKE your own luck.
It's not luck. It's positive mental attitude. Essentially, you MAKE your own luck."
I don't disagree with that. In fact, the mental state of patients in a lot of cases have much bearing on how well they recover/rehab.
However, I was addressing the factor of luck. Fleming discovered penicillin by accident. And, a certain amount of luck was involved because he was chucking out a few experiments when he noticed the effects on some cultures he was playing with.
Medicine remains as much art as it is science. It is not surprising that luck (and creativity) plays a factor in medicine.
Without 'luck' we wouldn't have had penicillin. They would've just thrown the moldy bread out.
The fact that high percentages of people do not respond to drugs for their problems, makes those that do 'lucky'. It is well known in the drug industry that this is true.
Perhaps the patient knew more about herself than her doctors gave her credit?
Medicine is worse than the weather predictions since there are so many variables.
I always think of penicillin. Today it can save my life and tomorrow it could kill me, since I could be allergic to it after I have used it successfully before.
So good observational skills and the ability to recognize the importance of an observation are "luck"??
The most exciting phrase to hear in science, the one that heralds new discoveries, is not Eureka! (I found it!) but rather, "hmm.... that's funny...."--Isaac Asimov
I think complexity theory comes into play with both.
Isaac was no fool as it turns out.
Ping to self for later.
So good observational skills and the ability to recognize the importance of an observation are "luck"??"
I think you missed the the first part of the sentence.
Fleming had already put quite a few of his petri dishes in to clean. If he hadn't gone to fetch some more to show a visitor what he was working on, he just might have put all the dishes in the disinfectant without taking a closer look. Had nothing to do with what you state above, until *after* he took a closer look at one of the retrieved cultures.
So, if one wants to play semantics, one could say the discovery was by 'chance'. I'd say lucky.
"In the fields of observation chance favors only the prepared mind." - Louis Pasteur