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In Science-Based Medicine, Where Does Luck Fit In?
NY Times ^ | September 19, 2006 | BARRON H. LERNER, M.D.

Posted on 09/19/2006 8:29:52 PM PDT by neverdem

Essay

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 “You’re 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 ...


TOPICS: Culture/Society; Extended News; News/Current Events
KEYWORDS: health; luck; medicine; religion; science; secularhumanism

1 posted on 09/19/2006 8:29:54 PM PDT by neverdem
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To: neverdem
an obese, diabetic patient of mine insisted on knee-replacement surgery against the wishes of her doctors

They generally want you to lose the weight before you have the surgery. Guess she got lucky and found a doctor who would do it anyway.
2 posted on 09/19/2006 8:34:10 PM PDT by P-40 (Al Qaeda was working in Iraq. They were just undocumented.)
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To: neverdem

Without an operational definition of luck, it remains: "superstitious behavior."


3 posted on 09/19/2006 8:35:28 PM PDT by Rudder
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To: Rudder

If it weren't for bad luck, I'd have no luck at all.


4 posted on 09/19/2006 8:37:43 PM PDT by Kirkwood
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To: neverdem
"In Science-Based Medicine, Where Does Luck Fit In?"

Paging Alexander Fleming....please pick up the white courtesy phone.

5 posted on 09/19/2006 8:43:12 PM PDT by Tench_Coxe
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To: neverdem
It's not simply luck that some people are more susceptible to some diseases, there are reasons for it.

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.

6 posted on 09/19/2006 8:49:39 PM PDT by untrained skeptic
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To: Tench_Coxe

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.


7 posted on 09/19/2006 8:54:05 PM PDT by alloysteel (In war, disproportionate force is the ONLY way to assure victory and subsequent peace.)
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To: alloysteel
"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."

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.

8 posted on 09/19/2006 9:00:04 PM PDT by Tench_Coxe
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To: neverdem

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.


9 posted on 09/19/2006 9:02:52 PM PDT by Secret Agent Man
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To: neverdem

Perhaps the patient knew more about herself than her doctors gave her credit?


10 posted on 09/19/2006 9:15:40 PM PDT by GummyIII
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To: untrained skeptic

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.


11 posted on 09/19/2006 9:34:53 PM PDT by art_rocks
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To: Tench_Coxe; jan in Colorado
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.

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

12 posted on 09/19/2006 10:16:25 PM PDT by Gondring (If "Conservatives" now want to "conserve" our Constitution away, then I must be a Preservative!)
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To: art_rocks
Medicine is worse than the weather predictions since there are so many variables.

I think complexity theory comes into play with both.

13 posted on 09/19/2006 10:17:15 PM PDT by Gondring (If "Conservatives" now want to "conserve" our Constitution away, then I must be a Preservative!)
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To: Gondring

Isaac was no fool as it turns out.


14 posted on 09/19/2006 11:01:55 PM PDT by Paladin2 (Islam is the religion of violins, NOT peas.)
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To: neverdem

Ping to self for later.


15 posted on 09/20/2006 2:19:24 PM PDT by DaveLoneRanger (Lord, help me to be the Christian conservative that liberals fear I am.)
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To: Gondring
"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.

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.

16 posted on 09/20/2006 2:23:29 PM PDT by Tench_Coxe
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To: Tench_Coxe
Which reminds me of another scientist quote:

"In the fields of observation chance favors only the prepared mind." - Louis Pasteur

17 posted on 09/20/2006 2:25:53 PM PDT by Tench_Coxe
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