By Rita Rubin
WebMD Health News
TEDMED 2014’s theme was “unlocking imagination,” but it might as well have been “unlocking the mysteries of medicine.”
Speakers at the 3-day event, many among the top in their fields, talked as much about what medicine can’t do as they did about what it can. They fessed up about their ignorance and admitted their mistakes.
“The mysteries of nature routinely humble us to the core of our being,” said cardiologist Elizabeth Nabel, MD, president of the Harvard-affiliated Brigham and Women’s Hospital in Boston and former director of the National Heart, Blood, and Lung Institute, part of the National Institutes of Health.
Nabel was one of dozens of speakers and performers who took to stages in Washington, D.C., and San Francisco for TEDMED 2014, streamed live to viewers around the world. TEDMED describes itself as “a global community of leading doers and thinkers from every walk of life.”
Bioethicist Amy McGuire, JD, PhD, spoke about the limitations of studying our genes. “Our genome sequence is not an infallible prophecy of our future,” said McGuire, director of the Center for Medical Ethics and Health Policy at Baylor College of Medicine in Houston.
Recently, McGuire said, colleagues offered to sequence her genome for free for a study they were doing. “Much to my surprise, I was tremendously ambivalent about wanting to go through with it,” she said. “How was I going to feel if I found out I have a genetic risk of getting Alzheimer’s disease or Parkinson’s disease?” Both, she said, had been diagnosed in close relatives of hers.
McGuire has studied the question of whether genetic information linked to an increased risk of disease increases peoples’ anxiety or motivates them to make healthy changes in their lives. “It’s really hard to get people to change their behaviors for the long term,” she said. Plus, people are “pretty terrible” about predicting how they’re going to react to bad news.
“The good news is we’re pretty adaptable,” McGuire said her research has found.
In the end, she allowed her colleagues to take a blood sample and sequence her genome, but she still hasn’t decided whether she wants to know the results. “I was much more concerned about the very subtle ways having access to genetic information would affect me and those around me.”
Both Nabel and internist Danielle Ofri, MD, a writer and attending physician at New York’s Bellevue Hospital, talked about the occasional shortcomings of medicine and doctors.
Early in her career, Nabel said, she prescribed Tylenol to a 32-year-old woman who’d come to the hospital with a fever and achiness. “To my horror, 2 days later she returned to the emergency room, having suffered a heart attack,” she said. “I was taught that heart disease was a man’s disease. Today, we know that when many women suffer a heart attack they don’t experience chest pain, but they feel tired, weak.”
Ofri called for medical leaders to talk publicly about mistakes they’ve made in caring for patients. “The vast majority of errors never come to light,” she said. “How can we fix them if we don’t know where they are?”
For now, though, physicians feel they must keep mum about errors, because they think that only incompetent doctors commit them. Ofri calls this “the toxic culture of perfection.” In reality, she said, “doctors and nurses, we make errors every single day. Luckily, most are small, but error is intrinsic to normal human functioning.”
Ofri has personal experience on the issue. “Precisely 4 months after completing my internship, I nearly killed a patient, and I didn’t tell a soul.” She had missed the bleeding in his brain, because she didn’t check his CT scan. Fortunately, the radiology resident did look at the man’s CT scan, and the patient underwent surgery that night.
“You can’t get much worse than missing the intracranial bleed,” Ofri said. “This could have been a death rather than a near miss…I was so ashamed that I didn’t tell anyone. Not that day, and not for 25 years.”
Often, patients get better not because of some drug their doctor prescribed, but because their doctor cared enough to write them a prescription, said Ted Kaptchuk. He’s a professor of medicine at Harvard and director of the Harvard-wide Program in Placebo Studies and the Therapeutic Encounter at Beth Israel Deaconess Medical Center in Boston.
“The drama of health care can alleviate symptoms,” he said. The white coat and the prescription pad can help patients feel better even before they fill a prescription. “The drugs actually mimic what the body can do, not the other way around.”
After earning a degree in Chinese medicine in that country, Kaptchuk returned to the U.S. to open a practice in Cambridge, MA. That’s when he noticed that patients sometimes looked better as he wrote out a prescription for herbs. If they’d come in with mobility issues, for example, they seemed to walk a little better before they even left his office. “I freaked. I said, ‘Lord, Lord, don’t make me a psychic healer.’”
That’s when he changed paths from practicing herbal medicine to studying the placebo effect. “The question is: How does this all work? What’s the neurobiology, the basic science here?”
Anesthesia, which has been administered in the U.S. for nearly 170 years, represents another medical mystery, said Harvard anesthesiology professor Emery Brown, MD, PhD. He’s the director of the Neuroscience Statistics Research Laboratory in the department of anesthesia and critical care at Massachusetts General Hospital. A greater understanding of how anesthesia works could lead to better ways of treating coma and other neuroscience problems, he said.
Anesthesia is more like death than sleep, Brown said. “You’re unconscious, it’s not supposed to hurt, you’re not supposed to form memories while you’re having the procedure. Still, physicians often tell patients that they’re going to be put to sleep for surgery, instead of, ‘I’m going to place you in a drug-induced reversible coma for your hernia repair,’” Brown said. “That wouldn’t go over very well.”
Photo: Amy McGuire, courtesy of TEDMED.